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Infectious Disease > Week 6: Rickettsial Diseases > Flashcards

Week 6: Rickettsial Diseases Flashcards

1
Q

Rickettsial Diseases AKA

A

Doxycycline Deficiency States

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2
Q

Doxycycline is okay in? Not okay in

A
  • Okay in children (NO evidence of staining teeth when used in short courses)
  • NOT okay in pregnant women
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3
Q

Rickettsialpox pathogen

A

Rickettsia akari

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4
Q

Scrub typhus pathogen

A

Orientia tsutsugamushi

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5
Q

What are Rickettsial Diseases?

A

Group of genetically similar intracellular bacteria that are transmitted by arthropods such as (ticks, mites, fleas, lice) and cause human disease on 6 continents and the vector’s geographic distribution determines when and how the disease presents clinically

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6
Q

Rickettsial diseases are caused by?

A

A group of genetically similar intracellular bacteria

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7
Q

Rickettsial diseases are transmitted by?

A

Arthropods (Ticks, mites, fleas, lice)

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8
Q

Determining factor of clinical presentation of Rickettsial diseases

A

Vector’s distribution geographically determines when and how the Rickettsial diseases present clinically

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9
Q

Typical presentation of Rickettsial diseases

A

typically causes

  • fevers
  • headache
  • rash
  • eschar “tache noire”
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10
Q

Rickettsial diseases that can be fatal

A
  • Rocky Mountain Spotted Fever
  • Ehrlichiosis
  • Epidemic typhus
  • Rarely anaplasmosis can be fatal
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11
Q

More about Rickettsial diseases

A
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12
Q

Rickettsiae Taxonomy

A
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13
Q

Anaplasmaceae Taxonomy

A
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14
Q

Coxiellaceae Taxonomy

A
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15
Q

Question

A
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16
Q

Arachnida Taxonomy

A
  • Hard ticks cause the majority of diseases
  • Soft ticks DONT cause the majority of diseases
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17
Q

Mites cause

A
  • Rickettsia akari (Rickettsial Pox)
  • Orientia tsutsugamushi (Scrub typhus)
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18
Q

Fleas cause

A

Rickettsia typhi

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19
Q

Lice cause

A

Rickettsia prowazekii

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20
Q

Case & pictures

A
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21
Q

Case & physical exam

A
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22
Q

Case & Labs

A
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23
Q

Case & biopsy

A
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24
Q

Rickettsia Taxonomy

A
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25
Q

What are convalescent serologies?

A

Initially IgG serologies are negative (as expected) but it takes awhile for these to form, 1-4 weeks later should have seroconverted

This is why you Treat first & Diagnose later regarding Rickettsial diseases

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26
Q

Why do you treat Rickettsial diseases first and diagnose later

A

Convalescent serologies

Initially IgG serologies are negatve as expected but 1-4 weeks later patient will seroconvert and IgGs will be positive

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27
Q

Question

A
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28
Q

Spotted fever group of Rickettsiae

A
  • Rickettsia rickettsi
  • Rickettsia africae
  • Rickettsia conori
  • Rickettsia akari
  • Rickettsia australis
  • Rickettsia japonicum
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29
Q

African Tick Bite Fever Pathogen

A

Rickettsia africae

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30
Q

Rocky Mountain spotted fever pathogen

A

Rickettsia rickettsi

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31
Q

Mediterranean spotted fever or Boutonneusse fever pathogen

A

Rickettsia conori

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32
Q

Rickettsiapox pathogen

A

Rickettsia akari

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33
Q

Queensland tick typhus pathogen

A

Rickettsia australis

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34
Q

Japanese spotted fever pathogen

A

Rickettsia japonicum

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35
Q

Epidemic typhus pathogen

A

Rickettsia prowazekii

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36
Q

Murine or endemic typhus pathogen

A

Rickettsia typhii

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37
Q

Scrub typhus pathogen

A

Orientia tsustugamushi

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38
Q

What is African Tick Bite Fever?

A

A common cause of fever in a returned traveler

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39
Q

Work-up of African Tick Bite Fever

A

Treat first

diagnose later

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40
Q

Treatment of African Tick Bite Fever

A

Doxycycline

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41
Q

African Tick Bite Fever Clinical Manifestations

A
  • Fever
  • Headache
  • Eschar
  • Maculopapular rash
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42
Q

Mediterranean spotted fever AKA

A

Boutonneuse fever

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43
Q

Mediterranean spotted fever clinical manifestations

A
  • Fever
  • Single eschar
  • regional adenopathy
  • Maculopapular rash on extremities
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44
Q

Mediterranean spotted fever geographic distribution

A
  • Mediterranean region
  • Africa to India Subcontinent
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45
Q

Mediterranean spotted fever vector

A

Ticks

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46
Q

African Tick Bite Fever vector

A

Ticks

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47
Q

African Tick Bite Fever Geographic distribution

A
  • Sub-saharan Africa
  • Caribbean
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48
Q

Rickettsiapox vector

A

Mouse mites

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49
Q

Rickettsialpox geographic distribution

A
  • North Africa
  • Korea
  • Balkans
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50
Q

Rickettsiapox clinical manifestations

A
  • Fever
  • Headache
  • papule->vesicular rash
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51
Q

Rickettsiapox

A
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52
Q

Rocky Mountain Spotted Fever vector

A

Ticks

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53
Q

Rocky Mountain Spotted Fever Gesographic Distribution

A
  • US
  • Canada
  • Mexico
  • Central America
  • Brazil
54
Q

Rocky Mountain Spotted Fever Clinical Manifestations

A
  • Fever
  • Headache
  • Abdominal pain
  • Maculopapular rash progressing centripetally to papular or petechial rash
55
Q

What is Rickettsialpox?

A

House mouse mite bite infection caused by Rickettsia akari endemic to Northeast US, North Carolina, Utah, Russia, Korea, South Africa

56
Q

Rickettsialpox disease course

A

Typically self-limited

57
Q

Rickettsialpox vesicular rash is commonly mistake for?

A

Chickenpox

58
Q

Rickettsialpox clinical manifestations

59
Q

Rickettsialpox treatment

A

Doxycycline

62
Q

Diseases that cause rashes that involve the palms and soles

10 listed

A
  • Rocky Mountain Spotted fever
  • Syphilis
  • Coxsackie virus (Hand/foot/mouth disease)
  • Erythema multiforme
  • Janeway lesions (Infective endocarditis)
  • Measles
  • Toxic shock syndrome
  • Meningococcemia
  • Keratoderma blennorrhagicum from reactive arthritides
  • Kawasaki disease
63
Q

Case Lab testing

64
Q

Case what is the cause of her symptoms?

A

Rocky mountain spotted fever

65
Q

Rickettsia rickettsii serologies

A

at admission and 4 weeks later

this is why you treat first and diagnose later

66
Q

Rocky Mountain Spotted Fever treatment

A

Doxycycline

67
Q

Rocky Mountain Spotted fever tropism

A

Infects vascular endothelial cells

68
Q

Diagnosis of Rocky Mountain Spotted Fever

A
  • Clinical
  • Serologic
69
Q

Rocky Mountain Spotted Fever prognosis

A

Fatal if not Tx’d early with Doxycycline

70
Q

Rocky Mountain Spotted Fever causes

A

Systemic vasculitis as it infects vascular endothelial cells

71
Q

Rocky Mountain Spotted Fever epidemiology

72
Q

Rocky Mountain Spotted Fever most common time of the year

A

May-August

73
Q

Rhipicephalus epidemiology

74
Q

Early Rocky Mountain Spotted Fever Early (1-4 days) clinical manifestations

A
  • Fever
  • Headache
  • GI symptoms
  • Centripetal macular rash 2-4 days after fever
  • Involves palms and soles
  • <50% pts have rash in early phase
  • Swelling arond eyes, backs of hands
75
Q

Rocky Mountain Spotted Fever late (day 5+) clinical manifestations

A
  • Rash -> petechial
  • Altered mental status/coma
  • Pulmonary edema/ARDS
  • Digit necrosis
  • Renal failure
76
Q

Diagnosis of Rocky Mountain Spotted Fever

A
  • Initial convalescent IgM/IgG
  • Skin biopsy w/specific antibody stain
    • Direct detection
    • Rapid
    • only available at special laboratories
77
Q

Why can’t gram stain diagnose Rickettsial infections?

A
  • Small peptidoglycan layer
  • Uptake Gram stain poorly
  • Very tiny
  • Intracellular organisms
78
Q

Rocky Mountain Spotted Fever treatment

A
  • Doxycycline (even for children)
  • In pregnant women, Chloramphenicol (however, there is an increased risk of death)
  • Best is Tick bite prophylaxis
79
Q

Question

80
Q

Typhus group of Rickettsia taxonomy

A
  • Rickettsia prowazekii
  • Rickettsia typhii
81
Q

Question

82
Q

Epidemic + Sporadic typhus vector

83
Q

Epidemic + Sporadic typhus pathogen

A

Rickettsia prowazekii

84
Q

Epidemic + Sporadic typhus geographic distribution

A
  • Epidemic - Mountainous Central + Eastern Africa, Central/South America, Asia
  • Sporadic in the US
85
Q

Epidemic + Sporadic typhus Clinical presentation

A

Very ill

  • acute onset fevers
  • myalgias
  • Headaches
  • SOB
  • Cough
  • Centrifugal rash occurs late
  • Gangrene of extremities
  • Jaundice

Can recur years later as Brill-Zinsser Disease

86
Q

Epidemic + Sporadic typhus can recur years later as

A

Brill-Zinsser Disease

87
Q

Epidemic + Sporadic typhus laboratory diagnosis

A

Acute and convalescent serologies

88
Q

Epidemic + Sporadic typhus treatment

A
  • Doxycycline
  • Chloramphenicol
  • Prevention - delousing (getting rid of lice)
89
Q

Endemic (murine) typhus pathogen

A

Rickettsia typhii

90
Q

Endemic (murine) typhus vector

A

Rat flea feces

91
Q

Endemic (murine) typhus geographic distribution

92
Q

Endemic (murine) typhus clinical presentation

A

Mild disease

  • fevers
  • myalgias
  • headaches
  • +/- GI symptoms
  • late onset centrifugal rash
93
Q

Endemic (murine) typhus diagnosis

A

Acute and convalescent serologies

94
Q

Endemic (murine) typhus Treatment

A
  • Doxycyline
  • Chloramphenicol
95
Q

Scrub typhus pathogen

A

Orientia tsutsugamushi

96
Q

Scrub typhus vector

A

Mites (chiggers)

97
Q

Scrub typhus geographic distribution

A
  • Japan
  • Eastern Asia
  • Northern Australia
  • Western and Southwestern Pacific
98
Q

Scrub typhus clinical presentation

A
  • High fever (lasts a long time if not treated)
  • Severe headaches
  • Severe myalgias
  • +/- GI symptoms
  • Rash
  • Eschar
  • Lymphadenopathy
  • Spontaneous abortions in pregnant women
99
Q

Scrub typhus laboratory diagnosis

A
  • Acute and convalescent` serologies
  • Biopsy for histopathology
100
Q

Scrub typhus treatment

A
  • Doxycycline
  • Chloramphenicol
  • Azithromycin
101
Q

Case

102
Q

What is this?

103
Q

Case - what is the diagnosis

A

Anaplasmosis

104
Q

What is Anaplasmataceae?

A
  • Intracellular bacteria
  • Anaplasma phagocytophilum - infects granulocytes
  • Ehrlichia chaffeensis - infects monocytes
105
Q

Anaplasma phagocytophilum tropism

A

infects granulocytes

106
Q

Ehrlichia chaffeensis tropism

A

infects monocytes

107
Q

Human granulocytic anaplasmosis pathogen

A

Anaplasma phagocytophilum

108
Q

Human granulocytic anaplasmosis cells affected

A

Granulocytes

  • Neutrophils
  • Eosinophils
  • Basophils
109
Q

Human granulocytic anaplasmosis vector

A

Ixodes tick

110
Q

Human granulocytic anaplasmosis geographic distribution

A
  • Upper midwest (Minnesota, Wisconsin)
  • New England, Northeast Atlantic States (Massachussets, Connecticut, New York, New Jersey)
111
Q

Human granulocytic anaplasmosis Clinical Presentation

A
  • Fever
  • Myalgias
  • Headaches
  • GI Symptoms
  • No rash unless coinfection
112
Q

Human granulocytic anaplasmosis Diagnosis

A
  • Nucleic acid amplification on blood
  • Often morulae on smear
  • Acute & Convalescent serologies
113
Q

Human granulocytic anaplasmosis treatment

A

Doxycycline

114
Q

Human Monocytic Ehrlichosis Pathogen

A

Ehrlichia chaffeensis

115
Q

Human Monocytic Ehrlichosis cells affected

A
  • Blood monocytes
  • Tissue phagocytes
116
Q

Human Monocytic Ehrlichosis vector

A

Amblyomma (Lone Star tick)

117
Q

Human Monocytic Ehrlichosis Geographic Distribution

A
  • Midwest (Missouri, Arkansas, Oklahoma)
  • Coastal Atlantic States (Maryland, Virginia, New Jersey, New York)
118
Q

Human Monocytic Ehrlichosis Clinical presentation

A
  • Fever
  • Myalgias
  • Headaches
  • GI symptoms
  • 1/3 patients have rash
119
Q

Human Monocytic Ehrlichosis diagnosis

A
  • Nucleic acid amplification on blood
  • Rarely morulae seen on smear
  • Acute & convalescent serologies
120
Q

Human Monocytic Ehrlichosis Treatment

A

Doxycycline

121
Q

Case & Lab Testing

122
Q

Coxiella burnetti serologies

123
Q

Coxiella burnetti causes?

124
Q

Q Fever pathogen

A
  • Coxiella burnetti
125
Q

What is Coxiella burnetti?

A

Intracellular gram negative bacteria that can live in soil for years and reservoirs are Sheep, Cattle and goats in placental tissue, feces and urine

126
Q

Transmission of Q Fever

A
  • inhalation
  • Unpasteurized dairy
  • Tick bite transmission (Very rare)
  • Downwind of a farm or parturient livestock
127
Q

Q Fever clinical presentation

A
  • Acute or chronic illness
  • Fevers
  • chills
  • sweats
  • myalgias
  • weight loss
  • Headaches
  • GI symptoms
  • Cough
  • Chest pain
128
Q

Q Fever disease spectrum

A
  • Pneumonia
  • Hepatitis
  • Myocarditis
  • Culture-negative endocarditis
  • CNS complications
  • Aneurysms
129
Q

Q Fever diagnosis

A
  • Acute and convalescent serologies
  • PCR blood, heart valve tissue, etc
130
Q

Q Fever treatment

A
  • Doxycycline
  • Endocarditis - Doxycycline + hydroxychloroquine x 18 months or longer
131
Q

Take home points of Rickettsial Diseases

Infectious Disease (82 decks)

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