Ecologic Studies on the Interepidemic Survival of Louse-Borne Epidemic Typhus Fever12

Rickettsial Infections Around the World, Part 2: Rickettsialpox, the Typhus Group, and Bioterrorism

“…29 Brill-Zinsser disease was isolated from the lymph nodes of two Russian immigrants who had come to the United States more than 20 years earlier. 30,31 It is believed that a weakening immune system or stress may reactivate the infection. 10 The clinical symptoms are usually milder than primary epidemic typhus and more closely resemble the symptoms of murine typhus.…”

Brill‐Zinsser Disease in a Patient Following Infection with Sylvatic Epidemic Typhus Associated with Flying Squirrels

“…Brill-Zinsser disease is a form of recrudescent epidemic typhus that occurs years or decades after primary typhus infection [1][2][3][4]. However, in the United States, improved sanitation and hygiene measures have largely eliminated the human body louse vector and epidemic typhus as public health concerns [1].…”

“…Past studies have described patients with Brill-Zinsser disease as those with a fever of unknown origin who had a history of living in an area where typhus is endemic and who presented with a headache and rash [2,3]. In more contemporary case reports (Table 3), patients with Brill-Zinsser disease have displayed a variety of signs and symptoms, and rash has been absent in at least 1 other published case report [9][10][11][12].…”

“…This patient experienced an illness compatible with either acute or recrudescent typhus infection, albeit perhaps more mild than some other cases reported in the literature. Past studies have suggested that only a fraction of patients with traditional louseborne typhus go on to experience recrudescent typhus [2]. Brill-Zinsser disease may be linked to waning immunity, stress, or other factors that facilitate recrudescence, although the precise mechanism is unknown and may vary among individuals.…”

Die Rolle der Brill -Zinsser’schen Krankheit in der Epidemiologie des Fleckfiebers in Bosnien und der Herzegowina (Jugoslawien)

“…Dafür spricht die ge lungene Isolierung von /?. prowazeki aus dem Blut von solchen Kranken, den an solchen Patienten gefütterten Läusen sowie aus den Lymphdrüsen Gesunder, die vor mehreren Jahren Fleck fieber überstanden haben und nachher lange Zeit in einer Um gebung gelebt haben, wo keine Läuse waren und wo sie sich nicht mit Fleckfieber infizieren konnten (19,10,11,9,18,2,7,15,13,14).…”