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

Arch Pediatr Adolesc Med. 2001 Mar;155(3):396-400. doi: 10.1001/archpedi.155.3.396.


Objective: To document the clinical, laboratory, and epidemiologic characteristics of pediatric patients with murine typhus.

Design: Pediatric patients were diagnosed using serologic testing, and clinical, 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 interviews were available for 97 patients aged 16 years and younger with murine typhus.

Main outcome measures: The frequency of clinical symptoms and signs, abnormal laboratory findings, epidemiologic findings, and measures of disease severity were determined.

Results: The clinical triad of fever, headache, and rash occurred in only 43 (49%) of 87 pediatric patients throughout the illness. Musculoskeletal symptoms were experienced by 43% of patients, whereas gastrointestinal tract symptoms (nausea, vomiting, anorexia, and diarrhea) occurred in 77%. Systemic involvement was evident by the frequent occurrence of abnormal laboratory findings referable to multiple organ systems, including the liver, kidney, 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 interval to defervescence was related to therapy with a tetracycline or chloramphenicol. Early recognition and treatment is important to prevent prolonged morbidity.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Severity of Illness Index
  • Texas / epidemiology
  • Treatment Outcome
  • Typhus, Endemic Flea-Borne / classification
  • Typhus, Endemic Flea-Borne / diagnosis
  • Typhus, Endemic Flea-Borne / drug therapy
  • Typhus, Endemic Flea-Borne / epidemiology
  • Typhus, Endemic Flea-Borne / physiopathology*


  • Anti-Bacterial Agents