Zoonotic skin infections

Question 1

General initial presentation of zoonotic infections

Answer 1

Flu-like symptoms

Question 2

What is the microbiological structure of Rickettsia

Answer 2

Gram negative Bacilli, obligate intracellular parasites

Question 3

What is significant about htem being obligate intracellular parasites?

Answer 3

It is damn near impossible to grow them in lab culture

Question 4

If you can’t culture rickettsia, how do you diagnose it?

Answer 4

Diagnosis is by appearanceand pt history, confirmed by serology

Question 5

All Rickettsia are sensitive to:

Answer 5

Doxycycline

Question 6

True Rickettsia infection features what

Answer 6

The Rickettsia Triumvirate
Fever
Headache
Rash

Question 7

Rickettsia replicate where?

Answer 7

Endothelial cells of small blood vessels

Question 8

This replication in Endothelial cells ultimatley causes

Answer 8

vasculitis

Question 9

Rocky Mountain spotted fever occurs in large part where?

Answer 9

East of the mississippi river (not in the rocky mtns at all.

Question 10

First symptom of RMSF

Answer 10

flu like headache

Question 11

Rash comes on a few days later and has what pattern?

Answer 11

Starts on the ankles and the wrists, moves radially from there (to the palms, soles, trunk)

Question 12

Muscle soreness (especially calves)

Answer 12

RMSF

Question 13

Major complications in RMSF

Answer 13

Septicemia, DIC

Question 14

Diagnosis of RMSF

Answer 14

Immunoflourescence assay. IF antigens against rickettsiae

Used to be Weil Felix Test. Anti-rickettsiae antibodies cross-react with Proteus OX antigens. MUST BE confirmed by 4x rise in titers

Question 15

Treatment for RMSF

Answer 15

Doxy….25% mortality if untreated

Question 16

How is Rickettsiae prowazekii spread?

Answer 16

Lice who contain the organism, bite you defacate in the bite spot, the bite spot itches and you scrath it thus working the feces into the bite. You then have the organism inside you

Question 17

Do we see R Porwazekii in the US

Answer 17

Nah….seen in regions of extreme poverty

EPIDEMIC TYPHUS

Question 18

Rash pattern

Answer 18

Spreads from trunks to extremities

Question 19

complications from R Prowazekii

Answer 19

myocarditis, CNS involvement

Question 20

R. Typhii?

Answer 20

Causes endemic typhus

Question 21

Where is R Typhii endemic in US?

Answer 21

Southern Texas, Southern Cal, Hawaii

Transmitted by the rat flea

Question 22

Endemic typhus is much less severe than epidemic typhus

Answer 22

true

Question 23

Ehrlichia

Answer 23

southern tick borne illness, 1,400 cases per year

Question 24

Erlichia Chafeensis is also referred to as

Answer 24

Human monocytic ehrlichiosis

Question 25

E. Chafeensis is spread by what>

Answer 25

Lonestar deer tick

Question 26

E chafeensis replicates in?

Answer 26

Monocytes

Question 27

Diagnosis of E. Chafeensis

Answer 27

blood smear, confirm with serology, treat with Doxy

Question 28

E. Chafeensis in monocytes are called

Answer 28

morulae...know this

Question 29

Anaplasma phagocytophilia is also called?

Answer 29

Human granulocytic anaplasmosis

Question 30

HGA is usually called

Answer 30

rocky mountain spotless fever

Question 31

HGA lives inside

Answer 31

granulocytes...also called a morulae,

Question 32

Spirochetes

Answer 32

spiral shaped, usualy too thin to gram stain, the two we need to know are Borrelia and Leptospira

Question 33

Borrelia undergo?

Answer 33

antigenic variation

Question 34

Borrelia burgdorferi

Answer 34

Lyme disease causative agent

Question 35

B Burgdorferi presentation

Answer 35

flu like, milder than RMSF

Question 36

How long do you have to remove the deer tick before infection

Answer 36

24 hours , In RMSF- 4 hours

Question 37

What is the rash pattern in lyme disease

Answer 37

Bulls eye rash (erythema chronicum migrans)

Question 38

Early LD

Answer 38

flu-like

Question 39

Secondary LD

Answer 39

disseminated disease, weeks or months later, arthritis, facial palsy, peripheral neuropathy

Question 40

chronic LD

Answer 40

erosive arthritis (really terrible knees), bells palsy

Question 41

Lyme disease DX

Answer 41

ELISA (this can give false positives), must to a Western Blot afterwards

Question 42

Treatment of early LD

Answer 42

doxy

Question 43

chronic

Answer 43

cephalosporins

Question 44

Relapsing fever is caused by

Answer 44

Borrelia hermsii and borreli recurrentis

Question 45

Borrelia hermsii is spread by

Answer 45

tick

Question 46

B recurrentis

Answer 46

louse

Question 47

Clinical presentation of Relapsing fever

Answer 47

fever for a week, two weeks off, fever again

Question 48

How do these bacteria cause recurrent fever?

Answer 48

antigenic variation

Question 49

DX of relapsing fever

Answer 49

blood smear, serology to confirm

Question 50

Leptospira interegans

Answer 50

urine contaminated water gets into cuts

Question 51

Symptoms of leptospirosis

Answer 51

flu like, renal damage, jaundice,

Question 52

dx or leptospirosis

Answer 52

serological, treat with penicillin, Vaccinate cattle and pets

Question 53

Bartonella Henselae

Answer 53

Cat scratch

Question 54

clinical presentation

Answer 54

swollen gland near scratch site...most will clear up in a couple weeks, treat with erythromycin