BY Jennifer L. Berghom
Dr. Zeeshan Afzal wants fellow physicians in the Rio Grande Valley to keep an eye out for murine typhus when treating patients with acute fever.
Afzal, a third-year medical resident in the UTRGV Family Medicine Residency program at McAllen Medical Center, says he decided to look into how prevalent the flea-borne infectious disease is in the area, after he noticed how many patients were coming to the hospital last year with high-grade fever, rashes and aches.
Many of those patients previously had gone to their primary care physicians for help, and were given medications. Eventually, they were admitted to the hospital because they were not getting better, he said.
While the symptoms can indicate a host of illnesses, Afzal said, he suspected they could result from a disease that is common here but often overlooked: murine typhus.
“Patients are often misdiagnosed because the symptoms are so nonspecific that you can easily confuse them with some other viral infection,” he said.
Murine typhus is spread through contact with fleas. Rats are the most common animal to carry the flea – Xenopsylla cheopis, or Oriental rat flea – but possums and other animals including cats and dogs also have been linked to spreading the illness.
The illness occurs in tropical and subtropical areas, and in the Unites States, most cases are reported in California, Hawaii and Texas; the Valley is considered a subtropical zone.
Hidalgo County had the highest number of reported cases of murine typhus in Texas from 2008 to 2016, with 673 cases reported, according to the Texas Department of State Health Services, which collects data on diseases, illnesses and other health information throughout the state
But Afzal believes the number could be higher because people with the disease are so often misdiagnosed.
Afzal and his colleagues at UTRGV, Dr. Sunand Kallumadanda and Dr. Feng Wang, as well as colleagues Dr. Vagish Hemmige and Dr. Daniel Musher of the Baylor College of Medicine, looked at patient charts from 2014 to 2016 and checked state health records to see just how prevalent the disease was in the Valley.
They also reviewed the patient charts of 90 adults and children who were diagnosed with murine typhus after being admitted to two hospitals in Hidalgo County.
The physicians found that 23 of the 90 patients who had murine typhus had already been to see their primary care physicians about their symptoms. Diagnoses they were given included influenza, viral syndrome and streptococcal pharyngitis (strep throat). It wasn’t until they were admitted to the hospital and had additional tests that it was determined they had murine typhus, the study found.
Complications from murine typhus occurred in 25 of the patients, and 13 patients required treatment in the intensive care unit. Complications included lung infections, pneumonia, pancreatitis, meningitis, inflammation of the gall bladder and muscles, and sepsis with kidney injury.
Eight of the 90 patients were never diagnosed while they were sick and recovered on their own. Their diagnosis was made after test results came back showing they had the illness.
The findings of the study were published in the August issue of the Centers for Disease Control and Prevention’s Emerging Infectious Diseases Journal.
Afzal said typhus can escalate quickly into something more serious, so it is important for doctors to exercise extra caution in diagnosing symptoms that include high-grade fever, rash and body ache.
“We don’t have the luxury of specialists here, so it’s become more important for primary care and family physicians to know about this infection,” Afzal said. “Also, the patient may not be able to afford to go to a specialist. The primary care doctor can make a lot of impact in a patient’s life and save a lot of money for the government and the patient.”