Typhus - an infectious disease characterized by cyclical passage, fever, severe intoxication, roseolous-petechial rash, lesions of the vascular and central nervous systems. Currently registered in the territory of developing countries, in Russia - is rare. Pathogen - R. prowazeki - fixed gram intracellular parasite. Rickettsia long persist in the environment in a dried state, to underwear and bed linen, in the feces of lice.
The source of the infectious agent is only sick people who become infected during the last 2 - 3 days incubation period, all the febrile period and up to 2 - 7-day normal temperature. The carrier of the infectious agent - a louse, mostly wardrobe. Lice infected sucking the blood of the patient with typhus and becomes contagious for 5 -6 Day. R. prowazeki, trapped in the body louse, together with the blood penetrate the epithelial cells of the intestinal wall, which multiply and go in the intestinal lumen. When sucking blood from human head lice occur defecation, together with a large amount of faeces rickettsiae. On the site of the bite occurs itching, a person brushing the skin and rub it lice feces containing the parasite.
The clinical picture. The incubation period - 5 - 25 days. The disease usually begins acutely: within 2-4 days, the body temperature rises to 39 - 40 ° C, marked fever, fatigue, dizziness and headache , insomnia, body aches, loss of appetite. The total duration of febrile period of 12-14 days. Observed hyperemia of conjunctiva, the skin of the neck and upper body, puffiness of the face (of a man emerging from the steam room). The skin feels hot and dry. At 3 to 4-day sickness transient conjunctival folds can detect the characteristic point spots of red or dark red color with a cyanotic shade diameter of 0.1 - 1.5 mm (Chiari -Avtsyna symptom). The same opportunities for education on the mucous membrane of the soft palate, as well as at the root of the tongue. Becomes positive symptoms and pinch the harness. May include the cold sores on the lips and nose wings. Tongue dry, lined with dirty-gray bloom, there are locks . From 3 to 4-day spleen usually increases, and later - the liver. There are euphoria and excitement possible delirium , at least - the state of lethargy, tremors of hands, tongue, head. When you try to stick his tongue marked his jerky movements - a symptom Govorov-Godelier. Often reveals meningeal syndrome. On 4 -6 day, there is one of the most important clinical signs - roseolous-petechial rash. Typical its location - on the sides of the trunk, flexor surfaces of the hands, back, inner thighs. 5 days and then begin to fade, and after 7-10 days fade - during the 3 elements of rash are in a state of "blooming" (pink, bright red, or cyanotic several coloring). Dimensions elements of an eruption from 1 to 3 mm in diameter, their edges ragged. Repeated eruptions are not observed. At the height of the disease may fall vascular tone up to the collapse. Almost always marked tachycardia , muffled heart sounds, shortness of breath . Blood results show moderate neutrophilic leukocytosis . Recovery is characterized by a decrease in temperature with 9- 11 th day of the disease within 2-3 days of rapid lysis to normal.
Complications occur in late and insufficiently effective treatment. These include pneumonia , which occurs in any period as a result of activation of secondary microflora; encephalitis and meningoencephalitis (including abscess), psychosis, myocarditis , collapse , thrombophlebitis , thromboembolism, trophic ulcers and bed sores.
Diagnosis is based on clinical, epidemiological history data (stay for 1-3 weeks before the onset of the disease in unfavorable sanitary conditions, the presence of head lice), the results of laboratory tests. Use specific serological tests: agglutination R. prowazeki, indirect hemagglutination (IHA), complement fixation. These reactions become positive in the 3 -5 th day of the disease in most patients with typhus.
Treatment. The patient was hospitalized, transportation is carried out on a stretcher accompanied by a health worker. Apply antibiotic tetracycline or chloramphenicol to 2-day temperature normalization, cardiovascular agents (kordiamin, caffeine or ephedrine, cardiac glycosides), as well as the initiation of patient hypnotics, tranquillizers. When a severe headache and high temperature are shown on the head cold, antipyretics. In severe intoxication administered intravenously 5% glucose solution, polyionic solutions gemodez, reopoligljukin.
Typhus patient must be under special medical supervision, since it has a strong excitation can appear suddenly, light-headedness , he can jump out of bed, run, jump out the window. Perhaps the collapse of development. Most of these symptoms occur at night, and during this period requires special attention to the patient. The nurse must often go to the House, airing it, follow the pulse and blood pressure of the patient. Write out recover after clinical recovery, but not earlier than 12 -14 day temperature normalization. Immunity in typhus non-sterile, pathogen can persist in the lymphatic system, for many years, and with a decrease in intensity of immunity may develop Brill disease - repeated (recurrent) typhus, which is characterized by a benign course of the disease, however, in the presence of lice disease patients Brill can be the source of infection of the pathogen to others.
Prognosis is usually favorable.
Prevention includes early detection, isolation and hospitalization of the patient, as well as the fight against head lice. According to epidemic indications conduct regular inspections on pediculosis children in preschool institutions, schools, patients admitted to hospitals and other groups. If you find lice carry out sanitization. Patients admitted to the detention center or hospital with typhus or suspected of it, as well as persons who were in contact with the patient undergo a complete sanitation. Simultaneously held disinfestation of premises, where he lived ill, clothing and bedding. For contact persons established medical supervision.
In the village, where there are cases of typhus, introduced inspection system with mandatory pediculosis sanitation of all family members, which detected lice. Persons whose temperature is raised, isolated and hospitalized. When the repeated cases of typhus, the presence of head lice among the population spend a full re-sanitize the hearth. For specific prevention of typhus typhus vaccine use; Vaccination - on epidemic indications. Also shown are vaccinated healthcare personnel working in the conditions of epidemic typhus. Vaccinate people aged 16 to 60 years.