Murine Typhus which was Difficult to Distinguish from Typhoid Fever；a Case Report and an Effective Collaboration with a Local Institute of Public Health

Abstract

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 en-zyme and C-reactive protein levels. Subsequent polymerase chain reaction (PCR) tests for D e n g u e , Chik un g un ya , 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 patientʼs 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 patientʼs clinical symptoms then continued to improve until discharge on day 11 of hospitalization. Diag-nosing 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.