Chain typhus. Typhoid (disease): pathogens, symptoms

Reading the chronicle of past centuries, now and then you come across information about outbreaks of such a disease as typhus. The disease mowed down people mainly in the most unfavorable moments of history: during wars, crises, social conflicts. What is this infection - typhus, and can it manifest itself in our time?

The first patients appeared in the poorest areas of the city or in the army. The disease spread very quickly over a large area, claiming many human lives. This was due to the fact that the carriers of typhus are those who quickly multiplied in poor areas, soldiers' trenches and refugee camps. Weakened by malnutrition and poor living conditions, people could not resist the infection. Currently, there are no large epidemics of this disease. Small outbreaks occur only in Asia and Africa.

The causative agent of this infectious disease is a polymorphic Gram-negative bacterium Rickettsia prowazeki. It is able to maintain its vital activity outside the body of the carrier for up to 3 months.

Dies at temperatures above 50 O in 10 minutes, and when exposed to disinfectants.

How is the disease transmitted

The main route of transmission of typhus is lice bites. The sick person is the source of the disease. When bitten by his lice, it becomes contagious after a week. Given that the insect lives for about 1.5 months, and the speed of its movement from one garment to another is quite high, it is able to infect not a single person.

After a bite, a small infiltrate appears on the human body, which is usually very itchy. It is when he combs an unwashed body on which there are lice feces containing bacteria that a person himself introduces the infection into his blood. Another way of infection can be respiratory. It is more susceptible to people caring for the sick, who, along with the dust from the patient's clothes, can inhale the feces of lice.

A person who has been ill with typhus once receives a strong immunity to the disease; a relapse can very rarely occur.

The disease has a pronounced seasonal character, which lasts from autumn to spring.

The period from the moment of infection to the onset of the first symptoms can last up to 25 days, but usually after a week the following signs appear:

• the temperature rises sharply;
• haunted by constant headaches;
• there is aches in the muscles and bones;
• nausea, dizziness and other signs of intoxication appear.

The second stage of typhus is characterized by the following clinic:

• the temperature rises to 39-40 degrees;
• increased headaches and intoxication;
• appetite disappears, vomiting appears;
• suffering from insomnia;
• the tongue is covered with a white coating;
• possible violation of consciousness, delirium;
• there is swelling of the face and hands;
• a rash appears on the 5-6th day.

A typhus rash can cover almost the entire body, except for the face. Most of all it is on the inner parts of the legs and arms. The rash is a small red rash with a small head filled with liquid, which is very itchy, leaving the patient uneasy.

The third stage of the disease is characterized by malfunction of the liver and kidneys, which leads to constipation and bloating, as well as urinary problems.

Increasing insomnia and high fever lead to persistent hallucinations and constant delirium.

On the 13th-14th day, a turning point in the course of the disease may occur: the temperature decreases, signs of intoxication recede, and the nervous system is restored within 2-3 weeks.

Lethal outcome is possible with infectious-toxic shock. Usually during the course of the disease, 2 crises are possible: on the 4th and 10th day of the illness.

Complications may affect the cardiovascular and nervous system. In rare cases, gangrene of the extremities may develop due to thrombosis.

At the first suspicion of a disease, the patient is hospitalized and prescribed bed rest, which lasts until the onset of the third stage of the disease and another plus five days. It is allowed to move independently around the ward only a week after the temperature drops.

Patients do not need a special diet, they are assigned to the general table, but its condition must be taken into account. Nausea and vomiting in the first days of illness can lead to a lack of appetite. It should be ensured that the patient is fully fed, getting enough vitamins and essential nutrients that the body needs to fight the disease. In addition, you should reduce the load on the liver and kidneys by reducing fried, spicy and salty foods from the diet.

Important! During this period, it is necessary to observe hygiene, monitor the cleanliness of clothes, body, and prevent the appearance of bedsores. Since the patient is not able to do this on his own, he needs good care.

Treatment of typhus is carried out with antibiotics of the tetracycline group and chloramphenylcol. This gives positive results already in 2-3 days. Kars treatment must be continued for another 2 days after the temperature drops to normal. Intravenous systems of detoxification solutions are prescribed, which significantly alleviate the patient's condition with 5% glucose,

During the entire illness, the patient should be observed not only by an infectious disease specialist, but also by a cardiologist and a neuropathologist. Ephedrine and sedatives may be used as needed.

In especially severe cases, prednisolone may be used.

You can talk about the final recovery only 2 weeks after the last manifestations of the disease.

Preventive measures

Knowing the epidemiology of typhus, prevention can be quite simple: the fight against pediculosis. This is the main method of protection against this disease. It is important to observe personal hygiene, wash clothes in a timely manner in water above 60 o, and also iron underwear.

If a sick person is identified, his personal belongings are subject to destruction, and household items are thoroughly disinfected.

If you are in the focus of the disease or in case of forced contact with the patient, you should undergo a ten-day course of treatment with tetracycline antibiotics.

On the video in detail about the causative agent of typhus:

The content of the article

According to L.V. Gromashevsky, the only source of infection is a sick person, starting from the penultimate or last day incubation period, during the entire period of fever and in the first two days of apyrexia, i.e. 20-21 days. The causative agent can be isolated from the blood even later, but its concentration is insignificant and has no significant epidemiological significance.
The mechanism of infection is transmissible. The carrier of infection is mainly clothing louse (Pediculus vestimenti), less often - head and pubic (Rediculus capitis, Pediculus pubis). Having sucked the blood of the patient, the louse becomes infectious for a person after a certain time (minimum 3-5 days), during which epithelial cells In the intestine, a sufficient amount of rickettsiae accumulates, the cells are destroyed and the rickettsiae enter the intestinal lumen. When the louse bites healthy person and sucks blood, her intestines fill up and at the same time infected excrement is excreted. A louse bite is accompanied by itching, a person itches and rubs its excrement with rickettsiae into the skin. AT salivary glands, there is no pathogen in the sucking apparatus of the louse, therefore, infection does not occur directly with a bite. The period required for a louse to become infectious depends on the concentration of the pathogen in the blood of a sick person and the temperature of the external environment, sometimes it drags on up to 18 days. In laboratory conditions, it is possible to infect people by aerosol. Individual cases of infection are associated with transfusion of blood obtained from donors during the incubation period of typhus.

Brill disease does not have the main signs of an epidemiological process. Sporadic "endogenous" recurrences of past typhus occur in the absence of a source of infection and lice. If epidemic typhus affects all segments of the population, then Brill's disease is observed in middle-aged people who had been ill with typhus many years ago. Rickettsiae appear in the blood of such a patient; in the presence of lice, it can become a source of infection.
The incidence of typhus is characterized by winter seasonality due to overcrowding of the population. For Brill's disease, seasonality is uncharacteristic. Recently, there is no typhus in European countries, only isolated cases of Brill's disease are observed. Susceptibility to infection is almost 100%. Immunity after suffering typhus is stable and long-lasting. Repeated cases of the disease are recorded very rarely.

Pathogenesis and pathomorphology of typhus and Brill's disease

In experiments on animals, it has been established that with intradermal infection, rickettsiae enter the bloodstream in just a few minutes (the first, epidemiological, phase of pathogenesis). In the blood, part of the rickettsia dies, the rest is fixed by vascular endothelial cells. The phase of reproduction of rickettsia and accumulation of endotoxin begins - the second phase of pathogenesis. Endothelial cells appear with a large number of rickettsiae (Muser cells). Due to the destruction of endothelial cells, rickettsia are released into the blood.
Here, some of them die, the rest again flows into the endothelium. This process is repeated 3-4 times until a certain summation of irritations occurs and massive ricketsemia develops, significant intoxication. This indicates the beginning of the disease. The next, third, phase of pathogenesis is angioparalytic. The action of the toxin, which causes vascular paralysis, is enhanced by endothelial damage at the sites of penetration into rickettsia cells. The reproduction of rickettsiae and associated swelling and desquamation of the vascular endothelium cause the development of generalized vasculitis.
Angioparalytic changes lead to functional disorders in many organs. Against the background of severe intoxication, there is a slowdown in blood flow, mainly in capillaries, precapillaries, arterioles, increased permeability of the vascular wall, metabolic disorders, hypoxia and dystrophic changes in organs and tissues.
Signs of vasculitis are observed from the first days of the disease, from the 6-8th day specific granulomas form. The phase of destructive-proliferative changes begins - the fourth phase of pathogenesis. Conventionally, it can be divided into two - thrombosis and general proliferative. Damage vascular wall leads to platelet aggregation and fibrin deposition in the affected areas of the vessels.
This period is characterized by the formation of warty thromboendovasculitis, i.e. the occurrence of parietal cone-shaped thrombi. Proliferative processes occur around the base of thrombi.
Proliferative formations (Popov's granulomas) are compact, resembling nodules. Granulomas occur in most organs and tissues. Especially a lot of them in the brain, where proliferative processes occur with the participation of neuroglial cells, so they are called gliogranulomatosis. Changes in the nervous system render typhus the nature of meningoencephalomyelitis. A significant number of Popov's granulomas also appear in the pituitary gland, adrenal glands, kidneys, gonads and other organs. AT spinal cord few of these elements.
Granulomas also appear in peripheral nerve structures. Damage to the vessels leads to a sharp headache, mental disorders, symptoms of damage to the nuclei cranial nerves, disorders of the heart, a tendency to collapse and others clinical manifestations illness.

The tension of the humoral and cellular immunity, convalescence occurs (the fifth phase of pathogenesis). Recovery is possible, in which the defective immunity leads to the persistence of rickettsia in the body. This creates the possibility of a relapse - Brill's disease. The presence of the pathogen in the blood during the endogenous development of the disease indicates the existence of a chronic carriage of rickettsia, which is sometimes considered as a latent infection. However, it is not possible to detect Provachek's rickettsiae in the body of a healthy person.
A hypothesis has been put forward, according to which rickettsia under the influence of immunity factors long time may be in the visual state (ultrastructures).
Pathological changes in the case of epidemic typhus should be characterized as a universal infectious acute vasculitis, the elementary form of which, according to I.V.
Davydovsky, is a verrucous thromboendovasculitis. Specific vascular lesions consist of cell wall destruction, thrombus formation, and liferative processes. The latter are mainly due to endothelial cells, the inner lining of blood vessels, plasma cells, fibroblasts. Proliferative processes around the vessels with the formation of cellular infiltrates (couplings) are characterized as perivasculitis, and damage to all layers of the vascular wall that cause necrosis and obstruction is described as destructive thrombovasculitis.
Pathomorphologically, in the first days of the disease, signs of universal acute vasculitis and angioparalytic manifestations are revealed, which cause significant hemodynamic “disturbances, especially in the central nervous system. There are usually no specific granulomas at this time. In the second week of the disease, thrombosis and granulomas already appear. a large number of granulomas in small and large vessels, dystrophic changes in various organs and tissues, parenchymal-interstitial myocarditis, pneumonia of various morphological types. Reverse changes often begin from the third week of illness.

Clinic for typhus

Initial period

period of illness

The appearance of a rash indicates the end of the initial period of the disease. At this time, the fever in most cases reaches its highest level.
The temperature curve is so typical that, according to L. V. Gromashevsky, it often allows a retrospective diagnosis. There are several variants of the temperature curve characteristic of typhus. More often, body temperature reaches 39-41 ° C within 2-3 days and is maintained at this level for 8-14 days, daily fluctuations do not exceed 0.7-0.8 ° C (febris continua).
Against this background, there are separate, significant fluctuations in temperature: its decrease on the 3-4th day of illness before the rash and on the 8-10th day 3-4 days before the fever stops. These temperature "cuts," as Rosenberg noted, seem to divide the temperature curve into sections averaging 4 days each. In the case of mild or moderate typhus, body temperature fluctuates significantly (febris remiltens). More often, fever, regardless of the type of temperature curve, lasts 14-16 days, although it can be delayed, especially with complications, up to 25-30 days. Fever usually ends with shortened lysis (within 3-4 days), sometimes critically.

characteristic feature typhus is exanthema, roseolous-petechial rash appears in almost 90% of patients on the 4-5th day of illness. On the first day, the rash is predominantly roseolous, sometimes with a bluish tinge, polymorphic, there are only individual petechiae. A significant number of petechiae already at the beginning of the disease indicates its severe course. However, already on the second day, the rash acquires a typical roseolous-petechial character, and since then hemorrhagic signs have prevailed. The rash first appears under the collarbones, on the inner surface of the shoulders, under the arm, then spreads to the lateral surfaces chest, back. The stomach, buttocks are less affected. A rash appears on the face only in severe cases. It also covers the soles, palms, the rash is completed in a few hours, although this process can last 2-3 days.
Due to the hemorrhagic nature of the rash, it changes color (“blooms”) in the process of development, like bruises. This is due to the conversion of methemoglobin to hematin, biliverdip and bilirubin. Separate elements of the rash, especially roseolous, except for different sizes and shapes on different stages transformations differ in color, the skin gives the impression of dirty. In very severe cases of the disease, along with small elements (petechiae), large hemorrhages appear. From the 11th day of illness, the rash becomes pale and gradually disappears. In severe cases, it can be stored longer, even up to the 15-16th day of illness. After the rash, pigmentation remains for a while.
During the peak of the disease, all clinical manifestations intensify, new signs appear. If in the initial period there are no significant mental disorders, then they may appear more often on the 5-8th day of illness. Headache, which at the beginning of the disease is almost the main clinical sign and entails the greatest suffering for the patient, at the height of the disease, with the appearance of new symptoms, seems to fade into the background. (Consciousness is disturbed, delusions, various illusions may occur, in severe cases - si an depersonalization. Particular delirium is observed in people who abuse alcoholic beverages. At the end of a fever, delirium often has the character of megalomania. Mental disorders associated with encephalitis. Signs of encephalitis are also bulbar disorders caused by Tliagranulomatosis. On the 7-8th day of illness, most patients show dysarthria and dysphagia of varying degrees. Quite frequent during this period is the loss of hearing due to lesions auditory nerve. Dizziness and nausea testify to lesions of the cerebellum. There are signs of Kernig, Brudzinsky, stiff neck. The number of cells in the cerebrospinal fluid ranges from 40 to 1500 per 1 µl, lymphocytes predominate. The pressure of the cerebrospinal fluid is increased, sometimes it is possible to detect rickettsia in it.
If the course of the disease is mild, there are no mental disorders, but almost always there are signs of damage to the nervous system in the form of excitement or euphoria, headache, sleep disturbance, weakness. In the case of severe and moderate course, neuralgia, neuritis, plexitis are possible. During the period of convalescence, they disappear, however, neuritis of the auditory and trigeminal nerves may be stored for several months.
Due to vascular damage from the first days of the disease, arterial hypotension is observed, which becomes more significant at the height of the disease, when collapse is possible. The collapse is often preceded by a rapid, within an hour or a day, decrease in body temperature (Segal's symptom). As a compensatory reaction to hypotension, tachycardia develops. In the case of a severe course of the disease, the pulse rate is ahead of the fever level. According to ECG, epidemic typhus is characterized by diffuse dystrophic changes in the myocardium. A characteristic sign of injury respiratory system is shortness of breath, various respiratory disorders are possible.
Hepagosplenomegaly appears at the beginning of the disease, at the height of it jaundice sometimes occurs. Quite often there is constipation, less often diarrhea. From the 4-6th day of illness, diuresis may decrease, the relative density of urine increases. Sometimes there is a clinic of acute nephritis.
On the part of the blood at the onset of the disease, moderate neutrophilic leukocytosis, monocytosis, thrombocytopenia, Turk cells are detected, ESR increases. In the stage of convalescence, lymphocytosis occurs. With the cessation of fever, a period of convalescence begins. In the first days of normal body temperature, the patients are drowsy, lethargic, adynamic. Hyperemia decreases, but still persists. The rash turns pale and gradually disappears. Due to the violation of tissue trophism, brittle nails and hair loss are observed. A groove appears on the nails, which delimits the old part of the nail from the new one that has grown during the illness - a symptom of Botkin.

Efficiency is restored very slowly, within a few months. For a long time memory suffers.

Prognosis of typhus and Brill's disease

Complications of typhus and Brill's disease

Clinical course of Brill's disease

Diagnosis of typhus and Brill's disease

It is considered timely to identify the patient no later than the 4th day of the disease. Isolation of the patient and disinfestation at this time prevents the spread of infection, so lice become infectious for people on the 4th-5th day of infection.

Supporting symptoms clinical diagnostics the initial period of typhus before the onset of a rash is an acute onset with fever, headache, characteristic behavior (excitation, euphoria), a typical appearance of the patient, persistent hyperemia and puffiness of the face, red eyes with a characteristic brilliance, (“drunk face and rabbit eyes”), symptoms of Zorohovich-Chiari, Rosenberg, Kotlyarenko, Govorov-Godelier, Dicha, Bettiger. The presence of a typical polymorphic roseolous-petechial rash from the 4-5th day of illness, symptoms of damage to the nervous system facilitate the diagnosis.
Diagnosis involves taking into account epidemiological data (the presence of patients with typhus, lice). To identify Brill's disease, they have information about the epidemic typhus suffered in the past.
Specific Diagnosis carried out with the help serological reactions. Historically, the agglutination reaction developed by Weil and Felix was the first to use the agglutination reaction of the Proteus vulgaris strain OX-19. In most patients, the reaction becomes positive from the 12-13th day of illness. With Brill's disease, it is positive only in 50% of patients, which is why the reaction has lost its significance.
To specific methods laboratory diagnostics belong to RSK, RIGA, agglutination reaction with Provachek's rickettsiae (PAP, Weigl's reaction). RSK is also used to identify those who have recovered from typhus, because antibodies are detected throughout life (diagnostic titer of anamnestic antibodies is 1:10). In patients with typhus, the reaction becomes positive from the 5-6th day; diagnostic titer 1: 160. Therefore positive result reactions in the first days of the disease almost excludes the possibility of a primary disease, i.e. indicative of Brill's disease. Diagnosis of this disease is also possible by determining the class of immunoglobulins, which includes antibodies against Provachek's rickettsiae. If they belong to class M immunoglobulins, this indicates a primary disease, and if they belong to class G immunoglobulins, it indicates Brill's disease. The Weigl reaction or PAP becomes positive from the 5-7th day of illness, from the 15th day in 100% of patients; diagnostic titer 1: 40-1: 80. More sensitive is RIGA, which becomes positive from the 3-4th day; the diagnostic titer is 1:1000, during the course of the disease it reaches 1:4000 - 1:64,000. For all reactions, an increase in antibody titer in the course of the disease (paired sera method) has a diagnostic value.

Differential diagnosis of typhus and Brill's disease

Treatment of typhus and Brill's disease

Prevention of typhus and Brill's disease

Typhus is a disease that is caused by an infection such as Rickettsia Prowaceca. The main symptom is a pronounced fever and intoxication of the whole organism. Particularly severe damage to the vessels and the central nervous system. An infectious disease appears mainly in developing countries during periods of social instability or natural disasters. At these moments, the lice of the population begins to rapidly gain momentum, provoking epidemic typhus.

The causative agent of typhus is Rickettsia Provaceca, which is a specific bacterium that forms a specialized group.

Scientists have found that Rickettsia prowazekii can die at 56 degrees for 10 minutes, and at 100 for half a minute. In the biological waste of lice, the virus persists for up to 3 months.

The transmission mechanism looks very simple. After a sick person is bitten by a louse, after 5-7 days it will also become an infectious individual. The infection enters the body of a healthy person through rubbing the biological waste of sick insects into the skin.

A person does not notice this process, because the bitten place is very itchy, and he just starts scratching it quickly. There is another way of infection - inhalation of lice excrement along with dust. But it is much less common.

After a person has been ill with typhus, a high susceptibility to it is formed in his body. Strong immunity develops. In some cases, there is an observation of repeated pathogenesis of typhus. In medicine, it is known as the Brill-Zinsser disease.

Classification of the disease and the first symptoms

The incubation period of an infectious disease is considered to be a period of 6 to 25 days. But usually in most cases after 14 days it becomes clear that a person has become infected. The clinic has a cyclical nature and is divided into the following periods:

• elementary;
• height;
• convalescence.

Symptoms of typhus in the initial period are characterized by high temperature, which is accompanied by a feeling of aching in the muscles. A person has severe pain and the first signs of poisoning of the body. In some cases, even before the appearance of the first obvious symptoms, insomnia occurs in a person, and working capacity decreases.

Further, the patient constantly begins to fever, and the temperature does not fall below 39–40 degrees and stays within these limits. On the 4-5th day there is a slight decrease, but general state it doesn't get better. After, the signs of intoxication only increase.

Added:

• increased headaches;
• dizziness;

• insomnia;
• vomiting may occur, the tongue becomes dry and covered with a white coating.

All this is accompanied by a disorder of consciousness.

The clinic of the disease at this stage during a visual examination is as follows:

• hyperemia and edema skin in the face and neck;
• conjunctiva;
• the skin becomes dry and hot to the touch.

Such symptoms occur due to the fact that the vessels become very fragile and lose their elasticity.

Symptoms at the height of the disease

A rash with typhus appears in the next period of the development of the disease, which is called the peak. This happens for 5-6 days. Rashes that appear during the peak period are called exanthema.

Enanthema is also characteristic in this case. All the symptoms of the initial period not only persist, but continue to worsen. Headaches are especially strongly perceived, which become pulsating in nature.

The etiology of typhus during this period is observed on the body of a sick person and on his limbs. The plaque on the tongue becomes dark brown. The patient has severe constipation and bloating.

During the peak of the disease in humans, the following deviations are observed:

• tremor of the tongue;
• wrong speech;
• mime disorder.

In some cases, psychological disorders, hallucinations or forgetfulness are noted.

During the period of convalescence, a decrease in body temperature can be noted. That is, after about 2 weeks, it comes to the usual limits. The symptoms of intoxication disappear. The person is slowly starting to get better. Some symptoms will still persist for 3 weeks, but become weaker every day. It can be attributed to weakness, apathy, memory impairment.

Methods for diagnosing an infection

In order to correctly establish the reason for the appearance of infectious diseases in the human body, it is necessary to donate blood and urine for analysis. When diagnosing typhus, the results of these tests can accurately determine the signs of a bacterial infection and the stage of intoxication of the body.

The clinic will be as accurate as possible if you analyze the reaction of indirect hemolytic agglutination, or RNGA for short. This method will allow you to find out almost all the information about the causative agent of typhus.

Doctors may also prescribe an indirect immunofluorescence reaction method, or RNIF for short. To date, it is considered the simplest and most inexpensive way to correctly diagnose an infection - the pathogen is very sensitive to it. Therefore, the risk of misdiagnosis is reduced.

Treatment Methods

If the epidemiology of the disease is suspicious, the person should be immediately placed in the hospital. First of all, he must observe bed rest until the temperature returns to normal and for 5 days after stabilization.

Typhoid patients can begin to get out of bed only a week after the retreat of the symptoms of fever. If you do not follow the instructions of bed rest, then various deviations and complications may develop. Therefore, the treatment of typhus is very long and painstaking.

Patients need very careful care from loved ones. They will help carry out hygiene procedures, engage in the prevention of bedsores and stomatitis.

Tick-borne typhus does not require the patient to follow a strict diet or special diet. Patients eat normally.

Relapsing fever is treated with antibiotics of the following groups:

• tetracyclines;
• chloramphenicols.

After starting to use these medications, in many patients, a positive result appeared as early as 2-3 days. Epidemiology suggests a course of drug use not only for the entire period of severe fever in the patient, but also 2 days after the temperature stabilizes. To relieve the effects of intoxication, detoxification solutions are prescribed intravenously.

After a person is admitted to the hospital, in addition to the attending physician, the sick person is observed by a neurologist and a cardiologist.

To ensure the full treatment of the patient, several doctors examine

To minimize the risk of complications.

All other drugs (painkillers, sleeping pills or sedatives) are prescribed according to individual need and corresponding symptoms.

The patient is discharged from the medical institution on the 12th day after the body temperature returns to normal and in the absence of other symptoms or complaints.

Disease prevention

To date, modern medications cope with the disease at 100%. The only exceptions are those cases in which assistance was provided late. Such cases are rare and occur through the fault of the patient himself, who did not call an ambulance.

Prevention of typhus should primarily be aimed at eliminating pediculosis, as well as timely and thorough treatment of infected premises. Sanitary and epidemiological control should be attentive to the procedures for disinfestation not only of housing, but also of personal belongings of typhoid patients.

Special attention should be paid to people who have come into close and close contact with carriers of typhus. As well as those who live in unsanitary conditions. Prevention usually consists of vaccination.

Vaccination is a highly effective way to protect your health

Consequences of the disease

by the most dangerous complication typhus becomes an infectious-toxic shock - a person can get it at the very peak of the disease. That is, it occurs 4-5 or 10-12 days after the start.

During this period, relapsing fever seems to recede and the patient has a short-term decrease in temperature (due to the development of acute cardiovascular insufficiency). Therefore, a person can experience myocarditis, thrombosis and thromboembolism.

In addition, malfunctions can occur in the work of the nervous system, as a result of which meningitis, meningoencephalitis can develop. During periods of incubation, an additional infection occurs and a person develops pneumonia, furunculosis, thrombophlebitis.

If the patient is not properly cared for, then during a long and strict bed rest, he will develop bedsores. Since the vessels are affected, there is a high risk of developing gangrene on the limbs.

To avoid such serious consequences, it is necessary to apply for medical care and follow all doctor's instructions.

also known as classic, European, or louse typhus, ship fever, or prison fever, caused by Provacek's rickettsiae, Rickettsia prowazekii(named after the Czech scientist who described them). Initially, typhus was an Old World disease. The first surviving descriptions of it were made in Germany in the 16th century. In the history of wars, typhus has often been a decisive factor: the number of victims of this disease often exceeded the losses in battles, as, for example, in the Thirty Years' War, during Napoleon's invasion of Russia, in the Crimean War, in the First World War. In post-revolutionary Russia between 1917 and 1921, about 3 million people died of typhus.

The fact that epidemics of typhus occur more often during the cold season and during periods of hostilities, when “lice” increases and large groups of people live in crowded conditions in conditions unsuitable for habitation, suggested that lice are carriers of the disease. In 1909, Sh. Nicol proved that the carrier of the causative agent of typhus from person to person is the body louse, Pediculus humanus corporis. The head louse can also transmit typhus, the pubic louse is extremely rare. The role of animals as a reservoir of infection has not been established. Between epidemics, the infection is maintained in a dormant state among people who are chronic carriers of pathogenic rickettsiae. Episodic cases of an infection called Brill's disease (a mild form of typhus) occasionally occur in the eastern United States.

A louse that has bitten a patient with typhus or a chronic carrier of rickettsia becomes contagious and can spread the infection, as happens during epidemics. Typhoid rickettsiae multiply in intestinal tract louse, which dies after about 12 days. The bite of an infected louse does not directly cause disease; infection occurs when combing, i.e. rubbing into the bite site of the intestinal secretions of the louse, rich in rickettsia. The incubation period for typhus is 10-14 days. The onset of the disease is sudden and is characterized by chills, fever, persistent headache, and back pain. A few days later, a mottled pink rash appears on the skin, first in the abdomen. The patient's consciousness is inhibited (up to a coma), the patients are disoriented in time and space, their speech is hasty and incoherent. The temperature is constantly raised to 40°C and drops sharply after about two weeks. During severe epidemics, up to half of the sick can die. Laboratory tests (complement fixation test and Weil-Felix test) become positive in the second week of illness.

Prevention measures include immunization with typhoid vaccine and the destruction of carriers - lice (disinsection). During World War II, the effectiveness of the killed vaccine (Cox vaccine) was confirmed by the results of large-scale immunization of American military personnel. The vaccine was prepared from inactivated rickettsia grown in yolk sac chicken embryos. The use of insecticides to kill lice also proved to be effective.

Timely treatment with tetracycline antibiotics (aureomycin, terramycin) and chloramphenicol (also known as chloramphenicol) in the required dosage greatly facilitates the course of the disease. Symptomatic agents are also used. Importance has patient care.

endemic typhus

(rat, flea, or American typhus) is caused by rickettsia R. mooseri. About 40 cases are reported in the United States every year. It is found in regions with a relatively warm climate in both hemispheres, predominantly in summer and mainly among rural residents; is milder than epidemic typhus. It is a disease mainly of rats, which is transmitted to humans by the bite of rat fleas. Therefore, the fight against rats is extremely important as a preventive measure. see also