MICP WEEK 17  TREATMENT

RICKETTSIAL INFECTIONS  TREATMENT SHOULD BE STARTED EARLY IN THE

RICKETTSIAL INFECTIONS FIRST WEEK OF ILLNESS
 RICKETTSIA SPECIES ARE GRAM NEGATIVE, STRICTLY  DOXYCYCLINE (FIRST CHOICE)
INTRACELLULAR BACILLI  TETRACYCLE (ALTERNATE)
 PLEOMORPHIC
 RICKETTSIOSIS (SICKNESS)  ROCKY MOUNTAIN SPOTTED FEVER
 RICKETTSIAL DISEASE CAN BE DIVIDED INTO FIVE  ETIOLOGIC AGENT: RICKETTSIA RICKETTSII
MAJOR GROUPS:  TRANSMISSION: BITE OF TICKS - GARAPATA
 TYPHUS  SUMMER / SPRING
 SCRUB TYPHUS
 SPOTTED FEVERS
 Q FEVER
 TRENCH FEVER
 TRANSMISSION
 BY BITE OF ARTHROPODS (TICKS-GARAPATA, LICE-
KUTO, FLEAS-PULGAS, MITES) EXCEPT Q FEVER
 ZOONOTIC EXCEPT EPIDEMIC TYPHUS

SPOTTED FEVER GROUP
 RICKETTSIALPOX
 ETIOLOGIC AGENT: RICKETTSIA AKARI
 TRANSMISSION: BITE OF MITES - SUROT
 ESCHAR: BLACKENED SCAB -- FEVER, HEADACHE, CHILLS,
MYALGIA -- SIGNS/SYMPTOMS LIKE VARICELLA, FIRM
RED MACULE AT BITE SITE - VESICLE RUPTURES
 SIGNS / SYMPTOMS
 LIKE RICKETTSIALPOX (EARLY S/S)
 2 TO 6 DAYS LATER, MACULOPAPULAR RASHES
(CENTRIPETALLY - ON HAND, FEET, TRUNK)
 SIGNS / SYMPTOMS - SYSTEMIC
 UNTREATED RMSF - RESULT IN SEVERE
SYSTEMATIC MANIFESTATIONS, INCLUDING
PNEUMONITIS, MYOCARDITIS, HEPATITIS, ACUTE
RENAL FAILURE, ENCEPHALITIS, GANGRENE, & DEATH
 TREATMENT
 DOXYCYCLINE

 VESICLES - MOSTLY LIMBS

 CONDITION IS SELF LIMITED

JASMINE ROSE ESPINAS
 TYPHUS GROUP
EPIDEMIC TYPHUS (LOUSE-BORNE TYPHUS)
 OTHER NAME: CAMP FEVER, JAIL FEVER, AND WAR
FEVER
 GRAM NEGATIVE, AEROBIC BACILLUS BACTERIA
 ETIOLOGIC AGENT: RICKETTSIA PROWAZEKII
 TRANSMISSION: BITE OF LOUSE
 TRANSMITTED IN THE FECES OF LICE - KUTO
 IN NORTH AMERICA, THE MAIN RESERVOIR FOR R.
PROWAZEKII IS THE FLYING SQUIRREL
 SIGNS / SYMPTOMS
 LIKE RICKETTSIAL INFECTION
 MACULOPAPULAR RASHES THERE IS SPARING OF
PALM & SOLES
 RELAPSE
 RECRUDESCENT INFECTION KNOWN AS BRILL-
ZINSSER DISEASE
 PREVENTION
BODY LICE THRIVE IN OVERCROWDED, PEOPLE AREN’T ABLE
TO BATHE OR CHANGE CLOTHERS REGULARLY, SO…
 BATHE REGULARLY; CHANGE INTO CLEAN CLOTHES
 WASH LOUSE-INFECTED CLOTHING
 MACHINE WASH AND DRY INFESTED CLOTHING AND
BEDDING USING HOT WATER (AT LEAST 1300 F) AND
DRY ON HIGH HEAT WHEN POSSIBLE
 NO VACCINE
Q FEVER (QUERY GROUP)
 ETIOLOGIC AGENT: COXIELLA BURNETII
 GRAM NEGATIVE COCCOBACILLI
 TRANSMISSION
 INHALATION OF DUST WITH ORGANISM OR
AEROSOLS
 INFECTED BY BREATHING IN DUST THAT HAS BEEN
CONTAMINATED BY INFECTED ANIMAL FECES, URINE,
MILK, AND BIRTH PRODUCTS THAT CONTAIN
COXIELLA BURNETII
 DIRECT CONTACT (E.G. TOUCHING, BEING LICKED)
WITH AN ANIMALS IS NOT REQUIRED TO BECOME
SICK WITH Q FEVER (CDC)
 SIGNS / SYMPTOMS
 LIKE INFLUENZA & NON - BACTERIAL PNEUMONIA,
HEPATITIS OR ENCEPHALOPATHY
 AN ACUTE STAGE THE PRESENTS WITH HEADACHES,
CHILLS, AND RESPIRATORY SYMPTOMS, AND AN
INSIDIOUS CHRONIC STAGE
 NO RASH/LESION

ENDEMIC TYPHUS (MURINE TYPHUS)

 ETIOLOGIC AGENT: RICKETTSIA TYPHI & RICKETTSIA
FELIS - COCCOBACILLUS BACTERIA
 R. TYPHI: RAT FLEA - PULGAS
 R. FELIS: CAT FLEA - PULGAS TRENCH FEVER
 TRANSMISSION: BITE OF FLEA  ETIOLOGIC AGENT: RICKETTSIA QUINTANA
 SIGNS / SYMPTOMS  TRANSMISSION: BITE OF LICE - KUTO
 LIKE EPIDEMIC TYPHUS  SIGNS / SYMPTOMS
 MILDER, RARELY FATAL, EXCEPT FOR ELDERS  HEADACHE, EXHAUSTION, PAIN, SWEATING, COLD
EXTREMITIES, & FEVER W/ ROSEOLA RASH
SCRUB TYPHUS
 ETIOLOGIC AGENT: ORENTIA TSUTSUGAMUSHI EHRLICHIOSIS
(RICKETTSIA TSUTSUGAMUSHI)  ETIOLOGIC AGENT: EHRLICHIA SENNETSU FOR
 TRANSMISSION: BITE OF MITES SENNETSU FEVER & EHRLICHIA CHAFFEENSIS FOR
 SIGNS / SYMPTOMS HUMAN EHRLICHIOSIS
 LIKE EPIDEMIC TYPHUS, EXCEPT ESCHAR (PUNCHED-  TRANSMISSION
OUT ULCER COVERED WITH BLACKENED SCAB)  TICK BITES
 WITH LYMPHADENOPATHY & LYMPHCYTOSIS  BLOOD TRANSFUSION & ORGAN TRANSPLANT
 WITH CARDIAC & CEREBRAL MOVEMENT  SIGNS / SYMPTOMS
 ORGANISM PARALYZES LYPHOCYTES, NEUTROPHILS,
& MONOCYTES
 NON-SPECIFIC SYMPTOMS WITH
THROMBOCYTOPENIA

JASMINE ROSE ESPINAS

  PREVENTION
 AVOID AREAS WITH INFESTATION
 PROTECTION FROM BITES
 ELIMINATING CIRCUMSTANCES THAT PROMOTE
LOUSE INFECTION (E.G., CROWDING, HOMELESSNESS)
AND GOOD PERSONAL HYGIENE (E.G. ,CHANGING
CLOTHES AT PREQUENT INTERVALS, BATHING,
BOILING, AND WASHING CLOTHES AND BEDDING)
 DELOUSING WITH 1% LINDANE, DDT POWDER, OR
LYSOL IS USEFUL IN SHELTERS AND IN PATIENTS
AND HOUSEHOLD CONTACTS

LYME DISEASE (LYME BORRELIOSIS)

RELAPSING FEVER  ETIOLOGIC AGENT: BORRELIA BURGDORFERI
 ETIOLOGIC AGENT: BORRELIA RECURRENTIS  FLEXIBLE SPIROCHETE WITH COARSE IRREGULAR
 A ZOONOTIC, VECTOR-BORNE DISEASE COILS
TRANSMITTED PRIMARILY BY TICKS AND BY LICE  SPIROCHETE BACTERIA
 NAMED AFTER THE FRENCH BIOLOGIST AMEDEE  MODE OF TRANSMISSION
BORREL  ARTHROPOD-BORNE INFECTION
 MODE OF TRANSMISSION  TRANSMITTED THROUGH BITE OF TICK (IXODES)
 TRANSMITTED FROM PERSON TO ANOTHER  RESERVOIR OF BORRELIA BURGDORFERI IS A WOOD RAT
THROUGH BITE OF LOUSE (PEDICULOSIS HUMANUS)  OBLIGATORY HOST
 RESERVOIR  MAMMALS PARTICULARLY DEER, ON WHICH THE
 RODENTS. INFECTION IS TRANSMITTED THROUGH TICK COMPLETES ITS LIFE CYCLE
BITE OF TICKS (ORNITHODORUS)  GEOGRAPHICAL DISTRIBUTION
 OTHER LITERATURE  THERE ARE FOCI OF LYME BORRELIOSIS IN
 INFECT HOST ONLY WHEN LOUSE IS INJURED, E.G., FORESTED AREAS OF ASIA, NORTH-WESTERN,
DURING SCRATCHING. CENTRAL, AND EASTERN EUROPE, AND THE USA
 SIGNS / SYMPTOMS: 3 STAGES
 1ST STAGE: PAINLESS, CIRCULAR RED RASH AT SITE
OF BITE SPREADING WITH A CLEAR CENTER (THUS
CALLED AS ERYTHEMA CHRONICUM MIGRANS)
ACCOMPANIED BY ARTHRALGIA
 2ND STAGE: AFTER FEW WEEKS OR MONTHS,
MYOCARDITIS OR PERICARDITIS, ASEPTIC
MENINGITIS, BELL’S PALSY * NEUROPATHIES
FOLLOWED BY LATENT PERIOD
 SIGNS / SYMPTOMS  3RD STAGE: ARTHRITIS INVOLVING LARGE JOINTS
 FEVER, HEADACHE, CHILLS (KNEES) & PROGRESSIVE CHRONIC CENTRAL SYSTEM
 FEVER LAST FOR FEW DAYS THEN RESOLVE  LABORATORY DIAGNOSIS
 FEVER RECURS WITH MULTI-ORGAN DYSFUNCTION  MICROORGANISMS CAN BE STANED BY GIEMSA OR
SILVER STAINS & CAN BE VISUALIZED BY DARKFIELD
MICROSCOPY
 SEROLOGICAL TEST: ELISA OR INDIRECT
IMMUNOFLOURESCENCE
 PCR
 CONFIRM: WESTERN BLOT
 TREATMENT
 LABORATORY DIAGNOSIS  AMOXICILLIN OR DOXYCYCLINE
 EXAM OF PERIPHERAL SMEAR OF BLOOD THAT  IF LATE STAGE: PENICILLIN G OR CEFTRIAXONE
SHOWS SPIROCHETE  PREVENTION
 CULTURE  PREVENT TICK BITE, WEAR THICK CLOTHING & USE
 SEROLOGICAL TEST INSECT REPELLANTS
 TREATMENT
 DRUG OF CHOICE: TETRACYCLINE

JASMINE ROSE ESPINAS

JASMINE ROSE ESPINAS