title: Murine typhus: a newly recognised problem in the Waikato region of New Zealand.
abstract: OBJECTIVE
  To characterise and investigate patients diagnosed with murine typhus in the Waikato District Health Board (DHB) region during 2006.
  
  
  METHODS
  We reviewed the hospital and general practitioner records of all patients presenting with clinical and serological evidence of murine typhus. All patients were interviewed by telephone using a semi-structured questionnaire to identify environmental risk factors for infection. A limited, retrospective serosurvey was undertaken and surveillance was enhanced.
  
  
  RESULTS
  12 patients were identified, all had either lived, or spent considerable time, in rural areas; 7 patients had seen rats on their properties 'regularly' and 3 remembered fleabites within the incubation period of the illness. The classic triad of symptoms is fever, headache, and rash--these symptoms were seen in 12, 11, and 8 patients respectively; lethargy, myalgias, nausea, and vomiting were also common. 11 patients had abnormal liver function tests at presentation, and 7 had low platelets. Treatment with doxycycline was associated with a shorter hospital stay.
  
  
  CONCLUSIONS
  Murine typhus has now been confirmed in rural areas throughout the Waikato DHB region. Rats are likely associated with disease in rural communities and rat control is a complex issue. However, a greater awareness of the disease should lead to earlier diagnosis and treatment.
authors.affiliation: Dept of Medicine, Rotorua Hospital, Private Bag 3023, Rotorua 3046. erana_gray@hotmail.com.
authors.forename: Erana
authors.initials: E
authors.lastname: Gray
authors.forename: Polly
authors.initials: P
authors.lastname: Atatoa-Carr
authors.forename: Anita
authors.initials: A
authors.lastname: Bell
authors.forename: Sally
authors.initials: S
authors.lastname: Roberts
authors.forename: Daud
authors.initials: D
authors.lastname: Al Mudallal
authors.forename: Graham D
authors.initials: GD
authors.lastname: Mills
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D051381:Rats; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis*