Fleaborne Typhus-Associated Deaths - Los Angeles County, California, 2022

Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June-October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus-associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyper-activation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts.

Automated summary

The number of reported fleaborne typhus cases in Los Angeles County has been increasing since 2010, with the highest number (171) reported in 2022. Among these cases, three severe manifestations were observed, including hemophagocytic lymphohistiocytosis, myocarditis, and septic shock with disseminated intravascular coagulation. Enhanced awareness among healthcare providers and public health authorities about the prevalence and severity of fleaborne typhus, as well as the importance of early doxycycline therapy, is crucial for prevention and treatment efforts.