title: Misdiagnosed murine typhus in a patient with multiple cerebral infarctions and hemorrhage: a case report.
abstract: BACKGROUND
  Rickettsias cause a wide spectrum of tick-, flea-, or mite-borne infections. Rickettsial infections have no classical manifestations and can often lead to encephalitis, which can be fatal if improperly diagnosed.
  
  
  METHODS
  A 74-year-old male farmer was admitted to the hospital with fevers and a headache that had lasted for 10 days, followed by 4 days of unconsciousness, and his condition continued to deteriorate. Images showed multiple acute lesions in the brain stem, and bilateral cerebral and cerebellar hemispheres. He was finally diagnosed with endemic typhus and treated with antibiotics that resulted in improvement.
  
  
  CONCLUSIONS
  The present report describes a patient with a rickettsial infection and subsequent deterioration to coma because of an initial misdiagnosis. Because of the similarity to other infectious diseases, physicians should be more vigilant towards the history and radiologic results to ensure early detection and avoid complications which may prove to be fatal.
authors.affiliation: Department of Neurology, The First Affiliated Hospital of the College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China. zyxuziqi@zju.edu.cn.
authors.forename: Ziqi
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of the College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China. sunnydays163@163.com.
authors.forename: Xiongchao
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department for Microbiology, Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China. lqycdc@163.com.
authors.forename: Qunying
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of the College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China. lix992@yahoo.com.cn.
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Neurology, The First Affiliated Hospital of the College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China. zysnhu5101@163.com.
authors.forename: Yewen
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001933:Brain Stem / Q000382:microbiology; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis*; D003128:Coma; D003951:Diagnostic Errors; D000067565:Farmers; D005334:Fever / Q000150:complications / Q000175:diagnosis*; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012281:Rickettsia; D016896:Treatment Outcome; D014437:Typhus, Endemic Flea-Borne / Q000150:complications / Q000175:diagnosis*; D014474:Unconsciousness
chemical_list: D000900:Anti-Bacterial Agents