Typhus natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Rickettsioses range in severity from diseases that are usually relatively mild (rickettsialpox, cat scratch disease, and African tick-bite fever) to those that can be life-threatening (epidemic and murine typhus, Rocky Mountain spotted fever, scrub typhus and Oroya fever), and they vary in duration from those that can be self-limiting to chronic (Q fever and bartonelloses) or recrudescent (Brill-Zinsser disease). Without treatment, fever may last 2 weeks, followed by a prolonged recovery time and a significantly greater chance of developing complications. Possible complications include renal insufficiency, pneumonia, meningitis. Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over age 60 have the highest risk of death.[1][2][3][4][5][6]
Natural History, Complications and Prognosis
Natural History
- The clinical severity and duration of illnesses associated with different rickettsial infections vary considerably, even within a given antigenic group.
- Rickettsioses range in severity from diseases that are usually relatively mild (rickettsialpox, cat scratch disease, and African tick-bite fever) to those that can be life-threatening (epidemic and murine typhus, Rocky Mountain spotted fever, scrub typhus and Oroya fever), and they vary in duration from those that can be self-limiting to chronic (Q fever and bartonelloses) or recrudescent (Brill-Zinsser disease).
- Without treatment, fever may last 2 weeks, followed by a prolonged recovery time and a significantly greater chance of developing complications.
- Delay in treatment may result in advanced disease, including neurologic manifestations such as confusion, seizures, or coma, and widespread vasculitis (damage to the endothelial cells that line blood vessels).
Complications
Possible complications include:
Prognosis
Without treatment, death may occur in 10 - 60% of patients with epidemic typhus. Patients over age 60 have the highest risk of death. Patients who receive treatment quickly should completely recover. Less than 2% of untreated patients with murine typhus may die. Most patients with rickettsial infections recover with timely use of appropriate antibiotic therapy.[3]
References
- ↑ Tsioutis C, Zafeiri M, Avramopoulos A, Prousali E, Miligkos M, Karageorgos SA (2017). "Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review". Acta Trop. 166: 16–24. doi:10.1016/j.actatropica.2016.10.018. PMID 27983969.
- ↑ Zhou YH, Xia FQ, Van Poucke S, Zheng MH (2016). "Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review". Medicine (Baltimore). 95 (8): e2928. doi:10.1097/MD.0000000000002928. PMC 4779037. PMID 26937940.
- ↑ 3.0 3.1 Taylor AJ, Paris DH, Newton PN (2015). "A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi)". PLoS Negl Trop Dis. 9 (8): e0003971. doi:10.1371/journal.pntd.0003971. PMC 4537241. PMID 26274584.
- ↑ Delord M, Socolovschi C, Parola P (2014). "Rickettsioses and Q fever in travelers (2004-2013)". Travel Med Infect Dis. 12 (5): 443–58. doi:10.1016/j.tmaid.2014.08.006. PMID 25262433.
- ↑ van der Vaart TW, van Thiel PP, Juffermans NP, van Vugt M, Geerlings SE, Grobusch MP, Goorhuis A (2014). "Severe murine typhus with pulmonary system involvement". Emerging Infect. Dis. 20 (8): 1375–7. doi:10.3201/eid2008.131421. PMC 4111165. PMID 25062435.
- ↑ Dotters-Katz SK, Kuller J, Heine RP (2013). "Arthropod-borne bacterial diseases in pregnancy". Obstet Gynecol Surv. 68 (9): 635–49. doi:10.1097/OGX.0b013e3182a5ed46. PMID 25102120.