In rare severe cases, marked rezchayshaya headache, loss of consciousness, delusions, agitation, rigidity neck, Kernig and Brudzinskogo symptoms, increased reflexes, swallowing disorders, speech. There are fibrillar twitching of facial muscles, tremor of limbs, ankle clonus, dyspnea, dysuria, etc. All this can be characterized as meningo-encephalitis typhous. In most patients, even mild forms characterized by changes in the cardiovascular system in the form of lowering blood pressure voiceless heart sounds, rapid pulse, frequent – extrasystole. Sometimes defined by expanding the boundaries of the heart, muscle noise at all auscultatory points. In patients with typhus decreased appetite, coated tongue is dry and dirty-gray bloom, often cracked, with protruding shaking, sometimes, "stumbling" on the teeth, bends (sign language – sign Govorova-Godelier). Often there constipation, and by the end of the disease is often observed without diarrhea pathological impurities.
The spleen and liver are usually enlarged with a 3-4th day of illness, they have a soft texture, increase their first determined percussion, then the 5-6th day of the liver and spleen disease begin to appear of the hypochondrium. Quite often, throughout the disease observed in patients with dry cough (diffuse bronchitis). In difficult cases, a leaking urine retention with dilation of the bladder (ishuira paradoxa). Blood picture at and peripheral nervous system is very relaxed, skin rash rather scanty, and often neobilnaya limited rozeoleznaya elements. Hectic period with milder forms of truncated to 06/08/10 days, the number of white blood cell count is often normal, sometimes marked leukopenia, but in all cases characterized by neutrophilia with a shift to the left. Typhus can be repeated in these cases due to reinfection develops only; for disease very similar to the primary typhus, and in most cases it is the identity. Mortality rates for typhus, due to effective adjuvant therapy, can be reduced to almost zero, especially when the use of tetracycline antibiotics. Complications.