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Murine Typhus which was Difficult to Distinguish from Typhoid Fever; a Case Report and an Effective Collaboration with a Local Institute of Public Health
1)Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 2)Department of General Medicine, Juntendo University School of Medicine, 3)Kawasaki City Institute for Public Health
Tomohiro HOSODA1)2), Takako MISAKI3), Hideaki SHIMIZU3), Nobuhiko OKABE3) & Mitsuo SAKAMOTO1)
(Received August 22, 2017)
(Accepted March 6, 2018)
Key words: murine typhus, typhoid fever, Rickettia typhi

Herein we present the case of a 19-year-old healthy Filipino woman with a 4-day history of fever and headache, who upon admission had a dry cough and rashes distributed on her trunk and proximal limbs. The patient had recently traveled to the Philippines, 1-4 weeks prior to admission, where she had been in close contact with cats and rodents. Laboratory tests showed thrombocytopenia, and elevation of liver enzyme and C-reactive protein levels. Subsequent polymerase chain reaction (PCR) tests for Dengue, Chikungunya, and Zika virus, respectively, and Giemsa-stained blood smear for malaria were negative. Her chest X-ray was normal. Our initial diagnosis was typhoid fever. However, even after administering ceftriaxone, the patient's fever and headache remained unimproved. A PCR analysis for Rickettsia species was then performed on day 6 of hospitalization, which revealed the presence of Rickettsia typhi. Therefore, the patient was diagnosed as having murine typhus, and minocycline treatment was started on day 9 of hospitalization. The patient's clinical symptoms then continued to improve until discharge on day 11 of hospitalization. Diagnosing murine typhus is difficult in clinical practice because of the non-specific symptoms. Respiratory symptoms and rashes spreading to the extremities will be indicators in distinguishing murine typhus from typhoid fever.

[ Kansenshogaku Zasshi 92: 391-396, 2018 ]

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