infectious diseases
Epidemic Typhus
Symptoms and Signs of Epidemic Typhus
After an incubation period of 7 to 14 days, fever, headache, and prostration suddenly occur. Temperature reaches 40°C in several days and remains high, with slight morning remission, for about 2 weeks. Headache is generalized and intense. Small, pink macules, which appear on the fourth to sixth day, rapidly cover the body, usually in the axillae and on the upper trunk and not on the palms, soles, and face. Later, the rash becomes dark and maculopapular. In severe cases, the rash becomes petechial and hemorrhagic. Splenomegaly sometimes occurs. Hypotension occurs in most seriously ill patients. Vascular collapse, renal insufficiency, encephalitic signs, ecchymosis with gangrene, and pneumonia are poor prognostic signs. Brill-Zinsser disease, a mild recrudescence of epidemic typhus, can occur years after the initial infection if host defenses falter. 