A 75-year-old man from Kerala, who recently visited Vietnam and Cambodia, was diagnosed with murine typhus on Friday, October 11.
After his trip, he saw a doctor on September 8 because he had body pain and felt tired. Tests for diseases from rats and fleas were unclear, but his liver and kidney functions were getting worse.
Doctors looked at his travel history and thought it might be murine typhus. This is the first reported case of this rare disease in the state.
Here’s what you need to know about the disease, its spread, symptoms, treatment, and prevention.
What is murine typhus?
Murine typhus is an infectious disease caused by the bacteria Rickettsia typhi. Fleas transmit it to humans through their bites. The disease is also called endemic typhus, flea-borne typhus, or flea-borne spotted fever. Rodents like rats, mice, and mongooses carry the disease.
Fleas that carry the disease can also live on other small animals, including pets like cats and dogs. Once a flea is infected, it can spread the disease for its entire life.
History of Rickettsial diseases in India
According to the Indian Council of Medical Research (ICMR), rickettsial diseases are some of the most elusive emerging and re-emerging infections. Their prevalence in India is increasingly recognized.
These diseases have been documented in India since the 1930s. Notable reports include:
- Scrub Typhus in the Kumaon region and Assam during World War II.
- Scrub and Murine Typhus cases from the Jabalpur area in Madhya Pradesh.
- Murine Typhus reported from Kashmir.
Surveillance studies across various regions of India have shown significant exposure to rickettsial infections in both animals and humans. The most commonly reported rickettsial disease in India is Scrub Typhus. Other notable diseases include Murine Flea-borne Typhus, Indian Tick Typhus, and Q fever.
Difference between murine typhus and scrub typhus
Both Murine Typhus and Scrub Typhus cause fever and headache, but they differ in how they spread, their symptoms, and where they are common.
Transmission:
- Murine Typhus: Spread by fleas, especially from rats. Humans get it from flea bites or contact with flea droppings.
- Scrub Typhus: Spread by bites from infected chiggers (tiny mites) found in rural areas of Southeast Asia, including India.
Symptoms:
- Murine Typhus: Fever, chills, headache, body aches, nausea, and vomiting. A rash may appear later but is less common.
- Scrub Typhus: Sudden fever, chills, severe headache, and a dark scab (eschar) at the bite site. Swollen lymph nodes and a rash are also common.
Severity and Location:
- Murine Typhus: Generally milder and found worldwide.
- Scrub Typhus: More severe and common in the Asia-Pacific region.
Causative Agents:
- Murine Typhus: Caused by Rickettsia typhi and sometimes Rickettsia felis.
- Scrub Typhus: Caused by Orientia tsutsugamushi.
Clinical Course:
- Murine Typhus: Symptoms appear 6 to 18 days after exposure and usually resolve with antibiotics.
- Scrub Typhus: Can last longer and may need more intensive treatment. If untreated, it can lead to severe complications.
How is murine typhus spread?
The disease spreads when infected flea droppings touch cuts or scrapes on the skin. It can also spread if mucous membranes come into contact with infected flea feces. Murine typhus does not spread from person to person.
The disease is found in tropical and subtropical coastal areas where rats are common. In India, cases have been reported in the North East, Madhya Pradesh, and Kashmir.
What symptoms does murine typhus cause?
Symptoms usually show up seven to 14 days after exposure. They include fever, headache, body aches, joint pain, nausea, vomiting, and stomach upset. Some people may get rashes a few days after the first symptoms. The illness rarely lasts more than two weeks but can last for months with complications if untreated.
For the Kerala patient, doctors used Next Generation Sequencing (NGS) technology, which uses microbial DNA, to diagnose the disease. Further tests were done at CMC Vellore to confirm it.
How do you treat murine typhus?
How can you protect yourself from murine typhus?
To protect yourself from murine typhus, keep fleas away from pets by washing them regularly and watching for signs of fleas. Use flea treatments if needed.
Keep rodents out of your home, especially the kitchen. Make sure food is properly covered.