Murine typhus in South Texas children

Background. Murine typhus is a zoonotic infection caused by Rickettsia typh i, This illness used to be endemic in the southeastern and gulf coast of th e United States and is now only rarely reported in South Texas and Southern California. Murine typhus causes a febrile illness with headache and rash that has been well-described in adults. Objective, To define the epidemiologic and clinical characteristics, labora tory findings, hospital course and response to therapy of children discharg ed from our hospital with a diagnosis of murine typhus, Methods. Retrospective chart review of all children discharged from Driscol l Children's Hospital, Corpus Christi, TX, from January 1, 1990, to June 30 , 1998, with a diagnosis of murine typhus, Patients, Thirty children (17 females) ages 2 to 17 years (mean, 10 +/- 4 y ears). Results, Eighty percent of the children were admitted between May and Novem ber, and 67% had a history of contact with or exposure to a potential anima l reservoir. Children were admitted after a mean of 7 +/- 4 days, The most common clinical features were fever 100%, rash 80% and headache 77%, Labora tory abnormalities included elevated erythrocyte sedimentation rate (75%), elevated serum transaminases (67%), hyponatremia (66%) and increased immatu re leukocytes without leukocytosis (63%), Only one child had leukocytosis a nd 40% had leukopenia. Defervescence occurred a mean of 35 +/- 19 h after i nitiation of appropriate antibiotics. Hospitalization lasted for a mean of 7 +/- 3 days. There were no readmissions and no patients died as a result o f the infection, Conclusions. Despite being rarely reported in this country now, murine typh us continues to be an important cause of fever and hospitalization for chil dren in South Texas. Children with murine typhus develop an illness similar to that reported in adults with fever, rash and headache. Children respond quickly to therapy with doxycycline or tetracycline and recover completely from their illness.