SHM Converge Scientific Abstract ePoster Gallery-Empowering the Hospitalist: A Case Series on Murine Typhus

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This case series examined adult murine typhus cases in Harris County, Texas, over five years to better define how the disease presents and how clinicians can recognize it earlier. Murine typhus is a flea-borne infection caused by <em>Rickettsia typhi</em>, with rats as the main reservoir, but cats, dogs, opossums, and other small mammals may also be involved. Because symptoms are often vague and overlap with other febrile illnesses, diagnosis is frequently delayed.

Using electronic medical record review, investigators identified 79 adults with positive serology and included 73 patients after exclusions. The cohort had a mean age of 43.8 years, was 59% male, and had an average hospital stay of 6.4 days. Illnesses were most common from April through July.

The most frequent symptoms were fever (94%), chills (72%), headache (67%), myalgias (53%), cough (51%), nausea, vomiting, rash, and dyspnea. Rashes often spread centripetally, and abdominal pain was commonly epigastric. Many patients reported exposure to flea-host animals such as cats, dogs, opossums, or rats. Pulmonary findings were prominent, including pleural effusions and atelectasis, and abdominal imaging often showed hepatomegaly or splenomegaly.

A useful diagnostic clue was the “pentad” of fever, rash, headache, thrombocytopenia, and transaminitis. Severe cases, especially those requiring ICU care, were associated with sepsis, shock, and respiratory failure.

The study concluded that hospitalists and primary care clinicians in endemic areas should maintain a high index of suspicion for murine typhus and begin empiric doxycycline early when the clinical pattern fits. Early recognition may reduce delays, improve outcomes, and limit unnecessary workups.

Asset Subtitle

Luay Boulahouache

Meta Tag

Author List Lauren Rash, Luay Boulahouache, Nathaniel P. Giles, Robert Atmar

Category Research

Concept Murine Typhus

Concept Fever

Concept Rash

Concept Thrombocytopenia

Concept Flea Exposure

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Luay Boulahouache

Track Outcomes Research

Keywords

murine typhus

Rickettsia typhi

flea-borne infection

Harris County Texas

adult case series

fever rash headache

thrombocytopenia transaminitis

doxycycline treatment

pulmonary findings

endemic febrile illness

Murine Typhus

Fever

Rash

Thrombocytopenia

Flea Exposure