Murine typhus in Thailand: clinical features, diagnosis and treatment

One hundred and thirty-seven patients with murine typhus were reviewed. A history of direct contact with rats was rare, and none gave a history of flea bite. No seasonal trend was observed. Clinical presentations included fever (100%), hepatomegaly (24%), rash (20%) and non-specific signs. Complications were uncommon but included jaundice, pneumonia, renal insufficiency and meningitis. Only two patients died. A single 200 mg dose of doxycycline significantly shortened the duration of fever: 79% were afebrile in 48 h, compared to 15% of the untreated group.