Murine Typhus presentationMurine typhus is a flea-borne illness caused by the bacterium Rickettsia typhi.

Murine typhus is a flea-borne illness caused by the bacterium Rickettsia typhi.
occurs worldwide, primarily in tropical and subtropical climates where rats (the primary animal reservoir) and rat fleas are present.
People become infected with R. Typhi when they come into contact with infected flea feces via scratched or abraded skin.

1. MURINE TYPHUS

2. Murine typhus Murine typhus is a flea-borne illness caused by the bacterium Rickettsia typhi. occurs worldwide, primarily in tropical and subtropical climates where rats (the primary animal reservoir) and rat fleas are present. People become infected with R. Typhi when they come into contact with infected flea feces via scratched or abraded skin. Infection can also occur when mucous membranes are exposed to infected feces or when a patient inhales the feces . Infections often occur in areas where humans and host animals come into regular contact, including areas of low sanitation where rats are abundant. Also be called flea-borne typhus or endemic typhus. www.cdc.gov

3. Several flea species have been identified as potential vectors for murine typhus, including the rat flea ( Xenopsylla cheopis ), cat flea ( Ctenocephalides felis ), and mouse flea ( Leptopsyllia segnis ). www.cdc.gov

4. Sign & symptoms begin 7–14 days following infection. typically present with fever, chills, headache, myalgia, arthralgia and rash. The rash -typically occurs at the end of the first week of the illness and lasts 1–4 days. -generally starts as a maculopapular eruption on the trunk and spreads peripherally (o ver the axilla and inner surfaces of arms) , sparing the palms of the hands and soles of the feet. The appearance of the rash varies, or may be absent altogether and should not be relied upon for diagnosis. Other symptoms include: Nausea/Vomiting
Abdominal pain
Altered mental status Pulmonary involvement : non-productive cough, effusio n and infiltrate in the Chest X-ray www.cdc.gov Case definition of infectious diseases 3 rd edition 2017

5. Investigations Common laboratory findings include anemia, thrombocytopenia, leukopenia, hyponatremia, and elevated levels of liver enzymes.
Indirect fluorescent antibody (IFA) assay: to detect IgG antibodies.
Immunohistochemistry (IHC) on tissue biopsy specimens
Polymerase chain reaction (PCR) assays using blood, plasma, or tissue specimens
Isolation of R. Typhi in culture www.cdc.gov

6. Treatment Doxycycline is the treatment of choice. Recommended dosages of doxycycline: Adults: 100 mg twice per day
Children under 45 kg (100 lbs.): 2.2 mg/kg body weight twice per day Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement (usually 7–10 days). www.cdc.gov

7. Almost all cases resolve completely with appropriate antibiotics. If the disease is not treated promptly, can lead to severe illness and cause organ damage. deaths are rare (estimated to be less than 1% of all cases). www.cdc.gov

8. Prevention and control No effective vaccine exists . 1) To avoid bites by flea . Keep the house clean by vacuuming thoroughly and regularly, especially below drapes, under furniture edges, and where the pets sleeps. Bathing and changing your clothes on a regular basis. The pets (indoor & outdoor pets) are treated for fleas by using pyrethroid insecticides or flea control products to remove the fleas that are on the pets. 2) Controlling the rodent population which are known to carry arthropods . No way for mouse to enter: to seal the mouse hole around the house and all the gaps to prevent the mouse to enter.
No food for mouse to eat: to seal the food and drink and discard the garbage immediately.
No space for mouse to stay: to remove the junk, waste and weeds around the house and seal the trash can to prevent the mouse to stay. www.cdc.gov.tw

9. Case Classification Suspected : A case that is compatible with the clinical description Confirmed : A suspected case with laboratory confirmation. Case definition of infectious diseases 3 rd edition 2017

10. Types of Surveillance Mandatory National Notification of Infectious Diseases under the Infectious Disease Prevention and Control Act 1988. When to notify Any suspected or confirmed case should be notified. How to notify A typhus case should be notified to the nearest District Health Office by submission of the notification form within 7 days from the diagnosis date. Case definition of infectious diseases 3 rd edition 2017

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