Brill-Zinsser disease

In patients with epidemic typhus, late relapse may occur if antibiotic therapy is discontinued early

• Pathogen: Rickettsia prowazekii.

• History.
• Clinical.
• Lice infestation.
• BB (leucopenia, eosinophilia), liver and kidney values, electrolytes.
• From the 2nd week of illness. Week of illness Weil-Felix reaction (agglutination test).
• From the 3rd week of illness complement fixation reaction.
• From the 3rd week of illness indirect immunofluorescence test.

• Only after the disease has been completely overcome is there lifelong immunity!
• High lethality.

Topical therapy

• Jacutin® gel (lindane) 0.3%. Use not recommended due to neurotoxicological side effects. In Switzerland, Jacuin® is no longer on the market.
• Loxazole Lot. 1% (reapply after 1 and 2 weeks).
• Permethrin 5% in e.g.: Excipial U Lipolotio.
• Prioderm® shampoo (reapply after 1 and 2 weeks).
• Paranix® Sprax (dimeticone), exposure time: 15 min., repeat after 7 days if necessary
• Lausweg® foam solution, exposure time: 15 min. , repeat after 7 and 14 days.
• Rausch Laus stop® cream, exposure time: 20 min., repeat after 7 and 14 days.

   

  Systemic therapy

• Doxycycline p.o. 100 mg 2x tgl. for 8-10 days.
• Alternatively: Ciprofloxacin p.o 500 mg 2x tgl.
• In severe cases, if necessary, i.v. glucocorticoids 100 mg/d for 2-3 days.

   

• Dresses and bed linen should be washed at a minimum of 60°C as part of the rehabilitation. Alternatively, these can be placed in airtight plastic bags for 3 days.

   

• 2 times a week, all family members should be checked with the lice comb.

   

• Cutting the hair is not effective, as even 5 mm long hairs are sufficient to hold nits.

1. Bechah, Y., et al., Epidemic typhus. Lancet Infect Dis, 2008. 8(7): p. 417-26.
2. McQuiston, J.H., et al., Brill-Zinsser disease in a patient following infection with sylvatic epidemic typhus associated with flying squirrels. Clin Infect Dis, 2010. 51(6): p. 712-5.
3. Ormsbee, R., et al., Serologic diagnosis of epidemic typhus fever. Am J Epidemiol, 1977. 105(3): p. 261-71.