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Vector-borne bacterial infections Flashcards

1
Q

bacilli

A

disease causing bacteria

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2
Q

what kind of bacilli is rickettsia

A

gram-negative

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3
Q

what makes rickettsia different from other gram negative rods

A
  1. peptidoglycan layer is minimal

2. LPS has weak endotoxin activity

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4
Q

what can you not use for treatment in Rickesttsi? and why?

A

Beta-lactams because LPD has weak endotoxin activity

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5
Q

obligate intracellular

A

cannot produce outside of host cell

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6
Q

where does Rickettsia replicate

A

in cytoplasm of cell

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7
Q

what stain is used to see Rickettsia

A

Giemsa

Gimenez

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8
Q

what is the common name for Rickettsia rickettsii

A

Rocky Mountain Spotted Fever (RMSF)

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9
Q

what is the pathogenic factor in Rickettsia rickettsii? how does it work

A

outer membrane protein A (Omp A)

- adherence to endothelial cells

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10
Q

Rickettsia rickettsii replicates where? this results in what

A

cytoplasm and nucleus

-vasculitis

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11
Q

how does Rickettsia rickettsii bypass the immune system

A

intracellular growth protects the bacteria from immune clearance

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12
Q

what is the most common Rickettsia causing human disease in USA

A

Rickettsia rickettsii

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13
Q

90% of infections occur during what time of year

A

April - September

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14
Q

what is the vector for Rickettsia Rickettsii? what family do they belong to

A

Ticks

Ixodeae family

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15
Q

name the 2 forms of ticks that cause Rickettsia Rickettsii

A 
Dermacentor andersoni (wood tick)
Dermacentor variablilis (dog tick)
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16
Q

where is Dermacentor andersoni found

A

rocky mountain states

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17
Q

where is dermacentor variablilis found

A

Southeast United states

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18
Q

what states had the highest incidence rates for Rocky mountain spotted fever

A 
Arkansas
Delaware
Missouri
North Carolina
Oklahoma 
Tennessee
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19
Q

what is the reservoir for rickettsia rickettsii

A

ticks via transovarian transmission

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20
Q

what is the process of a tick biting a human

A
  • bit is painless and goes unnoticed

- after 6-10 hours ….????

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21
Q

how long does rocky mountain spotted fever incubate

A

2-14 days

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22
Q

what are clinical symptoms for rocky mountain spotted fever

A 
fever
chills
headaches
myalgias
abdominal pain 
vomiting
hepatitis
respiratory failure
encephalitis
renal failure 
hypotension
myocarditis
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23
Q

when does the pathogenic rash appear for rocky mountain spotted fever

A

after 3-5 days

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24
Q

where does the pathogenic rash appear for rocky mountain spotted fever? do all victims get this rash

A

centripetal
palms and soles
no

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25
Q

what does centripetal rash mean

A

spreads from periphery to center

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26
Q

what happens in 20% of untreated cases for RMSF

A

fatal, clinical suspicion is key

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27
Q

what will the laboratory findings be for RMSF

A 
Thrombocytopenia 
coagulopathy
anemia
normal WBC count
hyponatremia 
Transminitis
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28
Q

Transaminitis what does that mean

A

Increased ALT/AST levels

could indicate liver damage

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29
Q

for RMSF when is diagnosis idealistic

A

before the onset of rash is clinical and epidemiological

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30
Q

RMSF, the organism in acute phase is detected how in the lab

A
  1. PCR
  2. Immunohistochemical methods in skin biopsy
  3. serology but confirmation needed
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31
Q

according to the CDC, when is RMSF notified to them

A 
fever plus any one of the following 
rash 
eschar
headache
myalgia
anemia 
thrombocytopenia
hepatic transaminase elevation
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32
Q

how do you confirm RMSF in the lab

A
  1. fourfold change in IgG specific titer reactive with R. rickettsii by indirect immunofluoresense assay (IFA) b/w paired serum specimens ( one speciemen taken in 1st week, second 2-4 weeks later )
  2. detect R. rickettsii DNA in a clinical specimen via amplification of a specific target by PCR asay
  3. demonstrate rickettsial antigen in biopsy or autopsy speciment by IHC
  4. Isolation of R. Rickettsii from clinical specimen in cell culture
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33
Q

for laboratory confirmation of RSMF why is IgM not used

A

lacks specificity and are usually false +

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34
Q

common name for Rickesstia akari

A

Rickettsailpox

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35
Q

what is the world distribution for Rickettsia Akari

A

cosmopolitan

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36
Q

how is Rickettsia akari transmitted

A

mites

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37
Q

what is the reservoir for Rickettsia akari

A

rodents ( common house mouse)

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38
Q

how does R. akari present

A

biphasic

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39
Q

what happens in the first phase for R. akari

A

1 week after bite: papule to ulcer to eschar at site of bite

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40
Q

what happens after the first phase of Rickettsialpox

A

incubates for 7-24 days

systemic spread

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41
Q

what happens in 2nd phage of R. akari

A 
high fever
severe headache
photophobia
papulovesicular rash, 
pox-like progression ( vesicles crust over)
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42
Q

when does R. Akari 2nd phase heal

A

within 2-3 weeks

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43
Q

for clinical symptoms with R. akari and R. Rickittsii which one has a milder course

A

R. akari

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44
Q

Anthrax

A

bacterial disease of sheep and cattle, typically affecting the skin and lungs.
- transmitted to humans, causing severe skin ulceration or a form of pneumonia

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45
Q

what is the difference in skin rashes with Anthrax and Rickettsialpox

A

anthrax patients only have eschar

Rickettsialpox: papule –> ulcer –> eschar

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46
Q

If Rickettsialpox is on the differential diagnosis list what other thing should be on the list

A

Anthrax

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47
Q

R. Prowazekii has what reservoir

A

humans

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48
Q

how is R. prowazekii transmitted

A

during blood meal

  • louse defecates highly infective feces
  • introduced into by body by scratching/hand contamination/ injured skin or mucous membrane
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49
Q

how long can lice feces remain infectious in R. prowazekii

A

100 days

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50
Q

how are louse transfered from human to human in R. prowazekii

A

sharing clothes

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51
Q

what are 2 syndromes for R. prowazekii

A

acute, potentially severe vasculitis

- Brill-Zinsser disease

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52
Q

when does acute, potentially severe vasculitis occur in R. prowazekii? what other symptoms present

A

7-14 days after contact with infected lice

fever, centrifugal maculopapular rash, CNS symptoms

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53
Q

what is Brill-Zinsser disease

A

recrudescent from 10-50 years after primary infection

- milder form, rash, flu-like symptoms, seen in elderly patients WWII refugees

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54
Q

how is R. prowazekii tested in the laboratory

A

serology (MIF) test

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55
Q

when is R. Prowazekii prevelent in the world

A

during disaster, war, famine

rare in US

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56
Q

R. prowazekii is transmitted how in the US

A

usually rare in US

  • “flying squirrels”
  • squirrels have fleas, fleas bite humans
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57
Q

R. Parkeri common names

A

American Boutonneuse fever

-Tidewater spotted fever

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58
Q

where does R. Parkeri usually occur

A

souther United States

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59
Q

what is the vector for R. Parkeri

A

Amblyomma maculatum ( Gulf Coast Tick)

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60
Q

clinical symptoms for R. Parkeri

A

fever, headache, myalgias

eschars and rash on PE

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61
Q

what is the mortalilty rate for R. parkeri

62
Q

what lab tests would be used R. Parkeri

A

serology
PCR
culture from skin biopsy

63
Q

what is the treatment for R. Parkeri

A

Doxycycline

64
Q

R. Typhi have what reservoir

65
Q

what is the main vector for R. Typhi

A

Xenopsylla cheopis ( rat flea) also cat flea ( esp in USA)

66
Q

where is R. Typhi usually found

A

worldwide, more in warm, humid areas

67
Q

how are humans infected with R. Typhi

A

inoculation of infective flea feces in bite wounds

68
Q

what is the endemic (murine ) typhus

69
Q

what is the epidemic (louse-borne) typhus

A

R. prowazekii

70
Q

what are some clinical manifestations of R. Typhi

A

fever, headache, chills, myalgias
rash ( variable)
mild symtpoms

71
Q

what labs should be runned for R. typhi

A

serology by IFA

72
Q

what is the common name for Orientia tsutsugamushi

A

scrub typhus

73
Q

what is the reservoir for Orientia tsutsugamushi

A

larval mites ( chiggers), via transovarian

74
Q

what is the vector for Orientia tsusugamushi

A

mites, feed only once in a lifetime

75
Q

where is Orientia tsutsugmamushi found in the world

A

Asia Pacific rim

76
Q

clinical symptoms of Orentia Tsutsugamushi

A

severe headache, fever, myalgias
maculopapular rash, spreads CENTRIFUGALLY
CNS complications
heart failure

77
Q

what lab tests check for Orentia Tsutsugamushi

A

Serology (IFA)

78
Q

what is the drug of choice to treat Rickettsial and Orientia infections

A

Doxycylcine

79
Q

what are alternative drugs to treat Rickettsial and Orientia infections

A

Chloramphenical or Fluoroquinolone

80
Q

when should treatment be administered if you think you have Rickettsial or Orientia infections

A

Immediately , don’t wait for confirmatory serology

81
Q

for RMSF what are the rules for giving Doxycline

A

Normally: don’t > 8yrs b/c dental staining/enamal hypoplasia
RMSF: drug of choice regardless of age of patient

82
Q

how should a tick be removed from the skin

A

don’t twist or jerk the tick when pulling with twizzers

83
Q

what are the 5 don’ts for Rickettsial disease

A
  • don’t wait for petechial rash to develop
  • don’t exclude diagnosis because no history of tick bite
  • don’t exclude diagnosis solely for geographic or seasonal reasons
  • don’t withhold therapy if there is any suspicion
  • don’t be afraid to use Doxycyline at any age
84
Q

what type of bacteria are Ehrlichia and Anaplasma

A

obligate intracellulular

85
Q

Ehrlichia and anaplasma don’t have what in the cell memebrane? Therefore what treatment will not work for them

A

no peptidoglycan or LPS

beta-lactams dont work

86
Q

Ehrlichia and Anaplasma grow on what type of cell

A

Hematopoietic cells

87
Q

where do Ehrlichia and Anaplasma replicate

A

phagosomes of host cells

88
Q

what is morula

A

microcolony of Ehrlichiae within a vacuole

89
Q

Another name for Ehrlichia chaffeensis

A

human monocytic ehrlichiosis HME

90
Q

what is another name for anaplasma phagocyophilum

A

human granulocytic anaplasmosis HGA

91
Q

what is the reservoir for Ehrlichia chaffeensis

A

deer and dogs

92
Q

what is the vector for Ehrlichia chaffeensis

A

ticks

Amblyomma americanum

93
Q

where is Ehrlichia chaffeensis usually found

A

southeast

south central and midwest states

94
Q

what and when do clinical symptoms occur for Ehrlichia chaffeenis

A 
1-3 weeks after bite: flue-like symptoms
late onset ( 1 week after) rash (spares hands and feet)
95
Q

what lab work is done for Ehrlichia chaffeensis

A

serology by IFA
PCR in blood
- peripheral blood (Giemsa) to see morulae in monocytes is insensitive

96
Q

what is the reservoir for Anaplasma phagocyphilum

A

Deer, sheep, rodents

97
Q

what vector does Anaplasma phagocyphilum use

A

hard-shelled ticks

Lxodes scapularis pacificus

98
Q

where does Anaplasma phagocyphilum predominantly occur

A

Northeast/north-central states and Norther California

99
Q

what are the clinical symptoms for Anaplasma Phagocyphilum

A 
1-3 weeks after bite: flue-like symptoms
late onset ( 1 week after) rash (spares hands and feet)
100
Q

what labs are done for Anaplasma Phagocyphilum

A
  • serology by IFA (paired specimens to see increase IgG_
  • blood PCR
  • peripheral blood ( Giesma) to see morulae in granulocytes is insenstive
101
Q

what are laboratory findings for Anaplasma and Ehrlichia

A

leukopenia
lymphopenia
thrombocytopenia
elevated liver enzymes

102
Q

what is the drug choice for Ehrlichia and Anaplasma

A

DOXYCLYCINE REGARDLESS OF AGE

103
Q

what happens if the patient fails to respond to Doxycycline within 3 days

A

there is an infection with other organism

104
Q

Borrelia recurrentis

A

epidemic relapsing fever

105
Q

Borrelia spp

A

endemic relapsing fever

106
Q

Borrelia burgdorferi

A

lyme disease

107
Q

what type of bacteria is Borrelia

A

weakly staining, gram neg. spirochetes

108
Q

what makes Borrelia a different bacteria from the rest of them

A

motile (flagella)

difficult to cultivate

109
Q

what is the leading vector for Borrelia burgdorferi

A

borne disease in USA

110
Q

what 3 main areas are Borrelia burgdorferi found

A

Northeast, Minnesotta, and Wisconsin

111
Q

what are other vectors for borrelia burgdorferi

A

lxodes scapularis

pacificus

112
Q

what is the reservoir for borrelia burgdorferi

A

white-footed mouse (peromyscus leucopus) and white-tailed deer

113
Q

how is borrelia transmitted

A

in tick’s saliva during prolonged period

114
Q

what time of the year does Lyme disease occur

A

June and July

115
Q

what is the incubation period for Lyme disease

A

up to 1 month from tick bite

116
Q

what are the 3 stages of Lyme disease

A

early localized
early disseminated
late disease

117
Q

what happens in early localized

A

distinctive rash: erythema migrans (bull’s eye)

118
Q

what happens in early disseminated

A

multiple EM, facial nerve palsy, meningitis

119
Q

what happens in late disease

A

arthritis (knees) carditis

120
Q

what are symptoms of Lyme disease

A

fatigue, joint pain, cognitive problems

121
Q

for early stage Lyme disease how is diganosis made and why

A

clinically b/c Ig are not detectable within the 1st 4weeks of infection

122
Q

what laboratory items would you use for Lyme disease

A

EIA or FIA

confirmatory Western Blot

123
Q

what is used to treat Lyme disease

A

Amoxicillin or cefuroxime for children equal to 8 years

124
Q

what is used to treat the CNS, carditis or recurrent arthritis in lyme disease

A

Ceftriaxone

125
Q

what does STARI stand for

A

Southern Tick-associated rash illness

126
Q

what are clinical symptoms for STARI

A

rash typical of erythema migrans and mild flu-like symptoms in NON-LYME ENDEMIC AREAS

127
Q

STARI is associated with a bite by what

A

Lone Start tick ( A. americanum)

128
Q

Preliminary studies show the cause of STARI is postulated to be a

A

spirochete: B. lonestari

129
Q

where does STARI occur

A 
Missouri
Maryland
Georgia
South Carolina
North Carolina
130
Q

what may serve as a reservoir for STARI

A

white-tailed deer

131
Q

name 4 reasons why STARI is different from lyme

A

onset of lesion was shorter

  • less likely to have multiple skin lesions, smaller sized lesions
  • rapid recovery
  • not linked to arthritis, neurologic disease, or chronic symptoms
132
Q

what medicine is used to treat STARI

A

Doxycycline

Amoxicillin

133
Q

under what circumstance does B. recurrentis occur

A

natural disasters

unsanitary conditions

134
Q

what is reservoir for Borrelia spp.

A

rodents, small mammals

135
Q

how do ticks transmit Borrelia spp.

A

feed nocturnally and contaminate the wound with saliva and feces that are infectious

136
Q

what are clinical syndromes for relapsing fever

A

fever, chills, headaches, hepatosplenomegaly

137
Q

what is the timeline for relapsing fever clinical symtpoms

A

incubation 1 week
afebrile period of 1 week
return symptoms
relapse

138
Q

what is the mortality rate for relapsing fever

139
Q

how does one lab diagnose relapsing fever

A

Giemsa on peripheral blood during febrile episode

140
Q

what is the treatment of relapsing fever

A

Doxycycline

Penicillin and Erythromycin for pregnant and children under 8 years of age

141
Q

what is Babesia

142
Q

Babesia shares the same vector and reservior as what other disease

A

B. burgdorferi

143
Q

what is the vector and reservoir for Babesia

A

v: lxodes ticks
r: white footed mouse

144
Q

what is the most common species for Babesia

A

babesia microti

145
Q

Babesia is what kind of parasite and what does it mimic

A

INTRA-ERYTHROCYTIC PARASITE

MALARIA

146
Q

what is the life cycle of Babesia

A

blood meal, introduces sporozoites into human host

  • sporozoites enter erythrocytes, asexual replication
  • replication causes the disease
147
Q

what are clinical manifestation for Bebsia

A 
hemolytic anemia
influenza like symptoms ( fever, chills, body aches)
Splenomegaly
hepatomegaly
jaundice
148
Q

what are risk factors for Babesia

A

advanced age, immunocompromised person

149
Q

how is Babesia lab diagnosed

A
  • detected by microscope examination of blood smear (maltese cross)
  • double check, b/c hard to distinguish from plasmodium
  • PCR detects low levels of parasites
150
Q

why is serology not helpful for Babesia

A

cannot distinguish between acute versus old infection

151
Q

what is the treatment for babesiosis

A

combination therapy
mild disease: Atovaquone PLUS azithromycin
severe disease: Clindamycin PLUS quinine

D & T exam 2 (27 decks)

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