Legionella and Coxiella Plague and other bacterial zoonotic diseases (3/6/18) Flashcards
(154 cards)
1
Q
when was legionnaires disease was found
A
legionnaires conveion in 1979 and 130 got sick and 25 died with similar sympotms
2
Q
morphology of legionella pneumophila
A
gram neg
aerobic
small pleomorphic bacilli
non capsule
3
Q
catalase response to legionella
A
positive
4
Q
where is legionella pneumophila found
A
in water and in soil
5
Q
what is infected by legionella pneumophila
A
facultative intraceullar bacteria(infects protozoa_
opportunistic pathogen
6
Q
how does legionella pneumophila infect protozoa
A
requires special media to isolate (buffered charcoal yeast extract (CYE)
7
Q
how is legionella pneumophila opportunistic pathogen
A
only smoked and immunocompromised hosts with bad cell mediated immunity
8
Q
what does legionella pneumophila
A
atypical pneumonia due to aerosols by humidifies and cooling systems
9
Q
legionella pneumophila virulence factor
A
Pili (fimbriae Flagella LPS type 4 secretion (Icm/Dot) legionell-containing vacuole in macrophages low metabolic state
10
Q
LPS of legionella pneumophila toxicity
A
less toxic than other gram-neg
11
Q
how does legionella pneumophila enter a low metabolic state
A
biofilm-imbedded cells resist stress
12
Q
what happens because legionella pneumophila is a Facultative intraceullar bacteria
A
can multiply inside free-living amoebas, other protozoa and alveolar macrophages
13
Q
pathogenisis of legionella pneumophila
A
aerosolized drops breathed in
grow in macrophages, causing inflammation, producing necrotizing multifocal pneumonia
14
Q
action of legionella-containg vacuole
A
made by mitochondiea, ribosomes, and ER proteins make the LCV to block the lysosomes and bacteria replicate inside of them
15
Q
how does legionella pneumophila resist immunity
A
intracellular multiplcation
16
Q
immunity against legionella pneumophila
A
innate and adpative mechanism
TLR in macrophages and dendritic cells recognize Legionella LPS
Th1 adaptive immune response: INF-gamma, Il-2, and Il-18 are produced and activate macrophages and intracellular killing
little use of antibodies
17
Q
cases of legionellosis
A
5000 in US
25000 in world
18
Q
how does legionellosis transmit
A
not person to person but via large complex manmade water systems (Hotel, hospitals, nursing homes, cruise ships)
19
Q
forms of legionellosis
A
Legionannaires disease: sever - pneumonia
Pontiac fever: mild self-limited form with flu-like symptoms (no pneumonia
20
Q
how are both forms of legionellosis spread
A
both by water and pontiac fever by sontaminiated soil
21
Q
why do we have an increase in legionellosis
A
climate change
aging US pop
Aging plumbing
increase of at risk patients
22
Q
leionnaires disease affects who
A
5% exposed mostly middle age or elderly smokers, and with chronic diseases of immunosuppression
23
Q
legionnaires disease leads to
A
shock, respiratory failure or both
24
Q
mortality rate of legionnaires disease
A
15%, and higher with health-care association (46%)
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symptomes of legionnaires disease
```
myalgia and headach
rising high fever
dry cough on 2nd/3rd day and chest pain
chills vomiting diarrhea confusion and delirium
hepatic dysfunction
```
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time between exposure and legionnaires disease
2-10 days
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diagnosis of legionnaires disease
difficult:
direct fluorescent antibody with culture of infected tissue
PCR
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how direct fluorescent antibodies are used to diagnose legionnaires disease
L. pneumophila- specific monoclonal antibodies that recognize all serogroups
use high-quality specimes (recognizes 25-50% o culture-proven cases
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gram staining for legionnaires disease
bad staining
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culturing for legionnaires disease
Buffered Charcoal est extract agar with vitamin, L-cystein, ferric pyrophasphate
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treating legionnaires disease
Fluoroquinolone or axithromycin are preferred
erythromycin can treat infection
not penicillin: most legionella produce beta-lactamases)
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how to prevent legionnaires
minimize aerosole in public places from contaminated water
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why is preventing legionnaires complicated
resist chlorine and head
| forms biofilms
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how to prevent legionnaires
dont use tap water in aerosolizing water
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infection in humans acquired by direct or indirect contact with animals
Zoonoses
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types of Zoonoses
Coxiella burnetii- Q-fever
Yersina pestis: Bubonic Plague
Brucella: undulant fever
Fancisella: Tularemia (similar to plague)
Pasteurella Multocida: soft tissue infection
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how to get coxiella burnetii
inhalatino of soil and dust contaminated after birth of infected animals
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how to get yersina pestis
exposure to flease from infected rodents
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how to get brucella
direct contact with animal infected
| ingested of contaminated diary
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how to get Fancisella
direct contact with infected mammal
inhalation
bite of infected tick
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how to get paseurella multocida
cat or dog bite
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what was Coxiella first seen as
a new type of Rickettsia
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what is Coxiella related to
LEgionella
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Morphology of Coxiella burnetti
gram-
| small coccobacilli
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pathogen as Coxiella burnetii
obligate intracellular pathogen (macrophages and phagocytic cells)
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where does coxiella burnetii grow well
placental tissues contaiminating soil after birth
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who is most at risk for coxiella burnetii
vets, famers, slaughter house workers, animal researchers
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infectious dose foc coxiella burnetii
1-10 organisms cuase disease in 50% (id50=1)
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Virulence factors for coxiella
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LPS
Type IV secretion (Dot/Icm)
Resistant to low pH and enzymes of phagolysomes
Coxiella-contain vacuole
Biphasic life cycle
```
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what happens to coxiella when phagosome and lysosome fuse
continues to multiple
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a phagolysosome-like compartment where Coxiella replicates
Coxiella-containing Vacuole
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The lifecycle of Coxiella
Small Cel variants: not metabolically active (like spore)
| Large cell variant: metabolically active- switches to this when enters into host cell
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how does Coxiella become a pathogen
Aerosol transmission- Inhaled into lungs
• Binds to alveolar macrophages and is passively taken up hrough phagocytosis
• Affinity for reticuloendothelial system (macrophages and monocytes)
• Can also invade non-phagocytic cells - epithelial and endothelial cells
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intracellular trafficking of Coxiella burnetii
Once in a phagosomelysosomal
fusion occurs normally, creating a phagolysosome (pH 5.4)
• Then Coxiella expands the compartment size creating the Coxiella containing vacuole (CCV),
• Transitions to the metabolically active LCV and begins to replicate –ntakes up to 6 days
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when symptomes of Q-fever occur
about 20 days after inhalation
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symptoms of Q-fever
flu like-abrupt fever, chills, muscle aches and headache
Stomach pain, nausea, vomiting and diarrhea
non-productive cough
Hepatosplenomegaly and abnormal liver function common
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symptoms of severe cases of !-fever
Pneumonia or hepatitis
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comlications due to Q-fever
myocarditis, pericarditis, encephalitis (rare)
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chronic infects of Q-fever are associtated with
endocarditiis
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how to treat Q-fever
recover without antibiotcs
| maybe 2 week with doxycycline
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how did the plague occure
non-immune rats lead to bacteremia
fleas feed on rats and get Y pestis
bacteria block intestines so fleas vomit up Y pestis into a bite wound
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when did the black plauge occure the most
high rat population and rat mortality
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when flease leae an infected rodent and pass the infection to other in the population, not to humans
sylvatic cycle
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masses of rats in close contact with humans, infected with flease-that bite huam
Urban cycle
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how did pneumonic plague occure
when humans infected Y. Pestis develop bacteremia, infecting the lungs leading to person to person spread (No fleas needed)
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exististance of sylvatic plauge
most continents
common in south east asian
not in western europe or australia
15 cases in the US
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morphology of Yersinia pestis
Gram-neg
bacillus (pleomorphic)
non-motile
Enterobacteriaceae family
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what part of yersinia pestis is needed for pathogenesis
virulence plasmids
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how does Y pestis turn on and off virulence factors
regulatory systems that sense temp, calcium, and otehr envirnomental triggers
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how does Y petsis multiply in flea foregun
low temp virulence factors
| phospholipase D- resists antibacterail factors in flea midgut
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who does Y pestis blocause vomitting by the flea
Coagulase
| Polysaccharide biofilm
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flea bite does what to Y pestis
temp shift shows new envirnoment so virulence changes
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virulence of Y pestis upon biting
Differ LOPS
F1 capsule
Plasminogen activator (Pla)
Yops
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LPS of Y. pestis upon flea bite
not recognized by TLR (immune evation
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F1 capsule of Y pestis
gel like capsule antiphagocytic
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role of plasminogen activator in Y pestis
spread through tissues - enzymatic and adhesion to matrix proteins
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Roll of Yops
destroy host cell
| deisrutpt host cell
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how does yops secreted by type III secretion affect professional phagocytes onces inside
disrupt signalling path, estroy cytoskeleton structures, trigger apoptosis, inhibit cytokine production and acidifiaction of phagosome
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what does Y pestis do when it enters the blood stream
reaches regional lymph nodes, lyses ost cell, multiply's rapidly and produces bubo
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what is bubo
hemorrhagic suppurative lymphadenitis
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Bacteremia of Y pestis leads to
Toxic shoeck - LPS endotoxin, yops, proteases, and aextracellular products
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incubation of bubonic plauge
2-7 days after flea bite
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what does bubonic plauge do
fever and painful bubo in groin or axilla
50-70% process to bacteremia and may die from gram-negative septic shock (hours to days after dubo)
5% develop pneumonic plauge, mucoid or bloody sputum
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Incubation period of pneumonic plauge
2-3 days after exposion
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what does Pneumonic play do to you
fever, malaise, tighten chest
cough,sputum, dyspnea (trouble breathing), and cyanosis(blue lips) later
death on 2-3rd day
no one survives without antibiotics within 24hurs
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diagnosis of Plague
gram-stained smears of aspirates from bubo show bipolar-staining gram-negative bacilli
Immunofluroescence techniquie in public heath labs
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how to isolte Plague
blood agar or MacConkey agar (takes a while though so patient may die)
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treating plague
Gentamicin or strptomycin withor without doxycycline
| Also ciprofloxacin or Chloramphenicol if meningitisis presently
89
if treat plague early, what is the mortality
less than 10%
90
morphology of Brucella abortus
Gram negative rods
small coccobacili
non-motile
Aerobe
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Brucella abortus tests positive to
catalse, oxidase, and urease
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can brucella abortus ferment sugar
no
93
envelope of brucella abortus
unusual, phosphatidylcholine like eukaryotic cells
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growth rate of brucella abortus
slow (2-3 days to culture
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where does Brucellosis occur
persist for life in animals reproductive organs
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what does Brucellosis cause
abortion, sterility, decreased milk production in cattle, goats and hogs
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how does Brucellosis spread
direct contact with infected tissues and ingestion of contaminated feed
not person to person
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how to control brucellosis
systematic control: vaccination, eradication of infected animals
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how many people get brucellosis
100/year
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how do humans get brucellosis
consumption of unpasteurized dairy and health products from mexico
cuts in skin, mucous membrean, inhalation ingestion
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occupational exposures to brucellosis
Vets, livestock, slaughterhouse owkres, lab workers
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what kind of pathogen is brucella
Facultative intracellular parasite of epithelial cells and phagocytes
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waht can brucella evade once past skin or mucous membran
evade innate immunity, specifically TLR because outer membrane looks like eukaryotes
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where doe Brucella multiply
macrophages in liver sinusoids, spleen, bone marrow, and reticuloendothelial systemto orm granulomes
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how does brucela live within a cell
inhibit myeloperoxidase system, phagosome-lysosome fusion and apoptosis of host cell
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what secretion system does Brucella have
type 4 like legionella
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what in cows, sheep,pigs, and goats stimulates brucella growth
erythritol (because human placents don't have this, Brucella can't infect human placentas
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immunity to brucella
antibodies formed, not protective
| T-cell mediated immune response critical using TH1-type response with cytokines to clean Brucela from macrophages
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symptoems of brcellosis (undulandt fever)
7-21 days after infection
malaise, chills, fever, headache, weight loss
periodic denching night sweats
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how long does brucellosis occure
weeks-to 1-2 years
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physical findings of brucellosis and localizing signs
few : less than 25 % show detectable englagement of lymph nodes
spelenomegaly most common but also lymphadenopathy and hepatomegaly
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diagnosiing brucella
isolate from blood of biopsy of liver,bone marrow or lymph nodes
slow to grow in plates, but modern tech speeds it up
serological test are available, but may not indicated current disease
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treating brucella
Doxycycline in combo with rifampin or gentamicin
| no vaccine
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effectiveness of brucella treatment
2-7 days for fever to break
| 10% relase within 3 months
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Morphology of Francisella tularensis
GRam-negative
non-motile
Coccobacilli - small rod
Aerobic
116
whay is needed for francisella tularensis to grow
cystein
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what kind of parasite is francisella tularensis
facultative intraceullular parsite of macrophages
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what does francisella tularensis cause
Tularemia ie rabbit fever
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why is francisella tularensis classified as a tier 1 select again
low dose
ease of spread
high virulence
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Virulence of F. tularensis
lipid rich capsule
| unusual LPS
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LPS immune response of F. tularensis
induce protective antibodies
| but not stimulate innate immunity (not recognized by TLR)
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natural infections of F. tularensis results in what for immunity
long lasting immunity as antibody titers remain high for years
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how is Tularemia spread
contact with infected mammal of blood feeding arthropod (tick bite)
rabbits, squirrels, muskrats, beaver, and deer can be infected without symptons
minor skin abrasion
inhalation
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Cases of Tularemia in the us
100-200 cases with high tick and rabiit associated strains
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where is tularemia not found
british isles, africa, S. america or australia
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how long does tularemia grow
unimpeded until phagocytes are enountered
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where do lessions occure for tularemia
near site of infection with ulceration
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what happens to tularemia upon macrophages ingestion
reside in phagosome, resists lysomome fusion and escape from host cytoplasm
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where can tularemia multiply
hepatocytes, kidneys, and alveolar epithelial cells
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a type of inflammation due to a college of immune cells ie macrophages found in many disease
Granuloma
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when does Granuloma occur
when the body attempts to wall off a foreing substance that it cannot eliminate
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incubation of tularemia
2-5 days
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what does tularemia progression depend on
site of inoculation and extendt of spread
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how does tularemia begin
acute onset of high fever (grater than 104 degrees F), chills, and malaise
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most common tularemia
ulceroglandular due to tick bite or infected animal
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ulceroglandular form of tularemia results in
ulcer and swollen lymph nodes
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Oculoglandular form of tularemia
inoculation through the ye, when butchering an infected animal
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oropharyngeal form of tularemia
ingestion of large dose (> 10^8) rsulting in sore thraot, mouth ulcer, tonsillitis, and swelling of lymph glands
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most serious Tularemia
Pneumonic form
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Pneumonic form of Tularemia reuslts in
inhalation of dust or aerosols result in pneumonic tularemia or infection like typhoidal from
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what can tularemi pneumonia develop hrough
bacteremia or inhalation
142
typhoidal form of tularemia
combination of genreal symptoms without locatlizing or other syndroms
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diagnosisng tularemia
diffisult because symptoms like other more common illnesses
use pateint history (tick, der fly bites, sick/dead animal contact)
serologic tests used: agglutinating antibodies usually present by week 2 of illness
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how to culture tularemia
hard to grow and must use choclate agar and sulfhydryl compounds
145
treating tularemia
antibioics: gentamicin and streptomycin
| also doxycycline and ciprofloxacin, but may relapse
146
who gets vaccine for tularemia
high risk population gets live attenuated vaccine
147
Morphology of pasteurela multocida
small coccbacillary
gram-
facultative anaerobe
148
why is pasteurella multocida a facultative anaerobe
oxidase positive
149
what can pasteurella multocida ferment
variety of carbs
150
penicillin susceptibility of pasteurella multocida
is, unline most gram-negaive rods
151
where is pasteurella multocida found
normal respiratory flora of domstic mammals (Dogs an cats)
152
most common cuas of infected dog or cat bite
pasteurella multocida
153
when does pasteurella mutlocida occure
24 hrs of animalbite or scratch
154
what does pasteurella mutlocida cause
diffuse cellulties with a well defined erythematous border
