Rickettsia can remain infected, without any symptoms, for

Rickettsia
prowazekii is classified as a gram-negative coccobacillus bacteria
belonging to the Genus Rickettsia. It is the agent causing epidemic typhus, also
known as louse borne typhus. Lice are vectors of the bacteria, and are strictly
human parasites (3). Epidemic typhus is spread through contact with body lice
infected with rickettsia prowazekii. Within
only two weeks of contact with infected body lice, individuals can begin exhibiting
symptoms. Symptoms include: fever, chills, headache, rapid, shallow breathing,
muscle aches, rash, cough, nausea, vomiting, and/or confusion. Occasionally,
individuals can remain infected, without any symptoms, for months or years
after they first show symptoms. Occasionally, these individuals can relapse in
disease, up to months or years following their first bout of illness. This response
is known as Brill-Zinsser disease. It normally occurs because the body’s immune
system has been weakened due to medication, advanced age, or other illness. Brill-Zinsser
disease exhibits symptoms much like the original disease, but typically much
milder (4).

Epidemic typhus is
diagnosed based on clinical features and symptoms present, a biopsy of any
present rashes with fluorescent antibody staining (which detects the organism),
serologic testing, and a polymerase chain reaction. The treatment for epidemic
typhus primarily involves administering doxycycline, or in some cases
chloramphenicol. These antibiotics are most effective when given shortly after
symptoms begin (2). If treated early, most individuals recover quickly.

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There is no
vaccine to prevent epidemic typhus. However, improved sanitary conditions,
insecticides, and antibiotics have been extremely effective in decreasing the
incidence of the disease (2). Furthermore, leading health organizations
recommend several hygienic practices to prevent spreading epidemic typhus.
Individuals should avoid overcrowded areas and areas where people cannot change
clothes or bathe on a regular basis. Lice may be common in these areas. If lice
are suspected on bedding or clothes, they should be treated with permethrin
which kills lice and offer long-lasting protection from lice infestation (4).

Additionally, because
of the presence of lice around the globe, rickettsia
prowazekii is considered an agent of bioterrorism. It could be used as a bioterrorism
agent because of many key traits. It is environmentally stable, small in size, uses
aerosol transmission, has a low infectious dosage, and high morbidity if not treated
quickly or correctly (1).