Tuesday, November 20, 2012

Breakout lousy (epidemic) typhus

Pathogen - spirochete Borrelia recurrentis, a carrier of infection - the wardrobe, and sometimes head lice.
Symptoms. The disease begins with a sudden rise in body temperature, a stunning chills, headache, and sometimes vomiting. Many patients have severe pain in the calf muscles, lumbar region, in the left upper quadrant.


Temperature quickly rises to 40 ° C (sometimes higher), for 5-7 days is held at this level, then just as quickly when sweating is reduced to normal levels. After the first attack within 7-8 days have normal temperature, then developed a new attack, which is accompanied by the same phenomena as the first.
However, the duration of febrile period is reduced to 3-5 days. Sometimes a second attack is more severe first.
After the second attack of 8-12 days can develop third episode lasting 1-2 days. Usually occurs 2 to start, much less - 3, but can be and 4-6 attacks. On examination, the patient experiences jaundice of the skin and sclera. In patients with significantly enlarged and indurated spleen, enlarged liver, tongue coated, dry, pronounced tachycardia (heart rate to 140-150 per minute).
Differential diagnosis. Crucial in the differential diagnosis is the detection of spirochetes in the blood Obermeyer (dark field), in a thick drop or a blood smear stained by Romanovsky - Giemsa. In a typical pattern, especially if you have multiple attacks, the diagnosis is not difficult, as relapsing fever is highly characteristic for relapsing fever.
At the first attack of relapsing fever of lousy differentiate typhoid typhus, tick-borne relapsing fever, leptospirosis, malaria, lobar pneumonia, influenza, meningococcemia, meningococcal meningitis, Omsk hemorrhagic fever, pappatachi.
Emergency. Provide the patient at rest, during chill wrap up warm, drink plenty of give. When hyperthermia is placed on the head cold, antipyretics (0.5 g acetylsalicylic acid or 0.25 g amidopirina inside), administered cardiovascular drugs (2 mL of 10% solution sulfokamfokain subcutaneously, intramuscularly or intravenously).
Treatment is carried out by penicillin 1000000-1500000 units 3-4 and intramuscularly to 5-7th day after normalization of temperature (to prevent recurrence).
Hospitalization. Patients to be hospitalized in the infectious ward special vehicles for infectious diseases.


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