Blanton Lucas S
Department Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA.
Infect Dis Rep. 2023 Oct 26;15(6):700-716. doi: 10.3390/idr15060063.
Murine typhus is an acute febrile illness caused by , an obligately intracellular Gram-negative coccobacillus. Rats () and their fleas () serve as the reservoir and vector of , respectively. Humans become infected when -infected flea feces are rubbed into flea bite wounds or onto mucous membranes. The disease is endemic throughout much of the world, especially in tropical and subtropical seaboard regions where rats are common. Murine typhus is reemerging as an important cause of febrile illness in Texas and Southern California, where an alternate transmission cycle likely involves opossums () and cat fleas (). Although primarily an undifferentiated febrile illness, a range of neurologic manifestations may occur, especially when treatment is delayed. Serology is the mainstay of diagnostic testing, but confirmation usually requires demonstrating seroconversion or a fourfold increase in antibody titer from acute- and convalescent-phase sera (antibodies are seldom detectable in the first week of illness). Thus, early empiric treatment with doxycycline, the drug of choice, is imperative. The purpose of this review is to highlight murine typhus as an important emerging and reemerging infectious disease, review its neurologic manifestations, and discuss areas in need of further study.
鼠型斑疹伤寒是一种由莫氏立克次体引起的急性发热性疾病，莫氏立克次体是一种专性细胞内革兰氏阴性球杆菌。大鼠（褐家鼠）及其跳蚤（印鼠客蚤）分别作为莫氏立克次体的储存宿主和传播媒介。当感染了莫氏立克次体的跳蚤粪便被擦入跳蚤叮咬伤口或黏膜上时，人类就会被感染。该病在世界许多地方都有流行，特别是在大鼠常见的热带和亚热带沿海地区。在得克萨斯州和南加利福尼亚州，鼠型斑疹伤寒正重新成为发热性疾病的一个重要病因，在这些地方，另一种传播循环可能涉及负鼠（北美负鼠）和猫蚤（猫栉首蚤指名亚种）。虽然主要是一种未分化的发热性疾病，但可能会出现一系列神经学表现，尤其是在治疗延迟的情况下。血清学是诊断检测的主要手段，但确诊通常需要证明血清转化或急性期和恢复期血清抗体滴度有四倍升高（在疾病的第一周很少能检测到抗体）。因此，必须尽早使用首选药物多西环素进行经验性治疗。本综述的目的是强调鼠型斑疹伤寒是一种重要的新出现和重新出现的传染病，回顾其神经学表现，并讨论需要进一步研究的领域。
