Flea-Borne Typhus? — October 18, 2018

Flea-Borne Typhus? — October 18, 2018

Flea-Borne Typhus? — October 18, 2018

Flea-Borne Typhus? — October 18, 2018 150 150 Emergency Medical Services Agency

Los Angeles County Department of Public Health (LAC DPH) has identified a number of cases of flea-borne typhus associated with the homeless population in downtown Los Angeles and the Willowbrook area of Compton.

LAC DPH states, “flea-borne typhus, also known as murine or endemic typhus, is a disease transmitted by fleas infected with Rickettsia typhi or Rickettsia felis. Flea-borne typhus is endemic in LAC with cases detected each year. In recent years, the average number of cases reported to LAC DPH has doubled to nearly 60 cases per year; however, geographic clusters of the size are unusual. Most cases occur in the summer and fall months. In LAC, the primary animals known to carry infected fleas include rats, feral cats, and opossums. People with significant exposure to these animals are at risk of acquiring flea-borne typhus”

When should EMS providers suspect typhus?

  • A fever of unknown cause, especially in patients at high risk (e.g., homeless, or those around feral cats or other mammals).
  • Other symptoms include chills, body aches, headache, and rash.

What are recommended actions by emergency departments and other hospital-based clinicians?

Consider a diagnosis of flea-borne typhus in patients with a non-specific febrile illness with headache, myalgia, rash, and laboratory abnormalities including leukopenia, thrombocytopenia, and elevation of hepatic transaminases, without alternate identifiable etiology.

  • LAC DPH asks that all suspected cases of flea-borne typhus, particularly in persons experiencing homelessness and those with exposure to outdoor animals such as stray cats, opossums, pet dogs and cats, be reported to Los Angeles County DPH Acute Communicable Disease Control Program within 1 working day. 
  • Weekdays 8:30 AM – 5:00 PM: call 888-397-3993. For consultation: call 213-240-7941
    – After hours: call 213-974-1234, and ask for the physician on call.

Long Beach Health and Human Services

  • Weekdays 8:00 AM – 5:00 PM: call 562-570-4302
    – After hours: call 213-974-1234, and ask for the physician on call.

Pasadena Public Health Department

    • Weekdays 8:00 AM – 5:00 PM (closed every other Friday): call the Communicable Disease Control Program at 626-744-6089
      – After hours: call 626-744-6043.
  • LAC DPH recommends that treatment for typhus not be delayed for diagnostic testing which includes serologic testing for R.typhi IgG and IgM antibodies. As there can be cross-reactivity with other rickettsiae, LAC DPH also recommends testing for antibodies against R. rickettsii, the causative agent of Rocky Mountain Spotted Fever. http://www.publichealth.lacounty.gov/acd/TyphusTesting.htm
  • Doxycycline is the treatment of choice; the dose of doxycycline for adults is 100 mg orally BID.  Treatment should occur for a minimum of five days or until 48 hours after patient becomes afebrile.

Are there concerns about contracting the disease if EMS or hospital personnel care for such patients?

  • There is no concern for person-to-person transmission therefore, standard precautions and PPE are indicated.
  • No additional methods for cleaning of ambulances after transport of suspected patients are indicated.

If fleas are noted, consider removing clothing and place in a biohazard bag.

Additional Resources