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DR VIDYA PAI Gram negative bacilli Obligate intracellular parasitism Primarily infect arthropods Transmitted to humans by vectors In humans infect vascular endothelium Howard Taylor Ricketts 1906 Genera- Rickettsia, Orientia, Ehrlichia (Coxiella, Rochalimaea) Pleomorphic coccobacilli 0.3-0.6X0.8-2 micron in size Gram stain not very useful, stain light(G –ve) Giemsa, Casteneda- bluish purple Machiavello, Giminez- deep red Do not grow in culture media. Yolk sac of chick embryo, HeLa and Hep-2 cell linesprimary isolation Animal inoculation- Guinea pigs, Mice Genus Rickettsia - 2 groups of diseases : TUPHUS FEVER, SPOTTED FEVER Genus Orientia – Scrub typhus Genus Ehrlichia - Ehrlichiosis GROUP SPECIES DISEASE VECTOR VERTEBRAT DISTRIBUTIO E N RESERVOIR TYPHUS R. prowazekii Epidemic typhus Louse Humans Worldwide R. typhi Endemic typhus Rat flea Rats Worldwide R. rickettsii Rocky Mountain Spotted Fever Tick Rodents North America R. conori (R. siberica, R. japonca) Indian Tick Typhus Tick Rodents India R.akari Rickettsial pox Mite Rodents USA, Russia SPOTTED FEVER DISEASES RICKETTSIAL AGENT INSECT VECTOR MAMMALIAN RESERVOIR a) Q fever C. burnetti Nil Cattle, sheep,goats b) Trench fever Rochalima Louse ea quintana Human The lice that almost defeated socialism Posted under Lenin, odd animals, socialism | Tags:civil war, fuel, grain, lice, reading Lenin, war communism | Comrades, we must concentrate everything on this problem. Either the lice will defeat socialism, or socialism will defeat the lice! Worldwide but common in Russia and East Europe. 1917-1922- Napolean retreat 25 million cases & 3 mil.deaths Socialism Vs Louse Von Prowazek Humansthe only natural vertebrate host Vector- Pediculus humanus corporis Incubation period: 5-15 days Clinical features: fever with chills, skin rash 4th- 5th day(trunk-limbs sparing face, palm, soles); 2nd wkstupor, delirium. Source of infection: Infected patient Mode of infection: Body louse feces rubbed onto abrasions on skin. Louse feeds on infected patient Rickettsiae multiply in GIT of the insect & appear in feces in 3-5 days. Louse may be transferred to another person Lice defecate while feeding and when louse feces is rubbed through minute abrasions caused by scratching.( aerosol inhalation/ conjunctiva- dried louse feces) Rickettsemia. TYPHUS= dhupa (Sanskrit)/ typhos(cloud). CFR= 40% Recovery-? Latency in lymphoid tissue ----Recrudescent typhus Reactivation Rickettsiae reservoir. of latent/dormant R. prowazekii can remain without louse as Fleaborne typhus Vector-Xenopsylla cheopis Humans acquire through - Bite of infected flea Mild disease No man to man transmission Worldwide- KASHMIR in India. Neill Mooser reaction- Tunica reaction to differentiate epidemic from endemic typhus. Male guinea pigs – intraperitoneal inoculation with blood from rickettsemic patient- inflammatory adhesions between the layers of tunica vaginalis- testes cannot be pushed into the abdomen. Rocky mountain spotted fever Siberian tick typhus Indian tick typhus R. rickettsii- the first insect transmitted bacterial pathogen to be recognised Transovarially transmitted in ticks(reservoirs) RMSF- Dermacentor andersoni, Most serious spotted fever North and South America Boutonneuse fever in the mediterranean - Conor India - Himalayas – Megaw 1917 Ripicephalus sanguineus Orientia tsutsugamushi East Asia, Korea to Indonesia, Australia Mite larvae (chiggers) Zoonotic tetrad (Agent. Chiggers, rats, vegetation ) Tsutsuga= dangerous Mushi= mite Affinity to blood cells Mulberry like clusters ( morula ) inside the infected cell Anaplasma/ Cowdria Tick borne infections of cattle and sheep E. sennetsu – Sennetsu fever ( lymphoid hyperplasia E. chaffeensis – Human monocytic ehrlichiosis E. equi - Human granulocytic ehrlichiosis Microscopy Serological Tests (Weil-Felix reaction, ELISA, IF, – Paired sera to be tested. Molecular methods – PCR. Isolation of Rickettsiae – HeLa, Vero cell lines, Chick embryo Disease Antigen OX19 OX2 OXK Epidemic typhus +++ + _ Brill Zinsser disease + _ + _ _ Endemic typhus +++ + - _ Spotted fever ++ ++ _ Scrub typhus _ - +++ Coxiella burnetti is the causative agent of ‘Q-fever’ Obligate intracellular, gram negative bacterium Distributed Found globally in many species of animals obligate intracellular pathogen . gram negative . Pleomorphic . size : rods:- 0.2 – 0.4 x 0.4 – 1.0 mc spheres :- 0.3 – 0.4 mc filterable . better stained with GIMINEZ and other rickettsiael stains . Grows well in yolk sac of chick embryos and in various cell cultures . Resistant to physical and chemical agents In pasteurization flash method is effective Can survive in dust and aerosols Inactivated by 2% formaldehyde 5% H2O2 1% Lysol . Resistant Air to heat, drying and disinfectants samples test positive for 2+ weeks Soil samples test positive for 150+ days A ZOONOTIC DISEASE Q stands for Query or Queensland Origin of disease unknown First reported cases were in Queensland, Australia Differentiating features from Rickettsiae: 1. Having smaller size 2. Resistance to heat and drying 3. Major route of transmission isinhalation/ingestion Primary Reservoir -? Bandicoots Goats Cattle Sheep * All eukaryotes can be infected TICKS Feces Urine Milk of infected animals During birthing the organisms are shed in high numbers in amniotic fluids and the placenta 109 bacteria per gram of placenta Do not touch! Most common route is inhalation of aerosols Consumption of raw Contaminated dust, manure, birthing products Tick bites (rare) Human to human also very rare gsbs.utmb.edu Person-to-person (rare) Transplacental (congenital) Blood transfusions Bone marrow transplants Intradermal inoculation Possibly sexually transmitted Center for Food Security and Public Health Iowa State University - 2004 Farmers, veterinarians, researchers, abattoir (slaughterhouse) workers etc. People who breed animals Immunocompromised Acute or Chronic Q fever gsbs.utmb.edu *Bacteria spread through blood Symptoms : Asymptomatic Self-limiting, flu-like disease Fever, nausea, headaches, vomiting, chest/abdominal pain Pneumonia & granulomatous hepatitis Chronic Q fever (> 6 months) Endocarditis & meningoencephalitis Hepatitis Spontaneous recovery Bacteria may remain latent in tissues for 2-3 years Hepatitis Endocarditis Cirrhosis Entry via inhalation Alveolar macrophages encounter bacteria C. burnetii phagocytosed Macrophage C. burnetii R Heinzen, NIAID Replication Low within phagolysosme pH needed for metabolism No cellular damage unless lysis occurs Can invade deeper tissue and cause complications Binding/entry into macrophages via: Integrin Associated Protein (IAP) Leukocyte Response Integrin (LRI) macrophage bacteria Binding & Entry Phagocytosis Phagocytic vesicle Lysis of phagolysosome and macrophage Phago-lysosome fusion: bacteria survive and multiplies Asymptomatic Looks like other disease (Flu or cold) Serology PCR, in most cases continues to be best method ELISA and other methods WEIL – FELIX test is negative . Bio safety level 3 (BSL-3) facility Very infectious (one organism causes infection) Listed by the CDC as a potential bioterrorism agent. Isolated in cell cultures or embryonated eggs Once infected, humans can have life-long immunity Acute Q fever treated with: doxycycline, chloramphenicol, erythromycin or fluoroquinolones Chronic Q fever treated with: More than one antibiotic tetracycline and cotrimoxazole for 2 years Vaccines : prepared from formalin killed whole cells attenuated strains trichloroacetic acid extracts NOT FOR GENERAL USE. Pasteurization and sterilization of milk and other dairy products Disinfect utensils, machines used in farm areas for birthing Regular testing of animals and those who work closely with them Protective Personal Equipment Family Bartonellaceae contain two genera Bartonella contain 3 species: Bartonella B.bacilliformis Grahamella B.quintana Grahamella does not infect humans B.henselae Carrions disease Daniel Carrion – Peru OROYA fever Causes OROYA fever Transmitted by SAND flies Infects RBCs INCUBATION PERIOD; 3 weeks to 3 months Fever Headache Chills Severe anemia Several weeks after recovery pt. develop nodular lesions on the body Secondarily infect produce ulcers – VERUGA PERUANA Demonstrated in blood smear by GIEMSA stain Seen in cytoplasm and adhere to cell surface Grown on NA agar contain rabbit serum, Hb Guinea pig inoculation leads to VERUGA PERUANA Susceptible to penicillin streptomycin Tetracycline Chloramphenicol Insecticides such as DDT should be used to eliminate sand flies Formerly called Rochalimaea quintana Causes TRENCH fever also called FIVE DAY fever Transmission; by body louse No animal reservoir vertical transmission does not occur in lice Lice after acquiring infection remain infectious through out life Mild symptoms leads to chronic bacteremia Relapse have been observed even after 20 years primary disease Rick quintana Rochalimaea quintana ( da Rocha Lima ) Bartonella quintana Detected in the gut of infected lice Isolate from pt. blood by culture sheep blood agar Weil-felix test negative PCR- detect organism in tissues World wars Recently Tunisia and Mexico USA Causes CAT-SCRATCH disease Occur by contact with scratch / bite of an infected cat Resolution in weeks to months 1 - 3 weeks Cat contact (scratch, bite, ? cat flea bite) Dissemination in immunocompromised hosts Regional lymphadenopathy Fever Endocarditis In AIDS pt. leads to; bacillary angiomatosis (vascular nodules/tumours appear on skin, mucosa etc ) bacillary peliosis( liver and spleen) lymph node biopsy – stained with WARTIN-STARRY SILVER IMPREGNATION –clusters of bacillus Grow on chocolate agar/ columbia agar Self limiting No specific treatment required