ENDEMIC MURINE TYPHUS (FLEA-BORNE)

Etiology and Epidemiology:-

Caused by R. typhi, endemic murine typhus has a rat reservoir and is transmitted by fleas.

• Humans become infected when Rickettsia-laden flea feces are scratched into pruritic bite lesions; less often, the flea bite itself transmits the organisms or aerosolized rickettsiae from flea feces are inhaled.
• In the United States, endemic typhus occurs mainly in southern Texas and southern California; globally, it occurs in warm (often coastal) areas throughout the tropics and subtropics.
• Flea bites often are not recalled by pts, but exposure to animals such as cats, opossums, raccoons, skunks, and rats is reported by ~40%.

RISK FACTORS: - Risk factors for severe disease include older age, underlying disease, and treatment with a sulfonamide drug.

CLINICAL MANIFESTATIONS: - Prodromal symptoms 1–3 days before the abrupt onset of chills and fever include headache, myalgia, arthralgia, nausea, and malaise; nausea and vomiting are nearly universal early in illness.

• Rash is apparent at presentation (usually ~4 days after symptom onset) in 13% of pts; 2 days later, half of the remaining pts develop a maculopapular rash that involves the trunk more than the extremities, is seldom petechial, and rarely involves the face, palms, or soles.

• Pulmonary disease is common, causing a hacking, nonproductive cough in 35% of pts. Almost one-fourth of pts who undergo CXR have pulmonary densities due to interstitial pneumonia, pulmonary edema, and pleural effusions.

• Laboratory abnormalities include anemia, leukopenia early in the course, leukocytosis late in the course, thrombocytopenia, hyponatremia, hypoalbuminemia, mildly increased hepatic aminotransferase levels, and prerenal azotemia.

COMPLICATIONS:-

• Complications may include respiratory failure, hematemesis, cerebral hemorrhage, and hemolysis.

• The duration of untreated disease averages 12 days (range, 9–18 days.

HOMEOPATHIC MANAGEMENT:-

The medicines that can be thought of use are:-

• Rhus tox
• Bryonia
• Aconite
• Camphor
• Gelsemium