title: Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases.
abstract: BACKGROUND
  Murine or endemic typhus, caused by Rickettsia typhi, has been reported in all continents. In the 1970s, no cases of murine typhus were diagnosed in Tunisia.
  
  
  METHODS
  The clinico-epidemiological characteristics of seven cases of murine typhus diagnosed at our hospitals since 1993 are reported. Diagnosis was confirmed by indirect fluorescence assay detecting specific R. typhi antibodies.
  
  
  RESULTS
  Murine typhus occurred in all ages from 18-80 years during the hot season in rural areas. Clinical features were: sudden onset of fever and absence of eschar in all cases, with maculo-papular rash (five cases), prostration (four cases), meningism (three cases) and pneumonia (four cases). Frequent laboratory findings were moderate thrombopenia (four cases) and elevated transaminases (four cases). Before the results of serology, clinical diagnoses were Mediterranean Spotted Fever (four cases), Q fever (one case), pneumonia (one case), and lymphocytic meningitis (one case). Serology confirmed all diagnoses with cross-reactivity with Rickettsia conorii.
  
  
  CONCLUSIONS
  Murine typhus exists in Tunisia and its prevalence is underestimated. Further, more specific studies are needed to evaluate the true prevalence.
authors.affiliation: Infectious Diseases Unit, F. Hached University Hospital, Sousse, Tunisia. amel.letaief@famso.rnu.tn
authors.forename: A Omezzine
authors.initials: AO
authors.lastname: Letaïef
authors.forename: N
authors.initials: N
authors.lastname: Kaabia
authors.forename: M
authors.initials: M
authors.lastname: Chakroun
authors.forename: M
authors.initials: M
authors.lastname: Khalifa
authors.forename: N
authors.initials: N
authors.lastname: Bouzouaia
authors.forename: L
authors.initials: L
authors.lastname: Jemni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012286:Rickettsia typhi / Q000276:immunology / Q000472:pathogenicity; D013921:Thrombocytopenia; D000637:Transaminases / Q000378:metabolism; D014416:Tunisia / Q000453:epidemiology; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*
chemical_list: D000907:Antibodies, Bacterial; D000637:Transaminases