Typhus is a serious infectious disease caused by rickettsia. It seems to many that this ailment has remained in the distant past and does not occur in developed countries. In Russia, this infection has not been recorded since 1998, however, Brill’s disease is periodically noted, and this is one form of typhoid. Rickettsia is a carrier of human parasites. Sanitary doctors report that lately more and more pediculosis occurs. This can cause an outbreak. In addition, imported infection cannot be ruled out. You can become infected while traveling and traveling to other countries where the disease is common. Therefore, everyone needs to know about the symptoms, treatment and prevention of typhus.
Cause of illness
The disease occurs due to the ingestion of rickettsia. A person is very susceptible to the microorganism that causes typhus. In microbiology, rickettsia is believed to occupy an intermediate position between bacteria and viruses. An infectious agent can penetrate the walls of blood vessels and stay there for a long time. Sometimes a microorganism lives inside a person for years, and the manifestations of the disease occur only when the immune system is weakened. Rickettsias are bacteria, but their ability to invade cells is more common with viruses.
The causative agent of typhoid fever dies at a temperature of more than +55 degrees after about 10 minutes. A temperature of +100 degrees destroys rickettsia almost instantly. Also, this bacterium does not tolerate the effects of disinfectants. However, the microorganism tolerates cold and drying well.
Transmission ways
This disease is transmitted by a vector-borne route, that is, through the blood. A sick person becomes a source of infection , and lice are carriers of typhus. That is why infection of the population with pediculosis can provoke the spread of pathology. In more rare cases, infection occurs with a blood transfusion of a sick person.
Louse gets an infection about 5-6 days after being on the body of a sick person and remains contagious for about a month. Then the insect dies. The disease is not transmitted by lice bites. The saliva of parasites does not contain rickettsia. Bacteria accumulate in the intestines of these insects and then come out with feces. Usually pediculosis in a person is always accompanied by severe itching. The patient becomes infected when he puts stool of lice into scratches and damage to the skin.
Epidemiologists suggest another route of transmission. A person can inhale particles of stool of parasites. In this case, the causative agent of typhus enters the body through the mucous membrane of the respiratory tract. Then rickettsia begin pathogenic activity in the body.
Can head lice be carriers? Doctors believe that these insects can also transmit the disease, but much less frequently than body parasites. Pubic lice are not able to tolerate rickettsia.
The spread of head lice can cause typhus. In the past, outbreaks of this disease often occurred in adverse conditions, during wars or starvation, when the level of hygiene and sanitation fell sharply.
The disease leaves behind immunity, but not absolute. Repeated cases of infection in rare cases have been noted. In medical practice, even triple infections with rickettsia were recorded.
Types of disease
There are epidemic and endemic forms of the disease. These pathologies have similar symptoms, but different pathogens and carriers.
Endemic typhus is more common in the Americas, as well as in countries with hot climates. Its causative agent is Rickettsia Monseri. Outbreaks of the disease occur in the summer, mainly in rural areas. The carriers of the infection are rat fleas. Therefore, the main role in the prevention of the disease is played by the fight against rodents.
Epidemic typhus is found only in European countries. The incidence is more often observed in winter and spring. The carrier are only body lice and head lice. Other parasites of humans or animals cannot spread this disease. The causative agent of epidemic typhus is rickettsia Provacheka.
An endemic form of the disease can occur in our country only in case of imported infection. This pathology is not typical for areas with a cool climate. Danger for central Russia is the epidemic typhus.
Pathogenesis
Rickettsia affects the adrenal glands and blood vessels. In the body, a lack of adrenaline hormone is formed, which leads to a drop in blood pressure. In the vascular walls, destructive changes occur, which causes the appearance of a rash.
Damage to the heart muscle is also noted. This is due to intoxication of the body. Myocardial nutrition is disturbed, this leads to degenerative changes in the heart.
In almost all organs, typhoid nodules (granulomas) are formed. Especially they affect the brain, which leads to severe headache and increased intracranial pressure. After recovery, these nodules disappear.
Incubation period and initial symptoms
The incubation period of the disease is from 6 to 25 days. At this time, the person does not feel the symptoms of pathology. Only at the end of the latent period can a slight malaise be felt.
Then a person’s temperature rises sharply to +39 and even +40 degrees. The first signs of the disease occur:
- body aches and limbs;
- pain and a feeling of heaviness in the head;
- feeling of tiredness;
- insomnia;
- redness of the eyes due to conjunctival hemorrhage.
At about the 5th day of illness, the temperature may decrease slightly. However, the patient's condition does not improve. Signs of intoxication are growing. Subsequently, the heat returns again. The following symptoms are noted:
- redness and swelling of the face;
- nausea;
- tongue coating;
- cardiopalmus;
- drop in blood pressure;
- dizziness;
- impaired consciousness.
Upon medical examination already on the 5th day of the disease, an increase in the liver and spleen is noted. If the patient is pinched by the skin, hemorrhage remains. The initial period of the disease lasts about 4-5 days.
The height of the disease
A rash occurs on day 5-6. Skin manifestations of typhoid are associated with vascular rickettsia. There are two types of rashes with this disease - roseola and petechiae. In one area of the skin, different types of rash can occur . Roseola are small spots (up to 1 cm) of pink color. The type of rashes can be seen in the photo below.
Petechiae are punctate subcutaneous hemorrhages. They are formed due to increased permeability of the walls of blood vessels. The rash covers the trunk and limbs. The palms, soles of the feet and face remain clean. Itching is not observed. In the photo you can see how rashes look like petechiae.
Plaque on the tongue at the height of the disease becomes brown. This indicates a progressive lesion of the spleen and liver. Body temperature is constantly elevated. Other symptoms of typhus are also noted:
- excruciating headache;
- difficulty urinating;
- confusion of consciousness;
- difficulty swallowing food;
- involuntary fluctuations of the eyeballs;
- lower back pain associated with damage to the vessels of the kidneys;
- constipation
- bloating;
- rhinitis;
- signs of inflammation of the bronchi and trachea;
- blurred speech due to swelling of the tongue.
With damage to the peripheral nerves, pains such as radiculitis can be observed. Enlarged liver is sometimes accompanied by yellowing of the skin. However, liver pigments remain within normal limits. A change in skin color is associated with impaired carotene metabolism.
The disease lasts about 14 days. With proper treatment, the temperature gradually decreases, the rash disappears and the person recovers.
Heavy form
In a severe form of the disease, a condition arises that is called “typhoid status” in medicine. It is characterized by the following manifestations:
- delirium and hallucinations;
- excitement;
- memory lapses;
- blurred consciousness.
In addition to neuropsychiatric disorders, typhus in severe form is accompanied by severe weakness, insomnia (up to complete loss of sleep) and skin manifestations.
Symptoms of the disease last about 2 weeks. The rash is noted in the third week. Then, with proper treatment, all manifestations of the disease gradually disappear.
Brill's disease
Brill’s disease occurs when rickettsia remains inside the body after typhus. Then, with a weakening of immunity in a person, a relapse of the infection occurs. Sometimes a repeated pathology appeared even 20 years after recovery.
In this case, the disease is much easier. There is a fever and a rash. The disease lasts about a week, does not give complications and ends in recovery. This pathology is observed today in people who have had typhoid many years ago.
Complications
During the height of the disease, a serious complication is possible - an infectious-toxic shock. It occurs as a result of poisoning the body with rickettsia poisons. In this case, acute insufficiency of the heart, blood vessels and adrenal glands is noted. Before this complication, the patient often has a fever. Especially dangerous are periods from 4 to 5 and from 10 to 12 days from the onset of the disease. It was at this time that the risk of developing this complication was increased.
Typhus can cause vascular and cerebral complications. Thrombophlebitis or meningitis occurs. Often another bacterial infection joins rickettsia. The patient has signs of pneumonia, otitis media, furunculosis, as well as inflammatory diseases of the genitourinary organs. These pathologies are often accompanied by suppuration, which can lead to blood poisoning.
The patient has to comply with bed rest. This can cause pressure sores, and in severe cases, gangrene can develop due to vascular damage.
How to identify a disease
Diagnosis of typhus begins with a medical history. In this case, the infectious disease doctor observes the following algorithm:
- If the patient has high fever, insomnia, severe headache and poor health for 3-5 days, then the doctor may suggest typhoid.
- If there is no rash on the skin on days 5-6, the diagnosis is not confirmed. In the presence of roseola and petechiae, as well as an increase in the liver and spleen, the doctor makes a preliminary diagnosis of typhoid, but laboratory tests are needed to clarify.
- If a person who has had typhoid in the past, after a high fever and malaise appears a rash in the form of roseola and petechiae, then he is given a preliminary diagnosis - Brill’s disease, which must be confirmed by laboratory diagnostics.
A general and biochemical blood test is taken from the patient. With the disease, an increase in ESR and protein and a decrease in platelets are determined.
Serological blood tests help accurately identify the causative agent of the disease. Many doctors begin the diagnosis with these tests:
- An enzyme-linked immunosorbent assay for antigens G and M is prescribed. In typhoid, immunoglobulin G is usually determined, and in Brill's disease, M.
- Blood is examined by the indirect hemagglutination reaction method. This allows you to identify antibodies to rickettsia in the body.
- Antibodies can also be detected by the reaction method of the component ligament. However, in this way, the disease is diagnosed only during the peak period.
Treatment methods
When confirming a diagnosis such as typhoid, the patient is placed in a hospital. Before a persistent decrease in temperature, a person is prescribed bed rest for about 8-10 days. Medical staff need to prevent pressure sores in patients, as well as constantly monitor blood pressure.
A special diet is not required. Food should be gentle, but at the same time enough high-calorie and rich in vitamins.
Drug treatment of typhus should be aimed at solving the following problems:
- the fight against the causative agent of the disease;
- removal of intoxication and the elimination of neurological and cardiovascular disorders;
- elimination of symptoms of pathology.
Tetracycline antibiotics act most effectively on rickettsia. The following drugs are prescribed:
- "Doxycycline";
- "Tetracycline";
- "Metacycline";
- "Morphocycline."
Usually, it becomes easier for a person by 2-3 days of antibacterial treatment. However, the course of antibiotics must be continued until normalization of body temperature. Sometimes doctors prescribe antibacterial drugs until they recover completely.
In addition to tetracyclines, antibiotics of other groups are also prescribed: Levomycetin, Erythromycin, Rifampicin. They help prevent the attachment of a secondary bacterial infection.
To remove the intoxication of the body, droppers are placed with saline solutions. To eliminate the symptoms of the heart and adrenal glands, appoint "Caffeine", "Adrenaline", "Norepinephrine", "Cordiamine", "Sulfocamphocaine". Antihistamines are also used: Diazolin, Suprastin, Tavegil.
At high temperatures, your doctor may recommend antipyretics. However, they should not get carried away too much, as these drugs can provoke cardiovascular complications.
An important role in therapy is played by anticoagulants: Heparin, Fenindion, Pelentan. They prevent the formation of thrombotic complications. Due to the use of these drugs, typhoid mortality has significantly decreased.
If the patient has clouding of consciousness, insomnia, delirium and hallucinations, then antipsychotics and tranquilizers are indicated: Seduxen, Haloperidol, Phenobarbital.
In severe forms of the disease, Prednisolone is prescribed. In order to strengthen vessels in case of typhoid fever, therapy is carried out with Ascorutin with vitamins C and R.
The patient is discharged from the hospital no earlier than 12-14 days of illness. After that, the sick leave is extended for at least 14-15 days. Further, the patient is under clinical supervision for 3-6 months. He is recommended to undergo examinations by a cardiologist and a neurologist.
Forecast
In the old days, this disease was considered one of the most dangerous infections. Typhus often ended in the death of the patient. Nowadays, when antibiotics are used, even severe forms of this pathology are cured. And the use of anticoagulants reduced mortality in this disease to zero. However, if this disease is left untreated, then a fatal outcome occurs in 15% of cases.
Other types of typhoid
In addition to the rash, there is also typhoid and relapsing fever. However, these are completely different diseases that are not caused by rickettsia. In medicine, the word "typhoid" refers to infectious pathologies, accompanied by fever and blurred consciousness.
The causative agent of typhoid fever is Salmonella, this disease is not tolerated by lice. Pathology proceeds with signs of damage to the gastrointestinal tract.
Typhoid fever is caused by spirochetes. Bacteria are spread by ticks and lice. This disease is also characterized by fever and rashes. Pathology must be differentiated from the rash form. Relapsing fever always has a paroxysmal course.
Typhoid Vaccination
The typhoid vaccine was developed in 1942 by the microbiologist Alexei Vasilievich Pshenichnov. In those years, this was an important achievement in the prevention of epidemic typhus. Vaccinations helped prevent an outbreak during World War II.
Is such a vaccine used today? It is used infrequently. This vaccine is given for epidemiological reasons if there is a risk of infection. Vaccination is carried out to employees of infectious diseases departments of medical institutions, hairdressing salons, bath houses, laundries, and disinfectants.
Vaccination does not protect completely from infection, since the disease does not always leave absolute immunity. However, if the vaccinated person gets an infection, the disease will proceed in a milder form. Vaccination is not the main place in the prevention of typhus. First of all, it is important to comply with measures aimed at combating human parasites.
How to prevent infection and the spread of infection
To prevent the disease, it is necessary to fight pediculosis. Doctors notify the sanitary-epidemiological station about each case of typhoid. In the focus of infection, treatment and disinsection of bedding, linen and clothes is carried out. If parasites still remain on the patient’s personal belongings after typhoid fever prevention measures, the treatment is repeated until they are completely eliminated.
It is necessary to establish medical supervision of all people in contact with the patient. The maximum incubation period of the disease is up to 25 days. During this period, it is necessary to regularly measure the temperature and inform the doctor about all the deviations in well-being.
Currently, all patients with prolonged fever (more than 5 days) are prescribed serological blood tests for rickettsia. This is one of the preventative measures for typhus. . , , . , . .