title: Spotted fever from Rickettsia typhi in an older woman: a case report from a geographic area where it would not be expected.
abstract: We describe the case of a 75-year-old woman presenting with spotted fever followed by acute renal failure and septic shock. The infection was caused by Rickettsia typhi, not reported in Calabria district (southern Italy) since World War II. The diagnosis of murine typhus was made 3 days after admission and was based solely on clinical criteria when her worsening condition required a prompt move to the intensive care unit. Therapy with tigecycline was then started immediately and the patient improved dramatically. The diagnosis of murine typhus was confirmed 10 days after admission by immunofluorescence assay. Our case is an example of how the diagnosis of murine typhus is challenging. However, in the case of a disease lacking specific symptoms, clinicians should never forget that, even in geographic areas considered free of flea-borne diseases, the components of the enzootic cycle are present and the diagnosis should never be underestimated.
authors.affiliation: Infectious Diseases Unit, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy. Electronic address: filippoluciani@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Luciani
authors.affiliation: Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Cosenza, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Cione
authors.affiliation: Unit of Geriatric Pharmaco-epidemiology, IRCCS - Italian National Research on Aging, Cosenza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corsonello
authors.affiliation: Intensive Care Unit, Annunziata Hospital, Cosenza, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Guido
authors.affiliation: Infectious Diseases Unit, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Santis
authors.affiliation: Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Cosenza, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cannataro
authors.affiliation: Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Cosenza, Italy.
authors.forename: Mariarita
authors.initials: M
authors.lastname: Perri
authors.affiliation: Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Cosenza, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Caroleo
authors.affiliation: Virology and Microbiology Laboratories Unit, Annunziata Hospital, Cosenza, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Cannataro
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D012286:Rickettsia typhi / Q000302:isolation & purification*; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis* / Q000453:epidemiology
keywords: Italy; Rickettsia typhi; Tigecycline