Murine Typhus: An Overlooked Enemy

Abstract

Fever due to murine typhus caused by Rickettsia typhi is underdiagnosed in pediatrics due to nonspecific symptoms. We summarize its clinical presentation in children to increase pediatricians' awareness of murine typhus. The classic triad of fever, headache, and rash is encountered in less than half of patients. Other common symptoms in children include nausea, vomiting, and abdominal pain. Frequent laboratory abnormalities in pediatric patients include elevated liver enzymes, lactate dehydrogenase, and erythrocyte sedimentation rate, as well as anemia. There is seasonal and geographic distribution, with most cases reported during warmer months in the Gulf Coast and California in the United States, often associated with flea or animal exposure for children. Pulmonary, neurologic, and renal complications are possible, although mortality is low. Patients of any age respond quickly to the initiation of doxycycline therapy. [ Pediatr Ann . 2022;51(11):e436–e439.]