[Two travellers suffering from typhus].
BACKGROUND
Endemic typhus, caused by Rickettsia typhi, belongs to the typhus group of the rickettsioses. The disease is prevalent worldwide and is probably an underestimated cause of illness accompanied by fever in travellers, due to its frequently mild presentation and resemblance to diseases like typhoid- or dengue fever. Broad-spectrum antibiotics are not effective in the treatment of endemic typhus, but the disease is responsive to doxycycline.


METHODS
A 57-year-old man and a 36-year-old woman, who had returned from Indonesia and Nepal and Tibet, respectively, both presented with fever, malaise, headache and arthromyalgia, and both developed a skin rash. A diagnosis of typhoid- or dengue-fever was suspected at first. The first patient improved after empirical treatment with doxycycline, the second recovered following treatment with azithromycin. Blood cultures and viral serology remained negative. Additional serology showed evidence of infection with R. typhi. Both patients made a complete recovery.


CONCLUSIONS
Endemic typhus should be included in the differential diagnosis of illness accompanied by fever in travellers, especially if blood cultures remain negative and no improvement is seen with broad-spectrum antibiotics.
Havenziekenhuis en Instituut voor Tropische Ziekten, afd. Interne geneeskunde, Rotterdam, the Netherlands.
Loek
L
Tan
Thijs M
TM
Beersma
Yvonne
Y
van Beek
Perry J J
PJ
van Genderen
D000328:Adult; D003715:Dengue / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D009390:Nepal; D009426:Netherlands; D012286:Rickettsia typhi; D018609:Tibet; D014195:Travel; D014435:Typhoid Fever / Q000175:diagnosis; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis*