Typhus making a comeback in Texas

Sara Strickland contracted typhus in 2009 when she was a graduate student at Rice University and living off-campus. A couple of possums had gotten into the crawl space of a house and more than likely had fleas, which can spread the disease. She became sick with fever, headache, chills, sweats, then a rash and dehydration. She had to be hospitalized before doctors diagnosed that it was typhus. She was treated with antibiotics and released in four days but says it took about a year for her to fully recover. She is living in Washington D.C. now. less Sara Strickland contracted typhus in 2009 when she was a graduate student at Rice University and living off-campus. A couple of possums had gotten into the crawl space of a house and more than likely had fleas, ... more Photo: Rod Lamkey Jr /For The Houston Chronicle Photo: Rod Lamkey Jr /For The Houston Chronicle Image 1 of / 21 Caption Close Typhus making a comeback in Texas 1 / 21 Back to Gallery

Typhus, a bacterial disease all but eradicated in most of the United States, is making a comeback in Texas.

Between 2003 and 2013, the disease increased tenfold in the state and spread from nine counties to 41, according to Baylor College of Medicine researchers.

Bexar County, which reported only four cases in 2013, had 66 last year, nearly double the previous year. Also in 2016, Bexar County had the second-highest number of infections next to Hidalgo County — which had 85 cases — and outranked other large counties, such as Harris and Dallas.

Researchers are not exactly sure why the numbers are increasing.

The symptoms are typically fever, headache and rash, but also achy muscles, nausea and vomiting. Of 1,763 people in the state who contracted typhus from 2003-10, the infection was severe enough that 60 percent had to be hospitalized. Four died, including one in Houston. In 2016, no patients in Bexar County died of the disease, according to Metropolitan Health District officials said.

“We can now add typhus to the growing list of tropical infections striking Texas,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor and Texas Children’s Hospital. “Chagas, dengue fever, Zika, chikungunya and now typhus — tropical diseases have become the new normal in south and southeast Texas.”

Typhus was common in the United States through the 1940s — more than 5,400 people contracted the disease in 1944 — when rats that thrived among busy ports, such as Galveston, carried fleas infected with Rickettsia typhi.

An aggressive pesticide campaign largely eliminated the problem in most U.S. areas — fewer than 100 cases were reported nationwide by the mid-1950s — though it never went away in the Rio Grande Valley.

“It’s an uncommon disease that’s most common near the border area, but it certainly occurs in South Texas and it seems to becoming more common in larger counties,” said Dr. George Crawford, professor of medicine and infectious disease at UT Health San Antonio. “I’ve certainly seen a number of cases from San Antonio and at least one from Hondo.”

Baylor University associate professor Dr. Kristy Murray, who recently published a study of typhus in the journal Emerging Infectious Diseases, said she believes the increase in cases is more than growing recognition of the disease or better surveillance.

The study showed 222 cases in Texas in 2013, mainly in Houston, Austin and San Antonio.

That was up from just 30 reported cases in 2003, all in the southern part of the state, in counties such as Hidalgo and Nueces where the disease has remained an issue over the decades. In 2016, the most recent state data available, the number of Texas cases had climbed to 364 from 324 the previous year

Unlike many tropical diseases, which predominate in poor areas, the new cases of typhus were just as likely to be reported in more affluent areas of cities.

The highest rate of attack was in children and young people ages 5 to 19.

“The positive is,” Murray said, “it can be treated successfully if it’s recognized.”

Rita Espinoza, chief epidemiologist for Metropolitan Health in San Antonio, said it’s possible that people had typhus before “but it went unrecognized and was never diagnosed. There are lots of reasons why the numbers can increase, and the reasons why are very hard to determine.”

The disease is easily confused with many viral ailments, Murray said, and doctors are not accustomed to looking for it, something she hopes the study remedies. Murray said she was surprised some of the people infected were able to survive, given the severity of their symptoms. Many spent time in the intensive care unit.

A flea bite itself is not sufficient to transmit the infection, which occurs when people scratch bacteria-laden flea feces left by the flea into the bite or other wounds. The fleas can be carried by rodents like rats or oppossum and then are transferred to household pets.

Espinoza said one problem in diagnosing typhus is that symptoms are common to other ailments.

“The only way to really know is to go to your physician and to get diagnosed.”

Both Espinoza and Crawford said the only way to prevent infection is to check and treat pets — especially cats and dogs — for fleas.

“People need to put typhus on their radar,” Murray said. “This is a big comeback, not a minor one.”

todd.ackerman@chron.com