Prevention and hospital regimen
The primary measure upon admission is a mandatory check for pediculosis based on clinical and epidemiological indications. Prevention of infection spread consists in identifying and destroying lice (body or head lice) through disinsection.
Important fact: after the elimination of pediculosis, the patient ceases to be epidemiologically dangerous and can continue treatment in a general ward.
Medical staff must carefully monitor the patient's mental status. There is a high risk of developing a delirious state, in which the patient may become a danger to themselves and others.
Etiotropic therapy
The basis of treatment is antibiotics that suppress the reproduction of *Rickettsia prowazekii*. The drugs are prescribed orally, or parenterally if swallowing is impossible.
- Drugs of choice (tetracyclines): Tetracycline or oxytetracycline is prescribed at 0.3–0.4 g 4 times a day. Doxycycline at 0.1 g 2 times a day.
- Alternative therapy: In case of intolerance to tetracyclines, chloramphenicol is used at 0.5 g 4 times a day.
- Duration of the course: Antibiotics must be taken up to and including the 2nd day from the moment of normalization of body temperature (apyrexia).
In in vitro experiments, rifampicin, ciprofloxacin, pefloxacin (cefloxacin), and sparfloxacin also demonstrate high activity against the pathogen. If a secondary bacterial infection joins (e.g., pneumonia or thrombophlebitis develops), additional antibiotics are prescribed taking into account the etiology of the complication.
Pathogenetic treatment and management of complications
In addition to eliminating the pathogen, it is critically important to compensate for disorders caused by intoxication and vascular damage. Basic therapy includes detoxification, antipyretics, analgesics, antiplatelet agents, and, if necessary, anticoagulants.
Specific measures:
- Vitamin therapy: Vitamins with vascular-strengthening effects (groups C, B, P) must be prescribed in sufficient dosages.
- Cardiovascular failure: To support hemodynamics, sympathomimetics (ephedrine, mesaton, norepinephrine, dopamine) are administered. The risk of developing collapse is especially high on days 5–7 of the disease.
- Infectious-toxic shock (ITS): Short courses of glucocorticosteroids (prednisolone, dexamethasone) are used.
- Delirium and agitation: Sedative therapy is prescribed (bromides, barbiturates, aminazine, haloperidol, sodium oxybutyrate). In severe cases, paradoxical ischuria (ishuria paradoxa) is possible, which requires additional monitoring of diuresis.
Nursing care, discharge timelines, and follow-up (dispensary care)
The patient requires regular fortified nutrition and thorough skin care to prevent pressure ulcers.
Recovery requires strict control of physical activity. The patient must observe strict bed rest until the 7th day of apyrexia. Getting out of bed and walking is allowed only from the 9th day of normal temperature. Discharge from the hospital is possible no earlier than the 12th–14th day of apyrexia.
Convalescence period: Clinical recovery occurs faster than tissue functions are restored. Patients almost always develop asthenic syndrome (headaches, insomnia, emotional lability, hypochondria, memory impairment). After discharge, long-term follow-up by the district therapist is required, as well as consultations with a cardiologist and neurologist.
Restrictions: Within 1 year after suffering typhus, patients are not recommended to perform work that requires constant attention, night shifts, or high strain (e.g., working as a train driver).
Briefly: answers to topical questions
What specific laboratory diagnostic methods are used to confirm epidemic typhus?
Serological and immunological methods are used to confirm epidemic typhus.
- Serological studies (performed in paired sera to record the rise in the titer of specific antibodies):
- IHA (indirect hemagglutination assay) — detection of antibodies is possible from days 5–7 of fever. Diagnostic titer is 1:1000.
- CF (complement fixation test) — detection of antibodies from days 7–9. Diagnostic titer is 1:160.
- MA (microagglutination test / agglutination test) with *Rickettsia prowazekii* — specific, agglutinins are detected from days 5–7, diagnostic titer is 1:200.
- Immunological studies:
- IFA / IIF (indirect immunofluorescence assay) — detection of rickettsial antigens.
- ELISA (enzyme-linked immunosorbent assay) — detection of rickettsial antigens.
What complications from the central and peripheral nervous system are characteristic of typhus, besides delirium?
Epidemic typhus is characterized by nervous system damage in the form of typhus meningoencephalitis.
- Mental disorders: productive psychoses, delusional ideas of persecution and guilt, sensory synthesis disorders: depersonalization, "double delusion", disturbance of body schema and its alienation, sensation of flying or falling from a height.
- Neurological and sensory disorders: pain along the neurovascular bundles, skin hyperesthesia, hyperacusis, photophobia.
- Motor disorders: limb tremor, general tremor, tongue tremor, convulsive syndrome, swallowing disorders, dysarthria.
- Meningoencephalitic manifestations: meningeal symptom complex combined with focal symptoms, nuchal rigidity.
- Other neurological signs: positive Govorov-Godelier sign.
- Highest manifestation of neurological disorders: coma vigile — complete immobility of the patient with preserved consciousness; the outcome of this condition is usually death.
The rule of timelines after temperature drop (apyrexia) "2–7–9–12": 2 days — continue giving antibiotics; 7 days — observe strict bed rest; 9 days — allow the patient to walk; 12–14 days — process the discharge.
Class and exam questions
Is the patient dangerous to others in the ward?
After detecting pediculosis and carrying out high-quality disinsection, the patient becomes epidemiologically safe and can be treated in a general ward.
How to distinguish primary typhus from Brill-Zinsser disease?
Brill-Zinsser disease is an endogenous relapse that occurs without pediculosis in people who have had typhus years ago. Serologically, in primary typhus, IgM is detected on days 5–7, while in relapse, high titers of IgG are determined from the first days.
Which days of the illness are considered the most critical?
The most dangerous period is days 5–7 of the disease. At this time, the risk of sudden acute cardiovascular failure (collapse) and the development of psychomotor agitation (delirium) is maximally high.
Is the patient allowed to get out of bed when they feel better?
No, the physical activity regimen is expanded strictly according to the days of apyrexia (normal temperature). Getting up and walking is allowed only from the 9th day without fever.
What else to study on this topic
- Clinical picture: "hood", "rabbit eyes", and Rosenber's symptoms
- Specific typhus exanthem and endothelial symptoms
- Differential diagnosis with meningococcal infection and leptospirosis
- Pathogenesis of typhus meningoencephalitis
- Serological diagnosis: rules for collecting paired sera for IHA and CF tests
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