Communicable Diseases

Epidemic Louse-Borne Typhus Fever

Identification

A rickettsial disease with variable onset; often sudden and marked by headache, chills, prostration, fever and general pains. A macular eruption appears on the fifth to sixth day, initially on the upper trunk, followed by spread to the entire body, but usually not to the face, palms or soles. The eruption is often difficult to observe on black skin. Toxemia is usually pronounced, and the disease terminates by rapid defervescence after about 2 weeks of fever. The case-fatality rate increases with age and varies from 10% to 40% in the absence of specific treatment. Mild infections may occur without eruption, especially in children and people partially protected by prior immunization. The disease may recrudesce years after the primary attack (Brill-Zinsser disease, ICD-9 081.1; ICD-10 A75.1); this form of disease is milder, has fewer complications, and has a lower case-fatality rate.

The IF test is most commonly used for laboratory confirmation, but it does not discriminate between louse-borne and murine typhus (ICD-9 081.0; ICD-10 A75.2) unless the sera are differentially absorbed with the respective rickettsial antigen prior to testing. Blood can be collected on filter paper that are forwarded to a reference laboratory. Other diagnostic methods are EIA, PCR, immunohistochemical staining of tissues, CF with group specific or washed type-specific rickettsial antigens, and the toxin neutralization test. Sending lice to a reference laboratory for PCR testing may help detect an outbreak. Antibody tests usually become positive in the second week.

Epidemic Louse-Borne Typhus Fever has been found in Communicable Diseases

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