Updated: 10/18/2018

[Blocked from Release] Typhus

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Snapshot
  • A marine deployed at Mt. Fuji presents to the emergency clinic with "the worst headache of his life," accompanied by fevers, chills, malaise, photophobia, and a macular/papular rash spread across his trunk, face, and upper extremities.
Introduction
  • Typhus is a bacterial disease that is caused by Rickettsia prowazekii and Rickettsia typhi
  • Spread via human lice and flea vectors from person-to-person
  • Form of typhus depends on which bacteria caused the infection
    • Rickettsia typhi
      • causes murine or endemic typhus
        • endemic typhus
          • uncommon in the United States
          • occurs in regions with poor hygeine and cold temperatures
          • known as "jail fever"
        • murine typhus
          • occurs in the southeastern and southern United States
          • associated with exposure to rat fleas or feces and other wild animals
          • often spread during the summer or fall seasons
          • rarely fatal
    • Rickettsia prowazekii
      • causes epidemic typhus and Brill-Zinsser disease
        • Brill-Zinsser disease
          • milder form of endemic typhus
          • spread by lice and fleas on flying squirrels
          • caused by reactivation of previous infection
          • more common in the elderly
Presentation
  • Symptoms
    • epidemic typhus
      • patients present 1-3 weeks after the bite with symptoms including sudden-onset
        • fever (104 F)
        • chills
        • severe headache
        • maculopapular rash
          • appears 5-9 days after onset of symptoms
          • spreads peripherally from trunk to extremities
        • cough
        • arthalgia
        • myalgia
        • photophobia
        • delirium
    • murine or endemic typhus
      • abdominal pain
      • diarrhea
      • backache
      • headache
      • extremely high fever (105-106 F)
        • may last for up to two weeks
      • dull, red rash
        • begins on the trunk and spreads peripherally
      • hacking, dry cough
      • arthralgia
      • myalgia
      • nausea
      • vomiting
  • Physical exam
    • hypotension
    • fever
    • photophobia
    • early rash
      • light rose color and blanches under pressure
    • late rash
      • dull red that does not fade
    • scattered petechiae
      • may be observed in patients with severe disease
Evaluation
  • Labs
    • CBC
      • may show anemia and thrombocytopenia
    • typhus antibody
      • present in individuals with active or previous infection
    • hypoalbuminemia
    • hyponatremia
    • elevated liver enzymes
    • may demonstrate mild kidney failure
Differential
  •  Rocky mountain spotted fever, Lyme disease
Treatment
  • Medical management
    • antibiotic therapy
      • indicated in all types of typhus disease
        • doxycycline
        • tetracycline
          • may permanently stain developing teeth
          • usually not prescribed in children
        • chloramphenicol (less common)
    • intravenous fluids and supplemental oxygen
      • may be indicated in patients with epidemic typhus
Prognosis, Prevention, and Comlications
  • Prognosis
    • epidemic typhus can be fatal is left untreated in 10-60% of patients
      • caused by peripheral vascular collapse
      • elderly patients are at greater risk
    • murine typhus is fatal in less than 2% of patients if left untreated
    • if diagnosed and treated early, vast majority of all cases fully recover
  • Prevention
    • avoid fleas and lice
    • quarantine patients who might have lice/fleas and can spread infection
  • Complications
    • renal insufficiency, pneumonia, and central nervous system damage
 

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