Summary about Disease
Widal-Abrami-Brill disease (Brill-Zinsser disease) is a recrudescence (relapse) of typhus fever. It occurs in individuals who previously had epidemic typhus (caused by Rickettsia prowazekii) and harbored the organism in their body for years, even decades, without any symptoms. It is generally milder than the primary epidemic typhus.
Symptoms
Symptoms of Brill-Zinsser disease are similar to those of epidemic typhus but are typically milder and of shorter duration. Common symptoms include:
Fever
Headache
Rash (maculopapular, similar to typhus but often less prominent)
Chills
Muscle aches (myalgia)
Causes
Brill-Zinsser disease is caused by the reactivation of Rickettsia prowazekii bacteria in individuals who previously had epidemic typhus and were never fully cleared of the organism. The bacteria remain dormant in the body for many years and can reactivate, causing the disease. The exact trigger for reactivation is not fully understood.
Medicine Used
The primary treatment for Brill-Zinsser disease is antibiotics. Commonly used antibiotics include:
Doxycycline
Tetracycline
Chloramphenicol (less commonly used due to potential side effects).
Is Communicable
Brill-Zinsser disease itself is generally not considered directly communicable from person to person. This is because the disease is a reactivation of a latent infection in an individual. However, if a louse feeds on someone with Brill-Zinsser disease and then feeds on another person, that person could potentially contract epidemic typhus, thus starting a new outbreak of typhus.
Precautions
The most important precaution is to maintain good hygiene and sanitation to prevent louse infestations. This includes:
Regular bathing
Washing clothes and bedding frequently
Avoiding crowded and unsanitary living conditions
Louse control measures (insecticides) in areas where typhus is endemic.
Early diagnosis and treatment of typhus to prevent latent infections.
How long does an outbreak last?
An individual's episode of Brill-Zinsser disease typically lasts for several days to a couple of weeks if left untreated. With antibiotic treatment, symptoms usually resolve within a few days. If an outbreak of epidemic typhus were to occur secondary to a case of Brill-Zinsser disease spreading to lice, the duration of the outbreak would depend on the effectiveness of public health control measures like insecticide use and hygiene promotion.
How is it diagnosed?
Diagnosis of Brill-Zinsser disease is based on:
Clinical presentation: Symptoms consistent with typhus-like illness in a person with a history of having lived in or traveled to an area where typhus is endemic.
Laboratory tests:
Serological tests: Detecting antibodies to Rickettsia prowazekii in the blood. A rising antibody titer or high levels of IgG antibodies suggest reactivation.
PCR: Polymerase chain reaction testing can detect the presence of Rickettsia prowazekii DNA in blood samples.
Timeline of Symptoms
The timeline of symptoms can vary, but generally follows this pattern:
Incubation Period: Not applicable, as this is a reactivation of a previous infection.
Initial Symptoms (1-3 days): Fever, headache, malaise.
Progressive Symptoms (3-7 days): Rash appears (usually on the trunk and spreads outwards), chills, muscle aches become more pronounced.
Resolution (with treatment): Symptoms begin to improve within a few days of starting antibiotics.
Without treatment: Symptoms can persist for 1-2 weeks and may lead to complications in rare cases.
Important Considerations
Brill-Zinsser disease serves as a potential reservoir for epidemic typhus.
Clinicians in areas where epidemic typhus has historically been present should be aware of Brill-Zinsser disease as a possible diagnosis in patients presenting with typhus-like symptoms, even many years after potential exposure.
Prompt diagnosis and treatment are important to prevent complications and to reduce the risk of transmission to others via lice.
Ruling out other febrile illnesses is important as the symptoms can be non-specific.