Epidemic spotted fever

• Ricketts 1909.
• Brill 1910.

Spotted typhus, typhus exanthematicus, classical spotted fever, louse spotted fever.

Extremely rare, notifiable disease caused by Rickettsia prowazekii with high lethality.

• Pathogen: Rickettsia prowazekii.
• Incubation period: 7-14 days.
• Rickettsia prowazekii is transmitted by clothes lice or their faeces. The pathogens enter the body through skin lesions as part of the sucking act.

• Unspecific early stage (cephalgia, exhaustion).
• In the course: Fever, somnolence.
• 3rd-6th days after onset of fever Appearance of roseolae with partly punctate haemorrhages on the trunk, which spread centrifugally. Palmoplantar involvement.
• Muscle twitching, pressure sensitivity of peripheral nerves, motor restlessness.
• Hypotonia.
• Bronchitis, conjunctivitis, splenomegaly.
• Mostly lice can be detected (pediculosis corporis)
• Facies typhosa: Livid-reddish face.

• 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 and indirect immunofluorescence test.

• Vaccination available.

• If no early therapy is given, a high lethality is to be expected.

• In cases where antibiotic therapy is discontinued early, late relapses may occur (Brill-Zinsser disease).
• After the disease is completely overcome, there is lifelong immunity.

• If necessary, intensive medical measures and transfer to the intensive care unit.
• Control of vital signs, fluid balance, electrolytes and protein replacement.

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. Botelho-Nevers, E., et al., Treatment of Rickettsia spp. infections: a review. Expert Rev Anti Infect Ther, 2012. 10(12): p. 1425-37.
2. Chapman, A.S., et al., Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006. Emerg. Infect. Dis., 2009. 15(7): p. 1005-1011.
3. Raoult, D., et al., Outbreak of epidemic typhus associated with trench fever in Burundi. The Lancet, 1998. 352(9125): p. 353-358.
4. Beutler, M. (2007). Keine Panik bei Läusen!. Pharmajournal, (18), 4-8. Retrieved from http://www.pharmasuisse.org/data/Oeffentlich/de/Publikationen/AKA-Publikationen/07_18_Laeuse_2_d.pdf