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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
What are convalescent serologies?
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
26
Why do you treat Rickettsial diseases first and diagnose later
Convalescent serologies Initially IgG serologies are negatve as expected but 1-4 weeks later patient will seroconvert and IgGs will be positive
27
Question
28
Spotted fever group of Rickettsiae
* Rickettsia rickettsi * Rickettsia africae * Rickettsia conori * Rickettsia akari * Rickettsia australis * Rickettsia japonicum
29
African Tick Bite Fever Pathogen
Rickettsia africae
30
Rocky Mountain spotted fever pathogen
Rickettsia rickettsi
31
Mediterranean spotted fever or Boutonneusse fever pathogen
Rickettsia conori
32
Rickettsiapox pathogen
Rickettsia akari
33
Queensland tick typhus pathogen
Rickettsia australis
34
Japanese spotted fever pathogen
Rickettsia japonicum
35
Epidemic typhus pathogen
Rickettsia prowazekii
36
Murine or endemic typhus pathogen
Rickettsia typhii
37
Scrub typhus pathogen
Orientia tsustugamushi
38
What is African Tick Bite Fever?
A common cause of fever in a returned traveler
39
Work-up of African Tick Bite Fever
Treat first diagnose later
40
Treatment of African Tick Bite Fever
Doxycycline
41
African Tick Bite Fever Clinical Manifestations
* Fever * Headache * Eschar * Maculopapular rash
42
Mediterranean spotted fever AKA
Boutonneuse fever
43
Mediterranean spotted fever clinical manifestations
* Fever * Single eschar * regional adenopathy * Maculopapular rash on extremities
44
Mediterranean spotted fever geographic distribution
* Mediterranean region * Africa to India Subcontinent
45
Mediterranean spotted fever vector
Ticks
46
African Tick Bite Fever vector
Ticks
47
African Tick Bite Fever Geographic distribution
* Sub-saharan Africa * Caribbean
48
Rickettsiapox vector
Mouse mites
49
Rickettsialpox geographic distribution
* North Africa * Korea * Balkans
50
Rickettsiapox clinical manifestations
* Fever * Headache * papule-\>vesicular rash
51
Rickettsiapox
52
Rocky Mountain Spotted Fever vector
Ticks
53
Rocky Mountain Spotted Fever Gesographic Distribution
* US * Canada * Mexico * Central America * Brazil
54
Rocky Mountain Spotted Fever Clinical Manifestations
* Fever * Headache * Abdominal pain * Maculopapular rash progressing centripetally to papular or petechial rash
55
What is Rickettsialpox?
House mouse mite bite infection caused by Rickettsia akari endemic to Northeast US, North Carolina, Utah, Russia, Korea, South Africa
56
Rickettsialpox disease course
Typically self-limited
57
Rickettsialpox vesicular rash is commonly mistake for?
Chickenpox
58
Rickettsialpox clinical manifestations
59
Rickettsialpox treatment
Doxycycline
60
61
Case
62
Diseases that cause rashes that involve the palms and soles 10 listed
* 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
Case Lab testing
64
Case what is the cause of her symptoms?
Rocky mountain spotted fever
65
Rickettsia rickettsii serologies
at admission and 4 weeks later this is why you treat first and diagnose later
66
Rocky Mountain Spotted Fever treatment
Doxycycline
67
Rocky Mountain Spotted fever tropism
Infects vascular endothelial cells
68
Diagnosis of Rocky Mountain Spotted Fever
* Clinical * Serologic
69
Rocky Mountain Spotted Fever prognosis
Fatal if not Tx'd early with Doxycycline
70
Rocky Mountain Spotted Fever causes
Systemic vasculitis as it infects vascular endothelial cells
71
Rocky Mountain Spotted Fever epidemiology
72
Rocky Mountain Spotted Fever most common time of the year
May-August
73
Rhipicephalus epidemiology
74
Early Rocky Mountain Spotted Fever Early (1-4 days) clinical manifestations
* 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
Rocky Mountain Spotted Fever late (day 5+) clinical manifestations
* Rash -\> petechial * Altered mental status/coma * Pulmonary edema/ARDS * Digit necrosis * Renal failure
76
Diagnosis of Rocky Mountain Spotted Fever
* Initial convalescent IgM/IgG * Skin biopsy w/specific antibody stain * Direct detection * Rapid * only available at special laboratories
77
Why can't gram stain diagnose Rickettsial infections?
* Small peptidoglycan layer * Uptake Gram stain poorly * Very tiny * Intracellular organisms
78
Rocky Mountain Spotted Fever treatment
* Doxycycline (even for children) * In pregnant women, Chloramphenicol (however, there is an increased risk of death) * Best is Tick bite prophylaxis
79
Question
80
Typhus group of Rickettsia taxonomy
* Rickettsia prowazekii * Rickettsia typhii
81
Question
82
Epidemic + Sporadic typhus vector
Louse
83
Epidemic + Sporadic typhus pathogen
Rickettsia prowazekii
84
Epidemic + Sporadic typhus geographic distribution
* Epidemic - Mountainous Central + Eastern Africa, Central/South America, Asia * Sporadic in the US
85
Epidemic + Sporadic typhus Clinical presentation
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
Epidemic + Sporadic typhus can recur years later as
Brill-Zinsser Disease
87
Epidemic + Sporadic typhus laboratory diagnosis
Acute and convalescent serologies
88
Epidemic + Sporadic typhus treatment
* Doxycycline * Chloramphenicol * Prevention - delousing (getting rid of lice)
89
Endemic (murine) typhus pathogen
Rickettsia typhii
90
Endemic (murine) typhus vector
Rat flea feces
91
Endemic (murine) typhus geographic distribution
Worldwide
92
Endemic (murine) typhus clinical presentation
Mild disease * fevers * myalgias * headaches * +/- GI symptoms * late onset centrifugal rash
93
Endemic (murine) typhus diagnosis
Acute and convalescent serologies
94
Endemic (murine) typhus Treatment
* Doxycyline * Chloramphenicol
95
Scrub typhus pathogen
Orientia tsutsugamushi
96
Scrub typhus vector
Mites (chiggers)
97
Scrub typhus geographic distribution
* Japan * Eastern Asia * Northern Australia * Western and Southwestern Pacific
98
Scrub typhus clinical presentation
* High fever (lasts a long time if not treated) * Severe headaches * Severe myalgias * +/- GI symptoms * Rash * Eschar * Lymphadenopathy * Spontaneous abortions in pregnant women
99
Scrub typhus laboratory diagnosis
* Acute and convalescent` serologies * Biopsy for histopathology
100
Scrub typhus treatment
* Doxycycline * Chloramphenicol * Azithromycin
101
Case
102
What is this?
103
Case - what is the diagnosis
Anaplasmosis
104
What is Anaplasmataceae?
* Intracellular bacteria * Anaplasma phagocytophilum - infects granulocytes * Ehrlichia chaffeensis - infects monocytes
105
Anaplasma phagocytophilum tropism
infects granulocytes
106
Ehrlichia chaffeensis tropism
infects monocytes
107
Human granulocytic anaplasmosis pathogen
Anaplasma phagocytophilum
108
Human granulocytic anaplasmosis cells affected
Granulocytes * Neutrophils * Eosinophils * Basophils
109
Human granulocytic anaplasmosis vector
Ixodes tick
110
Human granulocytic anaplasmosis geographic distribution
* Upper midwest (Minnesota, Wisconsin) * New England, Northeast Atlantic States (Massachussets, Connecticut, New York, New Jersey)
111
Human granulocytic anaplasmosis Clinical Presentation
* Fever * Myalgias * Headaches * GI Symptoms * No rash unless coinfection
112
Human granulocytic anaplasmosis Diagnosis
* Nucleic acid amplification on blood * Often morulae on smear * Acute & Convalescent serologies
113
Human granulocytic anaplasmosis treatment
Doxycycline
114
Human Monocytic Ehrlichosis Pathogen
Ehrlichia chaffeensis
115
Human Monocytic Ehrlichosis cells affected
* Blood monocytes * Tissue phagocytes
116
Human Monocytic Ehrlichosis vector
Amblyomma (Lone Star tick)
117
Human Monocytic Ehrlichosis Geographic Distribution
* Midwest (Missouri, Arkansas, Oklahoma) * Coastal Atlantic States (Maryland, Virginia, New Jersey, New York)
118
Human Monocytic Ehrlichosis Clinical presentation
* Fever * Myalgias * Headaches * GI symptoms * 1/3 patients have rash
119
Human Monocytic Ehrlichosis diagnosis
* Nucleic acid amplification on blood * Rarely morulae seen on smear * Acute & convalescent serologies
120
Human Monocytic Ehrlichosis Treatment
Doxycycline
121
Case & Lab Testing
122
Coxiella burnetti serologies
123
Coxiella burnetti causes?
Q Fever
124
Q Fever pathogen
* Coxiella burnetti
125
What is Coxiella burnetti?
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
Transmission of Q Fever
* inhalation * Unpasteurized dairy * Tick bite transmission (Very rare) * Downwind of a farm or parturient livestock
127
Q Fever clinical presentation
* Acute or chronic illness * Fevers * chills * sweats * myalgias * weight loss * Headaches * GI symptoms * Cough * Chest pain
128
Q Fever disease spectrum
* Pneumonia * Hepatitis * Myocarditis * Culture-negative endocarditis * CNS complications * Aneurysms
129
Q Fever diagnosis
* Acute and convalescent serologies * PCR blood, heart valve tissue, etc
130
Q Fever treatment
* Doxycycline * Endocarditis - Doxycycline + hydroxychloroquine x 18 months or longer
131
Take home points of Rickettsial Diseases

Infectious Disease (82 decks)

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