Disease Brill (Brill-Zinsser): causes, symptoms, diagnosis, treatment

Brill's disease (Brill-Zinsser, recurrent typhus) is an acute cyclical infectious disease, which is an endogenous relapse of typhus, which manifests itself after many years in people who have recovered from epidemic typhus. This disease is characterized by sporadic, lack of pediculosis, typical clinical symptoms, an easier course than with epidemic typhus.

Synonyms: repeated typhus, lat. Brilli morbus.

ICD-10 code

A75.1. Recurrent typhus (Brill disease).

Epidemiology of Brill-Zinsser's disease

The reservoir and source of infection is a person who has recovered in the past (2-40 years ago) typhus. Mostly elderly people are ill. Patients with pediculosis can be a source of primary typhus.

Brill's disease is characterized by the absence of a source of infection, seasonality and foci. In our country, the disease has been registered since 1958.

[1], [2], [3], [4]

What causes Brill's disease?

Brill's disease is caused by the rickettsia of Prowacek (R. Prowazekii).

Pathogenesis of Brill-Zinsser's disease

Brill's disease has the same pathogenesis and pathological anatomy as in epidemic typhus. However, the defeat of the vessels with the development of granulomatosis (Popov's nodules) is less pronounced, which is due to: specific immunity. This is also associated with a shorter duration of rickettsiaemia (8-10 days).

Symptoms of Brill's Disease

Brill's disease has an incubation period that can last for decades. Since the impact of the factor provoking a relapse, usually takes 5-7 days.

Symptoms of Brill's disease are similar to epidemic typhus. Brill's disease goes through the same periods, but differs less pronounced intoxication. It occurs mainly in the middle-aged (70% of patients) or in mild form. The rash on the skin appears at the same time and persists for 5-7 days, has the same localization, but rosaolous, large (0.5-1.0 cm) rose-papular elements predominate; Petechiae are absent or few. A number of patients (up to 10%) have no rashes. Serious mental disorders are rare, but possible: euphoria, agitation or inhibition, mild delirious syndrome, sleep disturbances, and sometimes depersonalization. Dimensions of the liver and spleen usually normalize to the 3rd-4th day after a drop in temperature. Changes in the cardiovascular system disappear by the 5th-7th day, and the functions of the central nervous system are restored to the 15-17th day after the temperature normalization.

Complications of Brill's disease

Brill's disease is complicated rarely, these complications are associated mainly with the advanced age of patients (thrombophlebitis, thrombosis) or with the attachment of secondary microflora (pneumonia, pyelonephritis).

[5], [6], [7], [8]

Diagnosis of Brill's Disease

[9], [10], [11],

Clinical diagnosis of Brill-Zinsser's disease

High fever, headache, injection of vessels of sclera and conjunctiva, in the anamnesis - transferred typhus.

Differential diagnostic signs of the epidemic form of typhus and Brill disease

Sign, criterion	Epidemic form - primary typhus	Recurrent form - Bril's disease
Nature of morbidity	Group or in the form of a chain of related diseases. Forming in the end an outbreak (epidemic)	Sporadic, "scattered" in the population and time
Confinement to winter-spring months	Clear: peak incidence in March-April	Missing: occurs in any month
Communication with the carrier (human lice)	Direct: there must be lice on the sick person or in his environment	No connection, no lice
Source of infection	Can be installed in the environment of the patient	Primary disease in the past (history or medical records)
Age of patients	High specific weight (up to 40-45%) of the number of active working age (up to 39 years) compulsory involvement of children and adolescents (up to 40%)	Children and adolescents do not get sick. At present, the age of patients is over 40 years old
Clinical course	Typical, the middle and severe forms of the disease prevail. Mortality up to 20% or more Complications: gangrenous lesions of extremities, ear lobes, etc.	A typical, severe form of the disease is absent, forms of mild and moderate severity prevail, without complications. Mortality is not higher than 1-2% '
The incubation period	On the average 10-14 days	The interval between the first disease (outbreak in the region) and relapse is 3 to 60 years
The results of serological studies with a specific antigen	Smooth rise of the antibody titer, diagnostic values are achieved no earlier than the 8-10th day of the disease. The presence of specific IgM	High values of antibody titers (predominantly IgG) in the first week of the disease are generally higher than the diagnostic ones

[12],

Specific and nonspecific laboratory diagnosis of Brill-Zinsser's disease

The laboratory diagnosis of Brill's disease uses predominantly serological methods. In this case, IgG is detected at an earlier time, and IgM may be absent.

Treatment of Brill's Disease

Treatment of Brill's disease is also treated as epidemic typhus. Hospitalize patients with suspected Brill disease is mandatory.