Brill-Zinsser disease is a form of recrudescent epidemic typhus that occurs years or decades after primary typhus infection [1–4]. However, in the United States, improved sanitation and hygiene measures have largely eliminated the human body louse vector and epidemic typhus as public health concerns [1]. In addition, the availability of tetracycline-class antibiotics to effectively treat rickettsial infections has reduced the severity and duration of infections [1, 4].
Although the classic louseborne cycle of Rickettsia prowazekii is not common in the United States, R. prowazekii infections are still sporadically reported. There have been at least 47 cases documented in humans since 1976 (Centers for Disease Control and Prevention, unpublished data) [5, 6]. Most of these cases had reported contact prior to illness onset with the southern flying squirrel, Glaucomys volans, which serves as a zoonotic reservoir for a sylvatic cycle of infection [5, 6]. In this report, we describe the first known reported case of Brill-Zinsser disease following a primary infection with sylvatic epidemic typhus acquired from flying squirrels.
Clinical Infectious Diseases, Volume 51, Issue 6, 15 September 2010, Pages 712–715, https://doi.org/10.1086/655891