MURINE TYPHUS PRESENTING AS SUBACUTE MENINGOENCEPHALITIS

Murine typhus is a febrile systemic illness, presenting with headache and undulating fever. Neurological involvement is considered a rare co mplication. During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus. Five of these patients presen ted with a syndrome of subacute ''aseptic'' meningitis or meningoencep halitis. Three had bilateral papilloedema and 2 had focal neurological signs. None had a rash or other systemic findings suggestive of ricke ttsial. disease. The diagnosis was based on serum and cerebrospinal fl uid serology and on prompt response to doxycycline therapy. These case s suggest that neurological involvement in murine typhus is more commo n than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas.