Reemerging Murine Typhus, Japan

Autor: Tsuneo Uchiyama, Saburo Sone, Hiroaki Muguruma, Ichiki Sato, Satoshi Sakaguchi, Yoshito Kusuhara, Seiji Yano, Hiroaki Kawano
Jazyk: angličtina
Rok vydání: 2004
Předmět:
Zdroj: Emerging Infectious Diseases, Vol 10, Iss 5, Pp 964-965 (2004)
ISSN: 1080-6059
1080-6040
Popis: To the Editor: Murine typhus is an arthropod-borne infectious disease caused by Rickettsia typhi, which is distributed widely around the world (1–4). In Japan, tsutsugamushi disease occurs most frequently in persons infected with rickettsioses (5). Spotted fever caused by R. japonica also occurs in the southwestern part of Japan (6,7). In the 1940s and 1950s, many murine typhus cases were reported in Japan. These diagnoses were made according to the clinical features of the illness and the reactivity of the serum samples to OX19 in Weil-Felix tests. A few cases were diagnosed on the basis of symptoms exhibited by animals infected with isolated rickettsiae and complement fixation tests, in addition to results of the Weil-Felix tests. The Weil-Felix test is useful for preliminary screening of rickettsiosis; however, the reaction could indicate epidemic typhus or spotted fever in some cases. Since 1958, only three murine typhus cases have been reported in Japan (8). In these cases, no serologic tests for epidemic typhus were conducted. Serum sample from patients with epidemic typhus and murine typhus frequently possess serologic cross-reactivity to R. typhi and R. prowazekii, respectively (9). Thus, the possibility of epidemic typhus could not be excluded definitively in these cases. On May 4, 2003, a 56-year-old man living in Tokushima, Japan, sought medical care; he had a temperature of 39.1°C and exanthema on the trunk and the upper limbs. No surface lymph nodes were palpable. He was treated with lincomycin and cefditoren pivoxil with no improvement. On day 3, the patient informed caregivers that he had been in a bamboo grove on days 1 and 11 before the onset of symptoms. C-reactive protein of the serum sample collected on day 3 was positive (= 7.6 mg/dL). From this finding, spotted fever was suspected; the disease is endemic in Tokushima. On day 4, the exanthema had spread systemically, and treatment with minocycline was started, which led to a gradual decrease in fever and rashes. The patient was admitted to the Tokushima University Hospital on day 6 of the illness for diagnosis and further treatment. Serum samples were collected from the patient on days 5, 6, 9, 20, and 34. Indirect immunoperoxidase tests on the serum samples for tsutsugamushi disease, spotted fever, murine typhus, and Q fever on day 5 of the illness were negative for immunoglobulin (Ig) G and IgM antibodies (
Databáze: OpenAIRE
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