{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:03Z","timestamp":1772740863510,"version":"3.50.1"},"reference-count":44,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Flea-borne typhus (FBT) is an infection caused by the bacteria\n                    <jats:italic>Rickettsia typhi<\/jats:italic>\n                    . It is usually an acute undifferentiated febrile illness; however, approximately one-quarter of patients suffer from organ-specific complications. In the present report, the case of a 51-year-old woman who originally presented to the clinic with a febrile illness is described. After being given supportive care with intravenous fluids and antiemetics for presumed viral infection, she returned to the emergency department the next day in a hypotensive state and experiencing respiratory distress, requiring emergent intubation in the context of developing severe acute respiratory distress syndrome (ARDS). An initial chest computed tomography scan revealed diffuse ground-glass opacities with interlobular septal thickening. Bronchoalveolar lavage was performed, revealing acellular eosinophilic aggregates consistent with pulmonary alveolar proteinosis (PAP). The clinical context of her serology strongly supported the diagnosis of FBT. This case illustrates the critical care complexities associated with FBT, in addition to a previously undescribed finding, PAP, in rickettsial infections. The patient\u2019s rapid progression of life-threatening ARDS and multiorgan dysfunction highlights the need for the timely diagnosis and treatment of FBT.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0833","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T16:11:55Z","timestamp":1767715915000},"page":"441-444","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Alveolar Proteinosis in a Patient with Severe Flea-Borne Typhus"],"prefix":"10.4269","volume":"114","author":[{"given":"Kourtney B.","family":"King","sequence":"first","affiliation":[{"name":"Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franklin A.","family":"Argueta","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Critical Care, Methodist Hospitals, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trey","family":"Kellogg","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santiago","family":"Martin Albo","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samy","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Barraza Aguilar","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Health San Antonio, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Anstead","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Medical Service, South Texas Veterans Health Care System, San Antonio, Texas;"},{"name":"Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher L.","family":"Dayton","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas;"},{"name":"Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","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":"b2","series-title":"Emerg Infect Dis","first-page":"412","article-title":"Murine typhus in Austin, Texas, USA, 2008","volume":"16","author":"Adjemian","year":"2010"},{"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":"Trop Med Infect Dis","first-page":"2","article-title":"History, rats, fleas, and opossums. II. The decline and resurgence of flea-borne typhus in the United States, 1945\u20132019","volume":"6","author":"Anstead","year":"2020"},{"key":"b5","series-title":"IDCases","first-page":"e00645","article-title":"Rickettsia typhi infection presenting as severe ARDS","volume":"18","author":"Tran","year":"2019"},{"key":"b6","series-title":"Lancet Respir Med","first-page":"554","article-title":"Pulmonary alveolar proteinosis in adults: Pathophysiology and clinical approach","volume":"6","author":"Kumar","year":"2018"},{"key":"b7","series-title":"BMC Pulm Med","first-page":"15","article-title":"Secondary pulmonary alveolar proteinosis: A single-center retrospective study (a case series and literature review)","volume":"18","author":"Zhang","year":"2018"},{"key":"b8","series-title":"Pulmonology","first-page":"351","article-title":"Images: Secondary pulmonary alveolar proteinosis in brucellosis","volume":"29","author":"Yan","year":"2023"},{"key":"b9","series-title":"AME Case Rep","first-page":"41","article-title":"Viral pneumonia and pulmonary alveolar proteinosis: The cause and the effect, case report","volume":"3","author":"Albogami","year":"2019"},{"key":"b10","series-title":"Emerg Infect Dis","first-page":"1375","article-title":"Severe murine typhus with pulmonary system involvement","volume":"20","author":"van der Vaart","year":"2014"},{"key":"b11","series-title":"Chest","first-page":"222","article-title":"Tick-borne pulmonary disease: Update on diagnosis and management","volume":"116","author":"Faul","year":"1999"},{"key":"b12","series-title":"Chest","first-page":"1348","article-title":"Comparative study of high-resolution CT findings between autoimmune and secondary pulmonary alveolar proteinosis","volume":"136","author":"Ishii","year":"2009"},{"key":"b13","series-title":"Am J Respir Crit Care Med","first-page":"890","article-title":"A unique case of secondary pulmonary alveolar proteinosis after e-cigarette, or vaping, product use\u2013associated lung injury","volume":"202","author":"Israel","year":"2020"},{"key":"b14","series-title":"Nat Rev Dis Primers","first-page":"16","article-title":"Pulmonary alveolar proteinosis","volume":"5","author":"Trapnell","year":"2019"},{"key":"b15","series-title":"Pneumonol Alergol Pol","first-page":"206","article-title":"Pulmonary alveolar proteinosis during a 30-year observation. Diagnosis and treatment","volume":"82","author":"Fijo\u0142ek","year":"2014"},{"key":"b16","series-title":"Infect Immun","first-page":"2599","article-title":"Rickettsia rickettsii infection of human macrovascular and microvascular endothelial cells reveals activation of both common and cell type-specific host response mechanisms","volume":"78","author":"Rydkina","year":"2010"},{"key":"b17","series-title":"Infect Immun","first-page":"2576","article-title":"Rickettsia-macrophage interactions: Host cell responses to Rickettsia akari and Rickettsia typhi.","volume":"70","author":"Radulovic","year":"2002"},{"key":"b18","series-title":"Infect Dis Rep","first-page":"132","article-title":"Flea-borne typhus causing hemophagocytic lymphohistiocytosis: An autopsy case","volume":"15","author":"Chandramohan","year":"2023"},{"key":"b19","series-title":"Am J Clin Pathol","first-page":"720","article-title":"Histopathology and immunohistologic demonstration of the distribution of Rickettsia typhi in fatal murine typhus","volume":"91","author":"Walker","year":"1989"},{"key":"b20","series-title":"Lung India","first-page":"205","article-title":"An unusual case of fatal pulmonary hemorrhage in pregnancy","volume":"28","author":"Dissanayake","year":"2011"},{"key":"b21","series-title":"Int J Infect Dis","first-page":"e246","article-title":"Resolution of secondary pulmonary alveolar proteinosis following treatment of rhinocerebral aspergillosis","volume":"14 (Suppl 3)","author":"Lin","year":"2010"},{"key":"b22","series-title":"Am J Clin Pathol","first-page":"797","article-title":"Endemic (murine) typhus; report of autopsy findings in three cases","volume":"17","author":"Binford","year":"1947"},{"key":"b1","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":"b2","series-title":"Emerg Infect Dis","first-page":"412","article-title":"Murine typhus in Austin, Texas, USA, 2008","volume":"16","author":"Adjemian","year":"2010"},{"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":"Trop Med Infect Dis","first-page":"2","article-title":"History, rats, fleas, and opossums. 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The decline and resurgence of flea-borne typhus in the United States, 1945\u20132019","volume":"6","author":"Anstead","year":"2020"},{"key":"b5","series-title":"IDCases","first-page":"e00645","article-title":"Rickettsia typhi infection presenting as severe ARDS","volume":"18","author":"Tran","year":"2019"},{"key":"b6","series-title":"Lancet Respir Med","first-page":"554","article-title":"Pulmonary alveolar proteinosis in adults: Pathophysiology and clinical approach","volume":"6","author":"Kumar","year":"2018"},{"key":"b7","series-title":"BMC Pulm Med","first-page":"15","article-title":"Secondary pulmonary alveolar proteinosis: A single-center retrospective study (a case series and literature review)","volume":"18","author":"Zhang","year":"2018"},{"key":"b8","series-title":"Pulmonology","first-page":"351","article-title":"Images: Secondary pulmonary alveolar proteinosis in brucellosis","volume":"29","author":"Yan","year":"2023"},{"key":"b9","series-title":"AME Case Rep","first-page":"41","article-title":"Viral pneumonia and pulmonary alveolar proteinosis: The cause and the effect, case report","volume":"3","author":"Albogami","year":"2019"},{"key":"b10","series-title":"Emerg Infect Dis","first-page":"1375","article-title":"Severe murine typhus with pulmonary system involvement","volume":"20","author":"van der Vaart","year":"2014"},{"key":"b11","series-title":"Chest","first-page":"222","article-title":"Tick-borne pulmonary disease: Update on diagnosis and management","volume":"116","author":"Faul","year":"1999"},{"key":"b12","series-title":"Chest","first-page":"1348","article-title":"Comparative study of high-resolution CT findings between autoimmune and secondary pulmonary alveolar proteinosis","volume":"136","author":"Ishii","year":"2009"},{"key":"b13","series-title":"Am J Respir Crit Care Med","first-page":"890","article-title":"A unique case of secondary pulmonary alveolar proteinosis after e-cigarette, or vaping, product use\u2013associated lung injury","volume":"202","author":"Israel","year":"2020"},{"key":"b14","series-title":"Nat Rev Dis Primers","first-page":"16","article-title":"Pulmonary alveolar proteinosis","volume":"5","author":"Trapnell","year":"2019"},{"key":"b15","series-title":"Pneumonol Alergol Pol","first-page":"206","article-title":"Pulmonary alveolar proteinosis during a 30-year observation. 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