TYPHUS

Typhus is an acute tick-borne disease that afflicts humans and other animals, it is caused by Rickettsial Bacterial Infections that are transmitted by body lice, ticks, mites and fleas (tick bites). Typhus from the Greek typhos (τύφος, التيفوئيد) meaning hazy or smoky delirium describing the state of mind of patients affected with typhus.

Pathogen – Rickettsia prowazekii.

Epidemiology

Source of infection – external parasites.

Mechanism of transmission:

Typhus is transmitted through the bite of lice (Isopods, woodlice).

Clinical picture

Incubation period ranges from 6 to 22 days. Typhus is characterized with an acute onset, symptoms usually develop suddenly and progresses quickly.

Intoxication syndrome, In Typhus symptoms develop suddenly, and temperature may also rise to reach 39 – 40 °c and lasts for 7-14 days, often with distinctive “incisions” in the 4th, 8th, 12th days of the disease; persistent headache, weakness, anorexia, insomnia, anxiety, euphoria and excitement may also be noticed.

The skin is hot and dry to touch, hyperemic bright red lips, hyperemia and puffiness of the face.

The rash appears on the fourth or fifth day of illness, patchy-roseolous rash, localized to the breast, lateral surface of the trunk, flexor surfaces of the extremities.

Hemorrhagic syndrome:
Enanthem Rosenberg, micro hemorrhage in the mucosa of the soft palate and tongue, appearing occasionally on the second or third day of illness (2-5 days after symptoms start).

Symptom-Chiari Avtsyna, bleeding in the transitional fold of the lower eyelid – it appears occasionally on the third or fourth day of illness.

Endothelial symptoms, Rumpel-Leede-Konchalovsky sign (a distal shower of petechiae that occurs immediately after the release of pressure from a tourniquet or sphygmomanometer), “harness”, “pinch”.

The manifestations of meningoencephalitis: headache, dizziness, nausea, insomnia, tongue deviation, dysarthria, Govorov-Godelier symptom (jerky protruding tongue), flatness of nasolabial fold (Chronic Radiation Syndrome), possible mental disorders, delirium and meningeal symptoms.

Hepatosplenomegaly

Complications: toxic shock, an infectious-toxic encephalopathy, pneumonia, and vascular complications such as thrombosis, thromboembolism, thrombophlebitis, and heart attacks (strokes).

Differential diagnosis is carried out with flu, meningitis, hemorrhagic fever, typhoid and paratyphoid, psittacosis, trichinosis, endovasculitis.

Laboratory diagnosis

In the analysis of blood leukocytosis, eosinopenia, thrombocytopenia and moderately accelerated ESR.

Serological diagnosis – Complement fixation test (CFT) for the detection of antibodies specific for rickettsiae (Rickettsia prowazekii and Rickettsia typhi), a titer of 1:160 and above indicates positive results in this assay and confirms the diagnosis, An indirect hemagglutination test (IHA) in a dilution of 1: 1000, ELISA (enzyme-linked immunosorbent assay) for detecting Human anti-typhus antibody.

Treatment
Etiotropic therapy: The drug of choice is tetracycline at a dosage of 1.2 -1.6 g/day during the febrile period, and for two days of normal temperature.

Pathogenetic therapy: detoxifying, cardiovascular agents, anticoagulants.

Symptomatic treatment: sedatives, antipsychotics, antipyretics, analgesics.

Verified by: Dr.Diab (January 7, 2017)

Citation: Dr.Diab. (January 7, 2017). Typhus. Medcoi Journal of Medicine, 11(2). urn:medcoi:article15978.