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PUBLIC HEALTH > Zoonotic Diseases of SouthWest > Flashcards

Zoonotic Diseases of SouthWest Flashcards

1
Q

presence of zoonotic diseases in AZ is exacerbated by

A
  • diversity in wildlife species
  • disparities across communities
  • extreme climates
  • varrying topography
  • close proximity to international border
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2
Q

in AZ, tularemia circulates naturally among _____ and ______ and is usally found in areas above _______feet

A

rabbits and rodents
3,000 feet

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3
Q

Cases of tularemia in AZ have been related to exposure to what

A

rabbit or rabbit carcass, dog that was exposed to rabbit carcass, skinning elk, potentially from insect bites

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4
Q

Tularemia Agent

A

Francisella tularensis a gram (-) bacteria

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5
Q

T/F: tularemia is considered a potential bioterrorism weapon

A

T

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6
Q

most reported worldwide zoonoses

A
  • Rabies 55,000+
  • Leishmaniasis >2 million
  • Cysticercosis ~50,000 deaths
  • Brucellosis ~500K
    * Leptospirosis ~10 million
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7
Q

common zoonoses of the Southwest (6)

A
  • Tularemia
  • Rocky Mountain spotted fever (vectored by brown dog tick)
  • Chagas
  • Onchocerca lupi
  • hantavirus
  • plague
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8
Q

what is the third most common reported laboratory-associated bacterial infection

A

tularemia

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9
Q

tularemia incubation period

A

3-5 on average
but can be 1-14

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10
Q

how is tuleremia transmitted

A

drainage from tulameria lesion
flies can remain infective for 2 weeks
ticks remain infective throughout their lifetime

not directly transmitted from person to person

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11
Q

clinical diagnosis of tularemia

A

evidence or history of a tick or deerfly bit, exposure to tissue of mammalian host or exposure to contaminated water

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12
Q

tularemia symptoms

A
  • sudden fever
  • chills
  • headache
  • D+
  • muscle aches/joint pain
  • dry cough

w/out txt, can result in respiratory failture, shock, death

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13
Q

differential diagnosis for tularemia is…

A

plague

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14
Q

most common form of tularemia

A

Ulceroglandular
- usually following tick or deer fly bite or handling infected animal
- cutaneous ulcer w/ regional lymphadenopathy

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15
Q

regional lymphadenopathy w/ no ulcer (tularemia)

A

Glandular

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16
Q

Oculoglandular tularemia

A
  • bacteria gets into eye during butchering or touching eye
  • conjunctivitis w/ preauricular lymphadenopathy
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17
Q

Tularemia from eating/drinking contaminated food/water. Characterized by stomatitis, pharyngitis, tonsilitis, cervical lymphadenopathy

A

Oropharyngeal

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18
Q

most serious form of tularemia, caused by breathing dust or aerosols containing the organism

A

penumonic
primary pleuropulmonary disease

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19
Q

febrile (fever) illness w/out early localizing signs/symptoms (tularemia)

A

Typhoidal

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20
Q

Type A tularemia infections may be acquired from _____or_____

A

rabbits, ticks

A.II strains localizeed to western US

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21
Q

type B tularemia infections are often associated w/ hosts such as….?

A

rodents and hares

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22
Q

Tularemia mode of transmission

A
  • bite from certain arthropods
  • inoculation of skin, conjunctival sac, oropharyngeal mucosa w/ contaminated water, blood, tissue while handling infected animals
  • handling/ingesting insufficiently cooked meat of infected host
  • inhalation of dust from contaminated soil/grain/hay
  • contaminated pelts and paws of animals
  • rarely from bites of animals that ate an infected animal
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23
Q

tularemia treatment

A
  • antibiotics
  • 14-21 days
  • symptoms may last for weeks but mosst patients completely recover
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24
Q

All confirmed, probable or suspect tularemia cases must be reported to ______ within 4 hours

A

AZDA

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25
Q

Tularemia prevention

A

inspect yard before mowing to avoid sick / dead animals
use dust masks
use insect repellent w/ 20-30% DEET
wear long pants, sleeves and sock to keep ticks and deer flies away
remove ticks asap
hunters wear gloves while skinning
drink only treated water while camping

26
Q

Rocky Mountain Spotted Fever (RMSF) is vectored by…

A

brown dog tick

27
Q

most severe disease caused by tick in USA

A

RMSF
Notifiable to CDC
5-10% of cases are fatal

28
Q

state in US w/ most cases of RMSF

A

AZ, mostly in communities w/ lots of roaming dogs

29
Q

what organism causes RMSF

A

Rickettsia rickettsii, gram (-) obligate intracellular parasite

30
Q

how is R.rickettsii transmitted? what is the incubation period?

A

bite of an infected tick
4-5 days most common but can be 2-14 days

31
Q

R. rickettsii invades ____Cells of the venules and capillaries, causing _______

A

endothelial cells, causing vasculitis

32
Q

RMSF clinical signs

A

Fever, severe lethargy
petechiae and ecchymoses on mucous membranes
focal retinal hemorrhages
edema of extremities
about 60% of cases have rashes but rash is uncommon in AZ

33
Q

late stage clinical signs of RMSF

A

necrosis, abdominal pain, V+, anorexia
altered mental status
myalgia or polyarthritis
vestibular deficits
dyspnea or cough

34
Q

Abnormal clinical findings associated w/ RMSF

A

hypoalbuminemia
moderate leukocytosis
thrombocytopenia

signs may resemble infection w/ Ehrlichia canis (which is also transmitted by brown dog tick)

35
Q

gold standard for RMSF diagnosis

A

indirect immunofluorescence assay (IFA) w R. rickettsii antigen, performed on 2 paired serum samples to demonstrate 4 fold rise in antibody titers

PCR testing

36
Q

RMSF treatment

A

doxycycline

mortality is related to incorrect txt or delayed diagnosis

prompt use of antibiotics reduces severity of illness

37
Q

RMSF prevention

A

prevent tick attachment, promptly remove if it occurs
topical or systemic tick control prevention
seasonal tick/flea dips
collars w/ amitraz or propoxur

txt of kennels/yards w/ acaricidal

38
Q

Primary domestic reservoir of chagas

A

dogs

39
Q

how many people in Mexico, central and south America are suspected to have Chagas

A

8 million
if untreated, infection is lifelong and can be life threatening

40
Q

chagas disease is caused by….

A

protozoan parasite: Trypanosoma cruzi, transmitted to animals and people by insect vectors

41
Q

T/F: Chagas is only found in the Americas

A

T

42
Q

Chagas transmission to humans

A

vector-borne infected triatomines (kissing bugs) - feces contains parasite, enters through bite or mucous membranes

congenital transmission (mother to fetus)

blood transfusion
organ transplantation
oral ingestion (Contaminated foods or acai, palm fruit, guava juice, sugarcane juice)

43
Q

presence of Chagas in AZ

A

up to 1/2 of all kissing bugs have it but no confirmed cases from bug bites

44
Q

Acute phase of Chagas (clinical signs)

A

acute phase = first few weeks-months of infection
fever, fatigue, body ache, rash, D+/V+
some may have Romana’s sign (swelling of eyelids near bite wound)
young children or immunocompromised people may die from myocarditis or meningoencephalitis

45
Q

Chronic phase of Chagas

A

lasts decades - lifetime
20-30% develop cardiac or GI complications

46
Q

Chagas diagnosis

A

during acute phase, can look for trypomastigotes in blood of CSF (PCR)

chronic phase - serologic testing

47
Q

Chagas treatment

A

antiparasitic txt (benznidazole or nifurtimox) kills parasite

symptomatic txt to manage symptoms

monitor heart w/ heart tracing test

48
Q

Chagas disease in dogs is a diagnostic differential in dogs w/….?

A

arrhythmias, myocardial dysfunction, congestive heart failure

can present w/ findings like dilated cardiomyopathy, arrhythmogenic R ventricle cardiomyopathy, infectious myocarditis, congenital tricuspid valve dysplasia

49
Q

Risk factors for Chagas in dogs

A

living or traveling in areas w/ infected insect vectors

dogs that live outside or do outdoor work

dog kennels

high densities of dogs in confined areas w/ heat and CO2 (attract kissing bugs)

50
Q

Chagas prevention

A

turn off outdoor lights
clean up brush
house dogs inside
use insecticides

51
Q

do traditional flea/tick repellants repel kissing bugs?

A

NO

52
Q

Onchocera lupi was first described…?

A

wolf in Georgia, 1967
has been identified in US since 2013 (possibly came from dogs from Europe)

53
Q

Onchocerca lupi most commonly infects…

A

dogs, cats, and humans in US (primarily southwestern states)

considered an emerging zoonosis

54
Q

organism that causes Onchocerca lupi

A

Filarial nematode

adults embedded in ocular nodules and granulomatous masses of infected dogs

55
Q

suspected arthropod vector of Onchocerca lupi

A

black fly or biting midge

56
Q

this disease involves infection in the eyes, joints, limbs and upper cervical spine (masses) in humans

A

Onchocerca lupi

57
Q

clinical symptoms of Onchocerca lupi in dogs

A

most are asymptomatic, esp if the worm is localized to the retrobulbar space of the eye (can’t be detected during ophthalmic exam)

58
Q

Clinical diagnosis of Onchocerca lupi

A

detection of ocular nodules in the sclera or conjunctiva

subconjunctival threadlike parasites
histopathological identification of adult worms
microfilariae from skin snip biopsies

in vivo confocal light microscopy

59
Q

Onchocerca lupi treatment

A

currently no evidence-based protocols

Drugs are administered based on treatments against other filarial parasites, mainly O. volvulus

if possible, surgical excision of periocular nodules

reoccurrences common

60
Q

Hantavirus occurrence in AZ

A

sporadically in rural areas, usually in northern regions but infected rodents can be found statewide

first discovered at 4 corners in 1993

61
Q

when was plague first introduced to US

A

1900 by rat infected steamships coming from Asia

epidemics occurred in port cities

PUBLIC HEALTH (18 decks)

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