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Typhus fever: treatment and prevention
Last reviewed: 23.04.2024
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All patients with suspected epidemic typhus must be hospitalized in an infectious disease hospital (department). They are prescribed a strict bed rest until the 5th-6th day of normalizing body temperature. Then the patients are allowed to sit down, and from the 8th day they can walk in the ward, first under the supervision of a nurse, and then independently. Patients need to constantly monitor blood pressure.
A special diet is not prescribed. Food should be gentle, quite high in calories and containing vitamins in daily needs.
Of great importance are the toilet of the mouth (prevention of purulent mumps and stomatitis) and skin hygiene (prevention of decubitus).
Drug treatment for typhus
Treatment of epidemic typhus consists in the appointment of first-line drugs antibiotics of the tetracycline group (tetracycline, doxycycline) and chloramphenicol. Antibiotics are prescribed in usual therapeutic doses: doxycycline orally 0.1 g twice a day, from the second day - once a day; tetracycline orally in a daily dose of 2 g in four doses (children 20-30 mg / kg). When tetracyclines are intolerant, treatment of epidemic typhus is carried out with chloramphenicol 0.5 g four times a day inwards. Usually the duration of the course is 4-5 days.
To reduce intoxication, the patient is given ample drink and intravenously injected with a 5% solution of glucose, isotonic sodium chloride solution, a polarizing mixture and the like drugs, forcing diuresis. To combat cardiovascular insufficiency appoint cardiac glycosides, vasopressors, as well as oxygen therapy. When excited, delirium sedative therapy [barbiturates, diazepam (seduxen), haloperidol, sodium oxybutyrate, remicidin].
With the development of infectious-toxic shock, the introduction of short courses of dextran (reopoliglyukin) in combination with glucocorticoids (prednisolone) is indicated. All patients are prescribed rutozid (askorutin), containing vitamins C and P, which have vasoconstrictive effect. To prevent thromboembolic complications, especially in elderly patients, anticoagulants are used [in the early period - heparin sodium (heparin), later - phenyldione (phenylin), etc.] under the control of a coagulogram. Analgesics, antipyretic agents are shown. With meningeal syndrome, dehydration with saluretic (furosemide, acetazolamide) is carried out.
Statement rules
You can not prescribe a patient from the hospital before 12-14 days after normalization of body temperature in the absence of complications. Terms of incapacity for work are determined individually, but not earlier than 2 weeks after discharge.
What prognosis does epidemic typhus have?
In the past, the mortality rate was about 10%, reaching 30-80% during some epidemics. When using antibiotics, deaths are rare (less than 1%).
Clinical examination
Clinical examination is carried out in the KIS for 3 months, in the presence of residual events - 6 months. Before the complete normalization of the function of the central nervous system is necessary to observe the neuropathologist, with myocarditis - observation of the therapist.
[7], [8], [9], [10], [11], [12]
How to prevent epidemic typhus?
Prevention of epidemic typhus is aimed at combating pediculosis.
Individuals with an increased risk of infection are vaccinated with vaccine E (typhoid typhoid combined live dry) at a dose of 0.25 ml subcutaneously once; revaccination in 1 year or vaccine typhytephalous chemical dry at a dose of 0.5 ml subcutaneously once with a booster at 4 months.
In the center of infection, sanitized patients are treated, and chamber disinfection of bedding is carried out: supplies, clothes and linen. The contact persons are observed for 25 days. In connection with the difficulties of clinical diagnosis, the similarity of typhus with a number of other diseases accompanied by fever, the need for timely diagnosis of each case for all patients with fever for more than 5 days should be conducted twice (with an interval of 10-14 days) serological examination for epidemic typhus.