Date Published: January 15, 2015
Publisher: Public Library of Science
Author(s): Sasha R. Fehily, Gail B. Cross, Andrew J. Fuller. http://doi.org/10.1371/journal.pntd.0003351
Partial Text: A 30-year-old female presented to a tertiary hospital with two weeks of fevers and left upper quadrant abdominal pain after returning from the Gili Islands, Indonesia. She was immunised against hepatitis B, hepatitis A, and typhoid. She did not take malaria prophylaxis and recalls being bitten by insects. Laboratory investigations revealed an elevated C-reactive protein level (158 mg/L), mild thrombocytopenia (148 10^9/L), and deranged liver functions tests. Her malaria smear and blood and urine cultures were negative. Serology for dengue fever, chikungunya, human immunodeficiency virus, hepatitis B, hepatitis C, hepatitis A, leptospirosis, and rickettsia were sent. Two days into the admission, she subsequently developed significant bilateral conjunctivitis and was reviewed by the ophthalmology unit (Fig. 1). Ophthalmoscopy revealed a small, pale, inactive spot on the retina. The lens, macula, and retina otherwise appeared normal. Without antibiotic treatment, the patient’s fevers and abdominal pain resolved, although the conjunctivitis worsened (Fig. 1). The patient in this manuscript has given written informed consent to publication of her case details.
Murine typhus is endemic to Indonesia, with the prevalence of positive Rickettsia typhi antibody levels in humans being one of the highest in the world . Outbreaks have been reported worldwide, but the endemic foci include the Southeast Asian, Mediterranean, and southern United States regions . The environmental circumstances that potentiate the prevalence of this disease are port cities, coastal, and high altitude regions [3, 4]. Infections with this gram-negative intracellular bacterium remain under-diagnosed and underreported, despite being endemic worldwide . Arthropod vectors, commonly the rat flea Xenopsylla cheopis, are responsible for the transmission of murine typhus to humans from an animal reservoir . This is consistent with the increased prevalence in tropical port cities, where rats are abundant .