TYPE TYPE - an infectious disease characterized by a cyclical course, fever, severe intoxication, roseola-petechial rash, damage to the vascular and central nervous systems. It is currently registered in developing countries, in Russia - rarely. The causative agent is Rickettsia Provacheka - an immobile gram-negative intracellular parasite. Rickettsia is stored for a long time in the environment in a dried state, on underwear and bedding, in the feces of lice.
The source of the causative agent of infection is only a sick person who is infected during the last 2–3 days of the incubation period, the entire febrile period, and up to 2–7 days of normal temperature. The carrier of the causative agent of the infection is a louse, mainly clothes. Lice become infected by sucking the blood of a patient with typhus fever and become infectious on the 5-6th day. Rickettsia Provacheka, lice that enter the body, along with blood penetrate into the epithelial cells of the intestinal wall, where they multiply and enter the intestinal lumen. When blood sucking on a person, lice defecate, along with feces a large amount of rickettsia is secreted. At the site of the bite, itching occurs, a person combes the skin and rubs lice feces containing the pathogen into it.
The clinical picture . The incubation period is 5 to 25 days. The disease usually begins acutely: within 2-4 days, body temperature rises to 39 - 40 ° C, there is fever, weakness, dizziness and headache , insomnia, pain throughout the body, loss of appetite. The total duration of the febrile period is 12-14 days. There is hyperemia of the face, conjunctiva, skin of the neck and upper body, puffiness of the face (the type of person who left the steam room). The skin feels hot and dry. On the 3-4th day of illness on the transitional folds of the conjunctiva, one can find characteristic point spots of red or dark red color with a cyanotic hue with a diameter of 0.1-1.5 mm (Chiari-Avtsyn symptom). The same formations are possible on the mucous membrane of the soft palate, as well as at the root of the tongue. The symptoms of a tourniquet and a pinch become positive. Herpetic eruptions on the lips and wings of the nose may be noted. The tongue is dry, covered with a dirty gray coating, constipation is observed. From the 3rd to 4th day the spleen usually enlarges, later - the liver. Euphoria and arousal appear, delusions are possible, less often - a state of inhibition, tremor of hands, tongue, head. When you try to stick out your tongue, its jerky movements are noted - a Govorov-Godelier symptom. Often, meningeal syndrome is detected. On the 4th – 6th day, one of the most important clinical signs appears - rose-petechial rash. Its typical localization is on the lateral surfaces of the trunk, flexion surfaces of the arms, back, and inner thighs. Elements of the rash are in a “blooming” state (pink, bright red or somewhat cyanotic) for 3 to 5 days, after which they begin to fade and gradually disappear after 7-10 days. The dimensions of the rash elements are from 1 to 3 mm in diameter, their edges are uneven. Repeated rashes are not observed. At the height of the disease, a drop in vascular tone is possible, up to a collapse. Tachycardia , muffled heart sounds, shortness of breath are almost always noted. Mild neutrophilic leukocytosis is detected in the blood . Recovery is characterized by a decrease in temperature from the 9-11th day of illness for 2-3 days in the form of accelerated lysis to normal.
Complications occur with late and insufficiently effective treatment. These include pneumonia , which occurs in any period due to the activation of secondary microflora; encephalitis and meningoencephalitis (including purulent), psychosis, myocarditis , collapse , thrombophlebitis , thromboembolism, trophic ulcers and pressure sores.
The diagnosis is based on the clinical picture, the data of the epidemiological history (stay 1-3 weeks before the development of the disease in unfavorable sanitary conditions, the presence of head lice), the results of laboratory tests. Specific serological reactions are used: agglutination with rickettsia Provacheka, indirect hemagglutination (RNGA), complement fixation. These reactions become positive on the 3-5th day of illness in most patients with typhus.
Treatment . The patient is hospitalized, transportation is carried out on a stretcher, accompanied by a medical professional. Antibiotics of the tetracycline or chloramphenicol group are used until the 2nd day of normalizing the temperature, cardiovascular agents (cordiamine, caffeine or ephedrine, cardiac glycosides), as well as sleeping pills, tranquilizers when patients are excited. With severe headache and high temperature, cold on the head, antipyretic drugs are indicated. With severe intoxication, 5% glucose solution, polyionic solutions, hemodesis, reopoliglukin are administered intravenously.
A patient with typhus should be under the special supervision of medical personnel, as he may suddenly become very agitated, delirious , he can jump out of bed, run, jump out of the window. Perhaps the development of collapse. More often these manifestations occur at night, and during this period special attention is required to the patient. The nurse should often enter the ward, air it, monitor the pulse and blood pressure of the patient. Prescribe patients after clinical recovery, but not earlier than on the 12-14th day of normalization of temperature. Immunity in typhus is non-sterile, the pathogen can persist in the lymphatic system for many years, and with a decrease in immunity, Brill's disease can develop - repeated (recurrent) typhus, which is characterized by a benign course of the disease, however, in patients with pediculosis, Brill's disease can be source of the causative agent of infection for others.
The prognosis is usually favorable.
Prevention includes early detection, isolation and hospitalization of the patient, as well as the fight against pediculosis. According to epidemic indications, regular pediculosis examinations of children are carried out in preschool institutions, schools, patients entering medical institutions, as well as other population groups. If pediculosis is detected, sanitization is carried out. A patient who was admitted to the isolation ward or hospital with typhus or suspected of typhus, as well as persons who were in contact with the patient, are subjected to complete sanitation. At the same time, disinsection of the premises where the patient lived, clothes and bedding is carried out. Contact persons are subject to medical supervision.
In the village where there are cases of typhus, a pediculosis screening system is introduced with mandatory sanitation of all members of the family in which pediculosis is found. Persons whose temperature is elevated are isolated and hospitalized. When there are repeated cases of typhus, the presence of head lice among the population, repeated full sanitation is performed in the outbreak. For the specific prevention of typhus, typhus vaccine is used; vaccination - according to epidemic indications. Vaccinations are also shown for medical personnel working in the event of typhus epidemics. Vaccinated persons aged 16 to 60 years.