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RICKETTSIACEAE

4 genera
1. Rickettsia
2. Rochalimaea
3. Coxiella
4. Ehrlichia

GENERAL CHARACTERISTICS
- IC organism; small, pleomorphic coccobacilli
- Natural hosts: arthropods, birds, mammals
- Human infections: char. by fever and skin
rashes
- Stain poorly with Grams; visulaized by
Giemsa and Machiavello methods
GROWTH CHARACTERISTICS
- require living cells for growth (except R.
quintana)
o embryonated eggs
o tissue culture
o lab. animals
- optimum temperature for growth 32-35oC
- intracellular multiplication: Distinct Biotypes
1. Typhus group: Scrub typhus, C. burnetti
= grow only in cytoplasm
2. Spotted fever grp.=grow both in
cytoplasm and nucleus
3. R. quintana = grow extracellularly in lice
and cell-free media
ANTIGENIC STRUCTURE
2 major antigens
1. Group-specific antigen = capsular matl
2. Type-specific antigen = cell wall
SEROLOGIC DIAGNOSIS
1. C-F abs
2. Microagglutination
3. Indirect hemagluttination (IHA)
4. Fluorescent antibody test (FA)
5. Wiel-felix reactions: cross reaction bet. AntiRickettsial abs that agglutinate serotypes of
Proteus polysaccaride O antigen (OX-2, OX19, OX-K) agglutinates appear a week in
Illness
- not specific, appear in __________
bacteremia
PATHOGENICITY
- stages:
1. absorption to cholesterol-containing
receptors
2. penetration into the cell wall
- characteristic pathogenesis:
o org invade vascular endothelial cells

o proliferation and pervascular


infitration

o thrombosis

widespread vasculitis
Rickettsial dse)

I. SPOTTED FEVER GROUP

(char. Of

A.
-

B.
-

Rocky Mountain Spotted Fever


American Spotted Fever: tickborne tryphus
95% of rickettsial dis.
Etiologic agent: Rickettsia rickettsi
vector: ticks
reservoir: dogs, rodents
! Humans are accidentally infected
o Rocky Mountain wood tick
(Dermacentor andersoni)
o Americal dog tick (Dermacentor
variabilis)
o Lone Star tick (Amblyomma
americanum)
o Rabbit tick (Haemaphysalis
leporispalustris)
IC: 3-12 days (fever, headache, malaise,
etc)
Charac. sign: skin rash (extremities 1st on
ankle & wrist--> trunk) with involvement of
palms and soles (diagnostic)
RASH: 2-3 days after onset of prodromal
syndrome that is Maculopopular ->
Petechial/Hemorrhagic
Patho: widespread endothelial damage -->
microhemorrhages --> fluid and electrolyte
imbalance --> necrosis --> shock --> DEATH
lab Dx: serologic
o (+) Weil Felix reaction (OX-19, OX-2)
Dx more based on Clinical Findings
DIFF Dx: Dengue & Meningococcemia &
other Microvascular dses
Without Tx: 20% mortality
Rx: Doxycycline, Tetracycline, (before:
Chloramphenicol if diff. meningococx/RMF),
Quinolones (given in Europe not ,8y.o),
Ciprofloxacin & Ofloxacin
Hx: Recent tick bite or contamination in
fingers while removing ticks
Human Infxn: BT & Needle Stick Injury
Prevention:
o vector control
o protective clothing
Rickettsial pox
etiologic agent: R. akari
vector: mite (Allodermanyssus sanguineus)
reservoir: rodent (Microtus fortis pellicus)
! Humans are accidentally infected
Primary lesion: erythematous papule -->
vesicle --> echar (Hallmark) assoc w/ Reg.
Adenopathy
RASH: Papulovesicular rash (Benign clinical
course)
I.P. unaware, but 3-7 days after
appearance of eschar: Fever, Chills, _______,
associated w/ Body malaise, Myalgia
DIFF DX:
A. Chicken Pox: often in Children, No
primary eschar, Entirely Vesicular
B. Small pox: Severe infection, No
vesicle

C. R. pox: common in Adult, assoc.


prim. W/ Eschar, cutaneous vesicle
surr. By vesicular ring
- Lab Dx: serologic
o (-) Weil Felix reaction
o Complement fixing, Ab (detected 1-2
months after illness) & Isolate from
lesion of infected person
- Tx: tetracycline and chloramphenicol
- Prev: control of rodents and mites
II.TYPHUS GROUP
- Countries:
- Vector: Ticks ! Humans are accidentally
infected
- Classification based on Intracellular
multiplication:
o Rickettsial Group: grows both in
Cytoplasm and Nucleus
o Typhus Group: grows only in
Cytoplasm
A.
-

Epidemic typhus (Louseborne typhus)


etiologic agent: R. prowazeki
I.P. 10 14 days
vector: thrive in Poor Hygiene
o human body louse (Pediculus
humanus corporis)
o human head louse (Ped. humanus
capitis)
- PHATO: louse can be infected when taking a
blood meal from a Rickettsemic Indiv. ->
org. multiply in louse -> appears in feces =
susc. Human in blood meal, louse defecate
-> Irritation -> scratching -> Minor
escuriation (Portal of Entry of Rickettsia)
- Characteristic: skin rash (appears 1st on
trunk --> exts (palms and soles not
involved) --> maculopapular --> petechial
hemorrhagic (appear 1 week after infection)
- Prodromal: Fever, Chills, GI complaints,
malaise, Myalgia
- Cx: myocarditis and CNS dysfunction
- Lab Dx: serologic
o (+) Weil Felix (OX-19, OX-2)
- Tx: chloramphenicol and tetracycline
- Prev: insecticides, Typhus vaccine
Brill-Zinser disease:
o Recrudescent infection: devp. many
years after epidemic typhus
(recurrence)
o mild; short duration
o Intense Headache, may dev.
Maculopapular skin Rash
o (-) Weil-felix reaction;
o C-F antibodies (+): after 2wks of
Illness
o Tx: Tetracycline and chloramphenicol
B. Endemic typhus (Murine typhus, Fleaborne typhus, rat typhus)
- etiologic agent: R. typhi

vector:
o rat flea (Xenopsylla cheopis ) impt
o rat louse (Polypax spinulosus)
! Humans are accidentally infected
- IC pd: 1-2 weeks
- Characteristics: skin rash begins on trunk
--> exts
- Fever, Headache, Gen. skin rash, Mild Illness
- PATHO: Cycle of Flea Rodent Flea Infxn;
Infected Flea have blood meal in host ->
scratching -> Excoriation (Portal of Entry)
from feces of flea
- Lab Dx: Serologic (C-F)
o (+) Weil-Felix (OX-19, OX-2): after
2wks of Illness
- Tx: tetracycline and Chloramphenicol
- Prev: insecticides and rodenticides
o to reduce rat-flea human
transmission
III. SCRUB TYPHUS (Chiggerborne typhus)
- Tsutsugamushi Dse. (Mite borne typhus)
- Mite 4 stages:
a. Larva (chigger?) feeds on vertebrae

etiologic agt: R. tsutsugamushi


3 major antigenic trpes: Karp, Gilliam, Kato
Vector: mite (trombiculla)
! Humans are accidentally infected
Incubation Period: 1-3 weeks
Skin rash: classical local cutaneous lesion ->
endurated vesicular --> ulcerated lesion
(present at time onset of dse) --> covered
w/ black scab (ESCHAR) w/ prom.
Lymphadenopathy (prox to eschar)
Prodromal: Fever, Chills, Headache
Cx: Spleenomegaly, Pneumonia, Respi.
Failure in severe cases and possible to have
another strain
Lab Dx: (+) Weil Felix (OX-K)
Rx: Chloramphenicol, tetracycline
Prev: protective clothing, insect repellants,
insecticides

IV. TRENCH FEVER (Shin bone F., Five Day F.,


Quintana F.)
- etiologic agent: R. quintant
- Vector: body louse (Ped. humanus corporis)
- R. quintana: the only rickettsia that can be
grown on cell-free medium
- Incubation period: 8-18 days
- Onset: Gradual or Abrupt
- Sx: mild to mod. fever, headache, malaise,
chillness and bone pain (esp. in tibial region)
- Lab Dx:
o Xenodiagnoses (feeding of lice in a
person infected with Risc. dse + in
louse tissue
o
prim. iso. on enriched blood agar

Rx: tetracycline, chloramphenicol


Prev: control of louse infestation

V. Q FEVER
- etiologic agent: Coxiella burnetti
- cycles of infection: arthopods & vertebrates
among domestic animals
- sheep & cattle share large quantity in
urine, Milk, feces & Placental products
- occupational dse (slaughterhouse and
textile industry) Febrile illness in livestock
industry
- human dse acquired via: skin (minor
abrassion), lungs (aerosol), mucus
membrane, GIT (consumption of milk),
conjunctival contact
- Sx: influenza-like illness, dry cough -->
pneumonia
- no rash
- Cx: Endocarditis
- Lab dx: C-F tests
o (-) Weil-felix reaction
- Rx: tetracycline and chloramphenicol
- Prev: Pasteurization
VI. SENNETSU RICKETTSIOSIS
- etiol agts: E. serinetsu
- vector: tick
- I.P. 2 weeks
- Sx: fever and chiils, headache, back and
joint pain, gen. lymphadenopathy, skin
rash RARE
- Dx: triad-fever, lymphadenopathy, inc.
mononuclear cells in peripheral blood,
serologic
- Rx: tetracycline
LEGIONELLA PNEUMOPHILA
-

Legionnaires Dse fulminant pneumonia


Pontiac Fever mild URTI
major pathogen of Family Legionellaceae
source: lakes, cooling towers/hotels, water
supplies of hotels and hospitals, Windborne
dust from excavation, nebulizer filled with
tap water (Nosocomial Legionellosis)

Morphology
- gram (-) bacilli 0.3-0.9 um in width and 2-20
um in length; motile with flagella
- Common staining: dieterie silver
impregnation method (in tissue or infected
yolk sac) used in demo. Spirochetes ->
baci?
- intensely brown to black against pale yellow
background
- inclusion granule: present
GROWTH CHARACTERISTICS
- aerobic
- growth maximum at 35 oC and 2.5 % CO2
optimum pH 6.9
- Muller-Hinton agar with iron and cysteine

colonies: convex, circular, glistening gray


colonies (ground glass appear.)
in 3-4 days: brown soluble pigment
other media:L Charcoal yeast extratc, FeelyGorman agar

BIOCHEMISTRY PROPERTIES
- catalase (+); weakly oxidase (+); (+) Blactamase
- hydrolyzes starch, gelatin, hippurate
RESISTANCE
- viable in broth culture for 112 days at 25 oC,
150 days at 4oC
- stream water, survive for 415 days
- survive as long as 139 days at room temp in
distilled water; for over a year in tap water
- rapidly killed by one minute exposure to 1%
formalin and 70% ethyl alcohol
- hyperchlorination of water supplies
eliminate org. from tap water
CLINICAL INFECTION
- M:F ratio = 3:1
- susceptible: smokers, immunosuppressed,
COPD , inc. alcohol intake
- source: airborne exposure
- clin. manifestation: mild pneumonia --> resp
distress
o not associated with preceding URTI
o with extrapulmonary manifests
PATHOLOGY
- acute fibrinopurulent pneumonia with
exudation of neutrophils macrophages and
large amounts of fibrin in the alveolar
spaces
- focal necrosis in alveoli and pleura
- bronchi not involved
LAB. FINDINGS
- mod., WBC, SR, liver enzymes,
hematuria, hyponatremia, proteinuria
- Chest Xray: unilateral patchy infiltrates w/
exudation consolidation
LAB. DIAGNOSIS
1. Direct demonstration of org. in specimen
* Dieterie Silver impregnation
2. Culture of org.:MHA
3. Detection of sp. antibodies in px. Serum
a. Indirect & direct immunofluorescent
test
b. ELISA
Rx: Quinolones, Not Penicillin, Erythromycin &
Rifampin
PONTIAC FEVER
- Non-pneumonia febrile illness
- Full recovery within 2-5 days
- No deaths reported
MYCOPLASMA

- C. mollicutes 3 families:
1. Mycoplasmataceae affects humans
2. Acheloplasmataceae
3. Spiroplasmataceae
- Mycoplasmataceae
1. Mycoplasma: M. pneumoniae; M. hominis
2. Ureplasma
- smallest freeliving bacteria
- pleuropneumonia org. (PPO) cattle
Pleuropneumonia-like org. (PPLO)
- characteristics:
1. Smallest reproductive units: size 200-300
nm
2. Highly pleomorphic because they lack a
rigid cell wall
3. Completely resistant to PENICILLIN but
inhibited by TETRACYCLINE
4. Can reproduce on cell free media; on agar is
the charac. fried egg appearance
5. Growth inhibited by specific antibody
6. Mycoplasmas have an affinity for cell
membranes
- replication by binary fission
- Motility: exhibit gliding motility in covered surface
CULTURAL CHARACTERISTICS
- CM: beef heart infusion / Peptone broth
infused with horse serum, yeast extract and
nucleic acids
- Solid medium:
dome-shaped colony
(dense central core)
fried egg
appearance
DETERMINANTS OF PATHOLOGENICITY
1. Adherence factor
2. Neurotoxin: M. neurolyticum
3. Lipopolysaccharide: with endotoxin-like
activity
DX: Production of cold agglutinase
- Non specific Ab agglutinates in Human RBC
in the coll agg. Appears in convalescence
per infected pts

MYCOPLASMA PNEUMONIAE
Atypical pneumonia
Prod. Neurotoxin & LPS (w/ endotoxin like
activity)

CHARACTERISTICS
- Vary from small coccoidal to short branched
filamentous cells
- Colonies: compact-mulberry colony
Typical fried-egg appearance
CLINICAL MANIFESTATION
- Worldwide, endemic
- Transmission: aerosol droplets
- Common in children <5 yrs.; incidence in
5-20 yrs age group
- Pneumonia mild: walking pneumonia
- Most common clinical syndromes:
tracheobronchitis
- Incubation period: 2-3 weeks

SSx: gradual onset of fever with malaise,


headache and non-productive cough
Chest Xray: bilateral feathery infiltrates ->
progress to rales & consolidation
Cx: OM, Bullous Meningitis, Myocarditis, M.
encephalopathy

PATHOLOGY (in M. pneumoniae)


- Bacteria attach to protein receptors on
respiratory epithelium interfere with
ciliary action desquamation and
inflammatory response
LAB DIAGNOSIS
1. Early stage clinical characteristics
2. Culture in enriched medium
3. Serologic tests:
cold agglutionation
CF test
Rx: Quinolones, Tetracycline & Eythromycin
DIFF Dx: consider other Atypical Pneumonia,
Pssitacosis, Legionellosis
Prevention
1. Avoid close contact with acutely ill patients
2. Prophylactic tetracycline
Mycoplasma Orale: Oropharynx
Mycoplasma Salavarium: Mouth
-

MYCOPLASMA HOMINIS
Associated with post abortion and post
partum fever, PIC, pyelonephritis
Self-limited but ABC tx recommended

UREAPLASMA UREALYTICUM
Formerly T.mycoplasma
Produce urease:urea ammonia
Associatedwith non-gonococcal urethritis;
postpartum fever
- Found in urogenital tract of sexually active
adults; STD
Rx: Tetracycline & Spectinomycin
-

BARTONELLA BACILLIFORMIS
Bartonellosis or Carrions disease
Transmitted by sandflies: Phlebotomus
(blood meal at night by female flies)
- Humans only vertebrae Reservoir
- Diseases:
1. OROYA FEVER
- Rapidly progressive, febrile,
highly fatal hemolytic anemia
2. VERRUGA PERUANA
- Skin disease characterized by
eruption of bright red,
angiomatous, wart-like lesions
- Chronic non fatal from oroya
Morphology
- Small, polymorphic motile, gram (-)
- coccoid, ring-shaped long angular forms
in
chains and clusters
-

Aniline dyes: stain weakly


Wrights or Giemsas: bright red-purple
- cultured specimen: flagellated
- parasitize RBC
Cultural Characteristics
- cell-free medium:semi-solid NA at 10%
rabbit
serum and 0,5% Hgb
- colonies are 1-5mm.puffs of white
- temp of 30oC favor growth
Clinical Infection
- transmission: female flies take a blood meal
- humans: only known reservoir
1. OROYO FEVER
- incubation period: 2-5 weeks
- characterized by fever, diffuse and
severe bone and muscle pains and
anemia
- highly fatal hepatosplenomegaly

secy infection at salmonella


2. VERRUGA PERUARIA
- localized or generalized
angiomatous
warts
- SSx: fever, generalized pains and
Malaise
- eruption lasts for a month to 2 yrs
Lab Dx
1. Giemsa-stained smear of peripheral blood
2. Blood culture
3. Serologic test
Tx
Penicillin, streptomycin, tetracycline and
chloramphenicol
Transfusion therapy
Control: DDT