Abstract
A patient residing in New Mexico had murine typhus diagnosed. A novel molecular assay was performed at the Centers for Disease Control and Prevention, and Rickettsia prowazekii, the agent of epidemic typhus, was found, rather than R. typhi. To our knowledge, this is the first reported case of epidemic typhus confirmed by means of polymerase chain reaction--based testing of cerebrospinal fluid, and it introduces a novel assay for the molecular diagnosis of both epidemic and murine typhus.
Highlights
A patient residing in New Mexico had murine typhus diagnosed
The diagnosis of murine typhus has traditionally been made on the basis of the results of serological assays; there is significant serologic cross-reactivity between the agent of murine typhus, R. typhi, and the agent of epidemic typhus, R. prowazekii
Epidemic typhus is rare in the United States and other developed countries
Summary
A novel molecular assay was performed at the Centers for Disease Control and Prevention, and Rickettsia prowazekii, the agent of epidemic typhus, was found, rather than R. typhi. A second lumbar puncture performed 3 days later revealed a WBC count of 46 cells/mm (73% neutrophils and 27% lymphocytes); glucose, 53 mg/dL, and protein, 73 mg/dL. On 25 June, he had a fever, stiff neck, mild confusion, neck and lower back pain (especially to palpation of cervical vertebral bodies) and photophobia. He did not have adenopathy, hepatosplenomegaly, or a rash. No one else in his family or relatives whom he visited became ill
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