Introduction
It is a clinical condition characterized as endogenous reinfection related to the earlier carrier state in individuals affected by epidemic typhus fever. It is not severe, although it can be mistaken for endemic typhus. Brill first mentioned it in New York but was not recognized as endemic typhus-related. Later, it was given recognition after Nasser mentioned his work. It has various other names like typhus, Brill disease, Recrudescent typhus fever, recrudescent typhus, Murine typhus, Epidemic typhus, Endemic typhus, and Jail fever.
How Is It Caused?
Brill-Zinsser disease is a bacterial infection caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii. Humans are known to be the natural reservoir for R. prowazekii. This microbe is prevalent worldwide, and the transmission mode is body lice. The mechanism behind this transmission is that when the feces of the louse are scratched or rubbed into wounds or the mucous membranes of the mouth, nose, or eyes, the transmission of this bacteria happens.
People in the United States are known to rarely contract epidemic typhus post-contact with flying squirrels. The reason for the same is the presence of fleas or lice on flying squirrels which act as vectors. Fatalities are rarely seen in children under ten years, whereas mortality increases with age and may reach nearly 60 % in patients older than 50 and left untreated.
What Are The Types?
The form of typhus is based on the type of bacteria causing the infection. Rickettsia typhi is known to cause murine or endemic typhus. It is more common in areas involving poor hygiene and cold weather. This type of typhus is also called jail fever. It is spread through lice and fleas of flying squirrels. Murine typhus is seen in the southeastern and southern United States and is more common during the summer and fall seasons. It is rarely fatal.
The risk factors for murine typhus are as the following:
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Getting exposed to rat fleas or rat feces.
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Other animals include cats, raccoons, skunks, opossums, and rats.
What Are The Signs And Symptoms?
The signs and symptoms depend on the type of disease.
Following are the signs and symptoms of murine typhus:
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Pain in the abdomen.
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Presence of a dull red-colored rash that starts in the middle of the body and spreads to various other parts of the body.
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Backache.
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Extremely high fever (105 to 106 degrees Fahrenheit) lasts two weeks.
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Dry cough.
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Arthralgia (pain in the joints).
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Nausea and vomiting.
Symptoms of endemic typhus are as the following:
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Chills.
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Cough.
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High fever (nearly 104 degrees Fahrenheit).
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Delusion.
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Joint pain (arthralgia).
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Very bright light may hurt the eyes.
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Headache.
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Rashes begin on the chest and spread to various other body parts. The palms of the hands and soles of the feet are not affected.
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Myalgia (severe muscle pain).
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Stupor.
How Can It Be Diagnosed?
Epidemic or louse-borne typhus can sometimes get misdiagnosed as typhoid fever in tropical countries. When you visit your physician, you will be asked about the signs and symptoms experienced by you along with your personal and family history. After that, a physical examination will be carried out. The doctor may ask for certain serological or immunohistochemical tests to diagnose a single case. Also, detecting R. prowazekii in a louse observed in a patient can be used for the diagnosis. A complete blood count (CBC) test can check anemia and decreased platelet count. Various other blood tests can be done to assess for increased levels of typhus antibodies.
They are as follows:
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Decreased levels of albumin.
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Mild kidney failure.
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Decrease in sodium level.
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Mildly increased levels of liver enzymes.
How Can It Be Treated?
The management of this condition is done using antibiotics, especially Doxycycline. The dosage is 200 mg/d and is given in two divided doses. If the patient is unconscious or there is vomiting, it is advisable to give Doxycycline through the intravenous route. The treatment is continued for two to three days after the symptoms disappear. However, a single 200 mg of Doxycycline is enough in such a case. The choice of medication during pregnancy is important as it can affect the developing fetus. Thus, Chloramphenicol can be given in the early phase of pregnancy or, if necessary, Doxycycline can be provided in the late stage.
How Can It Be Prevented?
As prevention is better than cure, the following methods can be used to prevent typhus:
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Immunization and louse control are known to be highly effective in the prevention of this disease. However, vaccines are not available now.
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Usage of insecticides every six weeks will also help control the louse population.
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Elimination of Lice: Lice can be eliminated by dusting infected people with lindane or malathion.
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Personal hygiene maintenance.
It is advisable to wash bedding and clothing at least once a week in hot water (greater than 54 degrees Celsius) and should be dried on increased heat. The non-washable clothes and items can be dry-cleaned. You can also seal the things in a plastic bag and store them for two weeks. Another option to clean bedding and clothing is with the help of permethrin. Permethrin is an insecticide.
Conclusion
Brill-Zinsser disease is caused by a person who has already been affected by epidemic typhus. The form depends on the type of disease. Although the condition is not fatal, the symptoms may affect the quality of life in the person. The diagnosis is done using various laboratory tests and can be managed with medications. Online medical platforms have made consulting physicians very easy. You can consult a specialist online to know more about this condition using these online medical platforms.
