HARLINGEN — Chase North of San Benito is 21, and his past two weeks have been pretty rough.
He started to feel poorly and his blood pressure was rocketing this way and that, from too high to really too high.
“My dad said, ‘Why don’t you
take his temperature?’ and I said, ‘OK,’ and I checked it and it was,
like, 104.9, and I was, like, ‘Oh, my gosh,’” said his mother, Dana
Rowe.
“So Monday I told my dad, ‘I’m
fixing to take him into the ER, this is not letting up,’” she said. “I
thought something serious was going on.”
Dana had Chase checked into ValleyBaptistMedicalCenter’s emergency room.
“Chase felt miserable so we got
him back, they ran a strep test, they ran a flu test, they pulled huge
vials of blood from his arm, I guess those were for the lactic acid,”
Dana said. “They did a CT scan of his head, they did a chest X-ray to
find out what’s going on.
“The bloodwork came back and his
liver numbers were up and his white blood cell count was down, which is
very odd considering that a fever means you have an infection,” she
said.
After leaving the hospital at
3:30 a.m., with no better idea of what was wrong, things did not improve
the next day. Dana took Chase to a local clinic.
Dr. Nina Torkelson knew the lack of a diagnosis in Chase’s case was becoming a problem.
“She started asking questions
about when it started, the whole rundown of it, and she said, ‘Let me
look at the result of his bloodwork in the ER one more time,’” Dana
said. “She looked at the blood results, and she noticed that the liver
functions were high and, like I said, the white blood cell count is low,
and there was something else she mentioned that was low, and she said,
‘It’s got to be typhus.’
“I go, like, ‘What?’” Dana said. “Are you serious? This is like something in Colombia, or some place like that.”
Or some place like South Texas.
Cat flea, rat flea
“Murine typhus is a rickettsial
disease caused by two distinct species of flea — you have the cat flea
and the rat flea,” said Angel Guevara, a zoonosis control specialist
with the Texas Department of State Health Services. “Primarily this
disease is transmitted by the rat flea, by infected fleas that are
harbored by rodents, opossums, cats, dogs and other small mammals.”
Zoonosis is a field of public
health science that studies diseases transmitted from animals to humans.
Guevara spoke recently at a seminar at the DSHS Harlingen office for a
dozen public health professionals who are on the front lines in the
state’s battle against typhus and other zoonotic diseases.
“A typical flea can fit on the
tip of a ballpoint pen,” Guevara told his audience. “Once born, they
will look for a blood meal within seconds once they jump on your pet.
“A female flea can produce up to
40 to 50 eggs a day, so it can produce at least 2,000 eggs during its
whole life,” he added. “And they lay these eggs within 24 to 48 hours
after they have a blood meal — they need that blood meal to produce
offspring.”
Much like another emerging
illness in South Texas, Chagas disease, murine typhus is transmitted by
the flea’s unsavory practice of defecating when it bites a host. A
person scratches the bite, and drives the rickettsia bacteria in the
feces into the wound and into the bloodstream.
Once the bacteria makes it
there, a patient starts to develop a fever, chills, headache, nausea
and, after about five days after the onset of symptoms, a rash.
“Most people will recover
without treatment, however, that might require some hospitalization,”
Guevara said. “We encourage you to get treated for it. If left
untreated, severe illness can cause damage to one or more organs,
including the liver, kidneys, heart, lungs and the brain.”
Diagnosing the problem
Guevara said obtaining an early diagnosis of murine typhus can be difficult not just for patients but for physicians as well.
Since the symptoms often
resemble common viral infections, it is only when a patient’s condition
doesn’t improve — and symptoms can last for weeks — that many doctors
call for a test to determine whether the rickettsial bacteria is
present. Another rickettsial disease, Rocky Mountain spotted fever, also
can come up positive in the test, but it is rare in the Rio
GrandeValley.
“Here in Texas, these symptoms
can be any variety of illnesses, so we have to rely on physicians,”
Guevara said. “We let them know that we do have murine typhus here ...
and they have to order that test.”
In CameronCounty, murine typhus
cases from 2015 through last year were 39, 32, and 37, said Esmer
Guajardo, health administrator with the Cameron County Department of
Health and Human Services.
“Generally what we do in terms
of alerts to the medical community is based on reporting,” she said.
“We’ll see a spike and we tend to have our providers on alert. Because
our numbers have been pretty consistent we just provide the general
information about typhus, that it’s something that should not be
overlooked.”
Why the Valley?
Murine typhus is an endemic
disease in the tropics and the subtropics, which means it is one of
those illnesses that are ever present, and the subtropics is where the
Rio GrandeValley falls latitude-wise.
Hidalgo, Nueces and Cameron
counties generally lead the way in murine typhus cases reported in
Texas. Part of the answer is found in the region’s mild weather, which
means fleas, eggs and larvae are not subject to winter-kill like in most
of the rest of the nation.
It also means many residents
leave pets outside year-round, and the pets then become reservoirs for
fleas that can carry disease.
“In some areas, people keep
their dogs indoors, but a lot of people tend to keep their dogs outside
around-the-clock,” Guajardo said, “and that’s obviously an avenue for
having some exposure to more fleas within the household.”
Another reason, at least in Hidalgo County, is population growth.
“We’re a weird county because
we’re the seventh-most populous county in Texas, and the only counties
bigger than us are very urbanized — Bexar County, Tarrant County, Collin
County, up near Plano, and Houston and Dallas,” said Eddie Olivarez,
chief administrative officer for Hidalgo County Health and Human
Services.
“We still have a lot of
rural-ness to our area, especially in the unincorporated areas of our
county, so what ends up happening is you still have (a) lot of areas
where, for lack of a better term, it’s prime for wildlife, prime for
some of these other critters where fleas and ticks are an issue.”
Traditionally, Hidalgo County
has led the state in the number of confirmed murine typhus cases
annually, recording 97 cases in 2015, 85 in 2016 and 99 cases last year.
Olivarez pinpoints the opossum and feral cats as prime suspects in the
county’s high typhus numbers.
“We’re still up there among the
higher problematic counties, but a lot of it has to do with population,”
he added. “Our population density is so tight, as we have more and more
people moving out into the country and into more rural areas, and we
have a lot more domesticated animals getting in with the opossum
population ... those are the situations that are causing the problem for
us.”
Passing the word
State health officials issued a
statewide alert aimed at medical professionals to be on the lookout for
murine typhus Nov. 30 of last year.
While Cameron and Hidalgo
counties’ numbers are relatively high but stable, other areas of the
state are seeing spikes in murine typhus cases. State officials are
saying only the numbers are “significantly” higher during the first
three months of this year compared to 2017.
They are urging local physicians
to be aware of the possibility patients may be showing symptoms not of a
viral disease, but a bacterial one.
“Typhus actually gets a little
bit more complicated because not only is it confusing for the flu, but
it’s also confusing for Zika and it’s also confusing for dengue,”
Olivarez said. “We do have Rocky Mountain spotted fever here on
occasion, but most of the time it’s imported, a person who becomes ill
went on a vacation to another area.
“Actually we’ve seen a few cases
of Lyme disease, which is very rare for us, but we’ve seen some of the
more localized cases especially up in the WillacyCounty area in Port
Mansfield just because of the high deer population,” he added.
For Chase North, the diagnosis of typhus proved a godsend, his mother said.
“His fever is almost gone, but
other than that, he is getting better every day,” Dana Rowe said. “I am
so thankful for Nina Torkelson, because nobody else could tell me, or
would tell me.”
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