25-Year-Old California Man Thought to Have COVID-19 Revealed He Had ‘Murine Typhus’
When a 25-yer-old Southern Californian man suffered headaches, fevers, chills, and muscle pain in July, the first thing his doctors did was have him tested for COVID-19.
The result was negative; although his symptoms continued that he decided to seek care in the emergency room.
Soon after, following another test for COVID-19 that again resulted in negative, and nearly three weeks of suffering the symptoms, he was diagnosed with a different disease: murine typhus - "a flea-borne illness," as described in reports on his condition.
Based on a case report published on November 3 in BMJ Case Reports, the man was feverish "with a temperature of 38.4 degrees Celsius" when he initially presented to the emergency department.
It was during this time when his COVID-19 test result came out negative for the second time. Reportedly too, his vital signs were said to be stable, and his physical exam went normal.
To treat the symptoms, doctors treated the 25-year-old with oral ibuprofen and discharged him with a diagnosis of "presumptive viral syndrome."
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A 25-year-old man continued to experience every day, persistent fevers, cough, chills, body aches, diarrhea, fatigue, headache and dizziness, and was diagnosed with murine typhus with symptoms Similar to COVID-19.
Persistent Symptoms
Several days after, the man went to his doctor for a follow-up, reporting his fevers, coughs, body pains, and vomiting persisted.
Added to his continuing symptoms, the patient told his doctor he has new back pain, and his temperature had risen to 39.9 degrees Celsius.
This time he was advised to go for urgent care. By the time he got there, the man's pulse rate was already at 125 bpm and his temperature slightly dropped. According to Cleveland Clinic, a normal "resting pulse rate for an adult" should be 60 to 100 bpm.
His physical exam again went normal. Following the test, this patient underwent treatment with the use of antibiotics and pain relief drugs.
Upon his discharge, he was prescribed azithromycin, an antibiotic given to patients to treat certain bacterial infections.
Diagnosed with 'Murine Typhus'
Despite the medications, the man continued to experience every day, persistent fevers, cough, chills, body aches, diarrhea, fatigue, headache, and dizziness.
On the 14th day of his illness, during another consultation with his doctor via the phone, he told the latter that he worked as a dog trainer. This time, he was tested for murine typhus, an infection transmitted by fleas.
As indicated in the case report, it was eventually inquiry into the occupational background of the patient as a dog trainer that contributed to the revelation of his murine typhus diagnosis.
To treat the then already-identified illness, the man was treated using 100 mg of doxycycline twice each day for two weeks.
Upon completion of the prescribed course of the drug, the patient successively experienced full recovery from his symptoms.
As a result, he started to cancel the pan CT scans the doctor ordered as part of his workup prior to the diagnosis of his murine typhus.
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Points Learned from the Disease
Even though murine typhus is frequently self-limited and mild, reports of severe illness linked to this disease have been reported.
The case report specified, "It presents with nonspecific symptoms" and is frequently misdiagnosed, not to mention under-reported.
More so, clinicians' lack of awareness of this disease can result in prolonged symptoms and higher healthcare costs. It is important to note that dogs, on top of cats and rats, can transfer murine typhus to humans.
Lastly, there is a need for clinicians to consider an extended differential diagnosis for COVID-19 if symptoms persist or don't improve, specifically in patients who have repeat negative testing. This, according to the report, can be quite a struggle, "given the wide overlap in COVID-19 symptoms with other disease processes."
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Nov 07, 2020 06:00 PM EST
