{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T20:00:09Z","timestamp":1780344009610,"version":"3.54.1"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,6]]},"abstract":"<jats:p>Murine typhus, caused by <jats:italic>Rickettsia typhi<\/jats:italic>, is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. We aimed to compare the health-care charges in those diagnosed with murine typhus to those with influenza, a febrile illness with an available rapid diagnostic test. A comparison of health-care\u2013associated charges at the University of Texas Medical Branch at Galveston demonstrated a median of $817 for influenza versus $16,760 for murine typhus (<jats:italic>P<\/jats:italic> &lt; 0.0001). Median laboratory ($184 versus $3,254 [<jats:italic>P<\/jats:italic> &lt; 0.0001]) and imaging charges ($0 versus $514 [<jats:italic>P<\/jats:italic> &lt; 0.0001]) were also higher in those with murine typhus. Those receiving at least one imaging study during their illness were greater in the murine typhus group (91.3% versus 20.3%) (<jats:italic>P<\/jats:italic> &lt; 0.0001). The median time needed to establish a confirmed or presumptive diagnosis was 2 days for influenza compared with 9 days for murine typhus (<jats:italic>P<\/jats:italic> &lt; 0.0001). The median number of health-care encounters was greater for those with murine typhus (2 versus 1) (<jats:italic>P<\/jats:italic> &lt; 0.0001). Eleven patients (15.9%) with influenza were hospitalized as a result of their illness compared with 16 (69.6%) with murine typhus (<jats:italic>P<\/jats:italic> &lt; 0.0001). The estimated mortality based on disease severity at presentation by Acute Physiology and Chronic Health Evaluation II scoring was similar in the two groups\u2014both had a median 4% mortality risk (<jats:italic>P<\/jats:italic> = 0.0893). These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0411","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T07:00:51Z","timestamp":1523343651000},"page":"1594-1598","source":"Crossref","is-referenced-by-count":16,"title":["Analysis of Health-Care Charges in Murine Typhus: Need for Improved Clinical Recognition and Diagnostics for Acute Disease"],"prefix":"10.4269","volume":"98","author":[{"given":"Rahat F.","family":"Vohra","sequence":"first","affiliation":[{"name":"Department of Internal Medicine\u2014Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas S.","family":"Blanton","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2014Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Emerg Infect Dis","first-page":"319","article-title":"Flea-borne rickettsioses: ecologic considerations","volume":"3","author":"Azad","year":"1997"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"311","article-title":"The changing ecology of murine (endemic) typhus in southern California","volume":"19","author":"Adams","year":"1970"},{"key":"b3","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1224","article-title":"Murine typhus\u2013Hawaii, 2002","volume":"52","author":"Centers for Disease Control and 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