Description, Causes and Risk Factors:
An endogenous reinfection associated with the “carrier state” in persons who previously had epidemic typhus fever. It is a rather mild disease and may be mistaken for endemic (murine) typhus; first described by Brill in New York City but not recognized as a recrudescent form of epidemic typhus until after the work of Zinsser.
Also known as Typhus.
Alternative Names: Recrudescent typhus fever, Brill disease, and recrudescent typhus, Murine typhus, Epidemic typhus, Endemic typhus, and Jail fever.
Brill-Zinsser Disease is caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii. The form of typus depends on which type of bacteria causes the infection.
Rickettsia typhi causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Lice and fleas of flying squirrels spread the bacteria.
Murine typhus occurs in the southeastern and southern United States, often during the summer and fall. It is rarely deadly.
Risk factors for murine typhus include:
Exposure to rat fleas or rat feces.
Exposure to other animals (such as cats, opossums, raccoons, skunks, and rats).
Rickettsia prowazekii causes epidemic typhus and Brill-Zinsser disease. Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the disease re-activates in a person who was previously infected. It is more common in the elderly.
Signs and symptoms:
Signs & Symptoms: Incubation period is about 1 week. Onset of illness is abrupt, with severe headache and fever. Fever rises rapidly to 38.8°-40.0°C (102°-104°F). Cough is prominent (70% of patients get). Myalgia (muscle pain) if present is severe. There is characteristic “crouching” posture. Rash can be seen on the upper trunk, on the fifth day, and then becomes generalized and involve the entire body except the face, palms, and soles. But more than half of the patients do not develop rash. Photophobia, dry, brown, and furred tongue, skin necrosis and gangrene of the digits, confusion and coma are other symptoms.
Possible complications include renal insufficiency, pneumonia, and central nervous system damage. Fatality is 7-40% in untreated cases.
Symptoms of murine typhus may include:
Dull red rash that begins on the middle of the body and spreads.
Extremely high fever (105 - 106 degrees Fahrenheit), which may last up to 2 weeks.
Hacking, dry cough.
Joint pain (arthralgia).
Nausea and vomiting.
Symptoms of endemic typhus may include:
High fever (104 degrees Fahrenheit).
Joint pain (arthralgia).
Lights that appear very bright; light may hurt the eyes.
Low blood pressure.
Rash that begins on the chest and spreads to the rest of the body (except the palms of the hands and soles of the feet).
Severe muscle pain (myalgia).
Diagnosis: Epidemic or louse borne typhus is sometimes misdiagnosed as typhoid fever in tropical countries. It can be diagnosed by the serologic or immunohistochemical diagnosis of a single case or by detection of R. prowazekii in a louse found on a patient.
A complete blood count (CBC) may show anemia and low platelets. Other blood tests for typhus may show:
Low level of albumin.
Low sodium level.
Mild kidney failure.
Mildly high liver enzymes.
High level of typhus antibodies.
Treatment: Doxycycline (200 mg/d, given in two divided doses) is the treatment of choice. If there is vomiting or patient is unconscious doxycycline can be given intravenously. Treatment is continued for 2-3 days after symptoms subside, though single 200 mg doxycycline is sufficient.
During pregnancy chloramphenicol early in pregnancy or, if necessary, doxycycline late in pregnancy is the treatment of choice.
Prevention: The best way to prevent is to maintain good personal hygiene. Clothes should be washed and changed regularly. Insecticides can be used every 6 weeks to control the louse population.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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