Histopathology and immunohistologic demonstration of the distribution of Rickettsia typhi in fatal murine typhus

D. H. Walker, F. M. Parks, T. G. Betz, J. P. Taylor, J. W. Muehlberger

Research output: Contribution to journalArticle

85 Scopus citations

Abstract

An 81-year-old woman had chills, fever, nausea, vomiting, and epigastric pain. On day 3 she had hematuria and was treated with trimethoprim-sulfamethoxazole. On day 5 she had a cough, hypotension, anemia, azotemia, and elevated hepatic enzyme levels. Her condition deteriorated with thrombocytopenia, anuria requiring dialysis, edema, and hypoalbuminemia. Treatment with chloramphenicol and doxycycline was started on day 10. By day 11, she was in hypotensive shock; on day 12 she had seizures and died. Murine typhus was diagnosed by demonstration of antibodies to Rickettsia typhi by indirect immunofluorescence. Necropsy revealed interstitial pneumonia, pulmonary edema, hyaline membranes, alveolar hemorrhages, petechiae and vasculitis in the central nervous system, interstitial myocarditis, multifocal interstitial nephritis and hemorrhages, splenomegaly, portal triaditis, and mucosal hemorrhages in urinary tract. Immunofluorescent R. typhi were demonstrated in the lungs, brain, kidneys, liver, and heart. This unusual death occurred in an elderly patient without rash who was treated too late with anti-rickettsial drugs.

Original languageEnglish (US)
Pages (from-to)720-724
Number of pages5
JournalAmerican journal of clinical pathology
Volume91
Issue number6
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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