Typhus: Treatment, symptoms, advice and help
The term refers to fevers caused by rickettsiae that are most commonly tick-borne infections.
Typhus: Incidence, age and sex
These conditions have a low incidence in the western world (100 per year) but are more common in the developing countries were the exact incidence has not been estimated.
The male female ration is 2:1 and the 20- 40 age group is most affected though it has been reported in children and elderly as well.
Signs & symptoms of typhus: Diagnosis
Patients present acutely with headache, rash and sometimes neurological disturbance.
In scrub typhus,the onset of symptoms is usually sudden with headache, often retro-orbital, fever, malaise, weakness and cough. An erythematous maculo-papular rash often appears on about the 5th – 7th day with generalized painless lymphadenopathy. The rash fades by the 14th day. Mild or subclinical cases are common
In epidemic typhus the onset is sudden with rigors, fever, frontal headaches, pains in the back and limbs, constipation and bronchitis. The eyes are congested and the patient becomes dull and confused. The rash appears on the 4th – 6th day soon becomes petechial with subcutaneous mottling.
Flea-borne or ‘endemic’ typhus humans are infected when the faeces or contents of a crushed flea which has fed on an infected rat are introduced into the skin. The symptoms resemble those of a mild louse-borne typhus. The rash may be scanty and transient.
Diagnosis is made on clinical grounds and response to treatment. Species-specific antibodies may be detected by complement fixation, microagglutination and fluorescence in specialised laboratories.
Causes and prevention of typhus
Epidemic typhus is caused by R. prowazekii and is transmitted by infected faeces of the human body louse. Scrub typhus is caused by R. tsutugamushi, transmitted by mites.Murine (endemic) typhus is caused by R. typhi and flea faeces contaminating flea bite wounds.
Prevention is by vector and reservoir control. Lice, fleas, ticks and mites need to be controlled with insecticides.
In severe infection cases, the patient is prostrate with cough, pneumonia, confusion and deafness. Cardiac failure, renal failure and haemorrhage may also develop. Convalescence is often slow and tachycardia may persist for some weeks.
In fatal cases the patient usually dies in the second week from toxaemia, cardiac or renal failure, or pneumonia.
All respond to tetracycline or chloramphenicol 500 mg 6 – hourly for 7 days. Louse-borne typhus and scrub typhus can be treated with a single dose of 200mg doxycycline, repeated for 2-3 days to prevent relapse. Nursing care is important. Sedation may be required for delirium and blood transfusion for haemorrhage.