title: Murine typhus in Tunisia: a neglected cause of fever as a single symptom.
abstract: OBJECTIVE
  We had for aim to describe the epidemiologic and clinic characteristics of murine typhus in a series of 43 serologically confirmed cases, in our region.
  
  
  METHODS
  Serologic screening for IgG and IgM against Rickettsia typhi was performed in 1024 patients during three years (2006-2008). The characteristics of patients with a positive serology were examined retrospectively. One hundred and seventy sera obtained from blood donors were tested to detect IgG against R. typhi to determine the seroprevalence of the infection.
  
  
  RESULTS
  There was evidence of recent R. typhi infection in 43 patients (4.2%) during the study period, and 3.7% of blood donors had IgG against R. typhi. The mean age of patients was 43.1 years and the sex-ratio was 1.04. Among the patients, 58.1% were from rural areas. No patient reported any exposure to rats or rat-fleas. There were more cases during the summer and fall. The most frequent complaint was fever as a single symptom (67.5%). A cutaneous rash was reported in 44.1% and headache in 60.5% of patients. Among the patients, 44.1% presented with thrombopenia and 47.2% with elevated liver enzymes.
  
  
  CONCLUSIONS
  Murine typhus seems to be frequent in Tunisia. This infection could be a threat for travellers. Serology should be performed systematically in patients with fever as a single symptom since its clinical presentation is non-specific.
authors.affiliation: Laboratory of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia. abirznazen2001@yahoo.fr
authors.forename: A
authors.initials: A
authors.lastname: Znazen
authors.forename: B
authors.initials: B
authors.lastname: Hammami
authors.forename: A Ben
authors.initials: AB
authors.lastname: Mustapha
authors.forename: S
authors.initials: S
authors.lastname: Chaari
authors.forename: D
authors.initials: D
authors.lastname: Lahiani
authors.forename: I
authors.initials: I
authors.lastname: Maaloul
authors.forename: M Ben
authors.initials: MB
authors.lastname: Jemaa
authors.forename: A
authors.initials: A
authors.lastname: Hammami
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001782:Blood Donors / Q000706:statistics & numerical data; D005076:Exanthema / Q000209:etiology; D005334:Fever / Q000209:etiology*; D006801:Humans; D006813:Humidity; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D007303:Insect Vectors; D051381:Rats; D012189:Retrospective Studies; D012286:Rickettsia typhi / Q000276:immunology; D012621:Seasons; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013696:Temperature; D014416:Tunisia / Q000453:epidemiology; D014437:Typhus, Endemic Flea-Borne / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D058260:Xenopsylla / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Fever; Fièvre; Murine typhus; Rickettsiose; Rickettsiosis; Typhus murin