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The Black Death and Other Pandemics
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Epidemic typhus is an infection with a bacterium called Rickettsia prowazekii that is transmitted from person to person by the human body louse; the bacterium resides in the feces of the louse. This louse is slightly different from the lice that infest the hair of schoolchildren. Instead, it infests the body and garments of persons of poor health and hygiene living in unclean conditions. Scratching the louse bites causes the person to rub the louse feces into the wound, thus inoculating the body with the bacterium. The signs and symptoms of typhus include fever, chills, headache, rapid breathing, body aches, cough, nausea, vomiting, confusion, and a rash. The red, petechial rash starts on the torso and spreads outward to the arms and legs. The mortality rate of untreated epidemic typhus is anywhere from 10 to 60 percent; with antibiotics, the condition is uniformly survivable. Epidemic typhus should be distinguished from endemic (murine) typhus, which occurs worldwide and is spread by the rat flea, and typhoid, a febrile condition with red spots on the skin caused by S. typhi, made famous in the twentieth century by the life and career of “Typhoid Mary.”
Health and Medicine in Interwar Europe
Published in Roger Cooter, John Pickstone, Medicine in the Twentieth Century, 2020
Despite intensive research into bacteriology there were few practical outcomes after the Great War: influenza swept the world and doctors could do nothing. Improvements to diphtheria serum therapy meant that anatoxin serum was available for preventive immunization, but this was only very partially used. For typhus, and many other infectious diseases, vaccines were difficult to produce and only partially effective, and there was no chemotherapy; typhus remained endemic in eastern Poland and Russia. A similar situation pertained to malaria in Southern Europe which was more amenable to destroying the mosquito habitats than to vaccines or anything other than the traditional quinine therapy. Some drug-based therapies continued to be highly toxic, e.g., salvarsan therapy for syphilis — public campaigns were waged against its compulsory use. Cancer became an increasing but intractable problem. Heroic surgical treatments were attempted for TB, e.g., the use of collapsed lung therapy. Generally this was an age of severe medical interventions — of malaria therapy for syphilis, or insulin coma shock therapy for mental illness. The techniques were dramatic although the outcomes were highly dubious. Eugenic sterilization fitted well with such draconian remedies, and its use became routine not only in Nazi Germany from July 1933 but also in Scandinavia.
The Pathogenesis and Pathology of the Hemorrhagic State in Viral and Rickettsial Infections
Published in James H. S. Gear, CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
At the onset, murine typhus is manifested by headache, myalgia, fever, chills, nausea, vomiting, abdominal pain, and weakness. A blanchable, macular rash appears on the abdomen, shoulders, chest, arms, and thighs, usually on the 5th day of illness with a range of 2 to 8 days. The rash later becomes maculopapular and occasionally petechial. Other clinical features may include cough, hemoptysis, tachycardia, basilar rales, hypotension, conjunctival hyperemia, and diarrhea or constipation. Fatality is rare, being observed once in Maxcy’s series of 114 cases133a and in none of Stuart and Pullen’s series of 180 cases.134 Hemorrhagic diathesis is quite rare.
Clinical profile and outcomes of Scrub typhus in pregnant women presenting to a tertiary care hospital of North India
Published in Journal of Obstetrics and Gynaecology, 2023
Bhavana Yadav, Ranu Soni, Manisha Biswal, Vanita Suri, Minakshi Rohilla
The clinical manifestations of scrub typhus include flu-like symptoms, fever, maculopapular rash, eschar, headache, cough, myalgia, lymphadenopathy, vomiting and abdominal pain (Xu et al.2017). In a few cases, the disease progresses to multi-organ failure and death (Peter et al.2015). The case fatality rate (CFR) is 30% or even higher in untreated cases (Rajan et al.2016). It is a major cause of acute undifferentiated febrile illness (AUFI) in India, with high CFR and a link to adverse foetal outcomes in pregnant women having the illness (Kim et al.2006, Chrispal et al.2010). Despite the fact that scrub typhus is uncommon during pregnancy and the influence of scrub typhus on pregnancy is unknown, few research suggests that it is linked to adverse pregnancy outcomes (Watt et al.1999, Mathai et al.2003, Phupong and Srettakraikul 2004). Therefore, the aim of the present study was to evaluate the clinical outcome of scrub typhus infection in pregnancy.
Acute transverse myelitis following scrub typhus: A case report and review of the literature
Published in The Journal of Spinal Cord Medicine, 2020
Hyun-Seung Ryu, Bong Ju Moon, Jae-Young Park, Sang-Deok Kim, Seung-Kwon Seo, Jung-Kil Lee
Scrub typhus has a latent period of 5 to 20 days, and symptoms include general malaise, headache, rash, lymphadenopathy, and fever.6 The eschar undergoes an ulcerative change, which is seen at the site of the mite bite. This skin lesion is found in 60–80% of patients with scrub typhus.7 The presence of an eschar is a useful dermatological factor in diagnosing scrub typhus even in cases in which a serologic diagnosis is not confirmed.8 For this case, a diagnosis of scrub typhus was suspected based on the presence of a typical eschar. However, in the absence of an eschar, it is difficult to make a diagnosis, and scrub typhus could be misdiagnosed. The present standard to diagnose scrub typhus is serologic testing, and the standard assay for detection of scrub typhus antibodies is IFA. Black et al.6 suggest that a diagnosis of scrub typhus using IFA should be based on a 4-fold titer increase.
Emerging and threatening vector-borne zoonoses in the world and in Europe: a brief update
Published in Pathogens and Global Health, 2019
Bacterial order Rickettsiales causes wide range of related diseases spread by ticks, fleas, chiggers and lice. Spreading abilities, morbidity and mortality rates of Rickettsiales are high. Typhus fever caused by Rickettsia prowazekii was classified as the category B on the list of bioterrorism agents [81]. The most common rickettsiosis in Europe is Mediterranean spotted fever caused by Rickettsia conorii. Even though the disease had been endemic to Southern Italy for many years [82], it has been spreading recently [83]. This infection may represent a severe threat, as its mortality rate is about 32% [84]. Anaplasmosis caused by Anaplasma phagophytophila has also a strongly increasing and widespread occurrence in Europe [85,86]. Recently, new human rickettsial infections have been recognized in Europe [82,87]. In general, rickettsioses occurrence increases in northern countries, which had been traditionally Rickettsia free [88]. It is supposed that this increasing occurrence is associated with the rise of temperature and decreasing number of frosty days [83,89,90]. Several rickettsial vaccines were developed; however, they were difficult, expensive and very hazardous to produce [91]. There is still no approved vaccine available yet [92].