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Murine typhus among Khmers living at an evacuation site on the Thai-Kampuchean border
A E Brown1, S R Meek, N Maneechai
1American Refugee Committee, Aranyaprathet, Thailand.
Abstract:
An outbreak of febrile disease involving 170 Khmer adults at an evacuation site in Thailand occurred during the dry season of 1986, only 8 months after the camp was constructed. The illnesses were characterized by persistent fever, retro-orbital headache, myalgias, and clinical response to tetracycline within 2-3 days. The symptoms, effectiveness of tetracycline, and presence of a large rat population raised the suspicion of murine typhus. Fourteen (74%) of 19 patients had elevated or rising antibody titers against Rickettsia typhi, confirming the clinical diagnosis. Rats were caught, and they and their fleas were identified. In agreement with the known Thai host and vector, 80 (93%) of 86 rats were Rattus exulans, and all of 32 fleas were Xenopsylla cheopis. This first reported outbreak of murine typhus in Thailand is notable for its occurrence in a new human settlement only 8 months after construction.
Insights
An outbreak of murine typhus occurred in a new Thai settlement, affecting 170 adults. This confirmed the first reported outbreak of Rickettsia typhi infection in Thailand, linked to rats and fleas.
Area of Science:
- Epidemiology
- Infectious Diseases
- Zoonotic Diseases
Background:
- An outbreak of febrile illness affected 170 Khmer adults in a Thai evacuation site in 1986.
- The illness presented with persistent fever, retro-orbital headache, and myalgias, responding to tetracycline.
Purpose of the Study:
- To investigate the cause of a febrile disease outbreak in a Thai evacuation site.
- To confirm the diagnosis of murine typhus and identify the etiological agent and vectors.
Main Methods:
- Clinical diagnosis based on symptoms and tetracycline response.
- Serological testing for Rickettsia typhi antibodies in patients.
- Identification of rodent hosts and flea vectors.
Main Results:
- Fourteen of 19 patients (74%) showed elevated or rising antibody titers against Rickettsia typhi.
- 80 of 86 rats (93%) were identified as Rattus exulans.
- All 32 fleas collected were Xenopsylla cheopis.
Conclusions:
- The outbreak was confirmed as murine typhus, caused by Rickettsia typhi.
- Rattus exulans and Xenopsylla cheopis were identified as the primary host and vector.
- This marked the first reported outbreak of murine typhus in Thailand, occurring in a recently established settlement.