Brill Disease (Typhus)
Contents
Causes
Symptoms
Exams and Tests
Treatment
Outlook (Prognosis)
Possible Complications
When to Contact a Medical Professional
Prevention
Typhus is a bacterial disease spread by lice or fleas.
Causes
Typhus is caused by 2 types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
Rickettsia typhi causes endemic or murine typhus.
- Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." The bacteria that causes this type is usually spread from rats to fleas to humans.
- Murine typhus occurs in the southern United States, particularly California and Texas. It is often seen during the summer and fall. It is rarely deadly. You are more likely to get this type of typhus if you are around rat feces or fleas, and other animals such as cats, possums, raccoons, and skunks.
Rickettsia prowazekii causes epidemic typhus. It is spread by lice.
Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the bacteria becomes active again in a person who was previously infected. It is more common in the elderly.
Symptoms
Symptoms of murine or endemic typhus may include:
- Abdominal pain
- Backache
- Dull red rash that begins on the middle of the body and spreads
- Fever (can be extremely high 105°F to 106°F, 40.6°C to 41.1°C) that may last up to 2 weeks
- Hacking, dry cough
- Headache
- Joint and muscle pain
- Nausea
- Vomiting
Symptoms of epidemic typhus may include:
- Chills
- Confusion
- Cough
- Delirium
- High fever
- Joint pain
- Lights that appear very bright; light may hurt the eyes
- Low blood pressure
- Rash that begins on the chest and spreads to the rest of the body (except the palms of the hands and soles of the feet)
- Severe headache
- Severe muscle pain
- Stupor
The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop small areas of bleeding into the skin.
Exams and Tests
A complete blood count (CBC) may show a low white blood cell count, anemia, and low platelets. Other blood tests for typhus may show:
- High levels of typhus antibodies
- Low levels of albumin
- Low sodium level
- Mildly high liver enzymes
Treatment
Treatment includes the following antibiotics:
- Doxycycline
- Tetracycline
- Chloramphenicol (less common)
Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all of their permanent teeth have grown.
People with epidemic typhus may need oxygen and intravenous (IV) fluids.
Outlook (Prognosis)
People with epidemic typhus who receive treatment quickly should completely recover. Without treatment, death can occur in up to 60% of patients with epidemic typhus. Those over age 60 have the highest risk of death.
Only a small number of untreated people with murine typhus may die. Prompt antibiotic treatment will cure nearly all people with murine typhus.
Possible Complications
Typhus may cause these complications:
- Renal insufficiency (kidneys cannot function normally)
- Pneumonia
- Central nervous system damage
When to Contact a Medical Professional
Call your health care provider if you develop symptoms of typhus. This serious disorder can require emergency care.
Prevention
Avoid being in areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population.
Measures to get rid of lice when an infection has been found include:
- Bathing
- Boiling clothes or avoiding infested clothing for at least 5 days (lice will die without feeding on blood)
- Using insecticides (10% DDT, 1% malathion, or 1% permethrin)