Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children

Objective: To document the clinical, laboratory, and epidemiologic characte ristics of pediatric patients with murine typhus. Design: Pediatric patients were diagnosed using serologic testing, and clin ical, laboratory, and epidemiologic data were retrospectively reviewed. Setting: Of 97 patients, 77 (79%) were identified and treated as inpatients and 20 (21%) were treated as outpatients; most resided in south Texas. Patients: Between 1979 and 1996, medical records and patient-physician inte rviews were available for 97 patients aged 16 years and younger with murine typhus. Main Outcome Measures: The frequency of clinical symptoms and signs, abnorm al laboratory findings, epidemiologic findings, and measures of disease sev erity were determined. Results: The clinical triad of fever, headache, and rash occurred in only 4 3 (49%) of 87 pediatric patients throughout the illness. Musculoskeletal sy mptoms were experienced by 43%, of patients, whereas gastrointestinal tract symptoms (nausea, vomiting, anorexia, and diarrhea) occurred in 77%. Syste mic involvement was evident by the frequent occurrence of abnormal laborato ry findings referable to multiple organ systems, including the liver, kidne y, blood, and central nervous system. Conclusions: Pediatric infection by Rickettsia typhi usually causes mild to moderate systemic illness, In children, the median duration of illness was 12 days (range, 5-29 days), but severe complications were rare. Length of illness was significantly related to the initial diagnosis, whereas the int erval to defervescence was related to therapy with a tetracycline or chlora mphenicol. Early recognition and treatment is important to prevent prolonge d morbidity.