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Murine typhus presenting as subacute meningoencephalitis
R Masalha1, H Merkin-Zaborsky, M Matar
1Department of Neurology, Soroka Medical Centre, Beer-Sheva, Israel.
Abstract:
Murine typhus is a febrile systemic illness, presenting with headache and undulating fever. Neurological involvement is considered a rare complication. During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus. Five of these patients presented with a syndrome of subacute "aseptic" meningitis or meningoencephalitis. Three had bilateral papilloedema and 2 had focal neurological signs. None had a rash or other systemic findings suggestive of rickettsial disease. The diagnosis was based on serum and cerebrospinal fluid serology and on prompt response to doxycycline therapy. These cases suggest that neurological involvement in murine typhus is more common than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas.
Insights
Neurological complications like meningitis are rare in murine typhus (a bacterial infection). However, this study found these neurological issues occurred more often than expected in endemic areas.
Area of Science:
- Infectious Diseases
- Neurology
- Rickettsial Infections
Background:
- Murine typhus, a systemic febrile illness, typically presents with headache and fever.
- Neurological involvement is historically considered an infrequent complication of murine typhus.
- Rickettsial diseases can manifest with diverse clinical presentations.
Observation:
- During 1994-1995, five out of 34 murine typhus patients exhibited symptoms of subacute "aseptic" meningitis or meningoencephalitis.
- These patients presented with neurological signs such as bilateral papilloedema and focal neurological deficits.
- Crucially, none of these patients displayed a rash or other typical systemic signs of rickettsial disease.
Findings:
- Diagnosis was confirmed through serum and cerebrospinal fluid serology.
- Patients showed a rapid clinical improvement following doxycycline treatment.
- The study identified a higher incidence of neurological involvement in murine typhus than previously documented.
Implications:
- Murine typhus should be considered in the differential diagnosis for subacute meningitis, particularly in regions where the disease is endemic.
- This finding expands the known spectrum of murine typhus manifestations.
- Early recognition and treatment with doxycycline are crucial for managing neurological complications of murine typhus.