Complains
A 21-year-old white female patient complains of severe pruritus in the lumbar and neck area as well as itching in the abdominal, axillary region, and the area of the shoulders. She began experiencing itching 9 days ago but has not complained to the doctor straight away. She is also worried about fever, headache, and increased sensitivity to light.
The result of the examination
There is erythema on the epidermis of the face, neck upper part of the chest. The skin has severe diaphoresis. The soft palate reveals petechia, the face is amimic. There are signs of popular and macular petechial eruptions on the trunk and the extremities. On the patient’s right arm the hemorrhages reach the size of an ecchymosis. From the patient’s words, they appeared 2 days ago. Some maculae contain separate hemorrhages – secondary petechiae. The conscience is disrupted. The patient is experiencing visual and olfactory hallucinations. There is a fresh trophic ulcer on the right foot, and an older one on the left with a newly-formed wheal, as well as early signs of decubitus ulcers on the back and both hips.
The result of the analysis
The CT scan of the brain showed an abscess 2 cm in diameter. The skin biopsy has revealed Rickettsia prowazekii. Based on the analyzed clinical symptoms and evaluated clinical data, we could arrive at the diagnosis of epidemic typhus caused by pediculosis.
Treatment
Antihistamines such as diphenhydramine hydrochloride are prescribed to relieve the itching, and parasiticides using a lotion containing pyrethrins to treat pediculosis. To treat epidemic typhus, the patient should be administered Doxycycline until the body temperature drops and stays low for at least 24 hours. Doxycycline must be used for at least 7 days. If it proves ineffective, Chloramphenicol should be used as the second line of treatment for epidemic typhus.