Twee reizigers met vlektyfus

Background

Endemic typhus, caused by Rickettsia typhi, belongs to the typhus group of the rickettsioses. The disease is prevalent worldwide and is probably an underestimated cause of illness accompanied by fever in travellers, due to its frequently mild presentation and resemblance to diseases like typhoid- or dengue fever. Broad-spectrum antibiotics are not effective in the treatment of endemic typhus, but the disease is responsive to doxycycline.

Case description

A 57-year-old man and a 36-year-old woman, who had returned from Indonesia and Nepal and Tibet, respectively, both presented with fever, malaise, headache and arthromyalgia, and both developed a skin rash. A diagnosis of typhoid- or dengue-fever was suspected at first. The first patient improved after empirical treatment with doxycycline, the second recovered following treatment with azithromycin. Blood cultures and viral serology remained negative. Additional serology showed evidence of infection with R. typhi. Both patients made a complete recovery.

Conclusion

Endemic typhus should be included in the differential diagnosis of illness accompanied by fever in travellers, especially if blood cultures remain negative and no improvement is seen with broad-spectrum antibiotics.

Conflict of interest: P.J.J. van Genderen received funding for educational courses on tropical diseases for general practitioners, royalties for a book chapter on side effects of drugs, and a reimbursement fee for attending symposia given by GlaxoSmithKline, Sanofi-Pasteur and MSD. Financial support for this article: none declared.