Abstract
Background: Murine typhus, caused by Rickettsia typhi, is a flea-borne illness historically endemic to the southeastern United States, with initial cases reported in Atlanta, Georgia in 1913. Following vector control efforts, incidence declined significantly, and the disease was removed from the nationally notifiable disease list in 1987. While recent cases have been reported in select regions, murine typhus has not been documented in Georgia for decades. We present a pediatric case in Atlanta that may represent the first reported instance in nearly 40 years, suggesting possible reemergence in the Southeast.
Methods: We conducted a case report analysis of a pediatric patient with febrile illness. Clinical data were obtained through detailed review of the patient’s medical record, including laboratory findings and hospital course. Diagnostic evaluation and follow-up testing were performed in collaboration with the local county public health department and the Centers for Disease Control and Prevention (CDC). Serologic testing for murine typhus IgG antibodies was interpreted in the context of clinical presentation and epidemiologic exposure.
Results: A previously healthy 12-year-old male presented with five days of fever, rash, arthralgia, and systemic symptoms. Initial evaluation suggested bacterial sepsis, toxic shock syndrome, and tick-borne illness. Despite broad-spectrum antibiotics, diagnostic studies were unrevealing. Rodent infestation in the home was identified. Serologic testing demonstrated murine typhus IgG positivity (1:128). Although confirmatory testing was unavailable, the compatible clinical findings, R. typhi IgG titer of 1:128, and reported household rat activity met the 2026 CDC surveillance criteria for a probable, but not confirmed, case of flea-borne typhus. The patient improved with doxycycline-containing therapy.
Conclusions: This case suggests possible reemergence of murine typhus in Georgia, where it has not been reported in decades. Clinicians in Georgia and the Southeast should consider murine typhus in patients with compatible symptoms and exposure history. Increased awareness and reconsideration of public health surveillance may be warranted.
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Recommended Citation
Mella-Velazquez, Giovanni; He, Christopher; Akinsola, Bolanle; and Miller, Judson
(2026)
"Murine Typhus in Georgia: Historical Context and a Probable Case of Resurgence Where Previously-Thought Eradicated,"
Journal of the Georgia Public Health Association: Vol. 12:
No.
1, Article 4.
Available at:
https://digitalcommons.georgiasouthern.edu/jgpha/vol12/iss1/4
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