A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy
Murine typhus is a flea-borne rickettsial infection caused by Rickettsia typhi , commonly seen in endemic regions like Southern California and Texas. While it typically presents with fever, rash, and headache, neurological symptoms such as altered mental status are rare. We present a case of a 66-ye...
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SAGE Publishing
2025-05-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096251345086 |
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| author | Jose Loayza Pintado MD Jorge Aboytes MD Cesar Uribe MD |
| author_facet | Jose Loayza Pintado MD Jorge Aboytes MD Cesar Uribe MD |
| author_sort | Jose Loayza Pintado MD |
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| description | Murine typhus is a flea-borne rickettsial infection caused by Rickettsia typhi , commonly seen in endemic regions like Southern California and Texas. While it typically presents with fever, rash, and headache, neurological symptoms such as altered mental status are rare. We present a case of a 66-year-old male in southern Texas with alcohol use disorder who developed progressive confusion, decreased appetite, and subjective fevers. He was found to have severe hyponatremia, acute kidney injury, and atrial fibrillation with rapid ventricular response. Despite supportive care and empiric antibiotics for a urinary tract infection, his encephalopathy persisted. Further history revealed exposure to flea-infested cats, prompting rickettsial testing and empiric doxycycline. Typhus immunoglobulin M antibodies later confirmed the diagnosis, and the patient showed marked improvement with doxycycline therapy. Murine typhus with altered mental status is a rare presentation, often leading to diagnostic delays. This case occurred in an endemic region, with exposure to flea-infested cats as a significant risk factor. The patient’s persistent encephalopathy prompted a broad workup, including rickettsial testing, which was confirmed on serology testing. Early doxycycline initiation led to symptom resolution. This case highlights a rare neurological presentation of murine typhus and emphasizes the importance of considering it in patients with unexplained encephalopathy in endemic areas. |
| format | Article |
| id | doaj-art-6895d705e17945b889df2d524da5a125 |
| institution | OA Journals |
| issn | 2324-7096 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj-art-6895d705e17945b889df2d524da5a1252025-08-20T02:01:06ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962025-05-011310.1177/23247096251345086A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained EncephalopathyJose Loayza Pintado MD0Jorge Aboytes MD1Cesar Uribe MD2University of Texas Rio Grande Valley, School of Medicine, Edinburg, Texas, USAUniversity of Texas Rio Grande Valley, School of Medicine, Edinburg, Texas, USAUniversity of Texas Rio Grande Valley, School of Medicine, Edinburg, Texas, USAMurine typhus is a flea-borne rickettsial infection caused by Rickettsia typhi , commonly seen in endemic regions like Southern California and Texas. While it typically presents with fever, rash, and headache, neurological symptoms such as altered mental status are rare. We present a case of a 66-year-old male in southern Texas with alcohol use disorder who developed progressive confusion, decreased appetite, and subjective fevers. He was found to have severe hyponatremia, acute kidney injury, and atrial fibrillation with rapid ventricular response. Despite supportive care and empiric antibiotics for a urinary tract infection, his encephalopathy persisted. Further history revealed exposure to flea-infested cats, prompting rickettsial testing and empiric doxycycline. Typhus immunoglobulin M antibodies later confirmed the diagnosis, and the patient showed marked improvement with doxycycline therapy. Murine typhus with altered mental status is a rare presentation, often leading to diagnostic delays. This case occurred in an endemic region, with exposure to flea-infested cats as a significant risk factor. The patient’s persistent encephalopathy prompted a broad workup, including rickettsial testing, which was confirmed on serology testing. Early doxycycline initiation led to symptom resolution. This case highlights a rare neurological presentation of murine typhus and emphasizes the importance of considering it in patients with unexplained encephalopathy in endemic areas.https://doi.org/10.1177/23247096251345086 |
| spellingShingle | Jose Loayza Pintado MD Jorge Aboytes MD Cesar Uribe MD A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy Journal of Investigative Medicine High Impact Case Reports |
| title | A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy |
| title_full | A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy |
| title_fullStr | A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy |
| title_full_unstemmed | A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy |
| title_short | A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy |
| title_sort | flea borne mystery unraveling murine typhus in a patient with unexplained encephalopathy |
| url | https://doi.org/10.1177/23247096251345086 |
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