Clinical Manifestations and Pathology

After an incubation period that may vary from 5 to 15 days, the onset of typhus is abrupt. Many patients are able to state the exact hour at which they noted the beginning of their illness. Headache, loss of appetite, and general malaise are followed by a rapidly rising fever. Bouts of chills, nausea, and prostration characterize the first week of illness. The most characteristic symptom of typhus is a widespread rash that appears about the fourth to sixth day after onset. Dark, reddish, discrete spots 2 to 5 millimeters in diameter appear scattered over the body and limbs. These lesions at first are bright red, but they rapidly become darker in color and more petechial in character. After recovery, the rash usually fades, but in rare cases it may leave a brownish stain that persists for several months.

During the first 2 or 3 days, the fever reaches its maximum, between 102° to 105°F, and is sustained for another 5 days, after which it falls rapidly if the outcome is favorable. In fatal cases, however, prostration becomes more progressive, with neurological symptoms increasing. These may include deafness, stupor, delirium, and eventually coma preceding death. Since 1948, however, when chloramphenicol and the tetracyclines (known collectively as broad-spectrum antibiotics) were introduced, no one need die of typhus if diagnosis is made in a timely manner.

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