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Blanton LS. Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae. Infect Dis Rep 2023; 15:700-716. [PMID: 37987401 PMCID: PMC10660532 DOI: 10.3390/idr15060063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
Murine typhus is an acute febrile illness caused by Rickettsia typhi, an obligately intracellular Gram-negative coccobacillus. Rats (Rattus species) and their fleas (Xenopsylla cheopis) serve as the reservoir and vector of R. typhi, respectively. Humans become infected when R. typhi-infected flea feces are rubbed into flea bite wounds or onto mucous membranes. The disease is endemic throughout much of the world, especially in tropical and subtropical seaboard regions where rats are common. Murine typhus is reemerging as an important cause of febrile illness in Texas and Southern California, where an alternate transmission cycle likely involves opossums (Didelphis virginiana) and cat fleas (Ctenocephalides felis). Although primarily an undifferentiated febrile illness, a range of neurologic manifestations may occur, especially when treatment is delayed. Serology is the mainstay of diagnostic testing, but confirmation usually requires demonstrating seroconversion or a fourfold increase in antibody titer from acute- and convalescent-phase sera (antibodies are seldom detectable in the first week of illness). Thus, early empiric treatment with doxycycline, the drug of choice, is imperative. The purpose of this review is to highlight murine typhus as an important emerging and reemerging infectious disease, review its neurologic manifestations, and discuss areas in need of further study.
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Affiliation(s)
- Lucas S Blanton
- Department Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA
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Blanton LS, Faccini-Martínez ÁA. Tigecycline for Severe Rickettsioses: Gained Experience Needing a Slight Grain of Salt. Infect Chemother 2022; 54:545-546. [PMID: 35920273 PMCID: PMC9533161 DOI: 10.3947/ic.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lucas S. Blanton
- Department of Internal Medicine – Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Álvaro A. Faccini-Martínez
- Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ferrero P, Piazza I, Lorini LF, Senni M. Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis. Indian Heart J 2020; 72:82-92. [PMID: 32534694 PMCID: PMC7296240 DOI: 10.1016/j.ihj.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/29/2020] [Accepted: 04/19/2020] [Indexed: 12/13/2022] Open
Abstract
We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis. Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis. Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively). In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.
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Affiliation(s)
- P Ferrero
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
| | - I Piazza
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - L F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - M Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
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Revilla-Martí P, Cecilio-Irazola Á, Gayán-Ordás J, Sanjoaquín-Conde I, Linares-Vicente JA, Oteo JA. Acute Myopericarditis Associated with Tickborne Rickettsia sibirica mongolitimonae. Emerg Infect Dis 2018; 23:2091-2093. [PMID: 29148392 PMCID: PMC5708254 DOI: 10.3201/eid2312.170293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report an unusual case of myopericarditis caused by Rickettsia sibirica mongolitimonae. Because of increasing reports of Rickettsia spp. as etiologic agents of acute myopericarditis and the ease and success with which it was treated in the patient reported here, rickettsial infection should be included in the differential diagnosis for myopericarditis.
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Stewart A, Hajkowicz K. Heterogeneity in skin manifestations of spotted fever group rickettsial infection in Australia. Australas J Dermatol 2018; 59:349-351. [DOI: 10.1111/ajd.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Adam Stewart
- Centre for Clinical Research; Faculty of Medicine; The University of Queensland; Royal Brisbane and Women's Hospital Campus; Brisbane Queensland Australia
- Department of Infectious Diseases; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
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Stenos J, Graves SR. Laboratory diagnosis of human infections transmitted by ticks, fleas, mites and lice in Australia. MICROBIOLOGY AUSTRALIA 2018. [DOI: 10.1071/ma18059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A wide range of human pathogens (viruses, bacteria, protozoa) are transmitted by ticks, fleas, mites and lice worldwide. Some of these infections occur in Australia1, whereas others appear to be absent, although they may occur in returned travellers. The key to diagnosis is two-fold: recognition of the possibility of a vector-borne infection by the treating doctor and confirmation of the diagnosis in a diagnostic, microbiology laboratory. Laboratory diagnostic assays include culture (used rarely), nucleic acid amplification (used increasingly) and serology (used often).
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Stewart A, Armstrong M, Graves S, Hajkowicz K. Rickettsia australis and Queensland Tick Typhus: A Rickettsial Spotted Fever Group Infection in Australia. Am J Trop Med Hyg 2017; 97:24-29. [PMID: 28719297 DOI: 10.4269/ajtmh.16-0915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsia australis, the etiologic agent of Queensland tick typhus (QTT), is increasingly being recognized as a cause of community-acquired acute febrile illness in eastern Australia. Changing human population demographics, climate change, and increased understanding of expanding vector distribution indicate QTT is an emerging public health threat. This review summarizes the epidemiology, pathogenesis, clinical features, treatment principles, and future directions of this disease. Increased recognition of QTT will enable consideration of and prompt treatment of R. australis infection by clinicians in Australia.
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Affiliation(s)
- Adam Stewart
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mark Armstrong
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stephen Graves
- Australian Rickettsial Reference Laboratory, Geelong, Australia
| | - Krispin Hajkowicz
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Graves SR, Stenos J. Tick-borne infectious diseases in Australia. Med J Aust 2017; 206:320-324. [PMID: 28403767 DOI: 10.5694/mja17.00090] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/20/2017] [Indexed: 01/14/2023]
Abstract
Tick bites in Australia can lead to a variety of illnesses in patients. These include infection, allergies, paralysis, autoimmune disease, post-infection fatigue and Australian multisystem disorder. Rickettsial (Rickettsia spp.) infections (Queensland tick typhus, Flinders Island spotted fever and Australian spotted fever) and Q fever (Coxiella burnetii) are the only systemic bacterial infections that are known to be transmitted by tick bites in Australia. Three species of local ticks transmit bacterial infection following a tick bite: the paralysis tick (Ixodes holocyclus) is endemic on the east coast of Australia and causes Queensland tick typhus due to R. australis and Q fever due to C. burnetii; the ornate kangaroo tick (Amblyomma triguttatum) occurs throughout much of northern, central and western Australia and causes Q fever; and the southern reptile tick (Bothriocroton hydrosauri) is found mainly in south-eastern Australia and causes Flinders Island spotted fever due to R. honei. Much about Australian ticks and the medical outcomes following tick bites remains unknown. Further research is required to increase understanding of these areas.
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Affiliation(s)
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, VIC
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Graves SR, Jackson C, Hussain-Yusuf H, Vincent G, Nguyen C, Stenos J, Webster M. Ixodes holocyclus Tick-Transmitted Human Pathogens in North-Eastern New South Wales, Australia. Trop Med Infect Dis 2016; 1:tropicalmed1010004. [PMID: 30270855 PMCID: PMC6082046 DOI: 10.3390/tropicalmed1010004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Abstract
A group of 14 persons who live in an area of Australia endemic for the Australian paralysis tick, Ixodes holocyclus, and who were involved in regularly collecting and handling these ticks, was examined for antibodies to tick-transmitted bacterial pathogens. Five (36%) had antibodies to Coxiella burnetii, the causative agent of Q fever and three (21%) had antibodies to spotted fever group (SFG) rickettsiae (Rickettsia spp). None had antibodies to Ehrlichia, Anaplasma, Orientia, or Borrelia (Lymedisease) suggesting that they had not been exposed to these bacteria. A total of 149 I. holocyclus ticks were examined for the citrate synthase (gltA) gene of the SFG rickettsiae and the com1 gene of C. burnetii; 23 (15.4%) ticks were positive for Rickettsia spp. and 8 (5.6%) positive for Coxiella spp. Sequencing of fragments of the gltA gene and the 17 kDa antigen gene from a selection of the ticks showed 99% and 100% homology, respectively, to Rickettsia australis, the bacterium causing Queenslandtick typhus. Thus, it appears that persons bitten by I. holocyclus in NE NSW, Australia have an approximate one in six risk of being infected with R. australis. Risks of Q fever were also high in this region but this may have been due to exposure by aerosol from the environment rather than by tick bite. A subset of 74 I. holocyclus ticks were further examined for DNA from Borrelia spp., Anaplasma spp. and Ehrlichia spp. but none was positive. Some of these recognised human bacterial pathogens associated with ticks may not be present in this Australian tick species from northeastern New South Wales.
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Affiliation(s)
- Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Chrissie Jackson
- Wongaburra Research Centre, Vetx Research, Casino, NSW 2470, Australia.
| | | | - Gemma Vincent
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Maurice Webster
- Wongaburra Research Centre, Vetx Research, Casino, NSW 2470, Australia.
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Maisch B, Ruppert V, Pankuweit S. Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options. Curr Heart Fail Rep 2015; 11:166-77. [PMID: 24723087 DOI: 10.1007/s11897-014-0196-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fulminant myocarditis is a clinical syndrome with signs of acute heart failure, cardiogenic shock, or life-threating rhythm disturbances in the context of suspected myocarditis. It is not an etiological diagnosis, but may have different underlying causes and pathogenetic processes - viral, bacterial, toxic, and autoreactive. Clinical management of the disease entity at the acute stage involves hemodynamic monitoring in an intensive care unit or similar setting. Rapid routine work-up is mandatory with serial EKGs, echocardiography, cardiac MRI, heart catheterization with endomyocardial biopsy for histology, immunohistology, and molecular analysis for the underlying infection and pathogenesis. Heart failure therapy is warranted in all cases according to current guidelines. For fulminant autoreactive myocarditis, immunosuppressive treatment is beneficial; for viral myocarditis, IVIg can resolve the inflammation, reduce the viral load, and even eradicate the microbial agent. ECMO, IABP, ventricular assist devices, LifeVest, or ICD implantation can bridge to recovery or to heart transplantation.
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Affiliation(s)
- Bernhard Maisch
- Medical Faculty of Philipps University Marburg and Cardiovascular Center Marburg, Erlenring 19, 35037, Marburg, Germany,
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Faccini-Martínez ÁA, García-Álvarez L, Hidalgo M, Oteo JA. Syndromic classification of rickettsioses: an approach for clinical practice. Int J Infect Dis 2014; 28:126-39. [PMID: 25242696 DOI: 10.1016/j.ijid.2014.05.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/23/2014] [Accepted: 05/24/2014] [Indexed: 10/24/2022] Open
Abstract
Rickettsioses share common clinical manifestations, such as fever, malaise, exanthema, the presence or absence of an inoculation eschar, and lymphadenopathy. Some of these manifestations can be suggestive of certain species of Rickettsia infection. Nevertheless none of these manifestations are pathognomonic, and direct diagnostic methods to confirm the involved species are always required. A syndrome is a set of signs and symptoms that characterizes a disease with many etiologies or causes. This situation is applicable to rickettsioses, where different species can cause similar clinical presentations. We propose a syndromic classification for these diseases: exanthematic rickettsiosis syndrome with a low probability of inoculation eschar and rickettsiosis syndrome with a probability of inoculation eschar and their variants. In doing so, we take into account the clinical manifestations, the geographic origin, and the possible vector involved, in order to provide a guide for physicians of the most probable etiological agent.
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Affiliation(s)
| | - Lara García-Álvarez
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain
| | - Marylin Hidalgo
- Microbiology Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José A Oteo
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain.
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