TyphusThe Rickettsial Disease
Rickettsiae:•   parasitic bacteria•   Obligate intracellular parasite•   Bigger than virus•   Smaller than bacteria•   Car...
Pathology• Widespread vasculitis and endothelial  proliferation affect organs• Thrombotic occlusion  gangrene
• Travellers/ inhabitants of endemic areas likely have  septicemia but (-)cultures ?Typhus• Incubation period: 2 -23 days
Signs Mild/ asymptomatic Severe/ systemic: sudden fever, frontal  headache, confusion & jaundice Eschar: dark crusty ul...
Laboratory•   Hemolysis•   Neutrophilia•   Thrombocytopenia•   Dec clotting•   Hepatitis•   Renal impairment
Epidemic typhus•   R. prowazeki•   Spread: human lice Pediculus humanus•   Brill Zinnser Disease•   Rash: truncal, then pe...
Rocky Mountain Spotted         Fever• R. rickettsii• Tick- borne• Rash begins as macules on hands/feetSpreading, becoming ...
Tick Typhus•   R. conorri•   Rash starts in axilla•   Becoming purpuric as it spreads•   Conjunctival suffusion•   Jaundic...
Scrub typhus•   Oriental tsutsugamushi•   Most common in SE Asia•   Signs:•   Eschar from chigger bite•   Hepatomegaly, co...
Scrub typhus• CXR: bilateral infiltration• Blood: LFT  inc, thrombocytopenia, neutrophilia, lymphocytosis,   +/- atypical ...
Murine Endemic Typhus• R. typhi• Spread: fleas from rats to humans• Prevalent in warm coastal ports
Diagnosis• clinical history• physical exam• tests based on identification of the bacterial genus  and species by PCR testi...
Diagnosis•   CBC: show anemia and low platelets•   High level of typhus antibodies•   Low level of albumin•   Low sodium l...
Treatment• Doxycycline 100mg/ 12hrs PO/IV for 7 days or48 hours after temp is normal• Chloramphenicol 500mg/ 6 hours PO fo...
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Typhus
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Typhus

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Typhus

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  1. 1. TyphusThe Rickettsial Disease
  2. 2. Rickettsiae:• parasitic bacteria• Obligate intracellular parasite• Bigger than virus• Smaller than bacteria• Carried by host arthropods• Invade human mononuclear cells, neutrophils, bld vessel endotheliums
  3. 3. Pathology• Widespread vasculitis and endothelial proliferation affect organs• Thrombotic occlusion  gangrene
  4. 4. • Travellers/ inhabitants of endemic areas likely have septicemia but (-)cultures ?Typhus• Incubation period: 2 -23 days
  5. 5. Signs Mild/ asymptomatic Severe/ systemic: sudden fever, frontal headache, confusion & jaundice Eschar: dark crusty ulcer at the site of a bite Rickettsial rash: macular, papular, petechial or hemorrhagic
  6. 6. Laboratory• Hemolysis• Neutrophilia• Thrombocytopenia• Dec clotting• Hepatitis• Renal impairment
  7. 7. Epidemic typhus• R. prowazeki• Spread: human lice Pediculus humanus• Brill Zinnser Disease• Rash: truncal, then peripheral
  8. 8. Rocky Mountain Spotted Fever• R. rickettsii• Tick- borne• Rash begins as macules on hands/feetSpreading, becoming petechial or hemorrhagic
  9. 9. Tick Typhus• R. conorri• Rash starts in axilla• Becoming purpuric as it spreads• Conjunctival suffusion• Jaundice, deranged clotting, meningoencephalitis, renal failure, cerebritis
  10. 10. Scrub typhus• Oriental tsutsugamushi• Most common in SE Asia• Signs:• Eschar from chigger bite• Hepatomegaly, cough, lymphadenopathy, tachyp nea, abdominal pain, constipation, edema, splenomegaly, vomiting , rash, petechiae, sudden deafness,
  11. 11. Scrub typhus• CXR: bilateral infiltration• Blood: LFT inc, thrombocytopenia, neutrophilia, lymphocytosis, +/- atypical lymphocytosis• Complications: pneumonia, pulmonary edema, meningitis, shock
  12. 12. Murine Endemic Typhus• R. typhi• Spread: fleas from rats to humans• Prevalent in warm coastal ports
  13. 13. Diagnosis• clinical history• physical exam• tests based on identification of the bacterial genus and species by PCR testing of skin biopsy of skin rash, skin lesions/blood samples• immunohistological staining that identifies the bacteria within infected tissue (skin tissue, usually)• Dx late or after the disease has been treated with antibiotics, when significant titers of antirickettsial antibodies are detected by immunological techniques.
  14. 14. Diagnosis• CBC: show anemia and low platelets• High level of typhus antibodies• Low level of albumin• Low sodium level• Mild kidney failure• Mildly high liver enzymes
  15. 15. Treatment• Doxycycline 100mg/ 12hrs PO/IV for 7 days or48 hours after temp is normal• Chloramphenicol 500mg/ 6 hours PO for 10-14 days• Azithromycin 500 mg 1 dose for tick & Scrub typhus
  16. 16. http://crisbertcualteros.page.tl

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