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ID Board Review > Rickettsia and related > Flashcards

Rickettsia and related Flashcards

1
Q

from Virginia

fever, HA, myalgias

multiple eschars on lower extremities, then

develops maculopapular rash on trunk spreading to extremities

3.3 > 14 < 149

LDH 1502 Tbil 2.4 ALT 195

How to Dx?

Rx?

A

Rickettsia Parkeri

similar to RMSF, EXCEPT IT HAS ESCHARS

Dx: PCR of eschar, or 4x increase in IgG (during illness, then 2-4 weeks later)

Rx: DOXY (Chloramphenicol preg)

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2
Q

from Virginia

fever, HA, myalgias

develops maculopapular rash on extremities spreading inward

3.3 > 14 < 149

LDH 1502 Tbil 2.4 ALT 195

How to Dx?

Rx?

A

Rickettsia Rickettsii/RMSF

NO ESCHARS (unlike Parkerii)

Dx: PCR/skin biopsy of lesions or 4x increase in IgG (during illness and 2-4 weeks later)

Rx: doxy (chloramphenicol pregnant)

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3
Q

58F returns from S. Africa with fevers, myalgias and scab on R-thigh.

What would her labs look like?

Rx?

A

African Tickbite Fever (Rickettsia Africae)

leukopenia, thrombocytopenia, elevated LFT’s

Rx: Doxy (chloramphenicol if pregnant)

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4
Q

55M from upstate NY with NHL receiving rituximab and requires multiple blood transfusions.

Pancytopenic with elevated Tbil and LDH.

How to Dx?

Rx?

Severely Ill?

Duration?

A

Babesiosis.

Dx: Ring forms in RBC on blood smear.

Rx: atovaquone and azithromycin (clinda+quinine alternative)

If severely ill: > 10% parasitemia benefit from exchange transfusion.

Duration: 6 weeks and at least 2 weeks after last positive smear.

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5
Q

Ascending Paralysis in a hiker from Seattle.

What does CSF look like?

Vector?

Treatment?

A

Tick Paralysis!

CSF is NORMAL

Dermacentor, amblyoma, Ixodes

Remove Tick!

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6
Q

Lyme Disease in Louisiana but no pathogen.

What is the syndrome?

What type of tick?

A

STARI

Amblyomma Americanum

Lone Star Tick

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7
Q

17M with conjunctivitis after squeezing a tick into his eye.

Rx?

A

Francisella tularensis conjunctivitis

Doxy/Gent/Streptomycin

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8
Q

Hiker from Nevada with fever, leukopenia and thrombocytopenia. No rash and illness is mild.

What physical exam finding?

What causes this?

A

Colorado Tick Bite Fever

splenomegaly

Virus

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9
Q

Patient presents with target lesion, fevers and cytopenias in Maryland.

What ELSE might he have?

A

So, this is lyme.

Anaplasma and Babesia

also trasmitted by Ixodes (as well as Borrelia miyamotoi and powassan virus)

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10
Q

When should you give single-dose doxy to prevent lyme disease?

A
  1. Attached tick identified as an adult or nymphal I. scapularis (black-legged) tick that transmits Lyme disease (also capable in Connecticut of transmitting Borrelia miyamotoi, human granulocytic anaplasmosis, Powassan virus and babesiosis)
  2. Tick is estimated to have been attached for ≥ 36 hours (based upon how engorged the tick appears)
  3. Antibiotic treatment can begin within 72 hours of tick removal
  4. The local rate of tick infection with B. burgdorferi is ≥ 20 percent (known to occur in parts of New England, parts of the mid-Atlantic states, and parts of Minnesota and Wisconsin)
  5. The person can take doxycycline (i.e., no contraindications such as pregnancy or breastfeeding)
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11
Q

How do you diagnose lyme arthritis?

A

Two tier serology with reflex IgG immunoblot

PCR of synovial fluid is specific, but not sensitive

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12
Q

treatment of lyme disease in pregnant patient?

A

amoxicillin

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13
Q

23M from west Africa presents with fevers, headaches and arthralgias x 4 months. Has soft posterior cervical lymph node.

Organism?

Dx?

Rx?

A

African Trypanosomiasis likely gambiense (Western, more chronic presentation)

Dx: Direct visualization in blood/csf

can get Ab test as well (POC - but not avail in us)

Rx: Melarsoprol

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14
Q

35M refugee from somalia has fevers, leukopenia and thrombocytopenia.

blood smear negative for malaria. But positive for something else.

What might happen if given PCN?

A

Borrelia recurrentis (spirochetes, seen on blood smear).

Louse-borne borrelia recurrentis which occur in poor hygiene areas (refugee camps)

If treat with PCN, can result in JH reaction (fevers and hypotension) - requires fluid and nsaids/steroids.

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15
Q

Tickborne relapsing fever cause fever:

Louse-borne relapsing fever causes fever:

A

1-3 days

3-6 days

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16
Q

What diseases can lice cause?

A

Epidemic Typhus (prowazekii)

Trench Fever (bartonella quintana)

Relapsing fever (borrelia recurrentis)

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17
Q

18M refugee from burundi presents with fevers, myalgias, cough and rash on trunk x 7 days - what is the vector?

A

Louse - this is epidemic typhus (prowazekii)

18
Q

Which tick transmits tularemia and RMSF?

A

Dermacentor

east of the rock mountains and limited areas of pacific coast

19
Q

what does this tick transmit? (3)

A

lyme

babesia

anaplasma

20
Q

20M in homeless in NY presents with ‘tache noire’ and also papulovesicular rash.

What is this?

What vector?

Reservoir?

Treatment?

A

Rickettsial Pox (akari)

house mite vector

rodents reservoir

Doxy (chloram in pregnant)

21
Q

Where is this found and what is the vector?

A

HME

SE/south central US

amblyomma americanum (lone star - STARI)

Morula

22
Q

Where is this and what is the vector?

A

HGA

northeast/mid atlantic

Ixodes scapularis

23
Q

what is recrudescent rickettsia prowazekii?

A

brill-zinsser disease

occurs in 15% of individuals with a history of primary epidemic typhus

remittent febrile course lasts about 7-10 days

24
Q

ascending paralysis

A

wood tick and dog tick toxin

25
Q

what is the feared adverse effect of chloramphenicol?

A

aplastic anemia

26
Q

Geography of HME vs. HGA

Lethality of HME vs. HGA

A

HME is concentrated in southern belt, while HGA is is in the NORTH

HME has mortality rate 3% vs HGA 0.7%

27
Q

23M dog trainer from south texas presents with fevers, myalgias.

dx?

Vector?

Treatment?

A

Murine (endemic) Typhus - serology

*Fleas from rodents and pets

usually self-limited, but give doxycycline as it can rarely cause severe illness

https://casereports.bmj.com/content/13/11/e239471

28
Q

Fevers and mylagias 2 months after hunting swine

A

Brucella!

Very long incubation period. (vs. Q fever which is 2-4 weeks)

29
Q

Micro and Clinical differences between epidemic and endemic typhus?

A

Epidemic: Prowazekii from Lice in refugees, crowded conditions and in US endemic in flying squirrels- can be LETHAL and recur (brill zinsser disease)

Endemic (murine): Typhi from fleas - endemic in US California, TX, Hawaii, mild disease with no recurrence

30
Q

58M 3 days of fever/headache. Pulled tick off neck 3 days ago after fishing.

WBC 2.4, PLT 75, LFT’s normal

Improved, but then 2 days later recurred and has fatigue for several weeks

No response to Doxy

Dx?

A

Colorado Tick Fever Virus (CTFV) a coltivirus

RNA virus

CTFV, SRV in Idaho - Triphasix fever with headaches, myalgia and lethardy+ lekopenia and thrombocytopenia.

31
Q

28F myalgia, cough, nausea, vomitting, f/c.

Macular rash on arms/thighs

cleaned out rat-infested garag

3.0>10< 98

Dx/Rx?

A

Murine/endemic typhis (R. typhi) from fleas

Doxy

32
Q

Patient returns from Israel with eschar and MP rash including palms and soles

A

Mediterranean spotted fever (MSF), also known as boutonneuse fever (BF), is caused by Rickettsia conorii subspecies conorii (R conorii)

Doxy

33
Q

fleas

A

rickettsia typhi (murine/endemic typhus)

yersinia pestis

34
Q

flying squirrels

A

rickettsia prowasekii (epidemic typhus)

35
Q

lice

A

bartonella quintana (trench fever)

borrelia recurrentis (louse-borne relapsing fever)

rickettsia prowazekii (epidemic typhus)

36
Q

50M with fever, rigors, night sweats and headache - develops dry cough and maculopapular rash after returning from indonesia.

A

epidemic typhus (ricketssia prowazekii)

37
Q

58M with ulcer on his knee from bug bite. Several weeks later develops lump in his groin.

A

Tularemia

Rx doxy, cipro, gent or streptomycin

38
Q
A

Black Legged TIck (Ixodes)

Nyph Stage most disease transmission

Lyme, Anaplasma, Babesia, Miyamotoii, Powassan

39
Q

how many meals to ticks have in their lives?

A

3

40
Q

What is most common tick to bite in virginia?

A

Lone Star (Ambloymma americanum)

Ehrlichia and Tularemia

(in south, STARI, heartland virus, bourbon virus)

41
Q

What tick transmits RMSF in virginia?

A

Dermacentor (Dog Tick)

also transmits Francisella

ID Board Review (11 decks)

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