TYPHUS FEVER GROUP

RICKETTSIACEAE :

Dr. Gayatree Nayak

 OUTLINE :
 INTRODUCTION
 CLASSIFICATION
 EPIDEMIOLOGY
 AGENT - HOST - RESERVIOR
 PATHOGENESIS
 MODES OF TRANSMISSION
 STRUCTRE
 ANTIGENICITY
 CLINICAL FEATURES
 MANAGEMENT
 LAB DIAGNOSIS
 PREVENTIVE MEASURES
 TREATMENT
 INTRODUCTION :
• Obligate intracellular bacteria

• Small non - motile , Gram-negative coccobacilli

• A zoonoses - considered as one among emerging and reemerging diseases

• Transmitted by Arthopod vector : tick , mite, flea or louse

• Human : accidental host

• Common diseases in India :

• Scrub typhus, Murine flea-borne typhus, Indian tick typhus, Q fever

• Rickettsia named after Howard Taylor Ricketts(1911)

CLASSIFICATION OF ORDER RICKETTSIALES

FAMILY RICKETTSIACEAE FAMILY ANAPLASMATACEAE

• Includes genera: • Includes genera :
• Rickettsia • Ehrlichia
• Orientia • Wolbachia
• Species of Rickettsia can be • Anaplasma
divided clinically : • Neorickettsia
• Typhus fever
• Spotted fever group
 Mammalian
Diseases Rickettsial agent Insect vectors reservoirs
Typhus group
(i) Epidemic typhus Rickettsia prowazekki louse humans
(ii) Murine typhus R. typhi Flea Rodents

Spotted fever group

(i) Indian tick typhus R. conorii Tick Rodents, dogs
(ii) Rocky mountain R. Rickettsii Tick Rodents, dogs
spotted fever
(iii) Rickettsial pox R. akari Mite Mice

Scrub typhus Orientia tsutsugamushi Trombiculid mite rodents

Others
(i) Q fever Coxiella brunetti Nil Cattle, sheep, goats
(ii) Trench fever Rochalimaea quintana louse human
 EPIDEMIOLOGY:
• EPIDEMIC TYPHUS :
I. Agent : R. prowazekii
II. Vector : Human body louse (Pediculosis humanus corporis)
III. Reservoir : Eastern flying squirrels & Humans
• ENDEMIC TYPHUS :
I. Agent : R. typhi
II. Vector : ratflea (Xenopsylla cheopis)
III. Reservoir : Rodents ( Rattus rattus)
MODES OF TRANSMISSION
• All Rickettsial diseases transmitted to humans by Arthropod vector

• Epidemic typhus : (1)Autoinoculation of organisms following rubbing or scratching of abraded

skin or mucosa contaminated by louse feces

(2) rarely by inhalation of louse feces, in the laboratory or during bioterrorism.

• Endemic typhus : transmitted by inoculation on skin or inhalation of fleas dried feces, less
frequently by fleae bite

• Risk factors : Unhygienic conditions

(Typical in refugee camps, prisons & overcrowded communities)

 STRUCTURE AND ANTIGENICITY
• Cell wall resembles gram negative bacteria
• Contains lipopolysaccharide , peptidoglycan , outer membrane
proteins(OMP)

• Omp A: Spotted fever group Rickettsiae

• Omp B : Both spotted fever group and Typhus fever group
• Group specific alkali stable lipopolysaccharide (LPS) antigen :
• Found in some Rickettsiae and certain species of Proteus (OX19,OX2,OXK)
 PATHOGENESIS
Adhesion to endothelial cell mediated by Omp A, Omp B

Organism get phagocytosed , remains inside a vacuole

Multiply by binary fission and lysis of vacuole with phospholipase

A released by bacteria

Endothelial cell lysis by via lipid peroxidation of host cell

membrane

Thrombosis of vessels due to Inflammation, leading to rupture &

necrosis
 CLINICAL FEATURES:
• EPIDEMIC TYPHUS : (Louse borne)
• An acute febrile illness accompanied by headache,myalgia,eye discharge,rashes
(Incubation period: 1-2 weeks)
• Rash on day 5 - start at upper trunk followed by generalized involvement
• Brill-zinsser disease:
• Recrudescent illness - years after acute disease
• Reactivation due to waning immunity
• Leads to sporadic infection or outbreaks
• ENDEMIC TYPHUS :( Flea borne )
• Similar to epidemic typhus but milder & rarely fatal
 LAB DIAGNOSIS
Serological antibody detection (specific and non-specifc
antibody )

Bacteria isolation

Neil-mooser reaction

PCR : Detecting genes 56 Kda/47KDa/16S rRNA or Omp genes

Histopathological examination
 SEROLOGY : MAIN STAY OF DIAGNOSIS

•Non Specific test : Weil – Felix test

•Principle :
•Antigenic cross reactivity ( Heterophile agglutination test )
•Group specific alkali stable lipopolysaccharide (LPS)antigen found in some rickettsiae is
also shared by certain strains of Proteus (OX19, OX2 and OXK strains)
• Procedure (Tube agglutination test)
•Agglutination test can be done by slide or tube method
 WEIL-FELIX TEST

1.Slide method
•Rapid screening method
•Place 50-100µl of patient serum on to reaction
circle of a glass slide
•Add a drop of desired antigen ( OX19 or OX2 or
OXK)
•Mix the suspension
•Rotate the slide for 1 minutes
•Visible agglutination indicates positive test
•A positive test should be confirmed with tube test
 WEIL-FELIX TEST

2. Tube method
• Dilute the patient serum (two fold) using
physiological saline
• Make final volume of 1 ml.
• Add 1 drop of antigen (OX19/OX2/OXK) in
each test tube
• Incubate at 50-55 c for 4-6 hours or at
37 c for 18 hrs
• Visible flocculation/granulation/ slight
agitation indicates the positive test
 INTERPRETATION OF WEIL FELIX
Rapid Slide Screening Test
Positive test : Agglutination within
1minute (presence of corresponding
antibody in patient serum)
Negative test: No agglutination
Quantitative Method
Positive reaction: Granular
agglutination
Negative reaction: (Physiological
saline as negative control) a cell button
formed
 ANALYSIS OF RESULTS
• Rickettsial antibodies detected against Proteus OX 19 ,OX 2,OX K antigens

Disease Elevated titer of antibody

Epidemic and endemic typhus OX 19

Tick born spotted fever OX 2 , OX 19

Scrub typhus OX K
 OTHER DIAGNOSIS METHODS
 Specific serological test done by :
 ELISA
 Indirect Immunoflourescense test
 Indirect Immunoperoxidase Assay
• Bacteria isolation :
 Inoculating into cell lines (Vero , WI-38 , HeLa), egg(yolk sac) or , animal (guinea pig )
• Neil Mooser reaction :
 Positive tunica reaction
 Intraperitoneal inoculation into guinea pig , leads to testicular inflammation
• Skin biopsy : Histopathological examination under microscope
 PREVENTION & TREATMENT
• Vector control ( Insecticides)
• Control of rodents and other animals
• Improvement in personal hygiene
• No vaccine is available at present
• TREATMENT :
 Doxycycline is drug of choice
 Alternatives: Azithromycin , Chloramphenicol
SUMMARY
THANK
YOU