Lice relapsing fever

Recurrent typhus is a group of acute infectious transmissible human diseases caused by borrelia. Characterized by attacks of fever, followed by periods of apyrexia. Transmitted by lice or mites.

Recurrent typhoid fever (epidemic recurrent typhoid, recurrent fever, epidemic recurrent spirochetosis, louse-borne relapsing fever) - acute infectious diseases caused by several species of spirochetes are transmitted by lice or mites and are characterized by recurrent attacks of fever lasting 3-5 days, which alternate with periods apparent health. Clinical diagnosis of recurrent typhus vshnogo confirmed by the coloration of the smear of peripheral blood. Treatment of recurrent typhoid fever is carried out by tetracycline and erythromycin.

ICD-10 code

A68.0. In vivo recurrent fever.

What causes recurrent typhus?

The carriers are mites Ornithodoros or lice, depending on the geographic region. Vernal recurrent typhus is rare in the United States and endemic in parts of Africa and South America, tick-borne in America, Africa, Asia, and Europe. In the United States, recurrent typhoid fever occurs mainly in the western states between May and September.

Lice are infected with spirochetes from sick people, biting them during fever. They are not transmitted directly to a person when bitten, but to the material of crushed lice through skin lesions, with combs, friction of clothes, etc. Undisplated lice do not transmit the disease. Ticks become infected from rodents, which are a natural reservoir of infection, and transmit the pathogens to a person with saliva or excreta falling into the wound with a bite. It was also reported about congenital Borreliosis.

Mortality is usually low (up to 5%), but may be significantly higher in children, the elderly, pregnant, with malnutrition, a weakened state, during epidemics.

What are the symptoms of recurrent typhus vshny?

Because mites feed impermanently and painlessly, mostly at night, most patients do not remember about bites, but can say that they spent the night in tents, caves, village houses. In these cases, the probability of a bite is very high.

Vernal recurrent typhoid has an incubation period that lasts from 3 to 11 days (an average of 6 days). The vesicular recurrent typhus has an acute onset: chills, high fever, tachycardia, severe headache, vomiting, pain in the muscles and joints, often delirium. At an early stage there are erythematous spots or hemorrhagic eruptions on the trunk and extremities, hemorrhages under the skin, mucous membranes, in conjunctiva are possible. The temperature remains high for 3-5 days, after which a crisis sets in, and it falls sharply. Recurrent typhoid fever lasts from 1 to 54 days (an average of 18 days).

Later, during the fever, the liver and spleen increase, jaundice, signs of myocarditis, heart failure, especially when carrying the infection with lice. Among the complications there are spontaneous abortion, ophthalmia, exacerbations of asthma and multiform erythema. Irritis, iridocyclitis, meningeal symptoms are rare.

Patients are usually asymptomatic from a few days to a week between the initial episodes and the first attack of fever. Relapse occurs in accordance with the life cycle of the pathogen and is manifested by a sudden resumption of fever, arthralgia and other symptoms described above. Jaundice in relapses occurs more often. Several days or weeks after the crisis, the patient usually has no symptoms of recurrent typhus vshinoi. Such febrile periods can be 2-10, the interval between them is 1-2 weeks. The severity of relapses is weakening each time, and as the immunity acquires complete recovery is achieved.

How is recurrent typhus diagnosed?

Diagnosis of recurrent typhoid fever is based on the recurring nature of fever and is confirmed by the detection of spirochetes in the blood during a period of elevated temperature. Spirochetes are visible in blood smears with microscopy in a dark field and when stained according to Wright or Giemsa. (More informative is the staining of acridine orange blood or tissue samples.) Serological tests are not informative. There is leukocytosis (with the predominance of polymorphic nuclears).

Differential diagnostics of recurrent typhus vshnogo carried out with arthritis in Lyme disease, malaria, dengue fever, yellow fever, leptospirosis, typhus and typhoid fever, flu and intestinal fever.

How is recurrent typhus treated?

In tick-borne fever, tetracycline or erythromycin is taken orally by 500 mg every 6 hours for 5-10 days. With a fever, a single dose of 500 mg of one of these drugs is sufficient. Effective also doxycycline orally at 100 mg 2 times a day for 5-10 days.

Children up to 8 years are prescribed erythromycin estolate 40 mg / kg / day. If due to emesis or a serious condition of the patient, oral administration of drugs is not possible, tetracycline is administered intravenously (500 mg in 100 or 500 ml of physiological solution) 1-2 times a day (children 25-50 mg / kg / day).

Children under the age of 8 years are given penicillin G 25 thousand units / kg iv every six hours.

Treatment of recurrent typhus vshinoho should begin as early as possible with a fever or an afifrile stage, but only not before the crisis itself because of the danger of the development of the Yarisch-Gerxheimer reaction, which can be fatal. In tick-born fever, the Yarisch-Gerxheimer reaction can be attenuated with acetaminophen by oral administration at 650 mg 2 hours before and 2 hours after the first dose of tetracycline or erythromycin.

Dehydration and electrolyte imbalance are corrected by parenteral fluid administration.

Headache eliminates acetaminophen with codeine. From nausea and vomiting appoint prochlorperazine inside or in / m 5-10 mg 1-4 times a day. In heart failure, appropriate therapy is indicated.

What prognosis does recurrent typhus have?

Recurrent typhus vshny has a favorable prognosis under the condition of early appointment of specific treatment of the disease. Adverse prognostic signs are intense jaundice, massive bleeding and heart rhythm disturbances.