Brill-Zinsser Disease

What is Brill-Zinsser Disease?

Brill-Zinsser disease (sypha sporadic typhoid) is a sporadic remote endogenous relapse of typhus in the absence of pediculosis. Manifesting typical symptoms of typhus, but easier over.

Cases of sporadic typhus without the participation of lice-carriers are described by the American researcher N.E. Brill (1910); later H. Zinsser and M. Castaneda (1933) explained their occurrence as a relapse of epidemic typhus.

Causes of Brill-Zinsser Disease

The reservoir and source of infection is a person who suffered from typhus 10-40 years ago. In the development of the disease there is no factor of infection. Cases of the disease appear in the absence of lice, often in persons living in good hygienic conditions. Elderly people who have had typhus in the past are ill. In case of licevism, patients with Brill-Zinsser disease are dangerous to others. The possibility of long-term (long-term) conservation of the pathogen in the body is assumed.

The frequency of the disease depends on the number of persons who have previously experienced typhus; it is high where outbreaks of the disease have occurred in the past. Brill-Zinsser disease is more often recorded in cities; usually it appears as sporadic cases. The disease is registered at any time of the year.

Pathogenesis during the Brill-Zinsser Disease

Ravkettsii Provocek, probably long-term preserved in the body in part of the patients who had typhus (according to the American researcher W. Price – in the lymph nodes). The causes of relapse in the remote period are unknown. The pathogenesis of the disease is identical to that of typhus.

Symptoms of Brill-Zinsser Disease

The disease is found mainly in older persons; it consistently goes through the same periods as typhus: the initial one, the height of the disease and convalescence. The clinical picture of Brill-Zinsser disease corresponds to mild or moderate forms of typhus.

Starting period. Moderate manifestations of fever (sometimes only subfebrile condition) and other signs of intoxication in the form of headache and sleep disorders are observed. In general, a febrile period with constant or remitting body temperature can be shortened to 7–8 days.

The period of height. Also, as with typhus, begins with the appearance of exanthema on the 5-6th day of the disease, but less rash elements. Often exanthema manifests itself only with roseola, which lasts for 1-2 days, or is completely absent. Rosenberg’s enanthem in Brill-Zinsser disease is rare, there may be no hepatolienal syndrome. Disorders of the cardiovascular system in elderly people are observed quite often, which to some extent may be due to the age characteristics of the sick person. Symptoms of the central nervous system are often moderate: headache, insomnia, some agitation, volubility. Hyperesthesia, meningeal phenomena, disorders of consciousness are not typical. At the same time, the symptom of Govorov-Godelier is quite often preserved.

Period of convalescence. The weakness, pallor of the skin, and functional lability of the cardiovascular system remain, but these disorders disappear much faster than with typhus.

Complications are extremely rare (mainly pneumonia, thrombophlebitis).

Diagnosis of Brill-Zinsser Disease

Apply the same serological methods as with typhus (RNGA, RSK). However, in Brill-Zinsser disease, antibodies are detected in higher titers, and from the first days of the disease they are mainly IgG. Since after typhus typhus, complement-binding antibodies in low titers persist for many years, in some patients with Brill-Zinsser disease they can be detected from the first days of the disease.