title: Murine typhus as a cause of cognitive impairment: case report and a review of the literature.
abstract: BACKGROUND
  Murine typhus is a systemic febrile illness caused by Rickettsia typhi, a gram-negative, obligate intracellular bacterium. It is found worldwide, including in the United States, where cases are concentrated in suburban areas of Texas and California. The disease manifests with fever, headache, and rash. Central nervous system involvement is rare in both adults and children. Aseptic meningitis and meningoencephalitis are the most common neurological presentations, occurring in 2% to 5% of cases. Neurological dysfunction, including memory impairment and behavioral alterations, can occur and usually are reversible. Long-term deficits are considered rare even in untreated cases and have not been described in the pediatric population.
  
  
  METHODS
  Single case report.
  
  
  RESULTS
  We describe a previously healthy 17-year-old girl infected with R. typhi who developed meningoencephalitis that resulted in chronic cognitive impairment despite treatment.
  
  
  CONCLUSIONS
  Murine typhus should be considered in the differential diagnosis of aseptic meningitis and meningoencephalitis. Early diagnosis and treatment can prevent death and long-term morbidity.
authors: Pediatric Infectious Diseases Division, University of South Florida College of Medicine, St. Joseph Children's Hospital, Tampa, Florida. Electronic address: scarr1@health.usf.edu.
authors: Silvana B
authors: SB
authors: Carr
authors: Pediatric Infectious Diseases Division, University of South Florida College of Medicine, St. Joseph Children's Hospital, Tampa, Florida.
authors: Dale F
authors: DF
authors: Bergamo
authors: Pediatric Infectious Diseases Division, University of South Florida College of Medicine, St. Joseph Children's Hospital, Tampa, Florida.
authors: Patricia J
authors: PJ
authors: Emmanuel
authors: Pediatric Epilepsy and Neurology Service, St. Joseph Children's Hospital, Tampa, Florida.
authors: Jose A
authors: JA
authors: Ferreira
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D009483:Neuropsychological Tests; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D014437:Typhus, Endemic Flea-Borne / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D000086:Acetazolamide; D010889:Piracetam
keywords: central nervous system; meningoencephalitis; murine typhus; pediatric