Murine typhus is a fea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild byt sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the pateints who showed acute respiratory distress syndrome as the initial presentation.

The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress syndrome (ARDS) was define according to the American-European Consensus Conference. The characteristics between the ARDS group and the non-ARDS group of murine typhus were compared.

Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group.

Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.