Ocular manifestations associated with murine typhus

Aims: To characterise and analyse ocular manifestations associated with acute murine typhus (MT), an infectious disease caused by Rickettsia typhi. Methods: Nine consecutive patients (18 eyes) with serologically confirmed MT at the acute stage were enrolled in this prospective, non-comparative study. All patients underwent complete ophthalmic examination, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography (FA) and indocyanine green (ICG) angiography. Results: Of nine patients, eight (88.9%) had bilateral ocular involvement related to MT, with (n=3) or without (n=5) associated ocular symptoms. Findings included mild vitreous inflammation (10 eyes; 55.6%), white retinal lesions (nine eyes; 50%), retinal haemorrhages (four eyes; 22.2%), retinal vascular leakage (seven eyes; 38.9%), hypofluorescent choroidal dots on FA and/or ICG angiography (11 eyes; 61.1%), optic-disc swelling (two eyes; 11.1%), optic neuritis (one eye; 5.6%) and opticdisc staining (11 eyes; 61.1%). All ocular findings had a self-limited course. Conclusion: Ocular involvement is frequently observed in acute MT. A systematic fundus examination, complemented by angiography in selected cases, may be helpful in establishing an early clinical diagnosis of the disease while serological testing is pending.