Fleaborne Typhus-Associated Deaths
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Fleaborne Typhus–Associated Deaths — Los Angeles County, California, 2022

Los Angeles County, California, 2022

Jemma Alarcón, MD; Armine Sanosyan, MPH; Zuelma A. Contreras, PhD; Van P. Ngo, MPH; Ann Carpenter, DVM; Jill K. Hacker, PhD; William S. Probert, PhD; Dawn Terashita, MD; Sharon Balter, MD; Umme-Aiman Halai, MD

Disclosures

Morbidity and Mortality Weekly Report. 2023;72(31):838-843. 

In This Article

Abstract and Introduction

Abstract

Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June–October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus–associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyperactivation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts.

Introduction

Fleaborne typhus is transmitted from infected fleas by inoculation of flea feces into the flea bite site, a skin abrasion, or mucous membranes.[1] The Oriental rat flea (Xenopsylla cheopis), a parasite of rats, is the historical vector.

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