micro- Gram- bacteria Flashcards Preview

LAST EXAMMMMMM Year I > micro- Gram- bacteria > Flashcards

Flashcards in micro- Gram- bacteria Deck (205):
1

What are the virulence factors of N meningitidis

polysaccharide capsule that is antiphagocytic
Endotoxin- LPS
IgA1 protease
ability to extract iron form transferrin
Pili

2

how many capsule serotypes are there for N meningitides? which ones causes menigitis

13
meningitis- A B and C

3

what results from meningococcal release of endotoxin

hemorrhage as petechiae on the skin and sepsis

4

What is IgA1 protease- N meningitidis

only found in pathogenic and cleaves IgA in half

5

What are the high-risk groups for N meningitidis

infants 6 mo- 2 yr
army recruits
college freshman

6

what is the clinical key to knowing that there is invasive meningococcal infection

petechial rash

7

What is the presentation of meningococcemia

spiking fevers, chills, arthralgia, muscle pains and petechial rash

8

What is Fulminant meningococcemia

Waterhouse-Friederichsen syndrome
septic shock
b/l hemorrhage to adrenal glands
rapid hypotension and tachycardia
DIC and coma may develop
death 6-8 hrs

9

What are the signs of meningitis in an infant

lethargy, fever, vomiting
sometimes a buldging open anterior fontanelle

10

What bacteria are responsible for meningitis in an infant less than 3 mo

E coli, L monocytogenes, Group B strep

11

What are the culprits for meningitis in older infants

H influenza
N meningitidis

12

What is the agar used to grow Neisseria

Thayer-martin VCN chocolate agar
V- vancyomycin (kills gram +)
C- colistin that kills gram- not Neisseria
N- Nystatin kills fungi

13

how do you differentiate between the neisseria species

meningitidis can produce acid from latose but gonorrhea cannot

14

What are the two most common STDs

1 chlamydia
2 Gonorrhea

15

What are the virulence factors of gonococcal infections

Pili
outer membrane protein porin
Opa proteins

16

What is the role of pili on N gonorrhea

not only help for adhesion but able for antigenic variation to escape phagocytosis

17

what is the role of outer membrane protein porin in N gornorrhea

promote invasion into cell
Por A and B- used to be PorI

18

What is the role of Opa proteins in N gonorrhea

promote adherence and invasion of epithelial cells
result in opaque colonies

19

Where does the gonococci multiply

in the endocytotic vacuoles

20

What can gonorrhea cause in men

urethritis
epididymitis, prostatis and urethral strictures

21

Describe gonorrhea in women

usually asymptomatic, sometimes urethritis
infects columnar epithelium of cervix
can progress to PID

22

What is PID

infection of uterus-endometriosis, fallopian tubes- salpingitis and or ovaries- oophoritis

23

What is the presentation of PID

fever, lower abdominal pain, abnormal menstrual bleeding and cervical motion tenderness

24

What are the complications with PID

sterility, ectopic pregnancy, absecess, peritonitis, peri-hepatisis(fitz-hugh-curtis syndrome)

25

what is the mechanism behind sterility caused by STDs

scarring of the fallopian tubes

26

what is Fitz-hugh-curtis syndrome

from N gonorrhea
inflames capsule around liver causing RUQ pain and tenderness

27

What is gonococcal bacteremia

invasion of blood stream
fever, joint pain, skin lesions
sometimes pericarditis, endocarditis and meningitis

28

Describe the presentation of septic arthritis in a gonorrhea infection

acute onset fever with pain and swelling in 1 or 2 joints
progressive destruction of the joint

29

What do you order to confirm gonococcal septic arthritis

examination of synovial fluid for incWBC, gram stain and culture

30

What is the most common kind of septic arthritis in young, sexually active inidividuals

N gonorrhea

31

If a pregnant mother transmits gonorrhea to child during birth what is presentation

ophthalmia neonatorum so give erythromycin in eyes

32

What diseases does Moraxella catarrhalis cause

otitis media and URI in patients with COPD or emphysema or in elderly

33

What is otitis media and 3 top culprits

middle ear infection
80% children by age 3
Strep pneumoniae
H influenza
Moraxella catarrhalis

34

A COPD patient with worsening wheezing SOB and cough can be assoc with what

new strain H influenza or Moraxella catarrhalis

35

What can kingella kingae cause

septic arthritis and osteomyelitis in children
endocarditis of native and prosthetic valves in children and adults

36

What are the slow growing gram - pathogens that cause endocarditis

Haemophilus spp
Actinobacillus spp
Cardiobacterium spp
Eikenella spp
Kingella spp

37

Describe morphology of Neisseria meningitidis

diplococci gram -
facultative anaerobe
high Co2 environment
ferment maltose

38

describe morphology of N gonorrhea

diplococci gram -
facultative anaerobe
high CO2
can only ferment glucose

39

What is Moraxella catarrhalis Resistant to

penicillins

40

What enteric bacteria canNOT ferment lactose

Salmonella, Shigella and Pseudomonas

41

What type of agar are used to grow enteric bacteria

EMB and MacConkey

42

describe EMD agar

methylene blue inhibits gram + and the lactose fermenters become deep purple to black
E coli become metallic green

43

Describe macconkey agar

inhibit gram + and lactose fermenters are pink/purple

44

What are the 3 major surface Ag on enteric bacteria

O Ag- outside LPS
K Ag- capsule over O Ag
H Ag- antigenic determinant making up subunits of flagella

45

What enteric does not have H Ag

shigella- because not mobile
Klebsiella penumoniae

46

What type of diseases are caused by enteric bacteria

diarrhea and UTI, pneumonia, bacteremia and sepsis

47

What is diarrhea without invasion

enterotoxins causing electrolyte and fluid loss from intestinal epithelial cells or epithelial cell death
watery diarrhea without systemic systems

48

What are enteric bacteria that invade intestinal epithelial cells

E coli, Shigella and salmonella

49

What does is a key clinical sign to an enteric that invades intestinal epithelial cells

bloody stool

50

What are the symptoms of an enteric bacteria that invades the lymph nodes and blood

abdominal parin and diarrhea containing WBC and RBC
deeper invasion has fever, headache and WBC

51

What are the enteric bacteria that invade lymph nodes and blood

salmonella typhi, yersinia enterocoitica and campylobacter jejuni

52

What are the common hospital acquired gram - enterics

E coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter, Serratia and Pseudomonas aeruginosa

53

What are the virulence factors that make E coli pathogenic

Mucosal accumulation of pili and ability to invade epithelial cells
Exotoxin production of heat labile and stable toxins, also shiva-like toxin
Endotoxin- Lipid A
iron binding siderophore which takes iron from transferrin or lactoferrin

54

What diseases can E coli cause

diarrhea, UTI, neonatal meningitis, gram - sepsis

55

Describe the presentation of Enterotoxigenic E coli

inhibit reabsorption of NaCl and stimulate secretion Cl and HCO3- leading to severe watery diarrhea
looks like rice water- cholera

56

Describe presentation of Enterohemorrhagic E coli

secrete shiga-like toxin that inhibit 60s ribosome
bloody diarrhea with severe abdominal cramps called hemorrhagic colitis

57

Describe Hemolytic uremic syndrome from E coli

anemia, thrombocytopenia and renal failure is assoc with strain EHEC 0157:H7
cattle may be the reservoir- hamburgers

58

Describe Enteroinvasive E coli EIEC

has ability to invade epithelial cells
fever
WBC invade intestinal wall and the diarrhea is bloody with WBC

59

What allows E coli to causes UTI and cystitis possible higher up causing pyelonephritis

the pili virulence factor

60

What is the most common cause of gram - sepsis? second to most?

E coli
Klebsiella penumoniae

61

Which type of patient is prone to klebsiella penumonia

hospital patients and alcoholics

62

What is kelbsiella pneumoniae pneumonia look like

bloody sputum
destroys lung tissue

63

What are the cross reacting Ag of Proteus and Ricketssia

OX2 OX19 OX-K

64

What is the presentation of Proteus UTI

urine is alkaline from the ability to split urea into NH3 and CO2

65

how can you distinguish shigella from E coli and Salmonella

shigella does not ferment lactose or produce H2S
E coli ferments lactose
Salmonella: produces H2S, cannot ferment lactose

66

What population is prone to shigella

preschool and nursing homes
contaminated water of hand to hand

67

What is presentation of shigella

fever abdominal pain, diarrhea with flecks of blood and pus

68

describe mechanism of shiga toxin

5 B subunits that bind and allow A subunit in that inactivates 60S ribosome inhibiting protein synthesis thus killing epithelial cell

69

What other virulent factor does salmonelly have instead of K Ag

the Vi factor which surrounds O Ag

70

What are the 3 gorups of Salmonella

typhi, cholerae-suis, enteritidis

71

Salmonella is most commonly acquired how in US

eating uncooked eggs and chickens

72

Which Salmonella is not zoonotic

typhi, only humans

73

What are the diseases that Salmonella causes

typhoid fever, carrier state, sepsis and gastroenteritis

74

What type of parasite is Salmonella

facultative intracellular

75

Describe presentation of typhoid fever

1-3 weeks post exposure including fever Ha and abdominal pain over RLQ
may have splenomegaly and diarrhea
rose spots on abdomen

76

How do you Dx salmonella typhi

culture of blood, urine or stool

77

what population is more prone to salmonella infections and why

asplenic like from sickle cell because Vi capsule is opsonized then taken to spleen because macrophages and neutrophils phagocytose opsonized bacteria

78

Patients with sickel cell anemia with salmonella are at high risk for what

osteomyelitis

79

what does diarrhea from salmonella look like

usually just watery
sometime mucus or blood but rare

80

What is the presentation of yersinia enterocolitica

fever, diarrhea, abdominal pain in RLQ
terminal ileum usually has mucosal ulceration

81

what is the shape of V cholera

curved gram - rod with single polar flagellum

82

What toxin does V cholera release

choleragen

83

What is the presentation of V cholera

watery diarrhea like rice water
Shock from isotonic fluid loss will occur if not rehydrated
diminished pulses, sunken eyes and poor skin turgor

84

Describe mech of choleragen

5 B subunits attached to GM1 ganglioside on intestinal epithelial cell allowing entry A. A will activate G protein increasing cAMP leading to active secretion Na Cl and inhibition of Na and Cl resorption

85

What will the stool look like in V cholera

no WBC but many curved rods with fast darting movements

86

What is the leading cause of diarrhea in japan

Vibrio parahaemolyticus

87

What are the most common causes of diarrhea in the world

Campylobacter jejuni, ETEC and Rotavirus

88

what is the presentation of Campylobacter jejuni

bloody loose diarrhea

89

What toxin does campylobacter jejnui release

LT toxin similar to that of E coli and a cytotoxin that kills mucosal cells

90

What is the most common cause of duodenal ulcers? second?

Helicobacter pylori
aspirin

91

What are the 2 leading causes of stomach ulcers (gastric)

1 is aspirin
2 is helicobacter pylori

92

99% of our flora in GI are what

obligate anaerobes fram - rods of the family Bacteroides

93

Which gram - rod does not have lipid A

bacteroides fragilis

94

What are risk factors to bacteroides fragilis proliferation

after surgery or tears in intestine or infection the bacteria will create abscesses

95

what organism produces a black pigment on blood agar and involved in necrotizing anaerobic pneumonias caused by aspiration of lots of sputum

Bacteroides melaninogenicus

96

What can Fusobacterium cause

aspiration peneumonia
abdominal and pelvic abscesses
otitis media

97

What are the anaerobic gram + cocci that are normally in our flora of mouth, vagina and intestine

peptpstreptococcus and peptococcus

98

What are the most common hospital acquired infections

penumonia- endo-trach tubes and mechanical ventilation
UTI- foley catheters
wound infections- recent surgery and implanted devices
blood infections- intravenous and intra-arterial lines
4Ws: wind water wound wires

99

What are the most common bacteria that cause hospital-acquired infections

E coli, Klebsiella and Enterobacter

100

What 4 highly resistant bacteria are becoming popular in hospital settins

Pseudomonas
Acinetobacter
Stenotrophomonas
Burkholderia

101

what type of pathogen is pseudomonas aeruginosa

obligate aerobe that doesN't ferment lactose
gram - rod
produces green (pyoverdin) and blue (pyocyanin) pigments with a sweet grape-like scent

102

What is the exotoxin released by P aeruginosa

exotoxin A that stops protein synthesis

103

What are important infections caused by P aeruginosa

Pneumonia
Osteomyelitis
Burn wound
Sepsis
UTI, pyelonephritis
Endocarditis
Malignant external otitis
Corneal infections

104

What patients are at high risk for pseudomonas penumonia

CF patients and immunocompromised patients

105

What type of patients are at a higher risk for osteomyelitis due to pseudomonas infection

DM patients with ulcers
IV drug abusers in their vertebrae and clavicles

106

What type of endocarditis is pseudomonas responsible for

usually right heart valve

107

where is malignant external otitis seen with pseudomonas

in the mastoid bone
usually DM patients

108

What is the BEPSEUDO pneumonic

Burns
Endocarditis
Pneumonia
Sepsis
External malignant otitis media
UTI
Diabetic Osteomyelitis

109

What population is at greatest risk for Burkholderia cepacia infection

CF

110

What type of pathogen is Acinebacter and what does it commonly cause

aerobic gram - common cause hospital pneumonia, burn infections and foley catheter-assoc UTI

111

What are Acinebacter bacteria commonly mistaken for

Neisseria

112

What are the virulent factors of H influenza

has polysaccharide capsule of polyribitol ribose phosphate 6 types a-f

113

What capsule of H influenza is assoc with invasive influenza in children

capsule b

114

What do the non encapsulated(nontypeable) strains of H influenza cause in children and adults?

otitis media in children
respiratory disease in adults that have weakened or pre-existing lung disease

115

What population is at higher risk for H influenza

COPD patients
children between 6 mo and 3-5yrs

116

What is the most serious infection that type b H influenza can cause? presentation?

meningitis
fever, vomiting and altered mental status in infants
sometimes neurodefects, mental retardation and seizures

117

What are the infections that H influenza type b can cause

meningitis, acute epiglottitis
septic arthritis
sepsis

118

what does acute epiglottitis look like

follows a sore throat and fever
severe wheezing
salaiva drooling out
large red epiglottis looks like red cherry

119

what is the most common cause septic arthritis in children between 6 mo and 3 yr

H influenzae

120

what is common presentation of septic arthritis from H influenza

usually one joint
fever, pain, swelling and decreased mobility of the joint

121

how does H influenza lead to sepsis

gets in blood from upper resp tract

122

What is in the H influenza vaccine

polyribotol ribose phostate( the capsule of H influenza) with mutatn diphtheria toxin protein and a N meningitidis outer membrane to activate T cells and Ab production

123

When is the Hib capsule vaccine given to children in the US

ages 2 4 6 and 15 mo
with DPT and polio vaccines

124

What species is responsible for painful chancroid

Haemophilus ducreyi

125

what is the Ddx for chancroid

syphilis, herpes, lympho granuloma venerum and H ducreyi

126

what is lymphogranuloma venerum assoc with

chlamydia trachomatis

127

What is a great way to Dx a genital ulcer

PCR multiplex that detects H ducreyi, T. palladium and herpes 1/2

128

What are included in the list of slow growing bacteria that can cause endocarditis

Haemophilus spp
Actinobacillus spp
cardiobacterium spp
eikenella spp
kingella spp

129

a women with pruritis and burning of her labia
dysura and fishy odors
with a slide of discharge having the presence of clue cells she probably has what infection

gardnerella vaginalis

130

what are the virulence factors of Bordetella pertussis

pertussis toxin
extra cytoplasmic adenlyate cyclase
filamentous hemagglutinin
tracheal cytotoxin

131

what is the mech of pertussis toxin

B subunit that binds and lets A in that increases cAMP causing histamine sensitization, increase insulin synthesis and promotion of lymphocyte production and inhibition of phagocytosis

132

what is the role of B pertussis extra cytoplasmic adenylate cyclase

increase cAMP in neutrophils lymphocytes and monocytes impariing chemotaxis and impaired generation of H2O2 and superoxide

133

What is the role of B pertussis filamentous hemagglutinin FHA

pili rod extending from bacterial surface involved in its binding

134

what is the role of B pertussis tracheal ctyotoxin

destroys epithelial cells causing the violent cough

135

How long is the incubation period for whooping cough and what are the 3 stages

1 week uncubation
Catarrhal stage
paroxysmal stage
convalescent stage

136

Describe the catarrhal stage of whooping cough

1-2 weeks
low grade fevers, runny nose, sneezing and mild cough
most contagious during this stage

137

describe the presentation of the paroxysmal stage of whooping cough

no fever
bursts of nonreproductive coughs
5-20 forceful coughs followed by inspiratory gasp through narrowed glottis sounds like a whoop
lasts a month or longer

138

what will the WBC count look like in B pertussis infection

increased lymphocyte count with just a modest increase in neutrophils

139

What is the convalescent stage of whooping cough

attacks are less frequent and patient is no longer contagious

140

what type of swab and agar is used for B pertussis

calcium alginate swab
Bordet- gengou medium

141

how do hospitals identify B pertussis

ELISA serological tests and PCR assays

142

What is the primary Tx for B pertussis

supportive
sometimes erythromycin

143

When is TDaP given

2 4 6 15-18 mo 4-6 yrs

144

When is Tdap given

19-64 yrs booster

145

What type of organism is legionella pneuomophila

aerobic gram - rod
facultative intracellular parasite for amoebas
can survive in biofilm

146

where is legionella primarily found as the source of infection

that is ubiquitous in natural and man-made water environments
Air conditioning units!

147

What are the two manifestations of legionella

Pontiac fever
Legionnaires disease

148

Descibe presentation of pontiac fever

HA, muscle aches, fatigue with fever and chills
strikes suddenly and lasts a week

149

describe legionnaires disease

high fevers and severe pneumonia

150

What is the presentation of pneumonia caused by legionella

lobar consolidative pneumonia that can be hard to differentiate from pneumococcal pneumonia

has fever with pulse-temperature dissociation (high fever and low HR) severe HA, confusion, myalgia and sometimes with rhabdomyolysis detected by increased serum CPK and myoglobinuria, cough, hyponatremia, hypophosphatemia, and elevated AST ALT alkaline phosphatase, LDH

151

What is common in Yersinia, Francisella, brucella and pasteurella

they are all gram - rods
all are zoonotic

152

What type of Dx testing would you do to confirm previous infection of yersinia, francisela or burcells

intradermal skin testing and DTH

153

What is Yersinia pestis known to cause

bubonic plague

154

What virulence factors does yersinia pestis have

F1- capsular Ag with antiphagocytic properties
V and W Ag unknown actions

155

Describe the staining of yersinia pestis

ends take up more stain than the middle
gram - rods

156

Where do the yersinia pestis bacteria replicate and invade

replicate in macrophages that take them up then move to nearest lymph nodes (usually inguinal)

157

What is the presentation of bubonic plague

swollen hot red painful nodes
fever and HA
hemorrhages under skin causing blackish color

158

patient has been camping in Arizona and New mexico how presents with fever what would you start to suspect

bubonic plague

159

What is tularemia

looks like bubonic plague
from handling rabbits

160

what diseases are caused from francisella tularensis

ulceroglandular tularemia
pneumonic tularemia

161

what is the presentation of ulceroglandular tularemia

well demarcated hole in the skin with black base
fever local swollen lymph nodes are red and painful

162

What is usually the transmission causing pneumonic tularemia

aersolization of bacteria during skinning and evisceration of an infected rabbit

163

What are the other organs invaded by francisella tularemia

eyes oculoglandular tularemia
GI typhoidal tularemia

164

How do you Dx francisella tularensis

clincal picture
skin test
measurement of titers
Not culture because extremely virulent

165

How do humans acquire brucella

direct contact with infected animal mear, aborted placentas, ingestion of infected milk

166

What is the presentation of brucella? including population seen in

penetrates skin, conjunctiva, lungs, or GI
fever chills, sweats, loss appetite, backache, HA and sometime lymphadenopathy
cyclical fever"undulant"
meat packin industry workers, veterinarian, farmer, traveler

167

how do you Dx brucella

culture from blood, bone marrow liver or lymph nodes

168

how do you prove active brucella infection

serologic examination with elevated anti-brucella Ab

169

why do you not close a wound if someone comes in with a cat or dog bite

perfect environment for Pasteruella multocida growth invading local joints and bones

170

What are shared characteristics of chlamydia and Rickettsia

gram neg
obligate intracell parasites because need host ATP

171

What is different in energy metabolism between ricketssia and chlamydia

ricketssia can oxidize certain materials to create ATP though still needed from host
chlamydia has no mech for ATP production

172

where does chlamydia like to inhabit

columnar epithelial cells that line mucous membranes

173

What types of infections does chlamydia cause

conjunctivitis, cervicitis and pneumonia

174

What are the two forms of chlamydia

Elementary body that does not divide but attaches and enters columnar epithelial cells and inhibits phagolysosomal fusion in endosome then can transfrom into IB
Initial Body "reticulate" inhibits phagolysosome fusion and grows then binary fission

175

What are the 3 types of chlamydia

trachomatis, psittaci and pneumonia

176

where does C trachomatis primarily infect

eyes and genitals

177

what is the leading cause of preventable blindness

C trachomatis

178

describe the conjunctival infection from C trachomatis

inflammation and scarring
scar tractino pulls folds of eyelids inward

179

What is inclusion conjunctivits and when is it seen

inflammation with purulent yellow discharge and swelling of eyelids
seen after birth 5-14 days

180

How do you Dx inclusion conjunctivits from C trachoma tis

basophilic intracytoplasmic inclusion bodies from scrapings of palpebral conjunctival surface

181

describe infant pneumonia from chlamydia

4-11 weeks of life
upper respiratory symptoms followed by rapid breathing, cough and respiratory distress

182

How do you Dx infant pneumonia from chlamydia

clinically
later confirmed by presence of anti-chlamydial IgM Ab

183

what are the primary infections causing Non gonococcal urethritis

chlaymdia and ureaplasma urealyticum

184

Why does chlamydia not respond to penicillin

has no peptigoglycan

185

What is indicative of NGU on gram stain

polymorphonuclear leukocytes but no intracell or extracell gram - diplococcie

186

What is the preferred Dx test for differntiating gnorrhea and chlamydia

nucleic acid amplification test like PCR on an endocervical swab or urine sample

187

What is super dangerous about untreated chlamydia

an lead to infertility from untreated PID

188

What is the clinical presentation of male chlamydia

epidiymitis with unilateral scrotal swelling, tenderness and pain assoc with fever

189

Wat Reiters sydnme and what is it assoc wit

inflammation arthritis of large joints in men btwn ages 20-40
inflammation eyes and urethritis
C trachomatis

190

What serotypes of C trachomatis cause lymphogranuloma venereum? presentation?

L1L2L3
painless papule or ulceration on genitals that heals spontaneously
migrate to regional lymph nodes which become tender and may break open and drain pus

191

What can be transmitted by working with pigeons, veterinarians and wooers at pet shops?
presentation

Chalmydophila psittaci
atypical pneumonia psittacosis 1-3 weeks after exposure

192

What type of cells does Rickettsia like to invade

endothelial cells that line blood vessels

193

What Ag does Ricketssia share with Proteus Vulgaris

Ox2 OX19 OX-K

194

What is the weil-felix test

reaction to use Ag cross reacting with P vulgaris to Dx rickettsial infection
Agglutination is + test

195

Describe presentation of Ricketssia ricketsii or RM spotted feer

within a week from a tick bite
fever conjunctival redness, severe headache and a rash that is on wrists, ankles soles and palms that spreads to trunk
resolves in 3 233k but can lead to death

196

What does rickettsial akari cause

tickettsial pox
from house mice mites
febrile with localized red skin papule that turns into a vesicle

197

What is an endemic

infectious disease that exists constantly thorughout a population

198

What is an epidemic

sudden onset and rapid spread of infection that affects large proportion of population

199

What spcies of Rickettsia cause typhus

Rickettsia prowazekii causes epidemic
Rickettsia typhi causes endemic

200

Presentation of epidemic typhus from Rickettsia prowazekii

abrubt onset fever and HA with 2 week incuvation period
small pink macules on upper trunk and cover body
not on palms and face
flying squirrels are vectors a lot. or lice

201

What is Brill Zinsser Disease

latent Rickettsia prowazekii with milder symptoms
detect with high IgG for the bacteria

202

presentation of endemic thyphus from Rickettsia typhi

10 day incubation from rat flea
fever, HA and flat rash

203

describe trench fever and what is the bacteria that causes it

Bartonella quintana
high fevers, rash, HA and severe back and leg pains
relapse 5 days later

204

What bacteria causes cat scratch disease

Bartonella henselae

205

What is the rickettsial disease that causes pneumonia and its presentation

Coxiella burnetti Q fever
abrupt fever with soaking sweats 2-3 weeks after infection
also have pneumonia
NO rash
transmitted from ticks and cattle