Diagnosis of Brill's disease (American form of European typhus fever) by skin biopsy

Abstract

1. 1. In the United States at present there seem to be three distinct types of rickettsial disease. Brill's disease (the American form of typhus fever) is found in the northeastern part of the country, murine (flea-borne) typhus occurs mainly in the southeastern part of the United States while Rocky Mountain spotted fever (mite-borne) occurs throughout all parts of the country. 2. 2. The pathological changes caused by Rickettsiae are essentially similar. These characteristic vascular changes consist of vasculitis and perivasculitis. If carefully looked for, the Rickettsiae may be found in the endothelial cells lining the blood vessels. The vessels usually affected are the smaller ones of the brain, lungs, skin and heart. 3. 3. Successful treatment of the typhus group of fevers for the present depends upon starting therapy within the first week following the onset of the disease. Because of the difficulties in carrying out specific complement fixation and agglutination tests for Rickettsiae, a simple method of early diagnosis by skin biopsy is described. 4. 4. Two patients with Brill's disease with characteristic clinical and pathological changes in the skin are presented. In one of the subjects, the rickettsial organisms were identified.