The Respiratory System.—Cough may appear in the first days, but usually is first troublesome about the time of the eruption. By the end of a week the cough becomes loose and râles of various types may be noted. Death often occurs from a terminal broncho-pneumonia.
The Nervous System.—Clouding of the consciousness is as marked in this disease as in plague. Dull aching frontal headache is marked and a dull stuporous state soon comes on. Delirium is marked in some cases. As in plague there are often the facies and mental state of alcoholic intoxication.
The Blood.—There does not seem to be anything very characteristic in the blood examination. Prowazek noted that the polymorphonuclears showed early fragmentation of the nucleus and that the cytoplasm stained very red with Giemsa’s stain. Robinowitsch noted that the leucocyte count fell in the first day or two, then gradually rose until the crisis and then again fell. The leucocytosis is only moderate, about 10,000, and the polymorphonuclears make up about 80 to 85%. Eosinophiles are decreased. Other observers have noted an increase in the large mononuclears.
Complications.—A bronchitis is very common and later on there may be such a profuse expectoration that the patient cannot get rid of it and may become cyanotic. Broncho-pneumonia is a very frequent cause of death. Otitis media and parotitis are not infrequent complications. Deafness is often marked.
Thrombosis of various vessels may be noted.
Gangrene of the extremities, especially the toes, is frequently present. Gangrene of areas subjected to pressure, as over the sacrum, is not infrequent. There does not seem to be the same tendency to gangrene of the genitalia as in spotted fever of the Rocky Mountains.
Diagnosis
The more gradual course of the fever and the less marked stuporous condition, together with positive blood cultures, should differentiate typhoid fever.
Plague has the same picture of alcoholic intoxication as typhus, but is without the rash. Influenza, with its acute onset, is confusing but does not show any increase in leucocytes.