DISPATCHES

Murine typhus case was initially identified in Reunion, France, in 2012 in a tourist. Our investigation confirmed 8 autochthonous cases that occurred during January 2011– January 2013 in Reunion. Murine typhus should be consid-ered in local patients and in travelers returning from Re-union who have fevers of unknown origin. Murine typhus, an acute zoonotic infection caused by Rickettsia typhi (1), occurs worldwide. It is under-diagnosed and largely underreported because of its non-specific characteristics and frequently mild course, a lack of active monitoring; and limited awareness among physi-cians (2). Symptoms include fever, headache, and inconsis-tent and transient rashes (1,3). Serious complications have been associated with acute infections (4). The death rate is generally low but can reach 4 % without the use of anti-bacterial drugs (1,4). The classic cycle involves rats (black rat [Rattus rattus] and brown rat [R. norvegicus]) in urban areas and the rat flea Xenopsylla cheopis (3). However, mu-rine typhus is also documented in suburban areas, where opossums, cats, dogs, and their fleas coexist (3). Reunion is a French overseas territory of 2,512 km2 in the southwestern Indian Ocean, 700 km east of Madagas-car, and has a tropical climate. Most of its 850,000 resi-dents live in coastal areas where major towns are located. Invasive rodents (rats, including the black rat, mice, and shrews) and endemic rodents (i.e., the tailless tenrec [Ten-rec ecaudatus]) are present both in rural and urban settings (5). X. cheopis and X. brasiliensis fleas are present mainly on rats, but their presence and their abundance vary accord-ing to the local climates of the island and to the seasons (6). Stray dogs and feral cats are numerous in the island and often are infested with fleas. In addition, domestic dogs and cats traditionally are allowed to run freely in both urban and rural areas. In early 2012, murine typhus was reported in a tourist returning from Reunion (7). We conducted a study to col-lect epidemiologic data and to describe clinical manifesta-tions for all murine typhus cases diagnosed in the infectious disease departments of hospitals in Reunion