Friday, February 27, 2009


The picture shows a man from Burundi who perhaps lived in crowded, cold, unhygienic conditions. He probably presented with abrupt onset fever, severe headache, tachypnea, chills, malaise, myalgias, arthralgias, abdominal tenderness, confusion, and drowsniess. The rash shown above began several days after onset of symptoms and is a red maculopapular eruption on the trunk that later spreads to the extremities. He probably had jaundice, elevated serum aminotransferases, and thrombocytopenia. All cultures are negative.

Even years after this initial episode, the patient may experience recrudescence with abrupt chills, fever, headache, malaise, and rash.

This is an interesting historical disease; periodic epidemics from the middle ages to the early 20th century killed millions of people; it has been estimated that this disease has caused more deaths than all the wars in history.

Challenge: What's the cause of this disease? What is the recrudescence called?

Image is in the public domain.

1 comment:

Craig Chen said...


This is epidemic typhus, a louse-borne exanthematous disease caused by Rickettsia prowazekii. The principal vector is the body and head louse (Pediculosis humanus); rickettsiae are present in the louse feces and introduced due to abraded or injured skin or mucous membranes. Recently, cases have been reported in Burundi, Rwanda, and Ethiopia. Recrudescence of this disease is Brill-Zinser disease, which is often mild. Serologic tests make the diagnosis, and drug of choice is doxycycline.

Sources: UpToDate; Wikipedia.