Rickettsia Ce a e

7/31/2019 Rickettsia Ce a e

1/110

RICKETTSIACEAEDr.T.V.Rao MD

T

Dr.T.V.Rao MD 1


2/110

Zinsser, Lice And History In 1935, Harvard Medical School physician and

researcher Hans Zinsser wrote the brilliantand original Rats, Lice and History in which hetraced the effects of vermin-borne disease onarmies, cities and populations. From hisextensive research on head and body lice,

Zinsser stated unequivocally that "the bodyand head louse carry the infection [typhus]from one human to another.

Dr.T.V.Rao MD 2


3/110

Zinsser, Lice And History

Dr.T.V.Rao MD 3


4/110

General Characteristics Small obligate intracellular coccobacilli Gram negative (poorly), better stained with

Giemsa (Blue) Have cell wall, bigger than virus but smaller

than bacteria Have DNA and RNA Have an ATP transport system that allows

them to use host ATP Arthropod reservoirs and vectors ( e.g. ,

ticks, mites, lice or fleas).

Sensitive to antibioticsDr.T.V.Rao MD 4


5/110

Category of rickettsia Genus

Rickettsia, Coxiella ,Orientia,Ehrlichia

Bartonella Species

Rickettsia prowazekii (epidemic typhus),

Rickettsia typhi (endemic typhus), Rickettsiarickettsii (spotted fever), Rochalimaeaquintana (trench fever), Coxiella burnetii (Q fever)

Dr.T.V.Rao MD 5


6/110

Dr.T.V.Rao MD

History 17 th -19 th century

Epidemics in Europe as aresult of war, disaster, or in prisoners

1909: Transmission by lice 1917-1925: Russia

Estimated 25 million cases End of WWII

DDT used for control Vaccine developed

6


7/110

Historical Photograph onTyphus

Dr.T.V.Rao MD 7


8/110

Structure: of BacteriaSimilar with Gram negative bacteria

Cell wall: outer membranepeptidoglycanlipopolysaccharide (LPS)

Microcapsule and polysaccharide

Two antigenically distinct groups:LPS : heat-stable, cross-reactive with

somatic antigens of non-motile Proteusspecies (Weil-Felix test)

Outer membrane protein: heat-unstable, species-specific

Dr.T.V.Rao MD 8


9/110

Rickettsia Small gram negative Bacilli Obligate intracellular pathogens. Parasites on - Lice, Fleas, Ticks Mites

colonizes the Gut.

In vertebrates colonizes Vascularendothelium and Reticuloendothelial

system. Dr.T.V.Rao MD 9


10/110

Five genera in this class causehuman diseases:

RickettsiaBartonellaCoxiella (does NOT cause skin rash )EhrlichiaOrientia

Dr.T.V.Rao MD 10


11/110

Replication

Dr.T.V.Rao MD 11


12/110

Five genera in this class causehuman diseases:

RickettsiaBartonellaCoxiella (does NOT cause skin rash)EhrlichiaOrientia

Dr.T.V.Rao MD 12


13/110

Dr.T.V.Rao MD 13


14/110

Genera 1.Rikettsia, 2.Orientia 3.Ehrcichia

Dr.T.V.Rao MD 14


15/110

Typhus Group Murine typhus (also known as endemic typhus and flea borne typhus)

Rickettsia mooseri (typhi) Epidemic typhus (also known as Brill - Zinsser disease and louse borne typhus) Rickettsia prowazekii Scrub typhus (or Chigger fever) Rickettsia tsutsugamushi

Dr.T.V.Rao MD 15


16/110

The Others Q Fever Coxiella burnetii Ehrlichiosis Ehrlichia canis Ehrlichia equi Ehrlichia chafeensis Several others now identified

Dr.T.V.Rao MD 16


17/110

RICKETTSIAL INFECTIONS

Fever, headache, malaise, prostration, skinrash & Hepatosplenomegaly Classified into groups:

1. Typhus Group Epidemic typhus ,Murine typhus , Scrub typhus

2. Spotted Fever Group RMSF, Rickettsiapox

3. Q Fever4. Trench fever5. Ehrlichiosis

Dr.T.V.Rao MD 17


18/110

Disease Organism Vector Reservoir

Rocky Mountainspotted fever

R. Rickettsii Tick Tick, wild rodents

Scrub typhus R. Tsutsugamushi Laval Mite(chiggers)

Mites, wild rodents

Epidemic typhus R. Prowazekii Louse Humans, squirrel fleas,flying squirrels

Murine typhus R. Thphi Flea Wild rodents

Q fever Coxiella Burnetii None Cattle, sheep, goats, cats

Diseases Caused by the Rickettsia

Dr.T.V.Rao MD 18


19/110

DISEASES RICKETTSIALAGENT

INSECTVECTOR

MAMMALIANRESERVOIR

TYPHUS GROUP

a) Epidemictyphus

R. prowazekii Louse Human

b) Murine

typhus(Endemic typhus)

R. typhi Flea Rodents

c) Scrubtyphus)

R.tsutsugamush

i

Mite Rodents

Dr.T.V.Rao MD 19


20/110

Rickettsia Prowazekii( Von Prowazekii )

Humans natural vertebrate hosts Vector - Human body louse,( Pediculus

humans corporis ) Lice get infected from patients. Life cycle get multiplied in gut 1 week Person person contact.

Lice bite causes itching and scratching Enters through respiratory tract / Conjunctivae Incubation 5- 15 days

Dr.T.V.Rao MD 20


21/110

Genus -Rickettsia Two groups Typhus fevers,

Spotted fever.Morphology Rickettsia pleomorphic

Coco bacillary,Size 0.3 to 0.6 micron

x 0.8 - 2 microns.

Gram negative, non motileNon capsulate not stained easilyGiemsa and Gimenez staining methods.

Dr.T.V.Rao MD 21


22/110

Typhus Fever

Dr.T.V.Rao MD 22


23/110

Typhus Fever group 1. Epidemic Typhus 2. Recrudescent typhus (

Brill Zinsser disease ) 3. Endemic typhus

Dr.T.V.Rao MD 23


24/110

EPIDEMIC TYPHUS (LOUSEBORNE TYPHUS)

Etiology: R. prowazekii

severe systemic infection &prostration

more fatal

Brill-Zinsser Disease recrudescent disease

Dr.T.V.Rao MD 24


25/110

Epidemic Typhus - 1 Also known as louse borne typhus because it is spread human-to-human via the body louse

(which dies of its infection with Rickettsia prowazekii after about three weeks) This is a serious disease consisting of fever, severe headache, myalgia, and central rash Untreated, the mortality ranges from 20 -

40% Major killer in concentration camps of WW II Dr.T.V.Rao MD 25


26/110

Cultivation Needs cell culture lines Grows in the Cytoplasm

Grows at 32 to 35

0c

Grows in yolk sac of developingchick embryo

Grows in mouse fibroblasts,Hela,Hep2

Dr.T.V.Rao MD 26


27/110

Cultivation Rickettsia can not be grown in

bacteriological media, Obligate

intracellular pathogens. In continuous cell lines, Guinea pig,

Mice Infect the endothelial cells of

vascular system. Can synthesize ATPDr.T.V.Rao MD 27


28/110

Life Cycle of Rickettsia

Dr.T.V.Rao MD 28


29/110

Replication

Dr.T.V.Rao MD 29


30/110

Dr.T.V.Rao MD

Transmission Human body louse

Pediculus humanus corporis

Infective for 2-3 days Infection acquired by feeding on infected

person

Excrete R. prowazekii in feces attime of feeding

Lice die within 2 weeks

30


31/110

Dr.T.V.Rao MD

Transmission Louse feces rubbed into bite or

superficial abrasions Inhalation of feces Sylvatic typhus

Flying squirrel

30 human cases in eastern and central U.S.

31
http://www.redpath-museum.mcgill.ca/Qbp/Images/mammals/squirrel,flying.jpg


32/110

PATHOLOGYMultiply in endothelial cells of small blood vessels

Vasculitis

(skin rashes;other organs DIC & vascular occlusion)

Swollen & necrotic

Thrombosis of the vessels

Dr.T.V.Rao MD 32


33/110

Antigenic structure

Species differ with Group specific

antigens. Sharing of antigens between

Rickettsia and Proteus basis of Weil Felix Heterophile agglutination Test.

Used Proteus strains 0X 19, OX2 OXKDr.T.V.Rao MD 33


34/110

Epidemic TyphusAlso called as Louse borne Typhus

Classical TyphusRussia Eastern Europe Devastating Epidemics

in wars

Napoleons retreat

Russia 3 million deaths 1917 1921India - Kashmir

Dr.T.V.Rao MD 34


35/110

R. Prowazekii

Louse

Human Human

Louse

Epidemic typhusDr.T.V.Rao MD 35


36/110

R. Typhi

Rodent

Flea Rat Tick Flea Human

Rodent

Murine typhus(much milder than epidemic

typhus)Dr.T.V.Rao MD 36


37/110

Le sions in Epidemic Typhus

Dr.T.V.Rao MD 37


38/110

Rickettsia Prowazekii( Von Prowazekii )

Humans - natural vertebrate hosts Vector - Human body louse,( Pediculus

humans corporis )

Lice get infected from patients. Life cycle get multiplied in gut 1 week Person person contact.

Lice bite causes itching and scratching Enters through respiratory tract / Conjunctivae Incubation 5- 15 days

Dr.T.V.Rao MD 38


39/110

Pediculus humanus corporis is theVector

Dr.T.V.Rao MD 39


40/110

Dr.T.V.Rao MD

Clinical Symptoms Incubation: 7-14 days High fever, chills, headache, cough, severe

myalgia May lead to coma

Macular eruption 5-6 days after onset Initially on upper trunk, spreads to entire body

Except face, palms and soles of feet

40


41/110

Clinical Features Fever, chills Rash on 4 th day

Spread from Trunk to Limbs Not face palms,

sole. In 2 nd week may into stuporous,delirious

stateMay reach 40 % fatality

Bacteria remain latent in Lymphoid tissue,cloudy state. Because of called as Typhus

May cause Recrudescent Typhus

( Called as Brill Zinser Disease.)Dr.T.V.Rao MD 41


42/110

Dr.T.V.Rao MD

Brill-Zinsser Disease Occurs years after primary attack

Person previously affected or lived inendemic area

Viable retained organisms reactivated Milder symptoms

Febrile phase 7-10 days Rash often absent Low mortality rate

42


43/110

Brill- Zinser DiseaseRecrudescent typhus fever

Earlier recovery from typhus fever Latency of the organism in lymphoid

tissue Reactivation leads to recrudescence.

Even louse get infected frompatients. Clinically similar but mild.

Dr.T.V.Rao MD 43


44/110

Pattern of Temperature chart inTyphus Fever

Dr.T.V.Rao MD 44

Endemic Typhus


45/110

Endemic TyphusR.mooseri

Also called as Murine or Flea borne typhus From Rats -Transmitted by Rat flea Rickettsia multiplies in Gut and shed in feces Humans bitten by infected Rat flees. Saliva or feces rubbed on bitten area, may

lead to infection. R.typhi R. Prowazekii similar, Biological and

Immunological tests.

Dr.T.V.Rao MD 45


46/110

Clinical features Mild disease Rat act as reservoir. Vector Rat flea -Xenopsylla cheopsis Rat flea bites rat Multiplies in the gut of the rat

Fleas un affted. Man gets infected accidentally Mexico Kashmir - chinaT.V.Rao MD

Dr.T.V.Rao MD 46


47/110

Experiments on AnimalsNeill-Mooser Reaction

Male guinea pig inoculatedintra peritioneally withblood of patients, orisolates of S.typhi produce

Fever, and scrotalswelling, enlarged tests,and cannot be pushedback.-due inflammationand adhesions between

layers of Tunica vagina Test positive in R.typhi

Dr.T.V.Rao MD 47


48/110

Dr.T.V.Rao MD

Treatment Chloramphenicol Tetracycline

Doxycycline 200mg Response within 48 hrs. usually

Vaccine Developed after World War II Not commercially available

48


49/110

Spotted Fever Group Rickets 1906 Rickettsia of this

group, multipliesin Nucleus andCytoplasm

Ticks transmit

Dr.T.V.Rao MD 49

RICKETTSIA INSECT MAMMALIA


50/110

DISEASES RICKETTSIAL AGENT

INSECTVECTOR

MAMMALIAN

RESERVOIR

SPOTTED FEVER GROUP

a) Indian tick typhus

R. conorii Tick Rodent, Dog

b) Rocky

mountainspotted fever

R. rickettsii Tick Rodents,

Dogs

c) Rickettsialpox

R. akari Mite Mice

Dr.T.V.Rao MD 50


51/110

Tick Typhus R.rickettsii Rock mountain spotted

fever R.siberica R.conori

R.australis.Ticks transmits bite- Trans ovarianspread

T.V.Rao MD Dr.T.V.Rao MD 51


52/110

Rocky Mountain spotted fever

Ticks in North / South America Tick type R.conori. Rickettsial Pox

Resembles like chicken pox

R. akari by miteMouse reservoir host.

Dr.T.V.Rao MD 52

Ti k d i


53/110

Ticks acts as vectors and reservoirsof Infection

Dr.T.V.Rao MD 53


54/110

Dr.T.V.Rao MD 54


55/110


Dr.T.V.Rao MD 55

Rock mo ntain spotted fe er


56/110

Rocky mountain spotted fever

Dr.T.V.Rao MD 56


57/110


Dr.T.V.Rao MD 57


58/110


Dr.T.V.Rao MD 58


59/110

Genus - Ehrlichia Small Gram negative , obligate intracellular

pathogens, Can infected Phagocytic cells. Called as Glandular fever Ehrlichia sennetsu causative agent. Cause atypical lymphocytosis No arthropod vector, Eating fish infected with flukes infected by

these bacteria.Dr.T.V.Rao MD 59


60/110

Monocytic Ehrlichiosis Caused by Ixodid ticks, E.chaffensis. Deer, cattle, Sheep reservoirs

Leucopenia Thrombocytopenia Liver is involved. Doxycycline effective in Ehrlichosis Human granulocytic Ehrlichosis E.equi.

Dr.T.V.Rao MD 60

Laboratory Diagnosis of Rickettsial


61/110

Laboratory Diagnosis of Rickettsialdiseases

Isolation Serology Isolations can be dangerous if not

well protected.

R.typhi R.conori, R.akari causestunica reaction R.prowazeki only fever

Dr.T.V.Rao MD 61


62/110

Diagnosis and Prevention

MicroscopySerological Test (Weil-Felix reaction, ELISA, IF,PCR)

Breaking the infection chain ( controlling and

killing the intermediate hosts and reservoirhosts)Inactivated vaccine has protective effectChloromycetin, tetracycline are helpful for

therapy, Sulphonamides are not administered(increasing the penetrating of the vessel).

Dr.T.V.Rao MD 62


63/110

Laboratory Diagnosis Tissue

cultures In Vero cells, MRC 5

cells.

Dr.T.V.Rao MD 63


64/110

SerologyWeil Felix Test

Test based on principle of Hetrophileagglutination tests

Non motile strains of Proteus are selected. OX19,OX2,OXK

Sharing alkali stable carbohydrate antigen bysome Rickettsia X certain strains of Proteusvulgaris OX19,OX2, and Proteus mirabilis OXK.

Dr.T.V.Rao MD 64


65/110

Laboratory Diagnosis Weil Felix is simple to perform but of

Historical importance Other tests

Complement fixation tests,

Agglutination,

Passive hem agglutination.PCR

Dr.T.V.Rao MD 65

DISEASE WEIL-FELIX


66/110

OX19 OX2 OXK

Epidemic typhus ++ +/- -

Endemic typhus ++ - -

Scrub typhus - - ++

RMSF + + -

Rickettsial pox - - -

Q fever - - -

Trench fever ? ? ?Dr.T.V.Rao MD 66


67/110

Different Methods of Diagnosis

Dr.T.V.Rao MD 67

Older Techniques


68/110

1. Giemsa Staining Technique:- utilizes peritoneal scrapings of infected mice.

Older Techniques:to detect O. tsutsugamushi

2. Weil-Felix Proteus Agglutination Test:-is a test which relies on the fact that Rickettsia and Proteus OX strains have common

antigens.:-is a test for the presence & type of rickettsial disease based on the agglutination of X-strain Proteus vulgaris with suspected Rickettsia in a patients blood serum sample. :-is commonly used in hospitals & clinics:-This test is now being replaced by a complement-fixation test.

Weil-Felix Proteus Agglutination TestDr.T.V.Rao MD 68

Newer Techniques


69/110

2. Indirect Immuno-Peroxidase(IIP)

Control Infected

IIP= is a modification of IFA technique thatreplaces the fluorochrome with peroxidase.

Slide is observed using a bright-field

microscope.

Staining reaction is positive when O.tsutsugamushi particles stain light brown.

Immunological Assays

Newer Techniques:to detect O. tsutsugamush i

Dr.T.V.Rao MD 69

Newer Techniques


70/110

4. Enzyme-linked Immuno-Sorbant Assay (ELISA)

1. Add antigens

Ag-coatedwell

3. Add anti-Ab 2. Add mouse serum

Ag-Ab

complex OpticalDensity

(OD)Reading

4. Add enzyme-

substrate mix

5.Let colorize

ELISA test is a technique for detecting & measuring antigen or antibody.:-It is one of the most reliable techniques to detect antibody

against scrub typhus infection.:-Its procedure is the principal for development of recent

rapid diagnostic kits.:-This technique is widely used in laboratories & hospitals.

Immunological Assays

Newer Techniques:to detect O. tsutsugamushi

Dr.T.V.Rao MD 70


71/110

Prophylaxis Control of vectors. Destruction

animal reservoirs,Dr.T.V.Rao MD 71


72/110

Scrub Typhus Scrub typhus caused by Mild to fatal 6-18 days after bite of Mite An Escher is formed at the site of bite With enlargement of Lymph nodes,

Interstitial pneumonitis,lymphadenopathy,spleenomegalyEncephalitis, Respiratory failure,circulatory failure

Dr.T.V.Rao MD 72


73/110

SCRUB TYPHUSEtiology: Orientia tsutsugamushi resembles Epidemic typhus except for

the ESCHAR generalized lymphadenopathy &

lymphocytosis cardiac & cerebral involvement may be

severe

Dr.T.V.Rao MD 73


74/110

Epidemiology Source of infection-------- Rat

Route of transmission----- Trombiculid mites Susceptible population---- All susceptible

Epidemic features---------- Tsutsugamushi

triangle

Dr.T.V.Rao MD 74


75/110

Epidemiology

Infected

animal Eg

g

Larva

Eg

g

Larva

Nymph

Nymph Adul

t

Adul

t Human

Natural cycle-natural focalizationNatural focus disease-zoonosis-borne diseases

Dr.T.V.Rao MD 75

Scrub Typhus


76/110

An important vector-borne disease, firstdescribed in 1899 in Japan.

During World War II, this disease killedthousands of soldiers who were stationed

in rural or jungle areas of the Pacifictheatre.

Scrub Typhus

The disease occurred and threatened people throughoutAsia & Australia. The range stretches from the Far-eastto the Middle-east (from Japan and Korea, Southeast Asia, Pakistan,India, to Arab countries and Turkey ). There are approx. 1 millioncases each year world-wide, & over 1 billion people atrisk.

Dr.T.V.Rao MD 76
http://www.map-of-asia.us/images/map-of-asia.gifhttp://www.map-of-asia.us/images/map-of-asia.gif


77/110

R. TsutsugamushiEggs Adult stage Nymphal stage

Nymphal stage Adult stage Eggs

Rats Nymphal stage Nymphal stage Human

Scrub typhus

Chigger

Dr.T.V.Rao MD 77

b h


78/110

Scrub typhus

Dr.T.V.Rao MD 78

Scrub Typhus : A Rickettsial Disease


79/110

Pathogen: Orientia tsutsugamushi Rickettsial bacteria

Vector: Leptotrombidium Chigger-Mite

An acute febrile, rickettsial diseasecaused by a gram-negative, rod-shaped (cocco-bacillus) bacterium,known as Orientia (Rickettsia)

tsutsugamushi.

Scrub Typhus : A Rickettsial Disease

O. tsutsugamushi is transmitted to vertebratehosts (rodents-primary host & humans-secondary or accidental host) by the bite of larvalmites (chiggers) of the genus Leptotrombidium , e.g. L. deliense, L. dimphalum, etc.

Dr.T.V.Rao MD 79


80/110

Pathogenesis and pathology

Inoculation Invade Locallymph node Spread byBlood stream

Invade Vascularendothelium

Papulemaculoppularescharulcer

Enlargementof locallymph node

Generalsymptoms of intoxication

General organhyperaemia.Systemiclyphadenopath

Dr.T.V.Rao MD 80


81/110

R. Tsutsugamushi

Eggs Adult stage Nymphal stage

Nymphal stage Adult stage Eggs

Rats Nymphal stage Nymphal stage Human

Scrub typhus

Chigger

Dr.T.V.Rao MD 81


82/110

Scrub typhus

Dr.T.V.Rao MD 82


83/110

Clinical Manifestation

Incubation period is 4~21

Sudden onset with a fever 1st week, systemic toxic symptoms

2nd week, get worse, complication

3th week, conv alesceDr.T.V.Rao MD 83

Specific features


84/110

Specific features

Eschar

Probability: Higher than 60%.

Location: Axillary fossa, inguinal region,

perianal region, scrotum, buttocks and thethigh.Appearance: an ulcer surrounded by a red

areola, is often covered by a dark scab.

The most specific manifestation of scrubtyphus .

Dr.T.V.Rao MD 84

Ri k i i l


85/110

Ricketisial pox Transmitted by mites, Similar other spotted fever Head ache ,fever Escher at the site of bite by mite.

Maculopapular rash, can bevesicular,

Fever lasts for 1 weekDr.T.V.Rao MD 85

Ski L i Mi


86/110

Skin Lesion Mite

Dr.T.V.Rao MD 86

Q F


87/110

Q Fever Occurs in veterinarians, ranchers, and animal

researchers who are in contact with infectedplacenta from sheep, cattle, or goats (no

arthropod vector for C. burnetii) Incubation period is 10 -28 days Fever and headache are common; 50% will

develop pneumonia after inhaling theorganism; hepatitis & endocarditis are rare Specific serology establishes the diagnosis

Bioterrorist threat? Dr.T.V.Rao MD 87

C i ll B ii


88/110

Coxiella Burnetii Q fever query fever Self-limiting flu-like syndrome with high

fever (40 ) Primary reservoirs are wild (cattle,

sheep, goat etc.) Non-cross reactive antigen with non-

motile Proteus (Weil-Felix reactionnegative)

Live in macrophages of vertebrate hostDr.T.V.Rao MD 88

Genus Coxiella


89/110

Q Fever Etiological agent ? Small in size called Coxiella burnetti

Ixodid tick spread the disease Domestic live stock get infected. Coxiella abundant in Tick feces, Survive in dried feces, Milk too infective Cause Human infection.

Dr.T.V.Rao MD 89

C i ll b i


90/110

Coxiella burnetti

Q fever Cow and sheep tick High resistance

abruptonset ,fever,headache,chills,myalgia,granulomatoushepatitis

chronic diaease withsubacuteonset ,endocarditis,hepaticdysfunction

Dr.T.V.Rao MD 90

Q F


91/110

Q - Fever

Dr.T.V.Rao MD 91

Q F


92/110

Q Fever Wool hides, Meat, Milk Enters through abrasions System infection through Intestine,

pulmonary, All organs are involved Can cause serious infection,

Hepatitis and meningitis,May last for 2 3 years as chronic condition

Infects Monocytes and MacrophagesDr.T.V.Rao MD 92

Q Fever


93/110

Q Fever

Dr.T.V.Rao MD 93


94/110

Pasteurization of Milk Which method is better ?

Pasteurization byholders method noteffective

Flash methodeffective.

Phase variation

applicablePhase I and Phase II

Dr.T.V.Rao MD 94

Cli i l f t


95/110

Clinical features

Present with head ache, chills,Pneumonia

Endocarditis, Meningitis,Encephalitis

Can cause latent infections.

Dr.T.V.Rao MD 95

Q Fever


96/110

Q Fever

Dr.T.V.Rao MD 96

L b t Di g i


97/110

Laboratory Diagnosis

Indirect Immunofluorescencemethods

Polymerase chain reaction, Genus specific applications in

progress. Isolation of the organism is

dangerous Dr.T.V.Rao MD 97

Treatment


98/110

Treatment Doxycycline is effective. Tetracycline are highly

effective Nursing care May need blood transfusion.

Dr.T.V.Rao MD 98

Eh li hi i


99/110

Ehrlichiosis Ehrlichia chaffeensis most common

Human monocytotropic ehrlichiosis (HME) E. ewingii has also been identified Transmitted by lone star tick ( Amblyomma

americanum) White-tailed deer major host for tick

species and natural reservoir for bacteria Infections in coyotes, dogs, and goats

have been documented

99


100/110

Ehrlichiosis Clinical Information


101/110

Ehrlichiosis Clinical Information

Onset occurs 5 10 days after tick bite Infects leukocytes

E. chaffeensis prefers monoctyes E. ewingii prefers granuloctyes Morulae can be identified

Rash observed ~33% of patients with HME Vary from petechial or maculopapular to diffuse

erythema Occurs later in disease

Rash rarely seen with E. ewingii infections

101

E . Chaffeensis Laboratory


102/110

yCriteria

Confirmed Fourfold change in IgG by IFA in paired serum samples Detection of DNA by PCR Demonstration of antigen by IHC in biopsy or autopys

sample Isolation of bacteria by cell culture

Supportive Elevated IgG or IgM by IFA, ELISA, dot-ELISA or other

formats Morulae identification by blood smear microscopicexamination

102

Bartonella


103/110

Bartonella Gram ve bacilli/Anthropoids B.bacilliform, B.quintana,B henselae Bartonella bacilliform Also called as Oroya fever, A Medical student Peruvian

Daniel Carrion Credited for isolation.Called as Carrions Disease

Dr.T.V.Rao MD 103

Bacterial Morphology


104/110

Bacterial Morphology

B.bacilliform Pleomorphic

gram negativebacteria Carries a tuft of

polar flagella.

Dr.T.V.Rao MD 104

Cli i l f t


105/110

Clinical features Progressive Anemia, Bacterial invasion of

Erythrocytes

Carries high mortality

Dr.T.V.Rao MD 105

Bartonella ( Rochalimia )


106/110

Bartonella ( Rochalimia ) Bartonella Quintana Called as trench fever Called as five day fever. Grows in cell free culture media.

Chronic/Latent infections Infection may lost > 20 yearsT.V.Rao MD

Dr.T.V.Rao MD 106

Bartonella Henselae


107/110

Bartonella Henselae Cat scratch disease (CSD) Weil-Felix reaction negati ve

Infection by cats or dogs Parinaud Eye -Lymph node

syndrome

The eye looks red, irritated, andpainful,

similar to conjunctivitis .Dr.T.V.Rao MD 107

Bartonella henselae
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/1469der0069-04.jpg&template=izoom2http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/1469der0069-04.jpg&template=izoom2http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/1469der0069-04.jpg&template=izoom2


108/110

Bartonella henselae Also called s cat scratch disease Caused by B.henselae Needs lymph node biopsy Staining sections with Warthim

Starry sating Associated in AIDS patients.

Dr.T.V.Rao MD 108

Prevention


109/110

Prevention Use of repellents in endemic areas Protective clothing in endemic areas Careful inspection & quick removal of ticks Useful vaccine for RMSF is available for high

risk groups such as forest rangers that work inendemic areas

Weekly doxycycline may prevent scrubtyphus infection in field workers

Dr.T.V.Rao MD 109


110/110

Programme Created by Dr.T.V.Rao MDfor Medical and Paramedical Students in

the Developing World Email

[email protected]

Documents

Rickettsia Ce a e