Presentasi Rickettsia 5-2-2014

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RickettsiaKELOMPOK 4

RABU, 5 FEBRUARI 2014



Rickettsia

- Coccobacilli

- Small (0.3-0.5 x 0.8-2.0 um)

- Gram-negative

- Aerobic

- Obligate intracellular parasites of eucaryotic cells.

- Have typical Gram-negative cell walls,

- Lack flagella.











INFECTIOUS DOSE

• precise infectious dose unknown

• It generally have a very low infectious dose (bite ofa single tick is sufficient to cause RMSF in humans)

INCUBATION PERIOD:

•

2-14 days after the bite of an infected tick



Epidemology

The spotted fever rickettsiae found in every continent

except Antarctica.

RMSF: Primarily occurs in US but has been reported in

southern Canada, Central America, Mexico, and parts ofSouth America. It is rarely seen elsewhere

Rickettsialpox: Has been identified in large cities in

Russia, South Africa, and Korea.

Boutonneuse fever in Mediterranean countries (Spain,

Italy, and Israel)





Pathophysiology

Enter HumanBody

phagocytosed

multiply andaccumulate in

cytosol

escape from cell, damaging

its membrane and causing

influx of water (Spotted

Froup)

lysing the host cell

(typhus group)



Pathophysiology

The adhesins appear to be outer membrane proteins that

allow the rickettsia to be phagocytosed into the host cell.

Rickettsiae rely on the cytosol of the host cells for growth.

To avoid phagocytosis within the cells, they secretephospholipase D and hemolysin C disrupt the

phagosomal membrane allowing rapid escape



Sign and Symptom

Rocky Mountain spotted fever (RMSF)• Fever, headache, rash, confusion, and myalgia are cardinal

features.

• Headache is usually persistent, intense, and intractable.

•

GI symptoms (eg, abdominal pain and diarrhea) commonly occurduring early stages of illness.

Rickettsialpox

• After an incubation period of 9-14 days, a red papule develops at

the site of the mite bite. The papule subsequently develops an

eschar.

• Irregular fluctuating fever (38-41°C), headache, chills, rigors,

profuse sweating, myalgias, and occasionally by rhinorrhea, cough,

sore throat, nausea, vomiting, and abdominal pain.



Boutonneuse fever

• An eschar (tache noire), high fever (above 39°C), headache,

malaise and arthromyalgias. Headaches are less frequent inchildren. Unusual presentations, such as acute pancreatitis, have

also been described.

• African tick bite fever is similar but has a more timid presentation. It

differs from other similar rickettsioses in that it produces a painful

lymphadenopathy, multiple eschars, nuchal myalgia, and,occasionally, a sparse vesicular rash

Louse-borne (epidemic) typhus and Brill-Zinsser

disease (relapsing louse-borne typhus)

• fever, intractable headache, and rash.

• Rash appears on days 4-7 of illness and spreads from the trunk to

the extremities, sparing the face, palms, and soles.

• Conjunctival injection, rales, and delirium commonly occur.



Murine (endemic or flea-borne) typhus• Murine typhus is similar to louse-borne typhus but tends to

have a milder and shorter course.

• Fever is less pronounced and remittent, headache is less

severe, and rash is less extensive. Tsutsugamushi disease (ie, scrub typhus)

• The incubation period is approximately 1-2 weeks.

• In fewer than half of patients, the site of the mite bite

develops a necrotic eschar with enlargement of regionallymph nodes similar to rickettsialpox.



Q fever

• Primary infection asymptomatic.

• Incubation period ranges from 2-6 weeks.

• The three clinical presentations more commonly observed

are flulike illness, pneumonia, and hepatitis.

• Rash usually absent

• Chronic Q fever infection is less common (1-5%). It may be

manifested as endocarditis, chronic or relapsing

multifocal osteomyelitis, chronic hepatitis, chronic vascular

infection, endocarditis, pericarditis, or myocarditis• Humans contract the disease by inhaling contaminated

aerosols. Human infection also occurs after ingestion of

contaminated raw milk.





Diagnose

Visualized using Giemsa and Gimenez stainingmethods.

Immunohistochemical staining of skin biopsies

(in patients with rash) Immunofluorescent assays (IFAs) and ELISAs

antibodies to bacteria

PCR of blood, biopsy tissues and ticks (not

sensitive enough)





Treatment

Using doxycycline should be started early

and not wait for confirmation test

Chloramphenicol, azithromycin,

fluoroquinolones, and rifampin may be

alternatives, depending on the scenario.



Prevention

No vaccine Antibiotics are not recommended for

prophylaxis

Prevention by minimize exposure (by

using repellents, insecticides,

acaricides or wearing protective

clothing) to infectious arthropods and

animal reservoirs, when traveling in

endemic areas.



Sumber Pustaka

1. http://textbookofbacteriology.net/Rickettsia.html

2. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/rickettsia-

rickettsii-eng.php

3. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-

diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-

and-related-infections-anaplasmosis-and-ehrlichiosis

4. http://dermnetnz.org/bacterial/rickettsia.html

5. http://reference.medscape.com/article/968385

http://textbookofbacteriology.net/Rickettsia.html

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/rickettsia-rickettsii-eng.php


http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-anaplasmosis-and-ehrlichiosis



http://dermnetnz.org/bacterial/rickettsia.html

http://reference.medscape.com/article/968385



http://dermnetnz.org/bacterial/rickettsia.html













































http://textbookofbacteriology.net/Rickettsia.html

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Presentasi Rickettsia 5-2-2014