typhus fever

Spotted fever: description

Spotted fever (also called lice spotting fever) is an infectious disease caused by the bacteria Rickettsia prowazekii is caused. The germs are transmitted by bloodsucking lice.

Spotted fever is very rare in Germany today. Most recently, typhus epidemics occurred in Europe during the World Wars. At that time, people sometimes had to live under bad, hygienic conditions, for example in refugee areas. Nevertheless, the disease still occurs today in some parts of the world, for example in East Africa and in the Andean valleys of South America.

The typhus fever is not to be confused with typhus. Popular terms such as “lice typhus” or “typhus” are misleading. Typhoid fever is an infectious disease caused by salmonella. Misunderstandings can also occur in the Anglo-Saxon language area. There the typhus fever is called “typhus” or “thypus fever”. Typhus is called in English “typhoid fever”.

Typhus fever: symptoms

The time between the infection and the onset of typhus (incubation period) is 10 to 14 days. Symptoms are sudden: flu-like symptoms, such as severe headache, muscle and limb pain and a pronounced feeling of sickness or lethargy.

But typical for typhus fever are high fever and skin rash, The fever is very characteristic: it rises rapidly to 41 ° C in the first two days of illness, often accompanied by chills. It then lasts for at least ten days before the start of defilement. This takes about four to five days.

On the fourth to seventh day of illness, the typhus patients get a skin rash (rash). This begins at the trunk and spreads quickly to the extremities. The face as well as the hands and feet are left out. The exanthema is characterized by spots (macules), which show a colorful picture: some spots are crimson, others purple or pink. In addition, it comes to skin bleeding (petechiae).

Other symptoms seen in typhus include:

• unrest
• Trembling of the hands (tremor)
• speech disorders
• Disturbances of consciousness
• violence

The typhus favors further infections by other bacteria, so-called secondary infections. These include:

• Meningitis (meningitis)
• Pneumonia
• Myocarditis (myocarditis)

Therefore, in addition to the typhus symptoms, signs of these diseases may occur.

Typhus fever: causes and risk factors

The cause of typhus infection is the bacterium Rickettsia prowazekii. Transmission to humans is only possible through infected lice or tropical ticks. The lice excrete the pathogens via the faeces. Then the person rubs the bacteria into the skin by scratching the lice bites. There they multiply in the cells of small blood vessels. They destroy the blood vessel cells and enter the bloodstream. This way, they can spread throughout the body and infect new blood vessel cells over and over again. The result is more and more damaged vessels that even die off (necrosis) and thus causes skin bleeding.

Rickettsia prowazekii is no longer found in Germany today. This is different, for example, in East Africa or the Andean valleys of South America. Risk factors include high numbers of people and poor hygienic conditions. Then body lice multiply quickly and can thus transfer the rickettsia from one person to another. A direct infection from person to person is not possible with typhus fever. Therefore, infected people only pose a danger to others if the disease transmitters, the lice, are present in the environment.

Typhus fever: examinations and diagnosis

In order to diagnose typhus, it is above all the symptoms that are crucial. If your doctor has the suspicion that it might be typhus fever, he asks you the following questions:

• Have you been to Africa or South America lately?
• Have you noticed lice on yourself or your clothes?
• Since when do you have the fever?
• Where did the rash begin and how did it develop?

To detect a typhus infection, there is a blood test. In the process, specific antibodies are sought which the body has formed against the Rickettsia. This test should be performed by experienced specialized laboratories. The detection of typhus fever is notifiable.

Previously, tissue samples were taken from the patient and examined directly for the pathogen. This is usually done nowadays, because the testing of the tissue samples is unreliable and associated with an increased risk of infection.

In addition, the doctor must exclude other diseases that cause typhoid-like symptoms. These include:

• Infections with meningococci
• Typhoid abdominalis
• Hemorrhagic fever diseases
• Relapsing fever

Typhus fever: treatment

Typhus fever is mainly treated with antibiotics, for example tetracyclines or chloramphenicol. When typhus antibiotic treatment should start as early as possible, then it shows good chances of recovery. Already one to two days after the start of therapy, the fever is reduced. It is also possible to use antibiotics such as quinolones or rifampicin. The drug chloroquine, which is actually used in malaria, can be given in addition to increase the effect of other antibiotics.

In addition, it is important to pay attention to a balanced fluid and electrolyte balance of the patients. Possible secondary infections (additional diseases caused by other pathogens) must also be treated with appropriate means.

Spotted fever: Prevention

The typhus can best be prevented by the clothes lice are fought as a disease transmitter. For example, insecticides have been proven here. In addition, one should pay attention to the hygiene of the journey to endangered areas and not wear used clothes unwashed.

Basically, there is a vaccine against typhus. However, this is only recommended in exceptional cases, for example in humanitarian missions in refugee areas or for employees of special laboratories. For persons who have direct contact with typhus patients, there is the possibility of drug prophylaxis. For this purpose, the antibiotic doxycycline is administered once. But it is also best to make sure that you keep the clothes lice and thus the typhus from the body.

Typhus fever: disease course and prognosis

The typhus is a serious infectious disease that can be fatal in up to 40 percent of cases if left untreated. However, if it is treated in time, the prognosis is good: normally typhus heals completely and without consequences after antibiotic treatment.

However, it can take a few months for those affected to recover completely. Especially by malnutrition or a limited function of the immune system, the time of healing significantly extended.

In some cases, the typhus pathogens remain in the body for up to 30 years. Normally, they do not trigger a new illness during this time because they are kept in check by the body’s own defense system. If, however, it comes to the onset of symptoms, this is called Brill-Zinser disease. It runs much shorter and milder than that Typhus.