Brill's disease (Brill-Zinsser disease): causes, symptoms, diagnosis, treatment

Brill's disease (Brill-Zinsser, relapsing typhus) is an acute cyclic infectious disease, which is an endogenous relapse of typhus, which manifests itself many years later in people who have had epidemic typhus. This disease is characterized by sporadicity, absence of pediculosis, typical clinical symptoms, and a milder course than epidemic typhus.

Synonyms: typhus recurrence, lat. Brilli morbus.

ICD-10 code

A75.1. Relapsing typhus (Brill's disease).

Epidemiology of Brill-Zinsser disease

The reservoir and source of infection is a person who has had typhus in the past (2-40 years ago). Mostly elderly people are affected. 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 focality. In our country, the disease has been registered since 1958.

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What causes Brill's disease?

Brill's disease is caused by Rickettsia prowazekii.

Pathogenesis of Brill-Zinsser disease

Brill's disease has the same pathogenesis and pathological anatomy as epidemic typhus. However, vascular damage with the development of granulomatosis (Popov's nodes) is less pronounced, which is due to: specific immunity. The shorter duration of rickettsiaemia (8-10 days) is also associated with this.

Symptoms of Brill's disease

Brill's disease has an incubation period that can last for decades. From the moment of exposure to the factor that provokes a relapse, 5-7 days usually pass.

Symptoms of Brill's disease are similar to epidemic typhus. Brill's disease has the same periods, but is characterized by less pronounced intoxication. It occurs mainly in moderate (70% of patients) or mild form. Skin rash appears at the same time and lasts for 5-7 days, has the same localization, but roseolous, large (0.5-1.0 cm) roseolous-papular elements predominate; petechiae are absent or few in number. Some patients (up to 10%) do not have rashes. Serious mental disorders are rare, but possible: euphoria, agitation or inhibition, moderate delirious syndrome, sleep disorders, sometimes depersonalization. The size of the liver and spleen usually normalizes by the 3rd-4th day after the temperature drops. Changes in the cardiovascular system disappear by the 5th-7th day, and central nervous system functions are restored by the 15th-17th day after temperature normalization.

Complications of Brill's disease

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

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Diagnosis of Brill's disease

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Clinical diagnosis of Brill-Zinsser disease

High fever, headache, injection of the vessels of the sclera and conjunctiva, history of typhus.

Differential diagnostic signs of epidemic typhus and Brill's disease

Sign, criterion	Epidemic form - primary typhus	Recurrent form - Briel's disease
Nature of morbidity	Group or in the form of a chain of related diseases, eventually forming an outbreak (epidemic)	Sporadic, "scattered" in the population and time
Dependence on winter-spring months	Clear: peak incidence in March-April	Absent: occurs in any month
Communication with the carrier (human lice)	Direct: there are definitely lice on the patient or in his surroundings	There is no connection, there are no lice
Source of infection	Can be installed in the environment of the sick person	Previous primary disease (history or medical records)
Age of patients	High proportion (up to 40-45%) of the number of people of active working age (up to 39 years) mandatory involvement of children and adolescents (up to 40%)	Children and teenagers do not get sick. Currently, the age of patients is over 40 years old
Clinical course	Typical, moderate and severe forms of the disease predominate. Mortality rate up to 20% or more. Complications: gangrenous lesions of the extremities, earlobes, etc.	Typical, severe form of the disease is absent, mild and moderate forms prevail, without complications. Mortality is not higher than 1-2%'
Incubation period	On average 10-14 days	The interval between the first disease (outbreak in the region) and relapse ranges from 3 to 60 years.
Results of serological studies with specific antigen	Smooth increase in antibody titer, diagnostic values are achieved no earlier than the 8th-10th day of illness. presence of specific IgM	High antibody titers (mainly IgG) in the first week of illness are usually higher than diagnostic values

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Specific and non-specific laboratory diagnostics of Brill-Zinsser disease

Laboratory diagnostics of Brill's disease uses mainly serological methods. In this case, IgG is detected at an earlier stage, and IgM may be absent.

Treatment of Brill's disease

Brill's disease is treated in the same way as epidemic typhus. Hospitalization of patients with suspected Brill's disease is mandatory.