Disease Description (Causes and Symptoms)
- Cause: An acute bacterial infection caused by Rickettsia prowazekii, transmitted mainly through lice and their feces from an infected person. The bacteria can survive for a long time in dried feces.
- Pathophysiology: The bacteria invade vascular endothelial cells and cause systemic vasculitis (capillary damage and increased vascular permeability), resulting in fever, rash, and organ dysfunction.
- Main symptoms: Incubation period of 6–15 days. Sudden high fever, headache, muscle pain, severe malaise, chills, loss of appetite, insomnia, and anxiety. Around days 2–5, a pink to red rash begins on the neck and armpits and spreads to the back, chest, and limbs. In severe cases, complications such as decreased consciousness, cranial nerve symptoms, hypotension, and peripheral circulatory disorders may occur.
- Specific note: If not treated appropriately, the risk of severe complications and death increases. It may recur in a milder form decades after recovery (Brill–Zinsser disease).
Treatment
- Antibiotics: The first-line treatment is doxycycline. It is generally administered for at least 7 days, and continued administration for 48–72 hours (2–3 days) after the fever subsides is recommended.
- Alternative medication: In cases of pregnancy or when use of doxycycline is restricted, azithromycin (or another appropriate alternative according to the individual circumstances) may be considered. (The doctor will decide based on the individual situation.)
- Supportive care: Fluid administration, antipyretics and analgesics, oxygen supplementation, and intensive care for severe complications (such as encephalopathy, pneumonia, and shock).
- Infection control: Thorough disinfection and delousing of bedding, clothing, and other items used by the patient and cohabitants (insecticide treatment, hot washing and drying), patient isolation, and disinfection of the surrounding environment.
- Treatment precautions: Take the full course of antibiotics as directed by the doctor. Be sure to inform medical staff about pregnancy, childhood age, and any history of drug allergies.
Prognosis: If there are no complications, the condition improves within approximately 2–3 weeks. However, if complications occur or treatment is delayed, recovery may take several weeks to several months, and the risk of death increases in severe cases.
Checklist Before an Outpatient Visit (Items to Bring and Examples for Recording Medical History)
- Items to bring:
- A list of current medications (including prescription drugs, nonprescription drugs, and herbal medicines)
- History of allergies (medications, foods, and pharmaceutical agents)
- Recent temperature records (the date fever began and temperature trends), and notes on the date symptoms began and their progression
- Photos of the rash (if present, take photos at different times)
- Recent travel history (domestic and international), and whether there has been exposure to crowds, refugee facilities, disasters, or densely populated living environments
- Whether anyone else has similar symptoms (symptoms in family members or cohabitants)
- Whether pregnancy is possible (whether currently pregnant or planning a pregnancy)
- Example questions (useful for diagnosis and treatment decisions in the consultation room):
- The date the fever began and the highest temperature, and the date and locations where the rash began
- Possible recent contact with lice or changes in the living environment (hygiene and crowded housing)
- Whether antibiotics were recently taken and their effects
- Underlying diseases (immunosuppression and chronic diseases) and the condition of contacts
Examples of General Questions to Ask the Doctor
- What tests are needed to confirm this disease? (Such as blood PCR and antibody testing)
- What treatment is recommended, and what is the expected treatment duration? What are the side effects?
- What precautions should be taken to prevent complications? What are the criteria for requiring inpatient treatment?
- What testing or preventive measures (delousing and isolation) should be provided for contacts (cohabitants)?
- How do treatment options differ during pregnancy or breastfeeding?
Examples of Disease-Specific Questions
- I am pregnant. Is it safe for me to take doxycycline? (Please explain alternative medications and their risks and benefits.)
- How can I safely deal with lice and feces on bedding and clothing at home (washing, disinfection, and insecticide treatment)?
Note: This information is general medical information. Diagnosis and treatment decisions must always be made after consultation with the treating medical professional.