Murine typhus and leptospirosis presenting with undifferentiated symptoms of an acute febrile illness to Waikato Hospital, New Zealand, 2009–2010
James Irwin, Deon Tredoux, Graham Mills
Patients presenting to hospital with a febrile illness are often discharged without a clear diagnosis. This study aimed to identify what proportion of these patients presenting to Waikato Hospital have leptospirosis or murine typhus (an infection carried by rat fleas). Fifty-seven patients were studied. Nine were diagnosed with leptospirosis, five with murine typhus, three with Epstein-Barr virus (EBV), two with cytomegalovirus (CMV), five with bacterial sepsis and six with other diagnoses. A low blood platelet count was associated with murine typhus infection, and a low lymphocyte (white blood cell) count and and rural occupation with leptospirosis. There was a trend towards rural residence being associated with murine typhus infection. These two infections were the most common cause of undiagnosed fever severe enough to warrant referral to Waikato Hospital. A similar profile of infection may be present in other rural regions of New Zealand.
