title: Murine typhus in a pregnant woman.
abstract: BACKGROUND
  Murine typhus is a flea-borne disease caused by Rickettsia typhi. Although uncommon in most of the United States, it is endemic in Southern California. Most cases are unrecognized given its nonspecific viral symptoms and rare complications.
  
  
  METHODS
  A pregnant patient presented with complaints of fever and chills. Physical examination was benign. Laboratory abnormalities included elevated transaminases, proteinuria, and thrombocytopenia. The patient gave a history of exposure to cats and opossums in an area endemic for murine typhus. After empiric treatment with azithromycin, her clinical symptoms and laboratory abnormalities promptly improved. Serologies confirmed acute infection with R. typhi.
  
  
  CONCLUSIONS
  Although the signs and symptoms of murine typhus can mimic other pregnancy-related complications, a high index of suspicion in endemic areas can lead to the correct diagnosis and prompt treatment.
authors.affiliation: From the University of California-Irvine Medical Center, Orange, California; and Long Beach Memorial Medical Center, Long Beach, California.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Jolley
authors.forename: Raquel
authors.initials: R
authors.lastname: Pelayo
authors.forename: Tamera J
authors.initials: TJ
authors.lastname: Hatfield
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNulty
mesh_terms: D000328:Adult; D000818:Animals; D002140:California / Q000453:epidemiology; D002415:Cats; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D009893:Opossums; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011256:Pregnancy Outcome; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*