G Grouteau1, O Lancelot2, A Bertolotti3, P Poubeau3, R Manaquin3, A Foucher3, J Jaubert4, P Parola5, F Pagès6, G Camuset3. 1. Service de maladies infectieuses et tropicales, centre hospitalier universitaire de La Réunion, site sud, avenue Prés-Mitterrand, 97448 St-Pierre, Reunion. Electronic address: gaspard.grouteau@gmail.com. 2. Service d'accueil des Urgences, centre hospitalier universitaire de La Réunion, site sud, avenue Prés-Mitterrand, 97448 St-Pierre, Reunion. 3. Service de maladies infectieuses et tropicales, centre hospitalier universitaire de La Réunion, site sud, avenue Prés-Mitterrand, 97448 St-Pierre, Reunion. 4. Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site sud, avenue Prés-Mitterrand, 97448 St-Pierre, Reunion. 5. Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, 13005 Marseille, France. 6. Santé Publique France, 2, bis avenue Georges-Brassens, 97743 Saint-Denis cedex 9, Reunion.
Abstract
OBJECTIVE: Murine typhus (MT) is an acute zoonosis caused by Rickettsia typhi, a flea-borne rickettsiosis. The first autochthonous case was reported in 2012. Once autochthonous transmission of Rickettsia typhi was proven, we performed a prospective study to describe and raise awareness of this often-misdiagnosed disease among physicians. PATIENTS AND METHODS: We performed a prospective observational study of MT cases in La Réunion from 2012 to 2017. MT cases were defined as clinically compatible illnesses with a specific positive serology and/or PCR. RESULTS: Sixty-one confirmed cases were collected. The main clinical features were prolonged fever (90%), asthenia (87%), and headaches (79%). The main biological abnormalities were elevated liver enzymes (84%) and thrombopenia (75%). Renal function was normal in 90% of cases; it was an important feature because leptospirosis is a frequent cause of acute renal failure. A seasonal factor was observed with 79% of cases reported in the warm season and most of them in the west and south of the island (i.e., the dry areas). CONCLUSION: MT is an emerging disease in La Réunion, and local conditions could lead to an endemic situation. Cases of acute undifferentiated fever with headaches should guide to the diagnosis of MT especially in the warm season and dry areas. Leptospirosis is an alternative diagnosis, which differs from MT by its epidemiological characteristics and by the associated frequent renal dysfunction.
OBJECTIVE:Murine typhus (MT) is an acute zoonosis caused by Rickettsia typhi, a flea-borne rickettsiosis. The first autochthonous case was reported in 2012. Once autochthonous transmission of Rickettsia typhi was proven, we performed a prospective study to describe and raise awareness of this often-misdiagnosed disease among physicians. PATIENTS AND METHODS: We performed a prospective observational study of MT cases in La Réunion from 2012 to 2017. MT cases were defined as clinically compatible illnesses with a specific positive serology and/or PCR. RESULTS: Sixty-one confirmed cases were collected. The main clinical features were prolonged fever (90%), asthenia (87%), and headaches (79%). The main biological abnormalities were elevated liver enzymes (84%) and thrombopenia (75%). Renal function was normal in 90% of cases; it was an important feature because leptospirosis is a frequent cause of acute renal failure. A seasonal factor was observed with 79% of cases reported in the warm season and most of them in the west and south of the island (i.e., the dry areas). CONCLUSION: MT is an emerging disease in La Réunion, and local conditions could lead to an endemic situation. Cases of acute undifferentiated fever with headaches should guide to the diagnosis of MT especially in the warm season and dry areas. Leptospirosis is an alternative diagnosis, which differs from MT by its epidemiological characteristics and by the associated frequent renal dysfunction.