Acute Communicable
Disease Control

 
Contact Information
County of Los Angeles
Department of Public Health
Acute Communicable Disease Control
313 N. Figueroa Street, #212
Los Angeles, CA 90012
Phone: (213) 240-7941
Fax: (213) 482-4856
Email:acdc2@ph.lacounty.gov

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Acute Communicable Disease Control
Flea-borne Typhus Testing Information for Medical Professionals
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Providers should 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.

As symptoms are non-specific and laboratory testing is unreliable in acute phases of infection, treatment decisions should be based on clinical presentation and exposure history. Treatment for patients with suspected flea-borne typhus should not be delayed pending diagnostic tests.

Laboratory diagnosis can be conducted through 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. Serology performed on samples collected within the first week of onset can often be false-negative. Confirmation of R. typhi diagnosis requires paired serology of acute and convalescent samples (drawn 2 weeks later) demonstrating a four-fold increase in IgG titers. However, as not all patients return for additional testing, a probable diagnosis can be made with a single positive sample plus supportive clinical and laboratory criteria. Serological tests for both R. typhi and R. rickettsia are available at most commercial laboratories.

Testing at the LAC DPH Public Health Laboratory
The LAC DPH Public Health Laboratory provides R. typhi testing in addition to R. rickettsii testing on serum samples. Select the Rickettsial Antibody Panel for testing. PHL does not charge the submitter for these services.

A standard laboratory submittal form must be completed and accompany the specimen(s). Each specimen must be labeled with the patient name and a second identifier (date of birth or medical record number), date of collection, and specimen type. Include a copy of previous test results and any pertinent patient history with the specimen including onset date. Send specimens by courier or overnight shipper using the appropriate transport conditions for the specimen type. Ship packages Monday-Thursday to avoid weekend deliveries. Frozen specimens should be shipped on dry ice.

Reporting
Flea-borne typhus and other rickettsial infections are reportable in California. Reporting of cases guides the Los Angeles County Department of Public Health to target surveillance activities and health education. A standard Confidential Morbidity Report (CMR) can be used to file a report; the CMR may be faxed to the DPH Morbidity Unit at (888) 397-3778 or (213) 482-5508. You may also report cases by telephone during normal business hours from 8:00 a.m. to 5:00 p.m. to (888) 397-3993. For cases among residents of the cities of Long Beach or Pasadena, please contact their local health departments.

PRESS RELEASE: Public Health Reports Several Cases of Flea-Borne Typhus (10-4-18)

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