Shedding light on a dangerous disease

Rickettsia are gram negative micro organisms which stay in the intestinal canal of arthropods like ticks and lice. They are transmitted to human beings via excreta of the insect being deposited on skin or bite of the vector.

They can also be transmitted by close proximity to animals infected with the organisms such as dogs and rats. They multiply in the inner lining of blood capillaries of various organs and can damage to the skin, heart, lungs, kidney, skeletal muscles and central nervous system.

Rickettsial infections are a group of infections caused by the bite of a tick, flea or louse. Symptoms include a rash is the early stages and an acute fever.

There are various kinds of similarly manifesting diseases which are caused by Rickettsia and one in particular that is of relevance here in Rwanda.

Epidemic louse borne typhus is said to be prevalent in parts of Africa, particularly Rwanda and Ethiopia. It is caused by Rickettsia prowazeki. The transmission is by infected faeces of human body louse, usually by scratching the skin.

The patient suffering infects the lice and they in turn infect another person. In conditions of overcrowding, it spreads very rapidly. Large epidemics have occurred in Europe in the past as a sequel to war.

The onset of the illness is sudden with severe headache, rigors, high fever, joint pains and symptoms like bronchitis. A rash appears on 4th to 6th day of fever which spreads rapidly on trunk and limbs.

Symptoms increase in severity in the second week. Death can occur due to toxemia of high fever or damage to vital organs.

A person can get infected or bitten by ticks while walking bare footed on the ground or ticks can be carried on dogs. A maculo popular rash is formed on the trunk and limbs. In severe cases the patient may have signs of meningitis or inflammation of meninges i.e. coverings of brain.

Endemic typhus is caused by Rickettsia mooseri and is endemically present all over the world. It is caused by bite of a flea that has fed on infected rat. Illness is similar to other rickettsial infections, but mild in nature.

Rickettsial infections are often overlooked as a cause for high fever because of other causes of high fever like typhoid or malaria drawing more attention of medical personnel. 

In fact a doctor had suggested to me that I should write about rickettsial infections, while we were discussing the causes of fever. Skin rashes unless generalised are not even noticed by the patients.

Rickettsial infections often mimic the signs of pneumonia, bronchitis, or meningitis, causing delay in diagnosis or the disease being undetected altogether. Untreated, except for endemic typhus, it can be fatal, unless infection is mild.

Diagnosis is mainly based on clinical grounds and response to treatment. Serological tests are available but they can give false results also.

Treatment is by anti-infective agents mainly, tetracyclines or chloramphenicol or Rifampicin can be used in resistant cases.

It can be assumed very well that Rickettsial infections are the direct result of development of man and the poor hygiene both personal and at home. As forests are being cleared for plantation, the area attracts rats and mites.

Poor personal hygiene as is well known leads to louse infestation both of head and body. Unclean environment provides breeding ground for not only flies and mosquitoes but all bearers of disease like ticks, mites, fleas and rats.

Therefore to prevent Rickettsial infections, it is very essential to maintain good personal hygiene and also control vectors of the disease by using insecticides.

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