Tomohiro Hosoda, Takako Misaki, H. Shimizu, N. Okabe, M. Sakamoto
{"title":"难以与伤寒区分的鼠斑疹伤寒一例报告及与当地公共卫生研究所的有效合作","authors":"Tomohiro Hosoda, Takako Misaki, H. Shimizu, N. Okabe, M. Sakamoto","doi":"10.11150/kansenshogakuzasshi.92.391","DOIUrl":null,"url":null,"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.","PeriodicalId":17724,"journal":{"name":"Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2018-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Murine Typhus which was Difficult to Distinguish from Typhoid Fever;a Case Report and an Effective Collaboration with a Local Institute of Public Health\",\"authors\":\"Tomohiro Hosoda, Takako Misaki, H. Shimizu, N. Okabe, M. Sakamoto\",\"doi\":\"10.11150/kansenshogakuzasshi.92.391\",\"DOIUrl\":null,\"url\":null,\"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.\",\"PeriodicalId\":17724,\"journal\":{\"name\":\"Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2018-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.11150/kansenshogakuzasshi.92.391\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11150/kansenshogakuzasshi.92.391","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Murine Typhus which was Difficult to Distinguish from Typhoid Fever;a Case Report and an Effective Collaboration with a Local Institute of Public Health
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.