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1/11. Splenic involvement in endemic (murine) typhus: CT findings.

    Murine typhus is a rickettsial infection that remains endemic in parts of texas and california. Clinical manifestations of the infection are due to vasculitis. In a patient who acquired the infection in the united states, computed tomography demonstrated intrasplenic pseudoaneurysms, infarcts, and hemorrhage.
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2/11. A case of murine typhus in queensland.

    OBJECTIVE: To present a case of murine (endemic) typhus, the first to be reported within the last 30 years in australia. CLINICAL FEATURES: A 17-year-old pregnant woman presented with a viral-like illness and later developed a spotted rash, fever and headache. INVESTIGATION AND OUTCOME: Sera taken on Day 7 and Day 30 of the illness showed seroconversion to proteus OX19 (Weil-Felix) and to Rickettsia typhi (by immunofluorescence), indicating recent infection with Rickettsia of the typhus group. Her illness was clinically compatible with murine typhus. She responded well to erythromycin and delivered a normal infant at term. CONCLUSION: infection with rickettsia typhi (murine typhus) still occurs in australia. It can be diagnosed by means of specific serological tests for rickettsial disease, which are superior to the non-specific Weil-Felix test.
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3/11. Murine typhus: forgotten but not gone.

    An occasional patient presents the classical symptoms of a disease that has become uncommon. Typhus is an example of such a disease, since it is now well contained through control of its rodent reservoir. It is readily treated with tetracycline or one of its long-acting analogues, doxycycline or minocycline. Because typhus is infrequently encountered, the physician may not initially include it in his differential diagnosis. Our case serves as a remainder that with the increasingly frequent movement of persons from one geographic area to another, the uncommon rickettsial infection, murine typhus, should continue to be in the differential of a febrile patient. Furthermore, our case underscores the importance of including typhus in the differential of typhoid fever.
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4/11. A case of laboratory-acquired murine typhus.

    We encountered a 32-year-old Korean woman who developed murine typhus in a laboratory. She worked as a technician in a laboratory for rickettsial disease. Immunofluorescence test with rickettsial antigen (R. typhi) was positive at 1: 320 on admission and 1: 1280 after 4 weeks. A dose of 200 mg of doxycycline for 7 days proved to be effective for her condition.
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keywords = rickettsia
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5/11. Histopathology and immunohistologic demonstration of the distribution of rickettsia typhi in fatal murine typhus.

    An 81-year-old woman had chills, fever, nausea, vomiting, and epigastric pain. On day 3 she had hematuria and was treated with trimethoprim-sulfamethoxazole. On day 5 she had a cough, hypotension, anemia, azotemia, and elevated hepatic enzyme levels. Her condition deteriorated with thrombocytopenia, anuria requiring dialysis, edema, and hypoalbuminemia. Treatment with chloramphenicol and doxycycline was started on day 10. By day 11, she was in hypotensive shock; on day 12 she had seizures and died. Murine typhus was diagnosed by demonstration of antibodies to rickettsia typhi by indirect immunofluorescence. Necropsy revealed interstitial pneumonia, pulmonary edema, hyaline membranes, alveolar hemorrhages, petechiae and vasculitis in the central nervous system, interstitial myocarditis, multifocal interstitial nephritis and hemorrhages, splenomegaly, portal triaditis, and mucosal hemorrhages in urinary tract. Immunofluorescent R. typhi were demonstrated in the lungs, brain, kidneys, liver, and heart. This unusual death occurred in an elderly patient without rash who was treated too late with antirickettsial drugs.
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6/11. Imported rickettsial disease: clinical and epidemiologic features.

    PURPOSE AND methods: The rickettsioses continue to constitute major health problems in many parts of the world. With increasing international travel, recognition of rickettsial diseases by physicians is becoming more important. The clinical features of four cases of rickettsial disease imported into canada over a five-year period are presented; two patients with tick typhus (rickettsia conorii), one patient with scrub typhus (R. tsutsugamushi), and one patient with murine typhus (R. typhi). We also present the North American data over the past 10 years from the Centers for disease Control (CDC) (Atlanta). RESULTS: Since 1983 in the united states, three cases of imported scrub typhus, all after travel to india, were confirmed, as well as six cases of murine typhus after travel to southeast asia. At the CDC, 67 imported cases of tick typhus have been confirmed by indirect fluorescent antibody test since 1976; most illnesses occurred after travel to africa. CONCLUSION: Rickettsial diseases are underrecognized by physicians, who should consider these diagnoses in travelers returning from endemic areas. Since effective treatment is available, prompt diagnosis and treatment are important. In all cases, specific serologic confirmation should be obtained.
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7/11. epidemiology and ecology of rickettsial diseases in the People's Republic of china.

    Since 1949, information on rickettsial diseases in the People's Republic of china has been virtually nonexistent in the West. This is the first comprehensive review of the ecology and epidemiology of Chinese rickettsial diseases to be published outside the People's Republic. At least five rickettsioses exist in china: scrub typhus, murine typhus, epidemic typhus, q fever, and one or more spotted fever-group (SFG) rickettsioses. Although epidemic typhus has been controlled and scrub typhus has abated in many areas, murine typhus, q fever, and SFG rickettsiosis are important public health problems. Serologic surveys indicate high prevalences of antibodies to coxiella burnetii, Rickettsia tsutsugamushi, and SFG rickettsiae in some regions; these rickettsiae have been isolated from humans, arthropods, and animals. doxycycline has emerged as the best treatment for murine typhus, epidemic typhus, and scrub typhus. china offers both opportunities and challenges for the investigation and alleviation of the problems of rickettsial diseases.
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keywords = rickettsia
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8/11. Acute febrile cerebrovasculitis: a syndrome of unknown, perhaps rickettsial, cause.

    In late 1983, five patients living near Charlottesville, virginia, were treated for an unusual syndrome of fever, headache, altered mentation, multifocal neurologic signs, and cerebrospinal fluid pleocytosis. Clinical signs of brainstem disease developed in four patients. All five had had recent exposure to forests or wood and contact with flea-infested dogs. Two patients died; one survivor has had recurrent seizures. brain biopsy samples in two patients and autopsy findings in another showed cerebral vasculitis and perivasculitis involving mostly venules and capillaries. In the autopsy, the severest vascular lesions involved the brainstem and thalami, where they were accompanied by acute fibrinoid necrosis, but discrete vascular lesions of lesser intensity were randomly distributed in the white matter and cortex. Serologic studies on paired specimens in four patients showed significant cross-reacting antibody responses to rickettsial (typhus-group) antigens in the indirect hemagglutination, latex agglutination, and IgM microimmunofluorescence tests, but no agent was visualized or isolated. The cause of this serious inflammatory disorder is unknown.
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keywords = rickettsia
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9/11. Involvement of the kidneys in Mediterranean spotted fever and murine typhus.

    We reviewed 58 patients, 27 with murine typhus (MT) and 31 with Israeli Mediterranean spotted fever (IMSF), hospitalized at the Sheba Medical Center 1979-1988. Five patients with MT and five with IMSF had evidence of renal impairment. One patient with MT underwent a renal biopsy, and two patients with IMSF died and had autopsy examinations with histology of the kidney. The principal histopathological lesion found in those most severe cases of rickettsiosis-induced renal failure was multifocal perivascular interstitial nephritis. In contrast with previous reports, involvement of the kidneys in rickettsial infection seems to be relatively common. early diagnosis and treatment with hydration and specific antimicrobial agents is mandatory to prevent morbidity.
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10/11. Immunohistochemical diagnosis of typhus rickettsioses using an anti-lipopolysaccharide monoclonal antibody.

    A monoclonal antibody directed against an epitope on the lipopolysaccharide of typhus-group rickettsiae was developed for the purpose of detecting this heat-stable, proteinase-resistant antigen in formalin-fixed, paraffin-embedded tissues. rickettsia prowazekii organisms were identified in endothelium and macrophages in sections of the brains of three Egyptian men who died of epidemic louse-borne typhus in Cairo during world war ii and in the brain from a recent case of typhus fever acquired in burundi. R. typhi organisms were identified in endothelial cells from a fatal case of murine typhus and in experimentally infected mice. This approach is applicable not only to the study of archival tissues and experimental animal models but also could be used to establish a timely diagnosis of typhus-group rickettsiosis by immunohistochemical examination of cutaneous biopsies of rash lesions during the acute stage of illness.
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