Typhus

Background

Typhus refers to a group of infectious diseases that are caused by rickettsial organisms and that result in an acute febrile illness. Arthropod vectors transmit the etiologic agents to humans. The principle diseases of this group are epidemic or louse-borne typhus and its recrudescent form known as Brill-Zinsser disease, murine typhus, and scrub typhus. (For more information on pediatric scrub typhus, see the eMedicine article Scrub Typhus in the Pediatric: General Medicine volume.)

Pathophysiology

Epidemic typhus is the prototypical infection of the typhus group of diseases, and the pathophysiology of this illness is representative of the entire category. The arthropod vector of epidemic typhus is the body louse (Pediculus corporis). This is the only vector of the typhus group in which humans are the usual host. Rickettsia prowazekii, which is the etiologic agent of typhus, lives in the alimentary tract of the louse. A Rickettsia- harboring louse bites a human to engage in a blood meal and causes a pruritic reaction on the host’s skin. The louse defecates as it eats; when the host scratches the site, the lice are crushed, and the Rickettsia- laden excrement is inoculated into the bite wound. The Rickettsia travel to the bloodstream and rickettsemia develops.

Rickettsia parasitize the endothelial cells of the small venous, arterial, and capillary vessels. The organisms proliferate and cause endothelial cellular enlargement with resultant multiorgan vasculitis. This process may cause thrombosis, and the deposition of leukocytes, macrophages, and platelets may result in small nodules. Thrombosis of supplying blood vessels may cause gangrene of the distal portions of the extremities, nose, ear lobes, and genitalia. This vasculitic process may also result in loss of intravascular colloid with subsequent hypovolemia and decreased tissue perfusion and, possibly, organ failure. Loss of electrolytes is common.

Some people with a history of typhus may develop a recrudescent type of typhus known as Brill-Zinsser disease. After a patient with typhus is treated with antibiotics and the disease appears to be cured, Rickettsia may linger in the body tissues. Months, years, or even decades after treatment, organisms may reemerge and cause a recurrence of typhus. How the Rickettsia organisms linger silently in a person and by what mechanism recrudescence is mediated are unknown. The presentation of Brill-Zinsser disease is less severe than epidemic typhus, and the associated mortality rate is much lower. Risk factors that may predispose to recrudescent typhus include improper or incomplete antibiotic therapy and malnutrition.

Murine typhus and scrub typhus share the same pathophysiology as epidemic typhus, although they are somewhat milder. The incubation period is approximately 12 days for the typhus group. Prior infection with Rickettsia typhi provides subsequent and long-lasting immunity to reinfection. Read more »

Medical Alert Companies Comparison – Medical Alert Monitoring Systems

When you compare medical alert companies, you are not comparing companies medical alert device companies but service provider companies. This makes comparison process little tricky. Let me use industry knowledge and experience to act as shopper and market researcher.

Think you are going out to stay at a hotel that you’ve never been to before. We will use this analogy to compare medical alert companies. The hotel may appear clean, have nice surrounding, and great amenities, but the wait staff may not be providing good service you are expecting you may have been better off asking a friend what their experience was like, read reviews by others online, or a review by a local travel critic. That’s where we come in.

Assume the hotel is type of the medical alert monitoring device that you will use. Does it have all of the physical features, functions, or the look and feel that you want?

What kinds of Medical Alert Companies are there?

• Full Service These medical alert companies provide the entire operation from sales, to equipment service, to central station monitoring, all themselves. They do not source-out the operations to any third parties.

• Reseller/Marketing Only These medical alert companies take care of the marketing only of the product and service. In today’s digital age, they typically have a website and place ads in magazines, on television, or through retail displays in their storefronts.

• Partial Service These medical alert companies typically take care of the sales and service, but hire out the central station monitoring to a third party. This is due to the very high costs of opening and maintaining a central monitoring station; especially if it is certified or listed by one or more agencies like Underwriters Laboratories (UL).

• The hostess is like the sales person you’ll be speaking with. Are they able to give you an accurate estimate of how long your wait time may be for a table? If they tell you they can accommodate your group size, or maybe a request for special accommodations for a handicapper or a child playing areas?

• The hotel staff is like the customer service representatives and central dispatch operators. These are the people that you or your loved one will spend the most of your time communicating with and get the most satisfaction from. Are they attentive, knowledgeable, friendly, and patient? Are they maintaining the highest standards available and required to have continual training to be sure they are?

Who are then actual Medical Alert Monitoring Companies?

That can sometimes be very difficult finding out who is really who. The full service companies can be easy as they will usually come right out and tell you! The partial service companies will usually tell you who will monitor your loved one typically after you come right out and ask. Very few are up front about it, but some are.

It is not easy to get correct information from some reseller companies. We try to uncover who these companies are, and let you know who is providing the monitoring services for them, so you can read about the actual medical alert company servicing your loved one.

Why You Should Care about Medical Alert Companies?

The full service medical alert companies have a much larger capital and human investment than the partial and marketing only companies. That gives them a vested interest in the quality and care provided to their customers from end-to-end.

The partial service companies have a much greater investment than the reseller/marketing only companies because they take care of the sales, customer service, equipment service, shipping, etc. themselves. They don’t handle the monitoring, but they do more than just market the service.

It is very important to find-out what type of medical alert company you are dealing with. The more services that are under one roof could mean higher customer satisfaction and better quality control.

If you can get a quality, full service, and highly rated company in the same price range as a marketing only or partial company, would you pick the full service company?