{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:03Z","timestamp":1760059983484,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>(1) Background: Murine typhus, caused by Rickettsia typhi, is a neglected rickettsial disease and an underdiagnosed cause of acute febrile illness (AFI), particularly in endemic regions such as Indonesia. (2) Case description: We report a case series of four patients presenting with AFI of less than seven days in duration. Three patients were admitted with moderate disease, while one presented with septic shock with the macrophage activation-like syndrome (MALS) phenotype. Common clinical features included myalgia and headache; additional symptoms included cough, sore throat, and abdominal pain. Laboratory findings revealed bicytopenia, elevated transaminases, and raised inflammatory and bacterial infection markers. Common tropical infections\u2014dengue, typhoid fever, and leptospirosis\u2014and other potential sources of infection were excluded early during hospitalization. Diagnosis was confirmed by nucleic acid amplification testing (NAAT), which detected R. typhi in all patients. Doxycycline was initiated following confirmation, leading to defervescence within 36\u201348 h. (3) Conclusions: Murine typhus remains an underrecognized cause of febrile illness in Indonesia. In the near future, the inclusion of rickettsial testing in the diagnostic protocol of AFI will be crucial, as it enables timely administration of effective, low-cost treatment.<\/jats:p>","DOI":"10.3390\/tropicalmed10080204","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T08:02:06Z","timestamp":1753257726000},"page":"204","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Fever: A Serial Report on Moderate to Severe Murine Typhus Cases and Diagnostic Hurdles in Indonesia"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3644-3156","authenticated-orcid":false,"given":"Velma","family":"Herwanto","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Siloam Hospitals Kebon Jeruk, Jakarta 11530, Indonesia"},{"name":"Division of Internal Medicine, Faculty of Medicine, Universitas Tarumanagara, Jakarta 11440, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Utami","family":"Widiastuti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Siloam Hospitals Kebon Jeruk, Jakarta 11530, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Gunawan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medistra Hospital, Jakarta 12950, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khie Chen","family":"Lie","sequence":"additional","affiliation":[{"name":"Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia\/Cipto Mangunkusumo National General Hospital, Jakarta 10430, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gasem, M.H., Kosasih, H., Tjitra, E., Alisjahbana, B., Karyana, M., Lokida, D., Neal, A., Liang, C.J., Aman, A.T., and Arif, M. 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