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Chlamydia Rickettsia Handout

Chlamydia Rickettsia Handout

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Published by lorelie17

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Published by: lorelie17 on Nov 01, 2010
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03/20/2015

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Rickettsia, Chlamydia, Mycoplasma, Legionella, and Gardnerella 
Rickettsia
Classification – Family Rickettsiaceae with 3 medically important genera
Rickettsia 
Coxiella 
Rochlimaea 
Morphology and cultural characteristics
All are obligate intracellular parasites (except
Rochlimaea 
) that can growin both phagocytic and nonphagocytic cells.
Rochlimaea 
can be cultivated on artificial media containing blood
Rickettsia
Others are grown in embryonated eggs or tissue culture
Cultivation is costly and hazardous because aerosol transmission caneasily occur
Small, pleomorphic coccobacilli
Gram stain poorly, but appear to be G-
Stain readily with Giemsa
All, except
Coxiella 
, are transmitted by arthropod vectors.
Diagnosis/serological tests
Direct detection of
Rickettsia 
in tissues (Giemsa stain or directfluorescent antibody test) Weil-Felix reaction – in certain rickettsialinfections (typhus group) antibodies are formed that will agglutinate OXstrains of
Proteus vulgaris.
 
This is used as a presumptive evidence of typhus group infection,however, the test is not very sensitive or specific and many falsepositives occur.
 
Agglutination or complement fixation tests using specific Rickettsialantigens are better serological diagnostic tests.
Virulence factors
Rickettsial sp.
 
Induced phagocytosis
Recruitment of actin for intracellular spread
Coxiella burnetti 
Is resistant to lysosomal enzymes
Rickettsia cell-to-cell spread
Rickettsia rickettsii
Rickettsia
Clinical significance – the diseases caused by
Rickettsia 
are all characterizedby fever, headache, myalgias, and usually a rash.
Typhus fevers – incubation is 5-18 days.
Symptoms include a severe headache, chills, fever, and aftera fourth day, a maculopapular rash caused by subcutaneoushemorrhaging as
Rickettsia 
invade the blood vessels.
The rash begins on the upper trunk and spread to involve thewhole body except the face, palms of the hands, and thesoles of the feet.
The disease lasts about 2 weeks and the patient may have aprolonged convalescence.
Two types of typhus may occur:
Epidemic typhus – caused by R. prowazekii and transmittedby human lice as it bites and defecates in the wound.
This occurs in crowded areas causing epidemics. Mortalityrates are high in untreated cases. Following an initial attack,some individuals may harbor the organism of a latentinfection with occasional relapses = Brill-Zinsser disease
 
Endemic typhus – caused by R. typhi and transmitted to man by ratfleas.
The disease occurs sporadically, but is clinically the same, but lesssevere than epidemic typhus.
Rickettsia 
responsible for spotted fevers
Rocky mountain spotted fever – caused by R. rickettsii andtransmitted by ticks that must remain attached for hours in orderto 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 theextremities, including palms and soles, and spreading to thechest and abdomen.
If left untreated, the rash will become petechial withhemorrhages in the skin and mucous membranes due tovascular damage as the organism invades the blood vessels.
Death may occur during the end of the second week due tokidney or heart failure.
Rickettsial pox – caused by
R. akari 
and transmitted by a mousemite.
After a 1-2 day incubation a papule develops at the entrysite and within 1-2 weeks a fever, malaise, and headachedevelop followed by a rash.
The disease is mild and usually not fatal.
Q fever – caused by
Coxiella burnetii 
. The infection is acquired byinhalation of infectious material.
After an incubation of 14-26 days there is a sudden onset offever, chills, and headache, but no rash.
The disease is characteristically an atypical pneumonia lasting 5-14days with a low mortality rate.
Trench fever – caused by Rochalimaea quintana and transmitted by bodylice. Was a major problem during WW I and WW II.
After an incubation of 6-22 days, the patient experiences aheadache, exhaustion, leg pains, and a high, relapsing fever.
A roseolar rash occurs and the patient usually recovers.

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