Rickettsia, Chlamydia, Mycoplasma,

Rickettsia
Classification

Family Rickettsiaceae with 2 medically important genera

Rickettsia Coxiella

Morphology

and cultural characteristics

Both are obligate intracellular parasites that can grow phagocytic and nonphagocytic cells.

Diseases
Rickettsia

rickettssi causes Rocky mountain spotted fever Coxiella burnetti causes Q-fever

Rickettsia
Gram

stain poorly, but appear to be Gnegative But Stain readily with Giemsa Small, pleomorphic coccobacilli Cultivation is costly and hazardous because aerosol transmission can easily occur Others are grown in embryonated eggs or tissue culture Coxiella, are not transmitted by arthropod vectors.

Transmission
Rickettsiae

is that they are maintained in nature in certain arthropods such as ticks,lice,fleas and mites. With one exception are transmitted to humans by the bite of the arthropod The exception to arthropod transmission is C.burnettii the cause of Q-fever which is transmitted by aerosol and inhaled into the lungs

Rickettsia cell-to-cell spread

Rickettsia rickettsii

Rickettsia

Rickettsia responsible for spotted fevers Rocky mountain spotted fever caused by R. rickettsii and transmitted by ticks that must remain attached for hours in order to transmit the disease. An incubation of 2-6 days is followed by a severe headache, chills, fever, aching, and nausea. After 2-6 days a maculopapular rash develops, first on the extremities, including palms and soles, and spreading to the chest and abdomen.

If left untreated, the rash will become petechial with hemorrhages in the skin and mucous membranes due to vascular damage as the organism invades the blood vessels. Death may occur during the end of the second week due to kidney or heart failure.

Rocky mountain spotted fever

Rocky mountain spotted fever

Rickettsia
Q

fever caused by Coxiella burnetii. The infection is acquired by inhalation of infectious material. After an incubation of 14-26 days there is a sudden onset of fever, chills, and headache, but no rash. The disease is characteristically an atypical pneumonia lasting 5-14 days with a low mortality rate.

Rickettsia
The

Q-fever is the one rickettsial disease that is not transmitted to humans by the bite of arthropod The important reservoir for human infection are cattle, sheep, and goats. The agent C.burnettii which causes an inaaparent infection in these reservoir hosts is found in high concentration in the urine, feces placental tissues and amniotic fluid of the animals

 It

is transmitted to human by the inhalation of aerosols of these materials The disease occur worldwide chiefly in individual whose occupational expose them to livestock such as shepherds abattoir employees and farm workers Cow milk usually responsible for subclinical infection Pasteurization of milk kills the organism

Laboratory diagnosis
Diagnosis

of rickettsial disease is base on serologic analysis rather than isolation of the organism Although rickettsiae can be grown in cell culture or embroynated eggs This is hazardous procedures That is not available in standard clinical laboratories

 Serological

test Indirect immunofluorescence ELISA Are most often used Weil-felix test use if historic interest test But is no longer performed because of specificity and sensitivity is very low

Rickettsia
Treatment/antimicrobic
Chloramphenicol

therapy

or tetracycline

Wear

protective clothing and use insect repellents. Killed vaccine for Q-fever No vaccine for rocky mountain fever

Chlamydia
Classification

order Chlamydiales contains one medically important genus Chlamydia Are obligate intracellular parasites Cell walls are similar to the cell walls of G-B, but lack muramic acid

Diseases:
Chlamydia

trachomatis causes eye respiratory and genital tract infections C.trachomatis is the most common cause of sexually transmitted disease in United states Chlamydia pneumonia causes atypical pneumonia

Important properties
Chlamydia

are obligate intracellular

bacteria They lack the ability to produce sufficient energy to grow independently and therefore can grow only inside host cells They cell walls resemble those of Gnegative bacteria but lack muramic acid

 Chlamydia

have a replicative cycle different from that of all other bacteria The cycle begins when the extracellular metabolically inert spore like elementary body (EB) enters the cell And reorganize into a larger metabolically active reticulate body(RB)

 The

later undergoes repeated binary fission to form daughter elementary bodies which are release from the cell within cells The site of replication appears as an inclusion body(IB) which can be stained and visualized microscopically

 The

inclusion are useful in the identification of these organisms In the clinical laboratories

Chlamydia life cycle

Transmission
C.trachomatis

infects only humans and is usually transmitted by close personal contact, e.g., sexual or by passage through the birth canal. Individuals with asymptomatic genital tract infections are an important reservoir of infection for others

 In

trachoma, C.trachomatis is transmitted by finger-to-eye or fomite to eye contact C. pneumonia infects only humans and is transmitted from person to person by aerosols Disease caused by these organisms occurs worldwide But trachoma is most frequently found in developing countries in dry hot regions

Pathogenesis
Chlamydia

infect primarily epithelial cells of the mucous membranes or the lungs They rarely cause invasive, disseminated infections C.pneumoniae causes upper and lower respiratory tract infections especially bronchitis and pneumonia in young child

 C.trachomatis

exists in more than 15 immunotypes (A-L) types A,B,and C cause trachoma A chronic conjunctivitis endemic in Africa and Asia. Trachoma may recur over many years and may lead to blindness buts causes no systemic illness Type D-K causes genital tract infections

 Which

are occasionally transmitted to the eyes or the respiratory tract. Infants born to infected mothers often develop mucopurulent eye infections. Patient with genital tract infections caused by C.trachomatis have a high incidence of Reiter's syndrome

 Which

is characterized by urethritis arthritis and uveitis. Reiter's syndrome is an autoimmune disease caused by antibodies formed against C.trachomatis cross-reacting with antigens on the cells of the urethra joints and uveal tract

Trachoma

Laboratory diagnosis
Chlamydia

form cytoplasmic

inclusions Which can be seen with special stains (Giemsa stain) or by immunoflurescence The gram stain is not useful

 In

exudates the organism can be identified within epithelial cells by fluorescent antibody staining DNA probe method Antigen can be detected in exudates or in urine by ELISA Or a PCR based using the patients urine can also be used to diagnose disease

Chlamydia
Treatment/anti-microbic
C.

susceptibility

trachomatis

Trachoma

systemic tetracycline, erythromycin; long term therapy is necessary Genital tract infections and conjunctivitis tetracycline's and erythromycin

Mycoplasma
Classification

Mycoplasma Three common clinical isolates M. pneumoniae, M. hominis, and U. urealyticum

Morphology

and cultural characteristics

Do not possess the distinctive cell wall of bacteria M.pneumoniae is the major pathogen

Important properties
Plasma and

membrane is the outermost part of the organism is unique in bacteria in that it has a high content of sterols that act to prevent osmotic lysis small in size (too small to be seen with an ordinary light microscope) and highly pleomorphic

Very

 Dont

stain with a Grams stain Non-motile May possess a capsule Although some are free living, most are closely adapted parasites Grow on media enriched with serum (need cholesterol) Grow beat at 35-370 C either aerobically or anaerobic ally

pneumoniae grows in 5-14 days, M. hominis in 2-4 days, and U. urealyticum in 24-28 hours. M. pneumoniae colonies resemble fried eggs and can be stained with Dienes stain (they stain blue) Identification M. pneumoniae Isolation in culture

M.

Pathogenesis
M.pneumoniae

a pathogen only for humans, is transmitted by respiratory droplets In the lungs the organism is rod shaped with tapered tip that contains specific proteins that serve as the point of attachment to the respiratory epithelium

 The

respiratory mucosa is not invaded But ciliary motion is inhibited and necrosis of the epithelium occurs The mechanism by which M.pneumoniae causes inflammation is uncertain

 M.pneumoniae

has only one serotype and is antigenic ally distinct from other species of mycoplasma During the infection auto antibodies are produced against red cells (cold agglutinins) and brain, lung, and liver cells These antibodies may be the source of the extra pulmonary manifestations of infection

Mycoplasma colonies with Dienes stain

Clinical findings
M.pneumonia

is the most common type of atypical pneumonia It was formerly called primary atypical pneumonia disease The term Atypical means that a causative bacterium cant be isolated on routine media in the diagnostic laboratory

 Or

that disease does not resemble pneumococcal pneumonia The onset of M.pneumonia is gradual usually beginning with a non productive cough, sore throat or small amount of whitish non bloody sputum are produced Fever headache The disease resolve spontaneously in 1014days

Transmitted

by droplet infection After a 2-3 week incubation, the disease begins as a mild, upper respiratory tract infection and progresses to fever, headache, malaise, and a dry cough which is usually mild and self-limited.

 3-10%

develop clinically apparent pneumonia with occasional complications of arthritis, rashes, cardiovascular problems, or neurological problems.

Epidemiology
M.pneumonae

occur worldwide with an increased incidence in winter This organism is the most frequent cause of pneumonia in young adult And is responsible for outbreaks in groups with close contacts such as families, military personnel and college students

Laboratory diagnosis
Diagnosis

is usually not made by culturing sputum samples It takes at lest 1 week for colonies to appear on special media Serological testing is the mainstay of diagnosis Cold agglutination test Complement fixation test

Treatment
Erythromycin Penicillin

or tetracycline

and cephalosporin is ineffective because organism has no cell wall is no vaccine

There