Brill-Zinsser-disease

Last Updated: 2019-08-26

Author(s): -

Patients with epidemic spotted fever may have a late recurrence if antibiotic therapy is discontinued prematurely

  • Pathogen: Rickettsia prowazekii.
  • Anamnesis.
  • Clinic.
  • Lice infestation.
  • BB (leukopenia, eosinophilia), liver and kidney values, electrolytes.
  • From the 2nd week of disease Weil-Felix reaction (agglutination test).
  • Complement fixation reaction from the 3rd week of the disease.
  • Indirect immunofluorescence test after the 3rd week of the disease.
  • Lifelong immunity only exists after a completely survived illness!
  • High lethality

Topical Therapy

  • Jacutin® gel (lindane) 0.3%. Application not recommended due to neurotoxicological side effects. Jacutin® is no longer available on the Swiss market.
  • Loxazole solder. 1% (reapply after 1 and 2 weeks).
  • Permethrin 5% in e.g.: Excipial U Lipolotio.
  • Prioderm® Shampoo (use again after 1 and 2 weeks).
  • Paranix® Sprax (Dimeticon), application time: 15 min., possibly repeated after 7 days
  • Lausweg® foam solution, reaction time: 15 min. Repeat after 7 and 14 days.
  • Rausch Laus stop® cream, application time: 20 min., repeated after 7 and 14 days. 

Systemic Therapy

  • Doxycycline p.o. 100 mg 2x daily for 8-10 days.
  • Alternative: Ciprofloxacin p.o 500 mg 2x daily.
  • In pronounced cases, IV glucocorticoids 100 mg/d for 2-3 days. 

     
  • Clothes and bed linen should be washed at least 60°C as part of the renovation. Alternatively, they can also be placed in airtight plastic bags for 3 days.
     
  • All family members should be checked twice a week with the lice comb. 
     
  • Cutting the hair is not effective, as even 5 mm long hair is enough 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.