Murine Typhus Infected in Oku-etsu Area, Fukui Prefecture

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  • TAKAGI Kazutaka
    First Department of Internal Medicine, Fukui Medical University
  • IWASAKI Hiromichi
    Division of Transfusion Medicine, Fukui Medical University
  • KISHI Shinji
    First Department of Internal Medicine, Fukui Medical University
  • TAKADA Nobuhiro
    Department of Immunology and Medical Zoology, Fukui Medical University
  • NAKAMURA Toru
    First Department of Internal Medicine, Fukui Medical University
  • UEDA Takanori
    First Department of Internal Medicine, Fukui Medical University Division of Transfusion Medicine, Fukui Medical University

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  • 福井県奥越地方で発症した発疹熱

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Abstract

A 15-year-old girl, high school student, became febrile (38-39°C) with chills, more throat andcough on April 20, 1994. Until the onset, she was healthy and she had been camping with her classmatesin a wooded mountainous area in Oku-etsu, Fukui Prefecture. She consulted a local clinic on.April 21 and bacampicillin was initially administered and then changed to cefaclor on April 23. However, high body temperature continued and a maclopapular rash appeared on her face on April 24and gradually spread to her anterior chest and back. Blood examination showed a WBC count of2, 200/μl and she was admitted to our hospital on April 25.<BR>On admission, peripheral blood data showed leukocytopenia (WBC 2, 300/μl) with 5% atypicallymphocytes. Titers of anti-Rickettsia typhi serum antibodies (IgM, -G) were elevated (1: 80, 1: 640) and she was diagnosed as having murine typhus. On the second hospital day, 200 mg of minocycline (MINO) was administered per os and her body temperature fell to within the normal limits on thethird hospital day. On the 7th hospital day, the skin rash disappeared and she was discharged. Altogether, 320 high school students went camping with this patient. Among them, approximately 30 studentshad similar symptoms and signs as this case and had been diagnosed suspected viral infection.Twelve students of the 30 were admitted to other hospitals. It was considered that this case was partof an outbreak of murine typhus in the Oku-etsu area, Fukui Prefecture, but no further investigationwas performed. Murine typhus is usually a benign disease that is controllable by the administrationof MINO. In rare cases, infection can worsen to multiorganic failure, severe complications have beenreported in 1-4% of cases, and death has been reported in less than 3%. Recently, it has also beenreported that MINO not only has an antibiotic effect, but also play acts as a cytokine modulator in patientswith rickettsial infection. Thus, in febrile patients in whom uncommon Rickettsia infection issuspected, serological test for murine typhus should be examined and the immediate administrationof MINO is important.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 75 (4), 341-344, 2001

    The Japanese Association for Infectious Diseases

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