Figure 1. Timeline describing the transmission of Rickettsia typhi from an organ donor to 2 kidney transplant recipients, Texas, 2024. Day 1 of donor hospitalization is represented as −5, the day of death as −1, and the day of transplantation as 0, after which posttransplant days are listed, ending with the discharge of recipient 1 from the hospital on posttransplant day 20.
Figure 2. Chest radiographs from an organ donor with murine typhus, from a study describing the transmission of Rickettsia typhi from an organ donor to 2 kidney transplant recipients, Texas, 2024. A) Chest radiograph obtained at hospital admission, 5 days after symptom onset, with no specific abnormalities noted. B) Chest radiograph obtained on hospital day 3, revealing extensive alveolar opacities predominantly in the middle and lower lung fields.
Figure 3. Histopathological and immunohistochemical features of formalin-fixed, paraffin-embedded biopsy specimens collected from the right and left kidney allografts procured from a donor who died of murine typhus, from a study describing the transmission of Rickettsia typhi from an organ donor to 2 kidney transplant recipients, Texas, 2024. A) When stained with hematoxylin and eosin, both allografts showed multifocal, interstitial, and predominantly mononuclear peritubular infiltrates, associated with focal endarteritis (thin arrows), features of acute tubular injury, including epithelial attenuation with loss of apical cytoplasm (thin arrowheads), and pigmented casts (large arrow). B) Glomeruli displayed moderate mesangial hypercellularity and tuft adhesions to the Bowman’s capsules (arrows) and intracapillary and mesangial phagocytic foam-cells (arrowheads), That finding is compatible with focal segmental glomerulosclerosis. C) Short chains comprising small, rod-shaped bacteria were revealed in glomerular capillaries by the Warthin–Starry silver impregnation staining technique. Immunoreactive R. typhi antigens were noted within intracellular bacteria in endothelial cells of renal arterioles. D–F) An immunohistochemical stain for typhus-group rickettsiae revealed intact bacteria within endothelial cells of inflamed small vessels and vascular spaces of mesangial capillaries (arrows) and phagocytized bacterial antigens in the cytoplasm of glomerular foam-cells (arrows). Original magnifications ×400 (A, B and E) and ×1,000 (C, D, and F).
Figure 4. Annual case counts of murine typhus in Texas, USA, during 1920–2024. Cases increased from close to zero to ~ 500 in 1930s before spiking to ~2000 in 1940s, then back down close to zero by 1950s, and remained near zero until started creeping back up in 2000s, steadily increasing, now with ~800 cases/year
Donor-derived infections with Rickettsia typhi (agent of murine typhus) in 2 kidney transplant recipients (1 fatal)
Teaching points
- 🐭 typhus transmitted by fleas (& transplant)
- Cases 📈 in Texas
- Death of diffuse 🫁 , 🧠 edema w/o dx=👎 tx
- cfDNA MGS (Karius) can dx
wwwnc.cdc.gov/eid/article/...
