Typhus is a serious infectious disease caused by rickettsiae. It seems to many that this disease has remained in the distant past and does not occur in developed countries. In Russia, this infection has not been registered since 1998, however, Brill's disease is periodically noted, and this is one of the forms of typhus. The carrier of rickettsiae are human wearable parasites. Sanitary doctors report that pediculosis has become more and more common in recent years. This can cause a disease outbreak. In addition, an imported infection cannot be ruled out. You can become infected while traveling and traveling to other countries where this disease is common. Therefore, everyone needs to know about the symptoms, treatment and prevention of typhus.
Cause of disease
The disease occurs due to the ingestion of rickettsiae. A person is very susceptible to the microorganism that causes typhus. In microbiology, rickettsia are considered to be intermediate between bacteria and viruses. An infectious agent can penetrate the walls of blood vessels and stay there for a long time. Sometimesthe microorganism lives inside a person for years, and the manifestations of the disease occur only when the immune system is weakened. Rickettsia are classified as bacteria, but their ability to invade cells is more characteristic of viruses.
The causative agent of typhus 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 exposure to disinfectants. However, the microorganism tolerates cold and drying well.
Transmission routes
This disease is transmissible, that is, through the blood. A sick person becomes the source of infection, and body lice are carriers of typhus. That is why the infection of the population with pediculosis can provoke the spread of pathology. In more rare cases, infection occurs during a blood transfusion of a sick person.
A 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 are then excreted in the faeces. Usually, pediculosis in humans is always accompanied by severe itching. The patient becomes infected when he introduces lice feces into scratches and lesions on the skin.
Epidemiologists suggest another route of transmission. A person can inhale particles of parasite feces. In this case, the causative agent of typhus penetrates intobody through the mucous membrane of the respiratory tract. Rickettsia then begin disease-causing activity in the body.
Can head lice be vectors? Doctors believe that these insects can also transmit the disease, but much less frequently than body parasites. Pubic lice cannot tolerate rickettsia.
The spread of pediculosis can provoke infection with typhus. In the past, outbreaks of this disease often occurred in adverse conditions, during wars or famines, when the level of hygiene and sanitation fell sharply.
The disease leaves behind immunity, but not absolute. Re-infections have been reported in rare cases. In medical practice, even three rickettsia infections have been recorded.
Disease types
There are epidemic and endemic forms of the disease. These pathologies have similar symptoms, but different pathogens and vectors.
Endemic typhus is more common in the Americas, as well as in countries with a hot climate. Its causative agent is Rickettsia Montseri. Outbreaks of the disease are observed in the summer, mainly in rural areas. Carriers of infection are rat fleas. Therefore, rodent control plays a major role in disease prevention.
Epidemic typhus occurs only in Europe. The incidence is more common in winter and spring. The carrier is only body lice and head lice. Other human or animal parasites cannot spread the disease. The causative agent of epidemic typhusTifa is Rickettsia Provachek.
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. The danger for central Russia is epidemic typhus.
Pathogenesis
Rickettsiae affect the adrenal glands and blood vessels. In the body, a lack of the hormone adrenaline is formed, which leads to a drop in blood pressure. Destructive changes occur in the vascular walls, which causes a rash.
There is also damage to the heart muscle. This is due to the intoxication of the body. Myocardial nutrition is disturbed, this leads to degenerative changes in the heart.
Typhus nodules (granulomas) are formed in almost all organs. They especially 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 6 to 25 days. At this time, the person does not feel the symptoms of pathology. Only at the end of the latent period, a slight malaise may be felt.
Then a person's temperature rises sharply to +39 and even +40 degrees. The first signs of the disease appear:
- aches in the body and limbs;
- pain and feeling of heaviness in the head;
- feeling tired;
- insomnia;
- red eyes due to hemorrhage in the conjunctiva.
About the 5th day of illnesstemperature may drop slightly. However, the patient's condition does not improve. Growing signs of intoxication of the body. In the future, the high temperature returns again. Symptoms include:
- redness and swelling of the face;
- nausea;
- plaque on the tongue;
- palpitations;
- drop in blood pressure;
- dizziness;
- impaired consciousness.
At a medical examination, already on the 5th day of the disease, an increase in the liver and spleen is noted. If you pinch the patient's skin, then a hemorrhage remains. The initial period of the disease lasts about 4-5 days.
Period of peak of illness
A rash appears on the 5-6th day. Skin manifestations of typhoid fever are associated with vascular damage by rickettsiae. There are two types of rashes in this disease - roseola and petechiae. Different types of rash can occur on one area of \u200b\u200bthe skin. Roseolas are small spots (up to 1 cm) of pink color. The appearance of such rashes can be seen in the photo below.
Petechiae are pinpoint subcutaneous hemorrhages. They are formed due to an increase in the 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 what the rash looks like in the form of petechiae.
Plaque on the tongue at the height of the disease turns brown. This indicates a progressive lesion of the spleen and liver. Body temperature is constantly elevated. There are other symptoms of rashtifa:
- excruciating headache;
- difficulty urinating;
- confusion;
- difficulty swallowing food;
- involuntary fluctuations of the eyeballs;
- lower back pain associated with renal vascular disease;
- constipation;
- bloating;
- rhinitis;
- signs of inflammation of the bronchi and trachea;
- Unclear speech due to swollen tongue.
When the peripheral nerves are affected, pain of the type of sciatica can be observed. Liver enlargement is sometimes accompanied by yellowing of the skin. However, liver pigments remain within the normal range. A change in skin color is associated with a violation of the metabolism of carotene.
The disease lasts about 14 days. With proper treatment, the temperature gradually decreases, the rash disappears and the person recovers.
Severe form
When the disease is severe, a condition occurs, which in medicine is called "status typhoid". It is characterized by the following manifestations:
- delusions and hallucinations;
- excited;
- memory lapses;
- clouded consciousness.
In addition to neuropsychiatric disorders, severe typhus 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.
Brille's disease
Brill's disease occurs whenrickettsia remain inside the body after suffering typhus. Then, when the immune system is weakened in a person, a relapse of the infection occurs. Sometimes recurrent pathology appeared even 20 years after recovery.
In this case, the disease is much easier. There is a fever and rash. The disease lasts about a week, does not give complications and ends with recovery. This pathology is noted even today in people who had typhus many years ago.
Complications
During the peak of the disease, a serious complication is possible - infectious-toxic shock. It occurs as a result of poisoning the body with rickettsia poisons. At the same time, acute insufficiency of the heart, blood vessels and adrenal glands is noted. Before this complication, the patient often has a decrease in temperature. Periods from 4 to 5 and from 10 to 12 days from the onset of the disease are considered especially dangerous. It is at this time that the risk of developing this complication is increased.
Typhus can cause complications in the blood vessels and the brain. Thrombophlebitis or meningitis occurs. Often, another bacterial infection joins the rickettsiae. 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 stay in bed. This can cause bedsores, and in severe cases, gangrene can develop due to vascular damage.
How to identify the disease
Diagnosis of typhus begins with anamnesis. AtIn this case, the infectious disease specialist observes the following algorithm:
- If a patient has a high fever, insomnia, severe headache and feeling unwell for 3-5 days, the doctor may suspect typhoid.
- If there is no rash on the skin on the 5-6th day of illness, then the diagnosis is not confirmed. In the presence of roseola and petechiae, as well as an enlarged liver and spleen, the doctor makes a preliminary diagnosis of typhus, but laboratory tests are necessary to clarify.
- If a person who has had typhus in the past develops a rash in the form of roseola and petechiae after a high fever and malaise, 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. In the disease, an increase in ESR and protein and a decrease in platelets are determined.
Serological blood tests help to accurately identify the causative agent of the disease. Many doctors start their diagnosis with these tests:
- An enzyme-linked immunosorbent assay is prescribed for G and M antigens. In typhoid, immunoglobulin G is usually determined, and in Brill's disease - M.
- Blood is examined by the method of indirect hemagglutination reaction. This allows you to detect antibodies to rickettsia in the body.
- Antibodies can also be detected by the component binding reaction method. However, in this way, the disease is diagnosed only during the peak period.
Treatment methods
When a diagnosis such as typhus is confirmed, the patient is admitted to a hospital. Before a steady decrease in temperature, a person is prescribed bed rest for about 8-10 days. Medical staff need to prevent bedsores in patients, as well as constantly monitor blood pressure.
No special diet required. Food should be sparing, but at the same time sufficiently high in calories and rich in vitamins.
Medical treatment of typhus should be aimed at solving the following problems:
- fight against the pathogen;
- removal of intoxication and elimination of neurological and cardiovascular disorders;
- eliminate the symptoms of pathology.
Tetracycline antibiotics are most effective against rickettsiae. The following drugs are prescribed:
- "Doxycycline";
- "Tetracycline";
- "Metacycline";
- "Morphocycline".
Usually, a person feels better already on the 2-3rd day of antibacterial treatment. However, the course of antibiotics must be continued until the body temperature returns to normal. Doctors sometimes prescribe antibiotics until you are fully recovered.
In addition to tetracyclines, antibiotics of other groups are also prescribed: Levomycetin, Erythromycin, Rifampicin. They help prevent secondary bacterial infection.
To remove the intoxication of the body put droppers with saline solutions. To eliminate the symptoms of the heart and adrenal glands, prescribe "Caffeine", "Adrenaline","Norepinephrine", "Cordiamin", "Sulfocamphocaine". Antihistamines are also used: Diazolin, Suprastin, Tavegil.
If you have a high fever, your doctor may recommend antipyretics. However, you should not get too carried away with them, as these drugs can provoke cardiovascular complications.
An important role in therapy is played by anticoagulants: "Heparin", "Fenindione", "Pelentan". They prevent the formation of thrombotic complications. Thanks to the use of these drugs, the death rate from typhus has been significantly reduced.
If the patient has clouding of consciousness, insomnia, delirium and hallucinations, then neuroleptics and tranquilizers are indicated: Seduxen, Haloperidol, Phenobarbital.
In severe forms of the disease, Prednisolone is prescribed. To strengthen blood vessels in typhoid, therapy is carried out with the drug "Ascorutin" with vitamins C and P.
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. Then the patient is under dispensary observation 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 inthis disease to zero. However, if this disease is left untreated, then death occurs in 15% of cases.
Other types of typhus
Besides typhus, there is also typhoid and relapsing fever. However, these are completely different diseases that are not caused by rickettsiae. The word "typhoid" in medicine refers to infectious pathologies, accompanied by fever and clouding of consciousness.
Typhoid fever is caused by salmonella, a disease not carried by lice. Pathology proceeds with signs of damage to the gastrointestinal tract.
Relapsing fever is caused by spirochetes. The bacteria are spread by mites 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.
Vaccination against typhoid
The typhoid vaccine was developed in 1942 by microbiologist Alexei Vasilyevich 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 vaccination is done according to epidemiological indications, if there is a risk of infection. Vaccination is carried out for employees of infectious diseases departments of medical institutions, hairdressers, baths, laundries, disinfectors.
Vaccination does not completely protect against infection, as the disease does not always leave absolute immunity. However, if the vaccinated person receivesinfection, the disease will proceed in a milder form. Vaccination plays an important role in the prevention of typhus. First of all, it is important to observe measures aimed at combating human parasites.
How to prevent infection and spread of infection
To prevent the disease, it is necessary to fight head lice. Doctors notify the sanitary-epidemiological station about each case of typhus. In the focus of infection, bedding, linen and clothing are processed and disinsection. If, after taking measures to prevent typhus, parasites still remain on the patient’s personal belongings, then the treatment is repeated until they are completely eliminated.
It is necessary to establish medical surveillance for all people who have been in contact with the patient. The maximum duration of the 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 any 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 measures to prevent typhus. Long-term persistence of high temperature is one of the signs of this disease. It must be remembered that mild forms of the disease can occur with minor rashes, and it is not always possible to identify pathology by skin manifestations. Doctors have proven that in rare cases there is an asymptomatic carriage of rickettsiae. Therefore, testing is one of the ways to detect infection early andprevent the spread of the disease.
