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

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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 infection 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 (PHL) provides both serological and PCR testing for Rickettsia. R. typhi and R. rickettsii serum testing is available and PCR whole blood testing can detect all Rickettsia species. Select the Rickettsia IgM & IgG IFA option under the Immunoserology/Virology section on the submittal form to request serological testing. To request Rickettsia PCR testing, list it in the Title 17/Other text box. Whole blood submitted for PCR testing must be preserved with purple top EDTA tube. Deteailed specimen collection instructions can be found in the PHL test catalog. 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.

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.

PHL TEST CATALOG: 2020 Catalog of Laboratory Tests
PHL Test Request Form (v2 10-4-2021)

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
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