title: Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review.
abstract: Murine or endemic typhus, a febrile disease caused by Rickettsia typhi, is often misdiagnosed due to its non-specific presentation. We sought to evaluate all available evidence in the literature regarding the clinical and laboratory manifestations, epidemiological characteristics, and outcomes of murine typhus. Pubmed was searched for all articles providing available data. In an effort to incorporate contemporary data, only studies from 1980 were included. Thirty-three case series including 2074 patients were included in final analysis. Available evidence suggests that the classic triad of fever, headache and rash is encountered in only one-third of patients. Other frequent symptoms were chills, malaise, myalgia, and anorexia. A tetrad of reported laboratory abnormalities consisting of elevated liver enzymes, lactate dehydrogenase, erythrocyte sedimentation rate and hypoalbuminemia was detected. Complications were observed in one-fourth of patients, reported mortality was extremely low, but untreated patients had notably longer duration of fever. Among epidemiological characteristics, a seasonal distribution with most cases reported during warmer months, was the most prominent finding. Murine typhus in children exhibits several different characteristics, with abdominal pain, diarrhea, and sore throat reported more commonly, higher frequency of anemia, lower frequency of hypoalbuminemia, hematuria and proteinuria and a much lower rate of complications. This systematic review of published evidence provides a thorough description of the clinical and laboratory features of murine typhus and highlights important differences in children.
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece; School of Medicine, European University of Cyprus, Nicosia, Cyprus. Electronic address: tsioutis@sni.gr.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tsioutis
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece; Diabetes and Obesity Outpatient Department, Konstantopouleio General Hospital, Nea Ionia, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Zafeiri
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece; School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Asimakis
authors.initials: A
authors.lastname: Avramopoulos
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece; School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Efthymia
authors.initials: E
authors.lastname: Prousali
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece; Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Miligkos
authors.affiliation: Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece.
authors.forename: Spyridon A
authors.initials: SA
authors.lastname: Karageorgos
mesh_terms: D000818:Animals; D002648:Child; D005076:Exanthema / Q000209:etiology; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D016896:Treatment Outcome; D014437:Typhus, Endemic Flea-Borne / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
keywords: Doxycycline; Endemic typhus; Murine typhus; Rickettsia typhi; Triad