Murine Typhus in 5 Children Hospitalized for Multisystem Inflammatory Syndrome in Children

Article Figures & Data

TABLE 1

History, Physical Examination, and Clinical Course of 5 Children With Murine Typhus

	Case 1	Case 2	Case 3	Case 4	Case 5
Age in y	17	16	12	10	8
Days of fever	5	10	6	10	9
Headache	No	Yes	Yes	Yes	Yes
Rash	Yes	No	Yes	Yes	Yes
Abdominal pain	No	Yes	No	No	No
Other symptoms	Malaise	Diarrhea	Fatigue	Fatigue	Decreased appetite
	Dizziness	Myalgias	Chills	Myalgias	—
	—	—	Eye redness	Vomiting	—
	—	—	Decreased appetite	Cough	—
	—	—	Vomiting	Neck stiffness	—
	—	—	—	Eye redness	—
Exposure	Multiple animals, including puppy with fleas	Dogs	2 cats and 1 dog previously treated for fleas	2 dogs	1 dog
	—	Rats	—	1 cat	No known fleas
	—	Home treated for fleas	—	No known fleas	—
Physical examination at presentation	Fever	Fever	Dry lips	Abdomen tender to palpation in the right upper quadrant and epigastric area	Fever
	Tachycardia	Tachycardia	Eczematous patches and excoriations	Few scattered macules	Tachycardia
	Maculo-papular rash on trunk, back, and extremities	Tachypnea	Injected conjunctivae	—	—
	—	Conjunctival injection	—	—	—
	—	Abdominal tenderness	—	—	—
Days to fever resolution after doxycycline initiation	3	2	1	2	2
Recurrence of symptoms after discharge	None	None	None	None	None

TABLE 2

Laboratory Features of 5 Children With Typhus

Test (Reference Range With Units)	Case 1	Case 2	Case 3	Case 4	Case 5
White blood cell count^a (4500–13 000 per μL)	6.7	7.7	5.3	4.5	15.2
Lymphocyte % per absolute (1200–5200 cells per μL)	16 of 1080	34 of 2620	23 of 1210	38 of 1720	24 of 3620
Neutrophils % per absolute (1800–8000 cells per μL)	78 of 5200	56 of 4280	29 of 3620	52 of 2380	67 of 10 190
Hemoglobin (12.0–16.9 g/dL)	12.8	9.9	13.4	13.3	11.7
Platelets (140 000–400 000 per μL)	151	157	136	161	280
Sodium (135–146 mmol/L)	134	137	131	134	135
CRP (<1.0 MG/DL)	17.1	16.9	3.1	5.9	5.4
ESR (0–20 mm/h)	19	13	11	17	33
AST (10–45 U/L)	73	396	78	128	122
ALT (11–26 U/L)	70	344	43	73	236
LDH (340–670 U/L)	938	1506	N/A	1746	1378
D-dimer (≤0.40 μg/mL)	2.68	3.18	3.42	2.41	1.88
Ferritin (18–464 ng/mL)	383	535	454	271	101
Fibrinogen (220–440 mg/dL)	422	278	273^a	414	382
Procalcitonin (0.05–2.00 ng/mL)	N/A	0.77	N/A	0.44	0.54
BNP (<100.0 pg/mL)	<10	20.7	89.1	72.6	N/A
Troponin (<0.030 ng/mL)	0.025	<0.010	0.015	0.011	N/A
Electrocardiogram	Normal	Normal	Mild PR interval prolongation	N/A	N/A
Echocardiogram	Normal	Normal	Mild coronary-artery dilation	Normal	Normal
R typhi antibodies	IgM 1:64	IgM >1:1024	IgM 1:128	IgM 1:512	IgM >1:1024
	IgG <1:64	IgG >1:64	IgG <1:64	IgG 1:512	IgG 1:1024
SARS-CoV-2 PCR	Negative	Negative	Negative	Negative	Negative
SARS-Co2-2 IgM and IgG	Nonreactive	Nonreactive	Nonreactive	Nonreactive	Nonreactive

ALT, alanine aminotransferase; AST, aspartate aminotransferase; BNP, B-type natriuretic peptide; ESR, erythrocyte sedimentation rate; LDH, lactate dehydrogenase; N/A, not applicable; PCR, polymerase chain reaction.
↵a Obtained after admission.