Zoonoses Flashcards

1
Q

definition

A
  • diseases and infections which are naturally transmitted between vertebrate animals and humans under natural conditions
  • any type of organism included
  • directly transmitted from animals to people, or indirectly through the environment or vectors
  • human population is not part of life cycle, accidental insertion that is often dead end host
  • reservoir is non-human animal species that maintains infections
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2
Q

vector

A
  • transmits pathogen from reservoir to other animals
  • can also be reservoir itself
  • not all zoonotic diseases require a vector, some direct from animal to human
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3
Q

spectrum of disease

A
-broad
death from rabies
severe illness from the plague
chronic illness from Q fever
mild illness from psittacosis
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4
Q

transmission

A
  • routes varry
  • contact with saliva, blood, urine, or feces of an infected animal
  • bite by a tick, mosquito, fly
  • eating or drinking something unsafe- unpasteurized milk, undercooked meat, unwashed fruits and veggies
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5
Q

bacterial zoonotic pathogens

A
  • bacillus anthracis-no vector
  • francisella tularensis- tick, mosquito, deer flies
  • brucella species- no vector
  • yersinia pestis- fleas
  • bartonella henselae- fleas ?ticks
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6
Q

bacillus anthracis

A
  • gram pos rod
  • bacteria shed at death from hemorrhage from nose, mouth or anus
  • sporulizes on contact with O2, then infect humans or cow
  • can also be vectored by a biting fly, but not common
  • 3 types- cutaneous, inhalation, GI
  • GPR on culture of lesion
  • treat with cipro, doxy
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7
Q

cutaneous anthrax

A
  • small sore that develops into a blister (eschar)
  • blister develops into skin ulcer with a black area in the middles
  • significant edema
  • blister and ulcer do not hurt
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8
Q

GI anthrax

A

-nausea, loss of appetite, bloody diarrhea, fever, followed by bad stomach pain

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9
Q

inhalation anthrax

A
  • cold or flu symptoms and can include a sore throat, mild fever, and muscle aches
  • later sx include cough, chest discomfort, SOB, tiredness and muscle aches
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10
Q

francisella tularemia

A
  • aerobic gram neg rod
  • type a and b (for beaver!)
  • a more virulent and in US/Canada. B less virulent and in europe
  • both spread through direct contact or through vector (flea, tick, fly)
  • 5 types- ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic
  • can acquire by inhaling dust/aerosols contaminated with bacteria- farming/landscaping
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11
Q

ulceroglandular tularemia

A
  • most common form and usually occurs following a tick or deer fly bite or after handing of an infected animal
  • A skin ulcer appears at the site where the organism entered the body.
  • The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
  • glandular is similar but without ulcer
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12
Q

oculoglandular tularemia

A
  • occurs when the bacteria enter through the eye usually when a person is butchering an infected animal and touches his eyes
  • Symptoms include irritation and inflammation of eye and swelling of lymph glands in front of the ear.
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13
Q

oropharyngeal

A
  • results from eating or drinking contaminated food or water.
  • Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.
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14
Q

pneumonic

A
  • most serious form of tularemia.
  • Symptoms include cough, chest pain, and difficulty breathing.
  • This form results from breathing dusts or aerosols containing the organism.
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15
Q

Brucella

A
  • usually transmitted to humans by contact with infected farm animals
  • lots of different types
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16
Q

cattle signs for Brucella

A
  • third trimester abortions with B abortus
  • retained placenta- once expelled will have a leathery appearance
  • endometritis
  • birth of dead or weak calves
  • low milk yield
17
Q

brucella transmission to humans

A
  • contact of conjunctiva or broken skin with infected tissues
  • blood, urine, vaginal discharges, aborted fetuses, placentas
  • ingestion- raw milk/unpasteurized dairy products, rarely through undercooked meat
  • inhalation of infectious aerosols- pens, stables, slaughterhouses
18
Q

brucella human disease

A
  • can affect any organ or organ system
  • patients have cyclical fever in acute disease
  • variability in acute clinical signs- headache, weakness, arthralgia, depression, weight loss, fatigue, liver dysfunction
  • osteoarticular complications-20-60% of cases-arthritis, spondylitis, osteomyelitis
  • HSM- 33%
  • GI complications- 2-20%
  • GU involvement- 6-8%- orchitis and epididymitis
  • neuro- depression, mental fatigue- 305%
  • cardiovascular- 1-3%, endocarditis
  • chronic is hard to define- length, type and response to trt variable, localized infection
  • blood donations of infected persons should not be accepted
  • treated with doxy for 6 weeks plus streptomycin for first 14-21 days
  • doxy +gentamicin probably as effective
19
Q

diagnosis of brucella

A
  • isolation of organism in culture
  • gram ned bacillus
  • blood, bone marrow, other tissues
  • serum agglutination test, titer over 1:160
  • immunofluorescence
  • PCR
20
Q

prognosis of brucella

A
  • recovery is common
  • may last days, months, years
  • disability is often pronounced
  • about 5-8% of cases relapse
  • case fatality rate <2%
21
Q

plague

A
  • sylvatic cycle and urban cycle
  • transmitted through direct contact with rodents or through flea vector
  • once pneumonic in people can spread to other people
  • caused by gram neg bacterium yersinia pestis
  • can be isolated from bubo aspirates, blood cultures, or sputum culture if pneumonic
  • parenteral antibiotic therapy with streptomycin is recommended 1st line, gentamicin alt, or doxy if limited to oral
22
Q

clinical presentation of the plague

A
  • incubation period 1-6 days
  • history is suggestive of exposure to rodents, rodent fleas, wild rabbits, sick or dead carnivores, patients with pneumonic plague
  • bubonic- rapid onset of fever and painful, swollen, tender lymph nodes- usually inguinal, axillary, or cervical
  • pneumonic-high fever, overwhelming pneumonia, cough ,bloody sputum, chills
  • septicemic- fever, prostration, hemorrhagic or thrombotic phenomena, progressing to acral gangrene
23
Q

letptospira bacteriology

A
  • spirochete
  • small diameter means invisible to light microscope
  • motile-paired axial flagella, corkscrew motion
  • reasonably sturdy, can live outside host for weeks
  • pet and livestock reservoirs, shed in urine
  • passed to humans by contact with contaminated water- worlds most common zoonosis
  • endemic canine leptospirosis is becoming more common in US
24
Q

leptospira pathogenesis

A
  • L interrogans- bilious typhoid
  • 100-200 in US, half in hawaii
  • bacteria from contaminated water (swimming) or food enter abraded skin, mucous membrane, cross into lymphatics and lead to leptospiremia
  • no buildup, encodes toxins
  • acute febrile illness followed by either more mild, self limiting sx or severe multiorgan involvement
25
Q

leptospira pathogenesis 2

A
  • Normal incubation 5-14 days but variable
  • Anicteric leptospirosis: (normal course)
  • Phase 1 (acute): leptospira circulate in blood and multiply in blood vessel endothelium
  • Vasculitis from leptospiral toxins releases blood into tissues and deprives target tissues of oxygen
  • Initial sepsis can kill susceptible hosts, most clear it w/ opsonizing immunoglobulin
  • Spirochetes persist in privileged sites for weeks to months afterward

Phase 2: (delayed, immune) New or continued growth of leptospira in organs causes more severe symptoms
Liver: jaundice
Kidneys: renal failure
Lungs: hemorrhage
CNS: aseptic meningitis
Vascular system overall: HUS, DIC, thrombotic (TTP)

Icteric disease- Phase 2 follows phase 1 with less delay and greater severity

26
Q

leptospirosis dx

A
  • acute phase- 5-7 days of high fever, rigor, sudden headache, nausea, anorexia, diarrhea, cough, rash, muscle pain
  • delayed/immune phase-1-2 afebrile days, 4-30 days resumed illness with organ specific sx
  • conjunctival suffusion
  • chest xray for cardiac or lung involvement
  • hx-eating and swimming in endemic area
27
Q

leptospira dx in lab

A
  • can sometimes be cultured from patient urine
  • can sometimes be seen by darkfield from centrifuged urine or CSF
  • confirmation of diagnosis requires serology of paired acute and convalescent sera by CDC
  • panbio dipstick is FDA approved
  • histology-silver or IF staining of biopsies may reveal leptospires
  • anemia from DIC, elevated BUN/Cr
  • elevated bili an alkphos
  • elevated Cks
28
Q

leptospira trt

A
  • penicillin G, doxy or 3rd gen cephalosporins
  • maintain hydration
  • organ damage, admission for supportive care, restricted diet
  • kidneys usually healthy after recovery
  • jarisch herxheimer rxn
29
Q

leptospira prevention

A
  • sanitation-rodent control, use of protective clothing when working with livestock
  • vaccination- none useful in US, some countries vaccinate against their local serovars
  • prophylaxis- oral doxy for short term exposures
30
Q

bartonella

A

-carrions disease in peru- fever and blisters
-reservoir unknown
bartonella henselae is cat scratch fever

31
Q

bartonella h

A
  • multitude of manifestations depending on immune status
  • if immunocompromised- bacillary angiomatosis
  • if fine-asx, cat scratch, meningeoencephalitis, visceral involvement, stellar retinitis, bacteremia, osteomyelitis, pericarditis
  • 25,000 cases of cat scratch per year, usually in patients younger than 21
  • fleas carry it from cat to cat
  • infects kittens and can remain in bloodstream for 1 year, more likely to infect owner
  • human transmission through cats or possible fleas
  • usually self limited
  • if extensive adenopathy- azithromycin 1 time
  • bacillary angiomatosis- erythromycin or doxy
  • endocarditis-gentamicin and ceftriaxone
32
Q

clinical manifestations of cat scratch in normal immune

A
  • fever, enlarged tender lymph nodes
  • 1-2 weeks after exposure
  • papule/pustule at inoculation site
  • unusual manifestations-granulomatous, conjunctivitis, neuroretinitis, atypical pneumonia, endocarditis
33
Q

clinical manifestations of cat scratch in immunocompromised

A
  • bacillary angiomatosis
  • peliosis hepatitis
  • HIV patients
  • skin, subQ or bone lesions
34
Q

cat bites

A
  • pasteurella multocida
  • often clinical evidence of wound infection within a few hours of bite injury, scratch, or lick
  • cellulitis or abscesses +/- bacteremia
  • occasional cause of pneumonia and endocard
  • metastatic seeding of internal organs from bacteremia
  • CNS- meningitis, most often in young children or elderly
  • cause of rapidly progressive infections similar to group A strep or vibrio
  • patient may present within a few hours or cat bite with established severe infection
  • dx based on culture
  • trt with amoxicillin/cavulanate, ampicillin/sulbactam, penicillin, cipro, levofloxacin, doxy
  • first gen cephalo, cloxacillin, erythromycin and clinda not effective
35
Q

dog bites

A
  • capnocytophaga canimorsus
  • facultatively anaerobic gram neg rod, part of normal flora
  • many pts have hx of dog bite or scratch, less commonly in cats
  • cellulitis, bacteremia/sepsis, meningitis and endocarditis
  • severe-shock, DIC, acral gangrene, disseminated purpura, renal failire, meningitis and pulm infiltrates
  • ***fulminant sepsis following dog >cat bites, particularly in asplenic patients, alcoholics, or immunosuppressed
  • trt of mild- amox/claculanate, or clinda, doxy
  • severe-penicillin G 2-4 mU q 4hr IV or clinda 600 mg IV q 8hr
  • alternative-ceftriaxone 1-2q IV qd, cipro 400 mg IV q12hr or meropenem 1g IV q8hr
  • prevention in asplenic patients- amox/clavulanate for 7-10 days