{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T16:21:29Z","timestamp":1771950089921,"version":"3.50.1"},"reference-count":65,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Murine typhus is a flea-borne disease caused by <jats:italic>Rickettsia typhi<\/jats:italic> infection. The disease is a notifiable infectious disease in Taiwan. Specimens from suspected cases are required to be sent to the Taiwan Centers for Disease Control and Prevention for laboratory diagnosis. In this study, 204 cases of murine typhus were identified by bacterial isolation, real-time polymerase chain reaction, or indirect immunofluorescence assay between 2013 and 2020. The average incidence rate was 0.11\/100,000 person-years (95% CI: 0.08\u20130.13). Murine typhus occurred throughout the year, but it was most prevalent in summer (May to August). The majority of patients were males (75%), residents of Kaohsiung city (31%), and worked in agriculture, forestry, fishing, and animal husbandry (27%). Fever was the most common symptom, present in 95.6% of patients, followed by headache (41%), myalgia (33%), and liver dysfunction (33%). Only 13% of patients had a rash. Up to 80% of cases were among hospitalized patients, and 43% of patients developed severe manifestations. Serological assays also indicated coinfection events. Seven patients showed a 4-fold increase in antibody titers against <jats:italic>Orientia tsutsugamushi<\/jats:italic> (<jats:italic>N<\/jats:italic> = 2), <jats:italic>Coxiella burnetii<\/jats:italic> (<jats:italic>n =<\/jats:italic> 2), and <jats:italic>Leptospira<\/jats:italic> (<jats:italic>N<\/jats:italic> = 3). In conclusion, murine typhus is an endemic and important zoonotic rickettsial disease in Taiwan that cannot be ignored. Further epidemiological surveillance and clinical characteristics should be continuously investigated to prevent and control murine typhus.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0155","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T16:31:03Z","timestamp":1710261063000},"page":"768-778","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology of Murine Typhus in Taiwan from 2013 to 2020"],"prefix":"10.4269","volume":"110","author":[{"given":"Yeou-Lin","family":"Hsueh","sequence":"first","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiang-Fei","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei-Chun","family":"Chang","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsai-Ying","family":"Yen","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Ling","family":"Su","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsien-Chun","family":"Chiu","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huai-Chin","family":"Hu","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Ting","family":"Chung","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei-Yun","family":"Shu","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-Lin","family":"Yang","sequence":"additional","affiliation":[{"name":"Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"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":"Trop Med Infect Dis","first-page":"37","article-title":"History, rats, fleas, and opossums: The ascendency of flea-borne typhus in the United States, 1910\u20131944","volume":"5","author":"Anstead","year":"2020"},{"key":"b3","series-title":"Annu Rev Entomol","first-page":"553","article-title":"Epidemiology of murine typhus","volume":"35","author":"Azad","year":"1990"},{"key":"b4","series-title":"Clin Infect Dis","first-page":"913","article-title":"Murine typhus: An unrecognized suburban vector borne disease","volume":"46","author":"Civen","year":"2008"},{"key":"b5","series-title":"Acta Trop","first-page":"16","article-title":"Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review","volume":"166","author":"Tsioutis","year":"2017"},{"key":"b6","series-title":"Ann Trop Med Parasitol","first-page":"645","article-title":"Transmission cycle of murine typhus in Greece","volume":"88","author":"Chaniotis","year":"1994"},{"key":"b7","series-title":"J Health Sci Surveill Syst","first-page":"208","article-title":"A systematic review of the arthropod-borne rickettsial diseases with a special emphasis on Iran","volume":"9","author":"Soltani","year":"2021"},{"key":"b8","series-title":"Clin Microbiol Infect","first-page":"404","article-title":"Neglected bacterial zoonoses","volume":"21","author":"Chikeka","year":"2015"},{"key":"b9","series-title":"Emerg Infect Dis","first-page":"73","article-title":"Knowledge-based patient screening for rare and emerging infectious\/parasitic diseases: A case study of brucellosis and murine typhus","volume":"3","author":"Carter","year":"1997"},{"key":"b10","series-title":"Principles and Practices of Infectious Diseases","first-page":"2306","author":"Dumler"},{"key":"b11","series-title":"JAMA","first-page":"1365","article-title":"Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987","volume":"266","author":"Dumler","year":"1991"},{"key":"b12","series-title":"Arch Pediatr Adolesc Med","first-page":"396","article-title":"Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children","volume":"155","author":"Whiteford","year":"2001"},{"key":"b13","series-title":"PLoS Negl Trop Dis","first-page":"e0008641","article-title":"A systematic review of the untreated mortality of murine typhus","volume":"14","author":"Doppler","year":"2020"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0008704","article-title":"The neglected challenge: Vaccination against rickettsiae","volume":"14","author":"Osterloh","year":"2020"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0005430","article-title":"Significance of major international seaports in the distribution of murine typhus in Taiwan","volume":"6","author":"Kuo","year":"2017"},{"key":"b16","series-title":"PLoS Negl Trop Dis","first-page":"e0010394","article-title":"Delayed correlation between the incidence rate of indigenous murine typhus in humans and the seropositive rate of Rickettsia typhi infection in small mammals in Taiwan from 2007\u20132019","volume":"25","author":"Chiang","year":"2022"},{"key":"b17","series-title":"Mol Biol Evol","first-page":"1870","article-title":"MEGA7: molecular evolutionary genetics analysis version 7.0 for bigger datasets","volume":"33","author":"Kumar","year":"2016"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"256","article-title":"Isolation and identification of a novel spotted fever group Rickettsia, strain IG-1, from Ixodes granulatus ticks collected on Orchid Island (Lanyu), Taiwan","volume":"79","author":"Tsai","year":"2008"},{"key":"b19","series-title":"Emerg Infect Dis","first-page":"1970","article-title":"Human case of Rickettsia felis infection, Taiwan","volume":"14","author":"Tsai","year":"2008"},{"key":"b20","series-title":"PLoS Negl Trop Dis","first-page":"e0010369","article-title":"Molecular epidemiology of scrub typhus in Taiwan during 2006\u20132016","volume":"16","author":"Chen","year":"2022"},{"key":"b21","series-title":"J Formos Med Assoc","first-page":"594","article-title":"Clinical observation on two weeks fever (murine typhus) in Taiwan","volume":"60","author":"Weng","year":"1961"},{"key":"b22","series-title":"Taiwan Epidemiology Bulletin","first-page":"263","article-title":"Flea-borne (endemic) typhus: A case report","volume":"11","author":"Yao-Shen","year":"1995"},{"key":"b23","series-title":"Trans R Soc Trop Med Hyg","first-page":"489","article-title":"Murine typhus in Cyprus: A 9-year survey","volume":"106","author":"Psaroulaki","year":"2012"},{"key":"b24","series-title":"Epidemiol Infect","first-page":"972","article-title":"Epidemiological features of Mediterranean spotted fever, murine typhus, and Q fever in Split-Dalmatia County (Croatia), 1982\u20132002","volume":"136","author":"Punda-Poli\u0107","year":"2008"},{"key":"b25","series-title":"Emerg Infect Dis","first-page":"570","article-title":"Murine typhus in Canary Islands, Spain, 1999\u20132015","volume":"27","author":"Robaina-Bord\u00f3n","year":"2021"},{"key":"b26","series-title":"J Glob Infect Dis","first-page":"121","article-title":"Comparative study on the epidemiological trends and aspects of murine typhus in Korea in the last decade (2006\u20132015)","volume":"10","author":"Chang","year":"2018"},{"key":"b27","series-title":"Int J Infect Dis","first-page":"165","article-title":"Murine typhus. How does it affect us in the 21st century? The epidemiology of inpatients in Spain (1997\u20132015)","volume":"96","author":"Rodr\u00edguez-Alonso","year":"2020"},{"key":"b28","series-title":"PLoS Negl Trop Dis","first-page":"e0009685","article-title":"A spatio-temporal analysis of scrub typhus and murine typhus in Laos: Implications from changing landscapes and climate","volume":"15","author":"Roberts","year":"2021"},{"key":"b29","series-title":"Emerg Infect Dis","first-page":"633","article-title":"Clinical manifestations and molecular diagnosis of scrub typhus and murine typhus, Vietnam, 2015\u20132017","volume":"25","author":"Trung","year":"2019"},{"key":"b30","series-title":"PLoS Negl Trop Dis","first-page":"e0009186","article-title":"Sunbathing, a possible risk factor of murine typhus infection in Greece","volume":"15","author":"Labropoulou","year":"2021"},{"key":"b31","series-title":"Vector Borne Zoonotic Dis","first-page":"13","article-title":"High prevalence of Rickettsia spp. infections in small mammals in Taiwan","volume":"15","author":"Kuo","year":"2015"},{"key":"b32","series-title":"Open Vet J","first-page":"165","article-title":"Direct evidence of Rickettsia typhi infection in Rhipicephalus sanguineus ticks and their canine hosts","volume":"7","author":"Dzul-Rosado","year":"2017"},{"key":"b33","series-title":"Clin Microbiol Infect","first-page":"237","article-title":"Seroprevalence of Rickettsia typhi and Rickettsia felis in dogs from north-eastern Spain","volume":"15","author":"Nogueras","year":"2009"},{"key":"b34","series-title":"PLoS One","first-page":"e71386","article-title":"Molecular detection of Rickettsia typhi in cats and fleas","volume":"8","author":"Nogueras","year":"2013"},{"key":"b35","series-title":"Vet Microbiol","first-page":"97","article-title":"The role of dogs in the eco-epidemiology of Rickettsia typhi, etiological agent of murine typhus","volume":"163","author":"Nogueras","year":"2013"},{"key":"b36","series-title":"Am J Trop Med Hyg","first-page":"91","article-title":"Seroepidemiologic evidence for murine and scrub typhus in Malang, Indonesia","volume":"57","author":"Richards","year":"1997"},{"key":"b37","series-title":"Clin Microbiol Infect","first-page":"211","article-title":"Murine typhus in children: Clinical and laboratory features from 41 cases in Crete, Greece","volume":"15","author":"Gikas","year":"2009"},{"key":"b38","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"491","article-title":"Murine typhus in Cyprus: 21 Paediatric cases","volume":"26","author":"Koliou","year":"2007"},{"key":"b39","series-title":"Pediatr Infect Dis J","first-page":"200","article-title":"Scrub and murine typhus in children with obscure fever in the tropics","volume":"10","author":"Silpapojakul","year":"1991"},{"key":"b40","series-title":"Scand J Infect Dis","first-page":"451","article-title":"Murine typhus is a common cause of febrile illness in Bedouin children in Israel","volume":"38","author":"Shalev","year":"2006"},{"key":"b41","series-title":"Med Mal Infect","first-page":"226","article-title":"Murine typhus in Tunisia: A neglected cause of fever as a single symptom","volume":"43","author":"Znazen","year":"2013"},{"key":"b42","series-title":"Med Mal Infect","first-page":"22","article-title":"Emergence of murine typhus in La R\u00e9union, France, 2012\u20132017","volume":"50","author":"Grouteau","year":"2020"},{"key":"b43","series-title":"Int J Infect Dis","first-page":"e591","article-title":"Murine typhus in central Greece: Epidemiological, clinical, laboratory, and therapeutic-response features of 90 cases","volume":"16","author":"Chaliotis","year":"2012"},{"key":"b44","series-title":"Trans R Soc Trop Med Hyg","first-page":"250","article-title":"Murine typhus in Greece: epidemiological, clinical, and therapeutic data from 83 cases","volume":"96","author":"Gikas","year":"2002"},{"key":"b45","series-title":"Emerg Infect Dis","first-page":"1656","article-title":"Murine typhus and febrile illness, Nepal","volume":"14","author":"Zimmerman","year":"2008"},{"key":"b46","series-title":"J Intern Med Taiwan","first-page":"36","article-title":"Murine typhus with presentation of unilateral abducens nerve palsy: A case report","volume":"25","author":"Hsu","year":"2014"},{"key":"b47","series-title":"PLoS Negl Trop Dis","first-page":"e0010354","article-title":"Genetic typing of isolates of Rickettsia typhi.","volume":"16","author":"Kato","year":"2022"},{"key":"b48","series-title":"Chin Med J (Engl)","first-page":"1314","article-title":"Molecular epidemic survey on co-prevalence of scrub typhus and marine typhus in Yuxi city, Yunnan province of China","volume":"120","author":"Zhang","year":"2007"},{"key":"b49","series-title":"PLoS Negl Trop Dis","first-page":"e2163","article-title":"Concurrent infection with murine typhus and scrub typhus in southern Laos\u2013The mixed and the unmixed","volume":"7","author":"Phommasone","year":"2013"},{"key":"b50","series-title":"J Formos Med Assoc","first-page":"367","article-title":"Epidemiology of acute Q fever, scrub typhus, and murine typhus, and identification of their clinical characteristics compared to patients with acute febrile illness in southern Taiwan","volume":"108","author":"Lai","year":"2009"},{"key":"b51","series-title":"Zoonoses Public Health","first-page":"517","article-title":"The epidemiology and characteristics of Q fever and co-infections with scrub typhus, murine typhus or leptospirosis in Taiwan: A nationwide database study","volume":"64","author":"Lai","year":"2017"},{"key":"b52","series-title":"J Med Microbiol","first-page":"199","article-title":"Cross-reaction of immune sera from patients with rickettsial diseases","volume":"29","author":"Hechemy","year":"1989"},{"key":"b53","series-title":"Epidemiol Infect","first-page":"e286","article-title":"Diagnosis of spotted fever group Rickettsia infections: The Asian perspective","volume":"147","author":"Robinson","year":"2019"},{"key":"b54","series-title":"Am J Trop Med Hyg","first-page":"365","article-title":"Accuracy of rapid IgM-based immunochromatographic and immunoblot assays for diagnosis of acute scrub typhus and murine typhus infections in Laos","volume":"83","author":"Blacksell","year":"2010"},{"key":"b55","series-title":"Clin Infect Dis","first-page":"82","article-title":"Concomitant or consecutive infection with Coxiella burnetii and tickborne diseases","volume":"40","author":"Rolain","year":"2005"},{"key":"b56","series-title":"Am J Trop Med Hyg","first-page":"735","article-title":"African tick bite fever in a Taiwanese traveler returning from South Africa: Molecular and serologic studies","volume":"81","author":"Tsai","year":"2009"},{"key":"b57","series-title":"PLoS One","first-page":"e95810","article-title":"Human spotted fever group rickettsioses are underappreciated in southern Taiwan, particularly for the species closely-related to Rickettsia felis.","volume":"9","author":"Lai","year":"2014"},{"key":"b58","series-title":"PLoS Negl Trop Dis","first-page":"e0009355","article-title":"Neglected human Rickettsia felis infection in Taiwan: A retrospective seroepidemiological survey of patients with suspected rickettsioses","volume":"15","author":"Yang","year":"2021"},{"key":"b59","series-title":"Hong Kong Med J","first-page":"457","article-title":"A returned traveler with persistent fever due to murine typhus","volume":"8","author":"Ng","year":"2002"},{"key":"b60","series-title":"J Travel Med","first-page":"356","article-title":"Murine typhus in two travelers returning from Bali, Indonesia: An underdiagnosed disease","volume":"17","author":"Takeshita","year":"2010"},{"key":"b61","series-title":"Emerg Infect Dis","first-page":"1466","article-title":"Murine typhus from Vietnam, imported into Japan","volume":"12","author":"Azuma","year":"2006"},{"key":"b62","series-title":"J Travel Med","first-page":"310","article-title":"Murine typhus as a cause of fever in travelers from Tunisia and Mediterranean areas","volume":"17","author":"Angelakis","year":"2010"},{"key":"b63","series-title":"Am J Trop Med Hyg","first-page":"1049","article-title":"Murine typhus in returned travelers: A report of thirty-two cases","volume":"86","author":"Walter","year":"2012"},{"key":"b64","series-title":"Case Rep Obstet Gynecol","first-page":"6767351","article-title":"Successful detection of unrecognized Rickettsia typhi in pregnancy using cell-free next-generation sequencing","volume":"2020","author":"Stafford","year":"2020"},{"key":"b65","series-title":"Open Forum Infect Dis","first-page":"ofab147","article-title":"Characteristics of Rickettsia typhi infections detected with next-generation sequencing of microbial cell-free deoxyribonucleic acid in a tertiary care hospital","volume":"8","author":"Centeno","year":"2021"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/4\/article-p768.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/4\/article-p768.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/4\/article-p768.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T13:11:17Z","timestamp":1712149877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/4\/article-p768.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,3]]},"references-count":65,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0155","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,3]]}}}