Typhus: symptoms

Epidemic typhus has an incubation period that lasts from 5 to 25, more often 10-14 days.

Epidemic typhus occurs cyclically:

• the initial period is the first 4-5 days (from fever to rash);
• peak period - 4-8 days (from the appearance of the rash until the end of febrile state);
• period of recovery - from the day of normalization of temperature to the point when all the symptoms of epidemic typhus will not disappear.

Symptoms of epidemic typhus in the initial period

Prodromal symptoms of epidemic typhus are usually absent, sometimes at the end of the incubation period of typhus there is a mild headache, body aches, and cognition. Epidemic typhus begins with acute - progressively increasing symptoms of intoxication (headache, weakness, muscle pain, dry mouth, thirst, loss of appetite, dizziness). After 2-4 days a constant diffuse headache becomes intolerable, intensifying with a change in the position of the body, conversation, the slightest movement. Possible repeated vomiting.

The body temperature reaches a maximum (38.5-40.5 ° C and higher) to the 2-3rd day of the disease. The temperature increase has a constant, less remittent nature (with short "cuts" on the 4th, 8th and 12th day of the disease).

Patients suffer from a kind of insomnia: first they fall asleep, but often wake up from frightening, unpleasant dreams. During this period, typical symptoms of epidemic typhus are recorded: muscle and joint pain, irritability, anxiety, euphoria, agitation or inhibition.

The appearance of the patients is typical: the face is hyperemic, puffy, the eyes are red ("rabbit") due to the injection of vessels of the sclera. Note moderate cyanosis of the lips, flushing of the skin of the neck and upper chest. The skin is dry, hot.

The tongue is rather dry, not thickened, coated with a white coating. From the third day of the disease, the appearance of spots can be observed, the Chiari-Avtsyn symptom - point hemorrhages in the transitional folds of the conjunctiva, enanthemu on the soft palate (Rosenberg's symptom). Positive symptoms of pinch and tourniquet, which preceded the appearance of exanthema.

Characterized by moderate tachycardia and muffled heart sounds, hypotension. Mild dyspnea. From the 3rd-4th day, the increase in the liver and spleen is noted.

A day before the appearance of the rash, a "cut-in" of the temperature curve is possible.

Symptoms of epidemic typhus in the peak period

On the 4th-6th day of the disease, a plentiful polymorphous rose-oocyte-petechial rash appears. The first elements are determined behind the ears, on the lateral surfaces of the neck, followed by spreading to the skin of the lateral surfaces of the trunk, chest, abdomen, flexural surfaces of the hands and inner surfaces of the hips. On the face, palms and soles the rash is very rare. The dimensions of the elements usually do not exceed 3-5 mm. Epidemic typhus is characterized by polymorphism of the rash. Distinguish between roseola, roseola with secondary petechiae, rarely primary petechiae. As a rule, there are no pincushions. The appearance of new petechiae is a poor prognostic sign. Rosoles disappear without a trace in 2-4 days, and petechiae - after 7-8 days, leaving the brown pigmentation ("uncleanness of the skin").

The overwhelming majority of patients register relative and absolute tachycardia, a pulse of weak filling and tension. The borders of the heart are broadened, the voices are deaf. Often they listen to systolic murmur at the top. Arterial pressure, especially diastolic, falls, which is due to the vasodilating action of the toxin of rickettsia, the suppression of the activity of the vasomotor center, the sympathetic department of the nervous system and the adrenal glands.

Often there is shortness of breath. At the height of the disease, tracheobronchitis and focal pneumonia are revealed. The tongue is dry, covered with a thick gray-dirty coating, can take a brown color, often deep cracks occur. The majority of patients notice a significant deterioration in appetite, thirst, stool retardation and flatulence. Diuresis is reduced, but simultaneously with "temperature crises" it is possible to increase it. In some patients, a paradoxical ishuria is noted. When with a full bladder there is urination with drops.

The defeat of the nervous system manifests itself in addition to headache and insomnia by changing the behavior of the patient. Typical for this period are the symptoms of epidemic typhus - motor anxiety, followed by adynamia, rapid exhaustion, euphoria, fussiness, loquacity, irritability, sometimes tearfulness. Possible delirium, accompanied by hallucinations of a frightening nature. Mental disorders occur during a severe course of the disease with the manifestation of encephalitis.

Other typhoid-associated symptoms are associated with CNS lesions: amygia or hypomia, one-or two-sided nasolabial fold flattening, muscle tremor, Govorov-Godelie symptom, dysarthria, dysphagia, nystagmus, hearing loss, hyperesthesia of the skin, meningeal symptoms. In severe cases, against a background of high body temperature, in some patients, consciousness is broken, speech becomes disconnected, behavior is unmotivated (status typhosus).

The study of cerebrospinal fluid in a number of cases indicates serous meningitis (a slight increase in protein content, mild lymphocytic pleocytosis) or meningism (no abnormalities in the cerebrospinal fluid).

There are no characteristic changes in the haemogram. There is thrombocytopenia, mild leukocytosis, neutrophil reaction, more often with a stab-shift, eosinopenia, lymphopenia, a moderate increase in ESR.

Symptoms of epidemic typhus in the recovery period

The first sign of recovery is the normalization of temperature, caused by a decrease in intoxication. This reduces the severity of the typhoid status (enlightenment of consciousness) and signs of delirium. On the 3-5th day after a drop in temperature, the pulse and respiration rate is restored, blood pressure, liver size and spleen are normalized. Gradually all clinical symptoms of epidemic typhus fade away.

On the 12th day of apyrexia, in the absence of complications, the patient can be discharged. Full recovery occurs about a month after the normalization of temperature. Typical weakness persists for 2-3 months.

Complications of epidemic typhus

Epidemic typhus can be complicated by conditions that are associated with a typical typhus-affected vascular lesion and caused by a secondary bacterial infection.

The first group includes collapse, thrombosis, thromboembolism, thrombophlebitis, endarteritis, ruptures of cerebral vessels, damage to the nuclei of the cranial nerves, polyradiculoneuritis, intestinal bleeding, myocarditis, infarction, psychoses of the reconvalescence period and later. As a result of vascular injuries, pressure ulcers and gangrene of the distal parts of the limbs. Critical states are due to infectious-toxic shock, pulmonary embolism.

The second group of complications of typhus is secondary pneumonia, otitis, parotitis, abscesses, furunculosis, pyelitis, pyelocystitis, stomatitis, phlegmon of subcutaneous tissue.

[1], [2], [3], [4], [5], [6], [7]