title: Epidemiological, clinical and laboratory features of murine typhus in central Tunisia.
abstract: OBJECTIVE
  Murine typhus is an endemic zoonosis. It is difficult to diagnose because of its non-specific clinical manifestations. Our objective was to describe the epidemiological, clinical, laboratory, and treatment features of murine typhus.
  
  
  METHODS
  We conducted a retrospective study of 73 adult patients hospitalized for murine typhus from 2006 to 2011. The diagnosis was confirmed by a single titer of IgM≥128 or by seroconversion to typhus group antigen identified by indirect fluorescent assay.
  
  
  RESULTS
  The mean age of patients was 33.1 years (range, 13-68 years). Thirty-eight patients (52%) lived in rural or suburban areas; neither fleabites nor exposure to rats were reported. The most common clinical symptoms were: fever, headache, and myalgia. A maculopapular and non-confluent rash was observed in 47 patients (64.4%). No inoculation eschar was observed in any patient. Eight patients presented with interstitial pneumonia and two with lymphocytic meningitis. The diagnosis was confirmed by indirect fluorescence assay in every case. A single titer of IgM ≥ 128 was found in 62 (84.9%) cases. The other 11 cases were diagnosed by seroconversion. All patients were given antibiotics. Tetracyclines were prescribed in 57 cases (78%). The two patients presenting with meningitis were treated with fluoroquinolone. The outcome was favorable for all patients and no relapse was observed.
  
  
  CONCLUSIONS
  The features of murine typhus are non-specific. The definitive diagnosis is based on serologic testing by indirect fluorescent assay. Cyclins were the most prescribed antibiotics.
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: A
authors: A
authors: Aouam
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia; Unité de recherche UR12SP41, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia. Electronic address: adnene_toumi@yahoo.fr.
authors: A
authors: A
authors: Toumi
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia; Unité de recherche UR12SP41, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: H
authors: H
authors: Ben Brahim
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: C
authors: C
authors: Loussaief
authors: Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: B
authors: B
authors: Jelliti
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia; Unité de recherche UR12SP41, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: F
authors: F
authors: Ben Romdhane
authors: Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: S
authors: S
authors: Ben Yahia
authors: Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: M
authors: M
authors: Khairallah
authors: Department of Infectious Diseases, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia; Unité de recherche UR12SP41, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia.
authors: M
authors: M
authors: Chakroun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005076:Exanthema / Q000209:etiology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000209:etiology; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D012621:Seasons; D014416:Tunisia / Q000453:epidemiology; D014437:Typhus, Endemic Flea-Borne / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Murine typhus; Rickettsia typhi; Tunisia; Tunisie; Typhus murin