Typhus - types and classification, causes, symptoms, treatment. Typhus

Typhus is an infectious pathology of an anthroponotic nature, manifested by a pronounced intoxication symptom complex, as well as systemic damage to the entire human body, the pathomorphological basis of which is generalized panthrombovasculitis. Extremely Negative influence the disease “typhus” affects the activity of the heart vascular system and structures of the central nervous system, which is a life-threatening condition that requires immediate therapeutic correction.

The primary source in which the “typhus disease” was first mentioned is scientific works Girolamo Fracastoro, dating back to 1546, when this infectious pathology caused a large-scale epidemic in Europe. As a separate nosological unit, the disease “typhus” was identified only two hundred years after the first mention of the clinical picture of this epidemically dangerous infectious disease.

Epidemics of typhus have always caused mass mortality among the population, especially during war periods. A great contribution to the study of the etiological nature of the development of typhus was made by O.O. Mochutkovsky, who in 1876 carried out self-infection with the blood of a patient, thereby proving the infectious genesis of typhus.

The carriers of typhus in the form of lice were identified in 1913 and the causative agent of typhus was named Rickettsia prowazekii in honor of the famous scientist.

Infectious disease specialists usually distinguish between epidemic and endemic typhus, and this classification is based on the etiopathogenetic features of the development of this pathology. Epidemic typhus is often called rat and flea typhus, and its main causative agent is the rickettsia R. mooseri. Maximum annual incidence of epidemic typhus celebrated in America.

Endemic typhus is more often recorded in regions with warm climates and develops in humans from the bite of infected rat fleas. The clinical picture of typhus is characterized by cyclicity.

The causative agent of typhus

Typhus is caused by specific pathogens in the form of small gram-negative bacteria Rickettsia prowazeki, which are not motile and are unable to form spores and capsules. A feature of rickettsia is the polymorphism of their morphology. Thus, typhus is caused by rickettsiae in the form of cocci or rods, however, regardless of shape and size, all pathogens of typhus are pathogenic to humans.

To identify the causative agent of typhus in the laboratory, Romanovsky-Giemsa staining or Morozov silvering are used. To cultivate the causative agent of typhus, complex nutrient media, chicken embryos, and lungs of white mice should be used. Reproduction of rickettsia occurs only in the thickness of the cytoplasm of infected cells.

Typhus is transmitted by rickettsia, which in their antigenic composition contain somatic thermostable and type-specific thermolabile antigens, as well as hemolysin and endotoxin. Carriers of typhus in the form of infected lice, long time contain and excrete rickettsiae with feces, the vital activity and pathogenicity of which can persist for more than three months. Conditions that are detrimental to rickettsiae are exposure to elevated temperatures more than 56°C, treatment of contaminated surfaces with chloramine, formaldehyde, Lysol, acids, alkalis in normal concentrations. The source of typhus belongs to the second group of pathogenicity.

The source of typhus and the reservoir of pathogens is represented by patients suffering from this infectious pathology V active period, the duration of which lasts up to 21 days. Typhus is transmitted from a source to a healthy person in last days incubation period, the entire period of the clinical picture, as well as seven days after normalization of body temperature.

Epidemic typhus is characterized by a transmissible mechanism of transmission of the pathogen, the role of which is transmitted by infected body lice and head lice. Infection with a typhus carrier occurs when a patient suffering from typhus sucks blood, and the infectivity of such a louse remains for at least five days. During this period, active reproduction of rickettsia and their accumulation occur in the intestinal mucosa of the louse. Infection of a healthy person occurs by rubbing feces of an infected louse into the skin at the site of the bite, as well as by inhaling feces containing rickettsia into the respiratory tract.

Among people there is a high susceptibility to the development of this pathology, therefore typhus epidemics, as a rule, are large-scale. When monitoring patients with a history of typhus, it should be taken into account that, despite the intense post-infectious immunity, this category of people may develop a relapse in the form of Brill-Zinsser disease.

Endemic typhus, unlike other rickettsial diseases, is not accompanied by the development of true endemic foci. Favorable conditions The rapid spread of typhus is caused by unsatisfactory sanitary and hygienic living conditions for people. If we consider the category of increased risk for the development of typhus, then it should include persons without a fixed place of residence, service workers in contact with big amount of people. Infectious disease specialists note a certain tendency towards the seasonal course of typhus, since the maximum incidence rate occurs in early spring. Typhus is also characterized by nosocomial spread, provided that preventive anti-pediculosis measures are not observed in medical institutions.

Symptoms and signs of typhus

The average incubation period for typhus is two weeks, however, in some situations it may be shorter. incubation period. The clinical picture of typhus develops in stages, and in each clinical period there is a prevalence of certain symptoms.

Elementary clinical period Typhus lasts about five days and ends with the appearance of exanthema. It is extremely difficult to establish a reliable diagnosis at this stage of the clinical picture of typhus, however, early diagnosis significantly improves prognosis for recovery.

With typhus there is a fulminant acute onset clinical manifestations, although some patients may experience a short prodromal period, manifested by a feeling of weakness, worsening night sleep, psycho-emotional instability, and heaviness in the head. On the first day of the disease, a person experiences a sharp rise in temperature, which exceeds 40ᵒC. The patient's fever is accompanied by the appearance of diffuse headache and myalgia. The duration of febrile fever with typhus is on average five days, after which there is a short-term decrease in indicators, during which the patient shows no signs of improvement in well-being. Fever in typhus almost always has a wave-like character and is never accompanied by the development of chills, which fundamentally distinguishes it from febrile conditions in other infectious pathologies.

The negative effect of typhus intoxication on the structures of the patient’s central nervous system is the appearance of euphoria, excessive excitability, varying degrees disturbances of consciousness. When examining a patient suffering from typhus in the initial period of the clinical picture, there is hyperemia of the upper half of the body and especially the face, swelling of the soft tissues on the face, amicability, pronounced injection of the sclera, and symmetrical hyperemia of the conjunctiva. The skin is excessively dry.

Pathognomonic clinical sign in the initial period of the clinical picture of typhus is the detection of pinpoint hemorrhages on soft palate and mucous membranes back wall throats. Regarding the impact of typhus on activities of cardio-vascular system It should be noted that there is a clear trend towards.

The peak period of typhus is the appearance of a specific exanthema, which most often develops on the fifth day of the disease. During the peak period, the patient may have a feverish reaction for a long time, and the manifestations of the intoxication symptom complex may also increase. The rash associated with typhus has a profuse roseola-petechial character, and its development occurs simultaneously. The predominant localization of exanthema in typhus is the lateral surfaces of the torso and the internal surfaces of the extremities. The face, palms and soles of the feet are not affected by typhus.

The pathognomonic objective sign of typhus is the detection of excessive dryness of the tongue and the presence dark brown coating on its surface, the formation of which is caused by hemorrhagic diapedesis. In 80% of cases, typhus is accompanied by the development of hepatolienal syndrome. Gradually, the patient develops signs of increasing oliguria with the development of paradoxical diabetes.

In the structure of clinical symptoms that occur during the height of typhus, the first place is occupied by the so-called bulbar symptoms, which are characterized by a severe course. Primary bulbar neurological disorders is the appearance of tremor and deviation of the tongue, dysarthria, amymia, smoothness of the nasolabial folds. In addition, swallowing impairment, anisocoria and weakening of pupillary reactions gradually progress.

Severe typhus is manifested by the development of the so-called typhoid status and is observed in 10% of cases. Characteristic clinical markers of typhoid status are the development mental disorders in the form of psychomotor agitation, talkativeness, progressive insomnia, disorientation of patients, and the appearance of hallucinations.

The beginning of the convalescent period is considered to be normalization of body temperature, disappearance of intoxication symptoms, relief of exanthema, normalization of the size of the liver and spleen. During the period of convalescence after suffering typhus, the patient may experience asthenic syndrome in the form of weakness and apathy, pale skin, functional lability of the cardiovascular system, memory loss.

Diagnosis of typhus

Among nonspecific general clinical methods laboratory research patients with typhus should use a detailed blood and urine test, cerebrospinal fluid analysis, biochemical research blood. Thus, the appearance of changes in the general blood test indicators indicates a severe course of typhus and manifests itself in the form of lymphocytosis, the appearance of giant granulocytes, Turk cells, decreased absolute number platelets, moderate increase in ESR. Changes in red blood cells in the form of poikilocytosis are most often observed at the end of the febrile period.

Among the changes in the general analysis of urine during typhus, the most often observed is an increase in its density, the appearance of protein and casts in large quantities, and at high body temperature - microhematuria. IN general analysis cerebrospinal fluid in a patient suffering from typhus is detected.

The appearance of changes in biochemical analysis blood indicates an increase in the intensity of the intoxication syndrome according to the type of metabolic, increase residual nitrogen and creatinine, a decrease in total percentage composition protein with a predominant increase in the globulin fraction.

Specific laboratory diagnostic methods for typhus are serological tests. Using the Weil-Felix reaction, it is possible to determine the presence of antibodies to Provacek's rickettsia in the blood of the person being examined, however, this technique does not apply to rapid diagnostics and does not have high specificity for other types of rickettsia that are not related to the development of typhus.

Already in the first week of the disease, the diagnosis of typhus can be reliably established based on the results of the complement fixation reaction. The maximum reliability of the method is observed at the end of the second week of the disease. When performing an indirect hemagglutination reaction, it is possible not only to determine the amount of antibodies, but also to qualitatively assess the presence of specific antigens. Using an enzyme immunoassay for typhus, it is possible to determine the presence of specific antibodies, both class G and M. Increased quantity IgM indicates acute infectious process, while an increase in IgG concentration is laboratory marker Brill's disease.

Due to the fact that rickettsiae are difficult to cultivate on nutrient media, bacteriological methods laboratory diagnostics for typhus they are practically not used.

In addition to application laboratory methods verification of the causative agent of typhus, the attending physician can reliably establish a diagnosis, relying only on an analysis of the patient’s clinical manifestations, differentiating it from other diseases. Thus, in the initial period, the clinical picture of typhus is similar to that of typhus, illness, pneumonia and other infectious and non-infectious pathologies, accompanied by the development of fever. Distinctive feature A febrile reaction in typhus is a tendency to develop “Rosenberg incisions” on the fifth day of the disease.

Treatment of typhus

All cases of typhus or even suspicion of the development of this pathology in a patient is the basis for hospitalization of the patient in an infectious diseases institution. The entire period of febrile fever, as well as for five days after normalization of body temperature, the patient must lie down constantly. The diet for typhus is not limited.

As drugs of etiotropic significance, it is necessary to use antibacterial drugs of the tetracycline category (Tetracycline orally in a daily dose of 1.2 g, Doxycycline in a daily dose of 400 mg), as well as Levomycetin in a daily dose of 2.5 g. The pharmacological effectiveness of antibacterial drug therapy is assessed during the first 48 hours of illness. Duration antibacterial therapy directly depends on the duration of the febrile period and should continue until the intoxication manifestations are completely relieved.

An obligatory component of drug therapy for typhus is active detoxification therapy, which involves intravenous administration crystalloid solutions and increased diuresis. When adding signs, as well as in for preventive purposes it is advisable to use intramuscular injection Sulphocamphocaine.

Due to high risk development of thrombus formation in typhus, for preventive purposes the patient should use anticoagulants in the form of Heparin. Severe course typhus, accompanied by massive intoxication syndrome, is the basis for prescribing glucocorticosteroid drugs to prevent the development of acute adrenal insufficiency.

Prevention of typhus

First of all, the development of typhus can be avoided by observing basic sanitary and hygienic standards, as well as taking anti-pediculosis measures. In relation to the fight against lice, which are carriers of typhus pathogens, you can use various techniques in the form of mechanical removal of head lice by combing, boiling and ironing infected linen with a hot iron, as well as chemical methods of disinfection.

For chemical disinfection, use an aqueous emulsion of karbofos in a concentration of 0.15%, 5% boric ointment, 10% water-kerosene emulsion with exposure for 40 minutes. More effective is double treatment every ten days.

Currently, the most effective way to disinfect items of clothing and linen is chamber treatment. Techniques specific prevention typhus are used only in unfavorable epidemiological conditions in certain regions and involves the use of both killed and live vaccines.

In some situations, adults with massive lice use oral administration Butadione in a daily dose of 0.6 g, thanks to which human blood remains toxic to lice for two weeks.

Preventive measures in the outbreak consist of immediate hospitalization of persons suffering from typhus with concomitant complete sanitary treatment and disinsection of the patient's underwear. Convalescent drugs are prescribed no earlier than 12 days after the fever has subsided.

Persons who are in close contact with people sick with typhus are subject to medical observation for 25 days, during which daily thermometry is mandatory. In some situations, emergency prophylaxis with the use of Doxycycline in a daily dose of 0.2 g, Rifampicin in a daily dose of 0.6 g, and Tetracycline in a daily dose of 1.5 g for a course of ten days is used for persons exposed to typhus. Premises visited by a sick person should be treated with a 0.5% Chlorophos solution, followed by ventilation and wet cleaning.

Typhus – which doctor will help?? If you have or suspect the development of typhus, you should immediately seek advice from doctors such as an infectious disease specialist or therapist.

At all times, infectious epidemics have been the causes of massive deaths. Typhus is infectious in nature and is manifested by severe intoxication of the body, skin rashes, damage to the nerves and vascular system. Today, the disease is rare in developed countries; outbreaks of the disease are localized in developing countries and occur at the peak of extreme disasters and emergency situations.

The main causative agents of typhus

The disease can spread quickly among people. The causative agent of the disease is the Provacek rickettsia bacteria. They endure high temperatures. Death begins when the temperature rises to 50 ᵒC. The dry type is divided into 2 types.

Epidemic typhus:

• Occurs in humans when bitten by fleas that have sucked on rat blood;
• Epidemics are typical for warm countries;
• The disease is transmitted by body lice and head lice.

Having sucked on the blood of a sick person, they become sources of infection. In the intestines of insects, an increase in rickettsia occurs. A healthy person becomes infected when lice excrement gets into the wound and is bitten.

Endemic typhus is caused by rickettsia and is also transmitted from a sick person to a healthy person through lice feces.

The pathogen has distinctive feature, even in a dried state it survives. This allows the virus to enter the body through clothing and bedding. Disinfection with chlorine, formaldehyde, acids and alkalis is destructive to bacteria.

Symptoms of typhus at different stages

The incubation period lasts from 1 to 3 weeks. The disease occurs cyclically and has 3 stages: initial period, the height of the disease and complications of the disease. For initial stage Characterized by a rise in temperature to 39 ᵒC, a depressed state, muscle aches, and headache. A person begins to have sleep disturbances and general bad feeling. After 3 days, a feverish state occurs. On day 5, body temperature drops to 37 ᵒC. Intoxication of the body continues to increase. Disorders of the sensory organs appear, consciousness is impaired, the tongue becomes coated, and the mouth feels dry. Frequent vomiting occurs.

Symptoms of the initial stage:

• Low blood pressure;
• Redness of the skin;
• Rapid pulse;
• Bruising appears when the skin is pinched.

About fragility blood vessels say the bloody stars of the sky and mucous membranes oral cavity. The skin is dry and hot to the touch. Chiari-Avtsyn sign and hemorrhage appear small vessels eye. On the 6th day, the height of the disease begins.

Rashes appear on the limbs, which gradually spread to the body.

Intoxication of the body increases along with symptoms of poisoning and constant fever. Headaches become throbbing. The tongue is colored Brown color. The height of the disease is characterized by speech impairment, tongue tremor, fixation of one pupil, hesitation eyeballs With high frequency, swallowing disorder. Happening further violation sleep, with visions and hallucinations. The severe stage is characterized by clouding of consciousness, mental agitation, high talkativeness, and memory loss. The acute period lasts from 4 to 10 days. Then the symptoms gradually pass, and the recovery stage begins.

Epidemic typhus: complications, diagnosis and treatment

Complications often occur with typhus. The human blood vessels and nervous system are at risk. Diagnosis consists of laboratory and instrumental studies. Blood and cerebrospinal fluid are collected. Increased ESR in the blood speaks of inflammatory processes. The quantitative composition of platelets decreases. Cerebrospinal fluid determines lymphocytic cytosis.

As a result, you may experience:

• Myocardial development;
• Thrombotic stasis;
• Meningitis;
• Pneumonia;
• Furunculosis.

If the vessels of the extremities are damaged, gangrene may develop. TO instrumental studies include ECG, ultrasound and chest x-ray. More often, specialists resort to specific analysis. Serological tests highly reliably determine the presence of antibodies to rickettsia.

The maximum reliability of the method is observed after a week of pathology development.

For treatment, use drug therapy, including the tetracycline group of drugs, antibacterial drugs, pathogenic techniques to reduce intoxication of the body, antihistamines. Additional drugs are painkillers.

Vectors of typhus - insects

The disease is transmitted by lice. Moreover, the main carriers of the virus are clothed individuals, less often heads. Pubic insects do not spread typhus. The body louse prefers unsanitary conditions, pleasant smells and natural fabrics.

A comfortable living environment is dirty clothes, so that part of the population that has unfavourable conditions accommodation.

Handling personal belongings requires compliance with certain rules:

• Washing at high temperatures;
• Adding insecticidal agents to the powder, if they are not available, you can replace the ingredients with vinegar or tar soap;
• Dry clothes under ultraviolet rays;
• A mandatory method of disinfection is ironing clothes;
• Pediculicides must be used for the body.

The disease can be prevented by following the rules of hygiene and sterilization. The typhus vector must be destroyed. To prevent head lice, you need to wash your hair and comb your hair frequently. If infected, carry out procedures to remove lice and nits from the hair. Prevention of typhus involves maintaining personal hygiene, frequent changes linen, using only personal clothing, regular ventilation and washing of pillows and blankets.

How is typhoid transmitted: sources of infection

Typhus can only be transmitted by body lice and head lice. The source of infection can be animals and an infected person. After sucking blood containing rickettsia bacteria, the insects end up on the skin and hair areas of the body. Carrying out their vital functions, they lay eggs and excrement.

After the penetration of rickettsia, the bacterium begins to rapidly multiply in the insect’s body. The incubation period is 4-5 days.

The insect bites a person, injecting toxins into the epidermis. Each time they suck blood, the lice have a bowel movement. The skin becomes irritated by the injected toxins, causing itching and scratching. If lice feces get into wound surface epidermis, the circulatory system becomes infected with Rickettsia bacteria.

Routes of infection:

1. In some situations, infection may occur by air. Shaking bedding or underwear with dried mite feces can lead to infection. Getting into pulmonary tract, the bacterium wakes up and begins to actively multiply, affecting the circulatory and nervous systems.
2. Infections are known from donor blood transfusions taken from latest dates incubation period of an infected person.
3. Lice are very sensitive to changes in body temperature and quickly move from a sick host with a fever or a deceased person, crawling onto other people.

Dried feces are preserved long term life, with massive and prolonged gatherings of people and prolonged unprocessing of things, a chain mechanism of disease transmission occurs in 90% of cases.

Lice incubation period: how to avoid disease

After infection with rickettsia, the insect continues to live and function normally. In the insect's body, bacteria begin to multiply at high speed. Rickettsia viruses are tenacious and are able to resume their activity even in a dried state. When they enter the human body, they begin to multiply quickly.

Already on the 5th day feces are excreted great amount rickettsiae, which are deposited on:

• Fabric surfaces;
• Epidermis;
• And hairy parts of the body.

The reaction of the patient’s immune system occurs only after 2 weeks, and symptoms begin caused by intoxication of the body, damage vascular membranes and the nervous system. Rash appears cutaneous manifestation diseases. It takes about 2 weeks from the moment of infection to the first symptoms, so turning to specialists occurs already at the height of the disease.

Typhus is an acute infectious contagious disease, which in normal times occurs in the form of sporadic cases, at times giving outbreaks of large epidemics and is characterized by general phenomena intoxication, a peculiar rash on the skin and an enlarged spleen. The disease is caused by the bacteria Rickettsia. The carrier of the disease is the body louse, mainly the body louse. There are only two types of typhus:

Epidemic;
- Endemic;

Epidemiology and causes

The connection between large epidemics of typhus and public disasters - wars, famines - and the tendency of the disease to affect groups of the population living in poor hygienic conditions (prisons, migrants) has long been known. The internal meaning of this connection is now clear: under these conditions, moments are created that are conducive to the proliferation of lice, transmitters of the disease. When the louse disappears, typhus also disappears.

Humans do not have innate immunity to typhus. The patient becomes ill when bitten by an infected louse, but causes that weaken the body play a certain role, since typhus not only spreads greatly among the starving population, but also takes a severe course. Once past illness usually gives immunity for life. If there are cases of repeated diseases, they are extremely rare.

Pathogenesis and pathological anatomy

Anatomical changes consist of destructive and thrombotic processes in small arteries, veins and capillaries, with subsequent phenomena of proliferation and obliteration. These processes cause the formation of a nodule (granuloma) along the periphery of the vessel. The process affects the skin, muscles and especially the nervous system. In addition, heart damage (myocarditis), degeneration parenchymal organs, glandular damage internal secretion(adrenal glands).

Symptoms and signs of typhus

The incubation period usually ranges from 11 to 14 days. The disease rarely begins immediately. Usually within 2-3 days the patient complains of general malaise, headache, weakness. Chilling is sometimes observed, and vomiting is much less common. The temperature rises steeply. By the 3-4th day the disease reaches its full development. IN clinical picture 3 symptoms of typhus are striking: fever, rash and enlarged spleen.

Temperature

A sudden initial rise in temperature is completely unusual for typhus. Usually its maximum is reached by the 3-4th day. The temperature reaches 39-40°. Subsequently, the temperature takes Various types. From the 8-10th day the fall begins. A crisis similar to the crisis under lobar pneumonia or when relapsing fever, almost never happens. Usually the temperature drops within 3-4 days, so that the total duration of the febrile period is 12-14 days.

Rash

A clear symptom of the onset of typhus is a rash. Roseola appears on the 3-4th day. It has some differences from typhoid fever: each spot is not so sharply outlined, the contours merge, the color is slightly brownish, roseola is more abundant. Unlike typhoid fever, it is often seen on the face, and sometimes on the scalp. Roseola appears first on the chest, back, and sometimes on the arms. The duration of the rash is about 1 week.

Sometimes in parallel with roseola, very in rare cases even without it, a petechial rash appears on the skin. Petechial rash most often appears in severe cases. Roseola is absent only in very rare cases.

Spleen

A sign of the rash type is an enlarged spleen. It is noted quite early - on the 3-4th day of illness, which is very important in a differential sense in relation to typhoid fever. The enlargement of the spleen is slight; it protrudes from under the edge of the ribs by 1-2 fingers. Its consistency is either softer or denser. The enlargement of the spleen continues for 1-2 weeks.

Leather

Mostly it is dry. In rare cases, peeling is observed on the trunk. The glands are not enlarged. The mucous membranes are little changed: only in more severe cases there is slight conjunctivitis and pharyngitis.

Digestive tract

The tongue becomes dry early, thickly covered with a white coating and remains so throughout the entire period of fever. Appetite is moderately reduced, absent only in severe cases, quickly restored after a drop in temperature. The stool is normal or there is a tendency to constipation. The liver is enlarged - in more severe cases, in parallel with symptoms of cardiac weakness.

Respiratory system

Another symptom of typhus is problems in respiratory system person. In more severe cases, there is a slight cough, and dry wheezing when auscultated.

The cardiovascular system

At the beginning of the disease, the pulse becomes frequent, and it remains so throughout the entire illness, giving way to a moderate slowdown after the temperature drops; At this time, no sharp arrhythmias are observed. The heart is initially unchanged; on the 5th-6th day there is often an expansion of the boundaries, the appearance of uncleanness in the first tone, and a drop in blood pressure. These signs of typhus begin to improve after the temperature drops. Blood pressure at first it is sometimes higher than normal, from the 5th-6th day it begins to drop significantly, after the temperature drops it returns to normal.

Nervous system

The picture of intoxication is very clear. General weakness, headache, sharp hyperesthesia are common even in moderately severe cases, and in more severe cases delirium and confusion appear.

Kidneys

At the peak of the disease, the amount of urine is moderately reduced, the specific gravity is increased, and a positive diazoreaction is often noted. In severe cases, protein and casts appear.

Blood

IN acute stage- high leukocytosis of a neutrophilic nature. By the 7-9th day the fall usually begins.

Treatment and prevention

In severe cases of typhus, it is prescribed hospital treatment. The patient is prescribed bed rest until the fever subsides and the temperature normalizes. As drug treatment typhus, antibiotics of the tetracycline group are prescribed, and if they are intolerant, chloramphenicol and other drugs are prescribed.

Prevention of typhus is the fight against unsanitary conditions, lice, quick diagnostics, sanitization sick people and their habitats. In case of increased morbidity in the population, a vaccine is used. Due to the use of various antibiotics, the number of deaths from typhus in Lately decreased sharply.

Typhus - infection, which is caused by Provacek's rickettsia. Carrier of this disease is a body louse (in rare cases - a head or pubic louse). Typhus is characterized by damage to the inner lining of blood vessels. The disease is accompanied by disturbances in the functioning of the nervous and cardiovascular systems.

In rare cases, people who have already had typhus may experience a relapse of the disease. The recurrent variant of the disease is called Brill's disease.

Causes

The source of the disease is a person suffering from typhus or Brill's disease. The carriers of the disease are body lice (less commonly, head and pubic lice). When body temperature rises, lice leave the patient and move on to healthy people. In this way, the infection is transferred from person to person.

Very rarely, infection can occur through airborne droplets. There are also known cases of infection through donor blood. Cases of typhus usually occur during mass migrations of people, with mass head lice, as well as in crowded conditions with a lack of sanitation.

Symptoms of typhus

The first symptoms of typhus are headache, intoxication, chills and aches in the muscles and joints. After 2-3 days, the headache intensifies, body temperature rises, vomiting occurs and insomnia develops.

From the nervous system it is possible increased excitability or lethargy. In some cases, hallucinations, delusions, amia, muscle tremors and speech and hearing impairment are noted. Appearance the patient with typhus also changes. The face takes on a red tint, swelling occurs, the whites of the eyes become red and the lips turn blue.

Approximately on the 4th-6th day of the disease, the patient develops a rash, which is a roseola (pale pink rash), the diameter of which is from 2 to 5 mm. The main locations of the rash are the area behind the ears, abdomen, sides of the neck, chest and limbs. After some time, small hemorrhages may appear on the roseola. Subsequently, roseolas turn pale, and a slight pigmentation remains in their place.

Other symptoms of typhus may include: increased heart rate, decreased blood pressure, shortness of breath, tracheobronchitis, worsening bronchitis, stool upset, thirst, bloating and other symptoms.

The incubation period for typhus ranges from 5 to 25 days.

Diagnostics

Making a diagnosis is usually not difficult. Can be used to clarify the diagnosis linked immunosorbent assay and polymerase chain reaction.

Classification

Epidemic typhus can be typical or atypical. The typical form of typhus is characterized by the “classic” symptoms of typhus with rashes and a rise in body temperature.

There may be several atypical forms of typhus: typhus without rashes, erased form of typhus, abortive form, subclinical form.

Patient Actions

If characteristic symptoms appear, you should consult a doctor.

Treatment of typhus

Drug therapy for typhus boils down to taking antibiotics. The patient must remain in bed for 5-6 days. The patient is also prescribed anticoagulants, tetracyclines (doxycycline) and intravenous glucose.

According to indications, it is possible to take painkillers and antipyretics. To strengthen the walls of blood vessels, large doses of vitamin C are prescribed. With the development cardiovascular failure the patient may be prescribed cardiac glycosides and vasopressors.

Complications

Complications of typhus may include:

• thrombophlebitis;
• thromboembolism;
• cerebral hemorrhage;
• psychoses;
• myocarditis;
• otitis and mumps (develop against the background of the addition secondary infection);
• development of bedsores (develop with vascular disorders).

Prevention of typhus

Basic preventive measures aimed at combating head lice, as well as timely identification of sick individuals. People at increased risk of developing typhus should be vaccinated. If Brill's disease is suspected, a person is subject to mandatory hospitalization.

Typhus belongs to the category of acute anthroponotic diseases. It is characterized by severe intoxication of the body, feverish conditions, damage to the cardiovascular, nervous and other vital systems. important systems body.

The causative agent of epidemic typhus is Rickettsia Provacek. It penetrates the human body through the skin. The initial accumulation of harmful microorganisms occurs in lymph nodes, then they enter circulatory system and spread to other organs. Most severe complications in case of typhus, it affects the activity of the brain, adrenal glands and myocardium.

Epidemiology of infection

The carrier of the pathogens of epidemic typhus is an infected person, and the carriers are head and body lice, which multiply quickly in unsanitary conditions. It is for this reason that epidemic typhus is also known to us as “war fever”, because soldiers, often without the opportunity to wash themselves, suffered from this infection for several millennia. The mechanism of transmission of typhus is extremely simple. Lice move onto the body of a new host and, when bitten, inject him a large number of rickettsia, which are then rubbed even deeper into the skin when scratching the itchy area. The rapid spread of lice and the short incubation period of the disease often lead to epidemics, however, in the territory Russian Federation Outbreaks of infection have not been recorded for more than half a century. This fact partly explains effective prevention typhus. It also has an impact on a noticeable increase in the quality of life of ordinary people.

Symptoms of typhus and clinical picture

Epidemic typhus begins acutely. Within several days, the patient’s body temperature rises to critical levels. Patients with typhus experience severe headaches, suffer from insomnia and constant vomiting. Sometimes they experience psychoneurological disorders, manifested in blackouts and euphoria. The facial skin of infected people is hyperemic, and the injection of scleral vessels is pronounced. Already in the first days after the appearance of the first symptoms of typhus, patients experience heart problems. Typhus leads to hypotension, severe tachycardia, and muted heart rhythms.

On palpation internal organs In patients with typhus, an enlargement of the liver and spleen is detected. In some cases, the development of typhus is accompanied by suppression of urinary reflexes. Urine is released literally drop by drop, which causes a person great suffering and worsens his psychological state.

On the 5th-6th day of illness, a characteristic rash appears on the skin of sick people. Its largest accumulations are observed on the lateral surfaces of the trunk and limbs. Severe course of the disease contributes to the spread of rashes to the face and neck, and can lead to the development of meningeal syndrome. At adequate treatment Epidemic typhus is completely cured 1-2 weeks after the first symptoms appear.

Diagnosis of typhus

Possible complications

Since when typhus is diagnosed, the symptoms indicate damage to the heart, lungs and genitourinary system, complications are primarily localized in these organs. The most dangerous of them are adrenal insufficiency and infectious toxic shock. In addition, the development of pneumonia, thromboembolism and thrombophlebitis is possible.

Treatment of typhus

If there is any suspicion of epidemiological typhus, patients should be immediately hospitalized. They are prescribed bed rest, which is maintained until the patient has no symptoms. normal temperature for at least 5-6 days. Patients with typhus are prescribed tetracycline drugs and chloramphenicol. Simultaneously with etiotropic therapy, detoxification therapy is carried out by administering infusion solutions.

Prevention of typhus

The main measures for the prevention of typhus are aimed at registering cases of pediculosis, hospitalization of patients with fever unknown etiology and timely serological surveys. Special attention deserve children's groups and people living in hostels. If typhus is detected, patients are subject to isolation with disinfection and disinsection of their personal belongings.

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