Brill-Zinsser: Still With Us

Abstract

To the Editor.— Epidemic typhus, caused by Rickettsia prowazekii and transmitted by the human body louse, has been associated with wars, famines, concentration camps, and overcrowding since the beginning of recorded history. Brill-Zinsser disease is a recurrent form of epidemic typhus, unrelated to louse infestation, that appears sporadically years after the primary illness. 1 Clinical features are similar to but milder than those of epidemic typhus. 2 In the United States, R prowazekii infections have also been associated with the eastern flying squirrel ( Glaucomys volans ). 3 Since 1977, at the Centers for Disease Control, the laboratory results and epidemiologic data from four patients have been consistent with Brill-Zinsser disease. We report herein the only case of Brill-Zinsser disease diagnosed at the Centers for Disease Control in the 1980s. A 65-year-old man was hospitalized in April 1989 with a 3-day history of fever and chills. The patient lived in an urban