Relapsing fever is an acute infectious disease. Relapsing fever is caused by lice (epidemic relapsing fever) or ticks (endemic relapsing fever). The disease proceeds with alternating attacks of fever and periods of remission.

Relapsing fever is possible in all regions except Australia. The highest probability of getting typhoid, and in its most severe forms, is in Africa. So, in Sudan after the First World War, about 100 thousand people died from this disease in ten years.

In Europe, Asia, Africa, North and Central America, tick-borne relapsing fever occurs. Relapsing fever is carried by ticks of the genus Ornithodorus.

What factors provoke relapsing fever?

Relapsing fever is caused by spirochetes of the genus Borrelia. Tick-borne relapsing fever is a zoonotic vector-borne disease caused by different kinds Borrelia: B. caucasica, B. latyschewii, B. hispanica, B. persica, B. duttonii.

According to their biological, morphological properties, these borrelia are similar to the pathogens of epidemic typhus.

relapsing fever vectors

Tick-borne relapsing fever is carried by ticks of the family Argas persicus, Argasidae, which are reservoir hosts of spirochetes. In addition, various types of rodents can serve as reservoirs for Borrelia. Ticks are contagious throughout their life span (approximately 10 years). As a rule, human infection occurs due to a tick bite. Most often this happens in the warm season during the period of activation of the vital activity of ticks.

The carriers of epidemic relapsing fever are P. humanus humanus (clothes), Pediculus humanus capitis (head) and Phtirius pubis (pubic) lice. Only humans can get sick with epidemic relapsing fever.

The pathogenesis of relapsing fever

When Borrelia enters the human body, the cells of the lymphoid-macrophage system are introduced, where they begin to multiply and enter the blood in a much larger number. Under the influence of the bactericidal properties of blood, they begin to partially break down with the release of endotoxin, which affects the central nervous and circulatory system. The defeat of the systems is accompanied by fever, and foci of necrosis appear in the liver and spleen. Borrelia lingering in capillaries internal organs, violate the local blood supply, as a result of which a hemorrhagic infarction develops.

The first period of the disease, accompanied by fever, ends with the body producing antibodies to the first generation Borrelia. As a result most of Borrelia dies, which is clinically expressed in the onset of a period of remission. However, some Borrelia change their antigenic properties and become resistant to antibodies. They begin to multiply again, and when they enter the bloodstream, they cause a new attack of fever. Antibodies formed against the second generation of Borrelia also destroy most of them, but not all. This again provokes a relapse of the disease. Full recovery occurs only when the full spectrum of antibodies appears in the blood, destroying all barrel mutations. At the same time, after the recovery of stable immunity to this disease does not occur, since antibodies remain in the body for a short time.

Symptoms of relapsing fever

The first attack of relapsing fever begins suddenly. The patient feels a short chill, which is replaced by an increase in temperature. Appears headache, muscle and joint pain, vomiting, nausea. The temperature rises rapidly, the skin becomes dry, the pulse quickens, delirium occurs. The peak of the attack is accompanied by the appearance of rashes on the skin, the development of jaundice and an increase in the liver and spleen. During a fever, pneumonia or bronchitis may develop, and signs of heart damage are noted. The first attack lasts 2-6 days. After that, a period of remission begins, the patient's well-being improves. But after a few days, a second attack of the disease develops, which has similar symptoms.

Epidemic relapsing fever is characterized by several similar attacks, which, as a rule, end in complete recovery and the onset of temporary immunity to the disease. Tick-borne relapsing fever is characterized by four or even more similar attacks, which, however, have more mild symptoms and last less. But, it happens that the second attack is much more difficult than the first.

Relapsing fever is fraught with the development of complications: uveitis, meningitis, synovitis, rupture of the spleen, iridocyclitis, iritis.

Diagnosis of relapsing fever

Diagnosis of the disease is based on epidemiological data and clinical manifestations. The study of peripheral blood plays an important role in the diagnosis of relapsing fever. During an attack in the patient's blood, it is quite easy to detect the pathogen.

Treatment of relapsing fever

Treatment of epidemic relapsing fever consists in the use of antibiotics (levomycetin, penicillin, chlortetracycline), as well as arsenic preparations (novarsenol).

For the treatment of endemic relapsing fever, antibiotics of the tetracycline group, ampicillin, chloramphenicol are used.

Prevention of relapsing fever

Prevention of the disease is reduced to the fight against pathogens. Contact with lice patients should be avoided. At present, in our country and in a number of other countries, epidemic typhus is a rather rare disease.

Prevention of endemic relapsing fever consists in protecting people from contact with ticks, as well as in the destruction of rodents and other carriers in natural foci.

With the advent of heat, insects, carriers of infections dangerous to humans, are activated. Relapsing fever is one such disease, which is characterized by damage lymph nodes and undulating attacks of fever. Allocate endemic (characteristic of a particular area) and epidemic turning fever. The main carriers of the disease are ticks and lice, which are widespread throughout the world. Without treatment, the infection spreads throughout the body and causes irreparable harm to human health.

The main symptoms of relapsing fever:

• heat;
• headache;
• muscle pain;
• nausea;
• vomit;
• confusion;
• white coating on the tongue;
• rash.

Etiology and pathogenesis of the disease

Spirochetes of the genus Borrelia are the causative agents of relapsing fever. Microorganisms have a long spiral shape, thanks to which they easily move around the body. The causative agent of infection is unstable in the external environment. Borrelia die within 30 minutes from ultraviolet light and temperatures above 45°C.

Rodents are the main sources of spirochetes. Carriers of relapsing fever are ticks and lice. The causative agent enters the body of insects when bitten by a sick animal or person. In the body of mites and lice, Borrelia persist throughout life, multiply and accumulate in saliva.

The mechanism of transmission of the disease is transmissible (bites of infected insects). Endemic turning fever develops after the bite of ticks of the Argasidae family. Epidemic typhus is carried by head, pubic and body lice. The tick-borne type of infection is characterized by spring-summer seasonality, since insects are activated only at this time of the year. Epidemic typhus develops all year round.

After an insect bite, a papule develops on the skin, in which borrelia are located. A person, combing the bite site, helps the microorganism enter the bloodstream. The pathogen immediately enters the lymphoid cells, where it multiplies and re-enters the bloodstream. Bactericidal enzymes in the bloodstream destroy spirochetes, after which endotoxin is released. It damages the nervous, circulatory system, liver and spleen. This leads to the development of symptoms of rotary typhus.

Factors contributing to the development of infection

Tick ​​and flea bites are the main cause of relapsing fever, so everyone is at risk of infection. In most cases, a tick-borne form of the disease develops. There are risk groups of people who are more prone to this infection:

• persons living in endemic zones for relapsing fever;
• gardeners, agronomists, farmers, foresters;
• persons without a fixed place of residence;
• people with immunodeficiency diseases;
• persons living in poor sanitary conditions;
• rural residents.

These individuals are more likely to be outdoors, so the likelihood of contact with ticks is higher.

Important! Be careful when walking in nature. Watch for exposed areas of the body and carefully choose resting places. Also take a first-aid kit with an antiseptic and a plaster with you to nature in order to treat scratches or insect bites in time.

Classification of relapsing fever

Depending on the mechanism of transmission, relapsing fever is divided into:

• endemic (transmitted by ticks);
• epidemic (carried by lice).

There are periods of relapsing fever:

• a period of fever (characterized by the manifestation of all symptoms, lasts 6-8 days);
• a period of temporary well-being (no complaints, the condition is normalizing, lasts 7-8 days).

According to the severity of the course of infection, there are:

• light;
• average;
• heavy.

Clinical picture of the infection

The main symptoms of the disease:

• sudden onset;
• fever up to 41 ° C, chills;
• headache, muscle and joint pain;
• delirium;
• nausea, vomiting, diarrhea;
• hyperemia of the skin, which is replaced by jaundice;
• tachycardia;
• skin rash;
• "milky tongue" (moist, swollen, covered with a thick layer white plaque).

The incubation period of relapsing fever lasts 5-15 days, on average a week. The disease develops acutely with chills, fever up to 41 ° C. Gradually, unbearable pain in the head, joints, lower back and muscles is added to the symptoms. In the first days of the disease, patients are disoriented in time, delusional and see hallucinations. Sometimes vomiting, nausea or diarrhea joins.

In the early days of relapsing fever, the skin of patients is clean and highly hyperemic (red). After 3-4 days, jaundice and rashes appear. Patients note pain in the liver and spleen. Patients fall arterial pressure, heart rate and respiration increase. The tongue is moist, swollen, and covered with a thick layer of white coating, which is easily removed, but quickly reappears. During periods of jaundice, the plaque becomes yellow or mustard.

The attack of fever comes to an end in 7-8 days. Body temperature drops sharply, profuse (profuse) sweating occurs. Patients report severe weakness and quickly fall asleep. After sleep, the well-being of patients improves significantly. The period of temporary well-being lasts 6-7 days, after which the attack repeats again. Each subsequent period of fever is shorter but more severe than the previous one. Without proper treatment, the infection quickly leads to complications and death.

Which doctor to contact, complications and prognosis of the disease

The treatment takes place in the conditions of the hospital of the infectious diseases hospital until the patient fully recovers. With the development of complications, the patient is transferred to intensive care.

Most often, complications develop during the second or third attack. These include:

• bleeding;
• rupture of the spleen;
• collapse, coma;
• acute renal and hepatic failure;
• meningitis, encephalitis, severe lesions of the central nervous system(CNS).

These are serious conditions that require resuscitation and can be fatal.

With timely treatment, the prognosis is favorable, complete recovery is possible. After suffering relapsing fever, immunity persists for several months, so re-infection is possible.

"Milky tongue" (photo: www.sciencesource.com)

Doctor's advice. If bitten by a tick, you need to see a doctor as soon as possible. He will treat the wound and prevent relapsing fever. Do not remove the tick yourself. Early contact with specialists will save you from developing an infection and severe complications

Infection Diagnosis

It is possible to suspect relapsing fever after a thorough questioning and examination of the patient. Specific symptoms and a tick bite in recent times allows an accurate diagnosis. To confirm it, laboratory and instrumental diagnostic methods are used.

Fast and exact method is microscopy of a thick drop of blood, the sampling of which was during a period of fever. The smear reveals long spiral spirochetes. Methods are also used microscopic examination"hanging drop" or "dark field", which determines the mobility of the pathogen.

Serological diagnostic methods are used to isolate pathogen antigens from human blood. The most commonly used is the Compliment Binding Reaction (RCT).

A biological diagnostic method is used - infection of laboratory animals. For infection, the patient's blood is used during the period of fever and injected into mice or guinea pigs.

Treatment of relapsing fever

Antibiotic therapy is the main treatment for relapsing fever. Large doses of Penicillin, Levomycetin, Ampicillin, Tetracycline are used. Treatment lasts at least 10 days, until the patient recovers completely. The patient is discharged 15-16 days after the last increase in body temperature.

Detoxification therapy is carried out to alleviate the patient's condition with colloid and crystalloid solutions: Trisol, Hemodez, Rheosorbilact, etc. Antipyretics and painkillers are also used. For the prevention of liver failure, hepatoprotectors are administered to the patient.

Surgical treatment is used for bleeding, rupture of the spleen.

Disease prevention

Specific prevention of relapsing fever has not been developed. The main measures to prevent infection are:

• early isolation of patients with relapsing fever;
• fight against pediculosis (lice);
• monitoring of contact persons: daily measurement of body temperature for 2-3 weeks;
• educating people about the ways of infection.

But such methods do not reliably protect the population from relapsing fever. Therefore, it is necessary to follow the rules of individual prevention:

• adhere to personal hygiene;
• regularly checked for pediculosis;
• in spring-summer periods, carefully walk in nature, carefully choose places.
• do not sit on bare ground, use a blanket or bedding;
• Before walking in nature, try to leave as few exposed parts of the body as possible. First of all, close your legs well;
• do not rest in areas where there are many dry thickets;
• work in vegetable gardens, fields, in the garden with protective gloves;
• For tick bites, seek medical attention immediately.

By following these rules, you will protect yourself and your loved ones from the bites of various insects. After all, ticks and fleas carry not only relapsing fever, but also many other diseases. And remember, the sooner you see a doctor, the less negative consequences arise for your health.

Relapsing fever- a group of acute infectious transmissible human diseases caused by Borrelia. It is characterized by bouts of fever followed by periods of apyrexia. Transmitted by lice or ticks.

relapsing fever

Relapsing fever lice (other names - epidemic relapsing fever, relapsing fever, epidemic relapsing spirochetosis, louse-borne relapsing fever). Relapsing typhoid fever - anthroponosis, transmitted by lice, manifested by intoxication, enlargement of the spleen and liver, alternation of 2-3 or more febrile attacks with fever-free intervals.

ICD code -10

A68.0. Headache relapsing fever.

Etiology (causes) of lice typhus

The causative agent of lice typhus is the spirochete Borrelia recurrentis Obermeieri (Obermeyer's spirochete) of the family Spirochaetaceae, genus Borrelia, shaped like a filiform spiral with 6–8 curls; has active mobility; anaerobe. Reproduces by transverse division. It stains well with aniline dyes, gram-negative. Spirochete grows on special nutrient media.

The number of Borrelia protein antigens reaches several tens, their synthesis is encoded by different genes, some of which are periodically in an inactive "silent" form. During the disease, due to rearrangements in the chromosome, the “silent” gene is activated and the generation of Borrelia with a new antigenic composition appears.

Obermeier's spirochete contains endotoxins. Pathogenic for monkeys, white mice and rats; not pathogenic for guinea pigs.

AT environment B. recurrentis is not resistant, quickly dies when dried and heated to 50 °C. Sensitive to benzylpenicillin, tetracyclines, chloramphenicol, erythromycin.

Epidemiology of lice typhus

Source of infection- sick person. The chance of infection increases during bouts of fever. The carrier of Borrelia is the louse (mainly body louse, less often the head louse), which can transmit the infection 6–28 days after it feeds on the blood of a sick person. Spirochetes multiply and accumulate in the hemolymph of the louse. Infection of a person occurs when the hemolymph of a crushed louse gets on damaged skin (combing, rubbing with clothes).

Body louse - a carrier of infection

Susceptibility people to this infection is absolute.

Immunity after suffering lice relapsing fever, it is unstable, repeated diseases are possible.

In the past, relapsing fever was widespread in many countries of the world, the incidence increased sharply during wars, famines and other socio-economic disasters. During the First and Second World Wars, epidemics were observed everywhere. In Russia, lice relapsing fever was completely eliminated in the middle of the last century, but the possibility of importing this disease into our country from endemic regions cannot be ruled out: some countries of Asia, Africa, Central and South America. Characterized by seasonality with an increase in incidence in the winter-spring period.

The pathogenesis of lice typhus

Borrelia that have penetrated the skin into the human body are captured by the cells of the histiophagocytic system and multiply in them - this phase corresponds to the incubation period of typhoid fever. Then the pathogen enters the bloodstream - borreliemia develops, manifested by the following symptoms: chills, fever, etc. After a few days, antibodies are produced that inactivate borreliae. Microbes are not found in the peripheral blood, the fever stops. Due to the death of spirochetes, endotoxin is released, which acts on the cells of the vascular endothelium, liver, spleen, disturbing thermoregulation and microcirculation.

The accumulation of Borrelia in small vessels leads to the development of thrombosis, hemorrhage, DIC. Borreliemia and toxinemia manifest with the first febrile attack, after which some of the spirochetes remain in the central nervous system, bone marrow, and spleen. They multiply and a few days after the temperature returns to normal, they again enter the bloodstream, causing a second febrile attack. The new generation of Borrelia differs in the structure of antigens from the previous one, therefore the pathogen is resistant to the antibodies formed during the first attack, but is destroyed by the action of phagocytes and antibodies produced during the second attack. This process is repeated until the patient has antibodies to all generations of Borrelia.

Pathological and anatomical changes in those who died from typhoid fever are found primarily in the spleen, liver, brain, and kidneys.

The spleen can be enlarged 5-8 times, its capsule is tense, easily torn; in the parenchyma, hemorrhages, heart attacks, foci of necrosis are detected, in the vessels - thrombosis, a large number of Borrelia. Foci of necrosis are found in the liver.

In the brain, vasodilatation, hemorrhages, and perivascular infiltrates are detected.

Clinical picture (symptoms) of typhoid fever

The incubation period is from 3 to 14 (average 7–8) days.

Typhus classification

Clinical classification provides for the allocation of erased, light, moderate, severe form of lice relapsing fever. The severity criteria are the height and duration of fever, the severity of intoxication, the intensity of hemodynamic disorders.

The main symptoms and dynamics of their development

The vast majority of cases of typhoid fever are characterized by a violent, sudden onset with a tremendous chill, which after a few hours is replaced by fever and a rapid increase in body temperature to 39-40 ° C and above. Occasionally, the disease begins with a prodromal period, during which general weakness, fatigue, headaches and joint pains appear.

Already on the first day there is a severe headache, aching muscles (especially calf), lower back, joints, photophobia, insomnia. Loss of appetite, nausea, vomiting, thirst may occur. Patients become lethargic, lethargic, some show meningeal symptoms. There is an injection of the sclera, hyperemia of the conjunctiva. Possible nosebleeds, petechial rash, hemoptysis. From the second day of illness, the spleen enlarges, which causes a feeling of heaviness, pressure or dull pain in the left hypochondrium.

From the 3-4th day, yellowness of the skin and sclera appears, the liver enlarges. Typical shortness of breath, tachycardia up to 140-150 per minute, lowering blood pressure. The tongue is dry, densely coated with white coating, acquires a "milky", "porcelain" appearance.

Diuresis is reduced.

Hyperthermia in typhoid fever persists for 5-7 days, after which the body temperature drops critically to subnormal, which is accompanied by heavy sweating and often sharp drop BP to the point of collapse. The duration of the first attack ranges from 3 to 13 days. During the "crisis" up to 3-4.5 liters of light urine is released.

After the temperature normalizes, the patients feel better, the pulse slows down, but severe weakness persists.

The disease may be limited to one febrile attack (especially with early antibiotic treatment). In most patients, after 7–10 days of apyrexia, the body temperature suddenly rises again and a second febrile attack occurs, similar to the first, but shorter (3–4 days), although often more severe.

rice. 9-1g Temperature curve of fever in typhoid fever

In more than half of the cases, the disease ends with a second attack. Sometimes after 9-12, extremely rarely - 20 days after the next period normal temperature comes the third attack, even shorter and lighter. In total, 4–5 febrile attacks are possible, with each of the subsequent ones being shorter than the previous one, and the periods of apyrexia becoming longer. Early initiation of etiotropic therapy reduces the number of seizures.

In typical cases, the temperature curve is so characteristic that it is she who makes it possible to suspect relapsing fever.

The period of convalescence is long, the state of health of patients is restored slowly, within a few weeks after the final normalization of temperature, general weakness, fatigue, dizziness, and insomnia persist.

Complications of lice typhus

Specific complications, as with other spirochetosis, are meningitis, encephalitis, iritis, iridocyclitis. The most severe, but rare complication requiring urgent surgical intervention is rupture of the spleen. Nasal and uterine bleeding, hemorrhage in the brain and other organs are also possible. A critical decrease in body temperature by 4–5 °C may be complicated by collapse.

Mortality and causes of death

Mortality with timely antibacterial treatment is about 1% (in the past it reached 30%).

Diagnostics

Diagnosis is based largely on data from an epidemiological history - staying in an area where louse relapsing fever occurs. During the first attack, the main symptoms are taken into account: the most acute onset of the disease, hyperthermia from the very first hours, pronounced pain syndrome(headache, muscle pain), early enlargement and soreness of the spleen and liver, subicteric skin and sclera. In subsequent attacks, the typical appearance of the temperature curve helps the diagnosis.

Most informative method specific laboratory diagnostics consists in the detection of Borrelia Obermeier in the peripheral blood during fever (rarely during apyrexia). A smear and a thick drop of blood are examined, stained according to Romanovsky-Giemsa (as in malaria).

In a clinical blood test, moderate anemia, thrombocytopenia, an increase in ESR, a normal or slightly elevated white blood cell count are noted. In the urine, a small amount of erythrocytes, protein, hyaline cylinders are found.

Differential Diagnosis

Differential diagnosis is carried out with malaria, tick-borne relapsing fever, leptospirosis, influenza, typhus, meningitis, pneumonia, HL.

Mistakes can be avoided if the details of the epidemiological history are taken into account (stay in periods corresponding to the duration incubation period, in an area where relapsing fever occurs), repeated attacks of fever and the results of a thorough examination of blood smears in patients who fell ill suddenly, with a high fever, pronounced signs intoxication, rapid and significant enlargement of the spleen and its soreness.

Indications for consulting other specialists

Consultations of other specialists are indicated in case of complications: if a rupture of the spleen is suspected, an urgent consultation with a surgeon is necessary; with the appearance of signs of ITSH - resuscitator.

Diagnosis example

A68.0. Epidemic relapsing fever, severe form (in a blood smear of Obermeier's spirochete). Complication: rupture of the spleen.

Treatment of lice typhus

Mode. Diet

Patients with relapsing fever must be hospitalized. Strict bed rest is required until stable normalization of body temperature.

Medical treatment

It is carried out within 7-10 days with one of the antibiotics acting on Borrelia. Tetracyclines are considered the drugs of choice: doxycycline 100 mg twice a day or tetracycline 0.5 g four times a day.

to alternative antibacterial drugs include erythromycin in daily dose 1 g and benzylpenicillin 2 million-3 million IU / day intramuscularly.

At the same time, infusion detoxification therapy is prescribed.

It should be borne in mind that after the start of antibiotic treatment (especially benzylpenicillin), a Jarisch-Gersheimer exacerbation reaction is possible.

Convalescents are discharged from the hospital no earlier than 3 weeks after the final normalization of body temperature.

Forecast

The prognosis is favorable with the early appointment of specific therapy. Unfavorable prognostic signs are intense jaundice, massive bleeding, and cardiac arrhythmias.

Prevention of lice typhus

Specific prophylaxis has not been developed. The fight against pediculosis early detection and isolation of patients, their urgent hospitalization and chamber disinfection of things, sanitization of contact persons, who are under medical observation with daily thermometry for 25 days after the patient's hospitalization.

Relapsing fever refers to spirochetosis, their main feature is that attacks are replaced by periods of calm. The disease causes two types of fever:

• endemic (tick-borne);
• epidemic (lousy).

Seizures include:

• fever;
• intoxication;
• rashes (skin);
• slight jaundice;
• hepatosplenomegaly.

To establish the correct diagnosis, you need to conduct blood tests. In this disease, spirochetes will be found. Treatment is necessarily carried out with the use of antibiotics.

Relapsing fever is observed almost all over the planet, except for Australian villages, in different countries there are outbreaks. Countries with low level life, poor organization of living conditions and living conditions. Africa is the leader in the frequency of this infectious disease, the most severe form of typhus occurs here.

general information

The nature of the disease is infectious:

• it proceeds polycyclically;
• between attacks of fever there are periods of calm;
• two infections can cause the disease at once - tick-borne and lousy.

Both species are united by pathogens similar in structure, manifestations and transmission mechanism. Infection with Borrelia spirochetes leads to their development: they multiply very quickly, penetrating the blood in enormous quantities.

Borrelia

Borrelia cause zoonotic and anthroponotic (relapsing fever) infectious diseases. There are 20 species in this genus, but most of them are safe for humans. In nature, Borrelia and their carriers constantly interact.

Tick-borne typhus and lousy typhus are usually considered as separate infections. They differ in the structure of spirochetes, immune response and epidemiology. If the patients are not isolated in time, an epidemic develops.

The reasons

Epidemic relapsing fever develops after infection with Obermeyer's spirochete. She has a spiral shape of 4-8 turns, such a spirochete is very mobile. The source of infection is a sick person, he is dangerous with a fever. Louse relapsing fever is more difficult to carry than tick-borne, it causes complications.

Carriers - lice, in most cases - clothes. Spirochetes penetrate them by sucking blood, and in the hemolymph they multiply rapidly. Healthy man becomes infected if it crushes an insect with an infection. In this case, spirochetes can enter the body through scratches and wounds on the skin.

Epidemic relapsing fever spreads when hygiene is not observed, mass lice. Potentially dangerous are places where there are always a lot of people:

• barracks;
• prisons;
• rooming houses.

Temporary location in places of general congestion is favorable for infection. Especially when different segments of the population mix.

General crowds of people the first sign of the disease

In times of war, this disease often acquired the character of an epidemic. In Sudan, for example, in the 1940s, every tenth person had relapsing fever.

Tick-borne or endemic relapsing fever is caused by Borrelia spirochetes, they live in almost every corner of the Earth. They are very close to Obermeyer's spirochetes in morphology and properties.

They are transmitted to humans through rodents, ticks can settle on them, and they are carriers. In rodents, spirochetes live until the end of their lives, the offspring also become infected.

If an infected tick bites a person, tick-borne relapsing fever develops, epidemics for this type of typhus are not characteristic. Most often, people from Africa, Europe, Latin America, and Asia suffer from relapsing fever.

Symptoms of relapsing typhoid

The incubation period takes from 3 days to three weeks, then the patient has a fever. The temperature jumps, the person experiences a temporary fever, chills. Fever is accompanied by:

• weakness;
• pain in the muscles of the legs;
• headache;
• insomnia.

At the peak of the fever, symptoms of conjunctivitis appear, injection of sclera vessels, redness of the face, a rash appears, and nosebleeds occur. One of obvious signs- the tongue acquires an uncharacteristic high humidity, becomes swollen, covered with a dense whitish coating. Such a plaque is easy to remove, but it quickly reappears.

At the same time, the liver and spleen increase, after 5 days jaundice often appears. This is due to the fact that the cells of these organs are destroyed, places of necrosis appear.

Blood has bactericidal properties. Borelli, getting into the bloodstream, begin to break down, toxins are released. This leads to general intoxication, the structures of the central nervous system are damaged, circulatory system. Vomiting, oliguria, diarrhea (with mucus) begins.

The first fever lasts 5-8 days, while the immune system begins to work especially actively. Then 1-2 weeks observed apyrexia (interval between fevers).

After a fever, the patient suffers from hyperhidrosis, he has low blood pressure, while the tongue becomes cleaner, appetite returns, and manifestations of intoxication go away.

Borrelia can quickly change antigenic properties, therefore they develop resistance to the patient's immunity. Even after the appearance of antibodies in the human body, they continue their active reproduction and destructive effect. Only when the body reaches the maximum production of antibodies of a different spectrum, the disease will begin to recede.

Special occasions

With apyrexia, a person feels better, but malaise and weakness remain. Then the second wave of fever begins, the symptoms are the same. The second attack is shorter - 4 days., the interval without fever is lengthened, the attacks are repeated about 3 to 5 times. The next attack is shorter than the previous one, it is easier.

Some patients have only one episode of fever. It is related to the correct timely treatment. If there is no therapy, the disease will progress rapidly, febrile attacks can be repeated 10 or more times.

Complications are very dangerous, rupture of the spleen is considered dangerous. It leads to bleeding. In the absence of surgical intervention, lethality is guaranteed, and biliary typhoid often develops. It proceeds in two ways - typhoid and septic.

With typhoid, a hemorrhagic rash, jaundice, profuse diarrhea are observed, in pyrexia intervals the temperature remains elevated. With septic abscesses of internal organs, osteomyelitis, pneumonia, myocarditis develop. Biliary typhoid is often fatal.

Prognosis for patients

Now relapsing fever is quickly detected and successfully treated. Complications and mortality are observed in every hundredth patient. It is very dangerous to get infected during pregnancy. Relapsing fever causes bleeding in the uterus, premature birth.

Other complications include:

• diffuse bronchitis;
• pneumonia;
• iridocyclitis;
• acoustic neuritis;
• purulent otitis.

After infection, persistent immunity to the disease is not produced.

Symptoms of relapsing tick fever

It all starts with the bite of a small tick, a small papule with a rim remains at the site of damage. Incubation takes 5–15 days, followed by fever. The patient experiences all manifestations of intoxication. They last 1-4 days, before the onset of apyrexia, the temperature drops sharply. There are often ten or more attacks of fever. Apyrexia lasts from 2-3 days to 3-4 weeks, the course of the disease is 2-3 months.

Tick-borne relapsing fever is more easily tolerated. His attacks are shorter and his apyrexia is longer. After recovery, stable immunity remains. If there are no more bites (and this is a way of immunization), it is easy to get sick again.

The tick-borne form is not lethal. Complications occur less frequently.

Diagnosis and treatment

The first diagnosis is based on indicators of the epidemic situation and the symptoms that have manifested. If it is established that the patient has become infected, it is important to find the primary affect. To confirm the diagnosis, diagnostics are carried out in the laboratory, its task is to detect spirochetes in the blood. Sometimes they can conduct a biological test (guinea pigs are infected with the infected blood of the patient).

It is important to differentiate relapsing fever from the following disorders:

• brucellosis;
• malaria;
• flu.

In the treatment must be used antibacterial agents(Ampicillin, Penicillin, Tetracycline, Erythromycin). Recent times infectious disease specialists prefer to use new generation drugs - Mafarsen, Mafarsid, Miarsenol, Novarsenoli, the course of their administration is up to a week.

At proper treatment attacks of fever are quickly stopped, the results of intoxication are additionally eliminated. Detoxification during therapy is an important stage; the blood of such patients contains many toxins and spirochetes.

If there is such a complication as biliary typhoid, then cardiovascular drugs are included in the therapy.

Symptoms of impasse during treatment are persistent jaundice, frequent and severe bleeding, cardiac arrhythmias.

In this case, it is necessary to hospitalize the patient and isolate him; for this, special transport is used. It is important to ensure plentiful drink, bed rest and adequate complex treatment.

Prevention

Measures specific prevention has not yet been developed, vaccination does not exist. To prevent it, it is important to take the following measures:

• constantly fight pediculosis;
• monitor sanitary and hygienic conditions;
• promptly identify the sick and hospitalize them;
• in the outbreak, carry out active measures for disinfestation and disinfection.

It is important to exterminate the pathogens of relapsing fever, ticks and rodents should be destroyed. In the focus of the epidemic, it is important to protect yourself from the bites of infected ticks. You need to use repellents and special protective clothing.

Relapsing fever is very dangerous, in order not to get infected, you need to create decent living conditions, keep it clean, and destroy rodents in time.

lousy relapsing fever(synonym: epidemic relapsing fever, relapsing fever, relapsing fever).

Etiology. The causative agent - Obermeier's spirochete, found in the blood of patients during an attack, has the form of a spiral with a small number of turns, averaging 15-20 microns long, mobile, easily painted with aniline dyes.

Epidemiology. The source of infection is a sick person. are lice - body lice, less often head and pubic. Infection occurs when the body of the louse is damaged and the hemolymph of the infected louse, which contains, gets on the damaged skin (scratches, bites). Susceptibility to the disease is 100%. Only febrile patients are of epidemiological significance; in the period of apyrexia, patients are practically safe. The disease is common in countries with a low sanitary level of the population. In the USSR, relapsing fever has been eradicated.

Pathogenesis and pathological anatomy . The causative agent, having entered the bloodstream through damaged skin, spreads throughout the body. In organs rich in reticuloendothelium, the pathogen occurs, and then re-enters the blood in large quantities and death with the release of endotoxin. As a result of exposure to the pathogen itself and its endotoxin, dystrophic, inflammatory and necrobiotic processes develop in organs, especially pronounced in the liver and spleen, and hemolysis develops. The appearance of anemia progressing from attack to attack, and jaundice skin associated with hemolysis. In severe cases, it is pronounced sharply and is accompanied by significant jaundice and hemorrhagic phenomena. When pathoanatomical examination, a significant (5-6 times) is found. In the liver, kidneys, myocardium, dystrophic changes are observed. Sometimes there are hemorrhages in the kidneys, brain, on the skin.

After past illness unstable, recurring diseases are often observed.

Clinical picture and course. usually 5-8 days. The onset of the disease is sudden, with a tremendous chill, a rise in temperature to 39-409. There is a severe headache, pain in the muscles (mainly calf), along the nerves, in the joints. disappears, strong. The skin is dry. The tongue is coated with a white coating (“milky” or “chalky” tongue). The pulse is fast. From the first days of the disease, there is a feeling of pressure in the left hypochondrium due to the enlarged spleen, from the 3rd-4th day - a slight yellowness of the skin and sclera. dense and painful. The liver is also enlarged. Sometimes there are. In the period of fever, oliguria is noted, changing after the crisis copious excretion(up to 5 l) urine with a low specific gravity.

In the blood, there is a slight hypochromic, more pronounced in severe cases. During an attack in the peripheral blood, moderate neutrophilic leukocytosis with a shift to the left, lymphopenia, monocytosis and aneosinophilia. The number has been reduced. During apyrexia - leukopenia, monocytopenia, lymphocytosis (relative), plasma cells appear (up to 5-6%). Accelerated appears from the end of the first attack and lasts for several weeks. Sometimes the phenomena of meningism are noted.

The disease proceeds in the form of seizures. The duration of the first febrile attack is 5-7 days, sometimes shorter. The temperature drops critically at strong to normal or subnormal. During apyrexia, lasting 1-2 weeks, the patient feels almost healthy. Then the second attack begins, proceeding in the same way as the first. The duration of each subsequent attack is less than the previous one. Usually there are 2-3 attacks (rarely 4-6), after which recovery occurs.

Complications. The most formidable is the spleen, which in some cases can result in rupture of the spleen, followed by fatal bleeding. In second place is biliary typhoid - the result of the addition of a salmonella infection (paratyphobacillosis). Most often, this complication occurs in the second attack and is characterized by pronounced jaundice, hemorrhagic manifestations, numerous small various bodies. There are catarrhal and hemorrhagic, suppuration of the perichondrium of the costal cartilage, osteomyelitis, interstitial myocarditis. Mortality in the development of biliary typhoid up to 50%. Pregnant women have, with uterine bleeding. Often noted, neuritis, iritis, clouding vitreous body, swelling of the eyelids.

Diagnosis. In addition to the characteristic clinical picture and the course of the disease, an epidemiological history (lice, contact with patients with relapsing fever, stay in the area where this disease occurs) is of particular importance for diagnosis. Laboratory methods studies during an attack are reduced to repeated microscopy of a blood smear or a thick drop in a dark field and in a stained form. In the interictal period, when there are few spirochetes in the blood, they use the Bernhof enrichment method: they take 2-3 ml of blood from a vein into a test tube, centrifuge and look for spirochetes in the sediment. Of the serological methods, the Brusin-Rickenberg reaction (load phenomenon) is important, which is set with the patient's blood serum, platelets guinea pig and culture of spirochetes.

In the presence of antibodies in the blood, spirochetes are stuck around (loaded) with platelets.

Differential Diagnosis carried out with malaria, tick-borne relapsing fever, leptospirosis, lobar pneumonia(see articles on relevant diseases).

Treatment. Novarsenol during an attack is administered intravenously at a dose of 0.45-0.6 g in 10 ml of bidistilled water 2-3 times at intervals of 4-5 days, during apyrexia (on the 4-5th day) 0.45 g of the drug with repeated administration of the same dose after 6 days. If it is impossible to administer the drug intravenously, miarsenol is used intramuscularly at a dose of 0.45-0.6 g. However, this drug is inferior in efficiency to novarsenol. AT last years proposed mafarsen, mafarsid, sovarsen, which are less toxic. Nice results with early treatment of relapsing fever, it gives, which is prescribed 200,000-300,000 IU 5-6 times a day for 5-7 days. You can use chloramphenicol. The latter is especially indicated in the complication of relapsing fever with bilious typhoid, cardiovascular agents are recommended.

Prevention. The fight against lice (see). When diseases appear, it is necessary to identify and isolate patients in an infectious diseases hospital, the things of the patient and others as early as possible. The outbreak is monitored for 3 weeks. Convalescents are discharged from the hospital 3 weeks after the temperature normalizes.