Diagnosis
After an incubation period of one to two weeks, headache, loss of appetite, malaise, then fever, chills, marked prostration, and nausea. Four to six days after onset a characteristic rash appears over most of the body. The rash starts on the trunk then spread to the extremities. I always find patterns like this weird and no one has ever explained why.
The fever reaches a maximum by the end of the first week and continues until about the 12th day, when it falls, becoming normal about the 14th to 16th day.
Patients can remain infected, without symptoms, for years after they first get sick. They can relapse, called Brill-Zinsser disease, months or years following their first illness, although it is often milder.
There are serology and PCR.
Epidemiologic Risks
Spread by the body louse, worldwide in distribution. Called epidemic typhus.
In the US it is associated with flying squirrels and their nests (PubMed)(PubMed); likely what killed Bullwinkle.
Microbiology
R. prowazekii.Empiric Therapy
Tetracycline / doxycycline (preferred) OR chloramphenicol. Quinolones maybe, but stick with a tetracycline.
Pearls
Humans are infected by scratching a louse bite, thereby rubbing the louse's infected feces into the wound. Yuck. Disease from louse shit. It is a disease of crowding and squalor.
R. prowazekii can remain viable and virulent in the dried louse feces for days.
The infection has killed millions during times of war. For example, it was the cause of Plague of Athens during the Peloponnesian War, which killed Pericles. It killed more French than the Russians did during Napoleon's retreat and killed 3 million in WW1.
Last Update: 11/02/18.