Rickettsial diseases are infectious illnesses caused by bacteria called Rickettsia. These bacteria are transmitted to humans through bites from infected arthropod vectors, such as ticks, fleas, and lice. Common symptoms include fever, headache, muscle aches, rash, and fatigue. Prompt diagnosis and treatment with antibiotics are crucial for managing these diseases. Prevention involves avoiding contact with the vectors and practicing good hygiene. Rickettsial diseases can vary in severity, with some cases being potentially life-threatening if left untreated.
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
Scrub typhus is a mite-borne disease caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi). Symptoms are fever, a primary lesion, a macular rash, and lymphadenopathy. (See also Overview of Rickettsial and Related Infections.) Scrub typhus is related to rickettsial diseases.
lecture for MBBS students
Rickettsia named after HOWARD
TAYLOR RICKETTS died of Typhus fever contracted during his studies
Discovered spotted fever rickettsia (1906)
Obligate intracellular parasite
Gram negative pleomorphic rods
Parasite of arthropods – fleas, lice, ticks and mites.
No Human to human transmission.
Rickettsia are transmitted to humans by the bite of infected arthropod vector.
Multiply at the site of entry and enter the blood stream.
Localise in the vascular endothelial cells and multiply to cause thrombosis lead to rupture & necrosis
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
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Importance of Flexibility and Mobility
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. 1. Gram negative coccobacilli
2. Obligate intracellular.
3. Transmitted by arthropods except Coxiella.
4. Parasitize endothelial cells.
5. All form basophilic inclusion bodies.
3. Epidemiology
1. Scrub typhus is the most prevalent and
endemic in India. India is part of
Tsutsugamushi Triangle.
2. Indian tick typhus.
3. Murine endemic typhus.
4. Etoiology
Feature Indian tick typhus Scrub typhus Murine endemic typhus
Causative organism Rickettsia conorii Orientia tsutsugamushi Rickettsia typhi
Vector Hard tick
(Ixodes)
Trombiculid mite/ chiggers Rat flea
(Xenopsylla)
Mamalian host/
reservior
Dogs/ rodents
Man
Rodents
Man (accidental)
Rodents
Man (accidental)
Epidemiological
risk
Endemic in Maharashtra, Karnataka,
Tamil Nadu, Telengana and Kerala.
Woodlands, Large domestic animals in
vicinity
Endemic in India (Tsutsugamushi
Triangle)
Any terrain from sea levels to
himalayan foot hills Woods and
clearings
Warm and coastal parts of India.
5. Rash morphology >90% appearance on 3–4days. Begins
as faint macule and becomes petechial,
later to purpura. First appears on
extremities and spread centrally.
Involves palm and soles
40–50% appearance on day4–5.
Macular/maculopapular. Rarely
petechial. Starts on trunk and
spreads to peripheries.
<15% appearance. As macule and becomes
petechial on trunks, extremities, soles and palms
Eschar 3–5%(uncommon) 5–80%(pathognomonic)
Needs to be actively searched for
Uncommon
Other significant
findings
Gangrene of digits/earlobes leading to
autoamputation
GI symptoms (diarrhea/ abdominal
pain)
Peripheral edema & calf muscle
tenderness.
Regional lmphadenopathy
CNS involvement
(Typhus=clouding of sensorium)
Sensorineural hearing loss
CNS involvement (milder)
(Typhus=clouding of sensorium)
6. Entomology
Hard tick
• presence of scutum
• marginal grooves
Flea
• small, wingless insects
• characteristic jumping movement
Chiggers
• compact, microscopic, circular
with no differentiation body
8. Clinical Manifestations
Incubation period is 1 to 2 weeks.
Triad of fever, headache and rashes.
Fever:
• Fever of unknown origin.
• Abrupt onset, high grade with chills.
• Diagnosis considered in patients with acute febrile illness with headache and
myalgia, in endemic areas with history of tick exposure or contact with dogs.
• Scrub typhus (62.8%), Indian tick typhus spotted fever (32.6%) and endemic
typhus fever (4.7%).
Headache and Myalgia:
• Severe frontal headache and generalised myalgia (in muscles of the lumber
region, thigh and calf)
9. Rash:
• hallmark of Spotted fever.
• evolving (initially macular, becoming maculopapular,
petechial, purpuric or gangrenous)
• centripetal spread
• involve palms and soles.
i. in scrub typhus, uncommon than Spotted fever (30
to 43% cases).
ii. in endemic typhus, atypical, initially appears on
trunk, spread centrifugally and sparing palms and
soles.
petechial rashes
purpuric rashes
10. Eschar:
• pathagnomonic to Scrub typhus (7-97%).
• crusty necrotic lesion with or without surrounding erythematous halo
• At the location of the vector bite.
• painless, nonpruritic and about 1 cm in diameter.
• usually single, like ‘skin burn of cigarette butt’.
• associated with regional painful lymphadenopathy, it is a marker of hidden or
developing eschar.
11. Systemic presentations:
i. Consider Rickettsia in aseptic meningitis or meningoencephalitis with
epidemiological history.
ii. Cough associated with pulmonary infiltrates or pneumonias, recommended
to add empiric treatment in addition to management of pneumonia, in
endemic regions.
iii. Gastrointestinal and hepatic presentation in the form of nausea, vomiting,
diarrhea, abdominal pain, Hepatosplenomegaly and hepatitis.
iv. Acute renal failure (ARF), as bad prognosis. Suspect in fever presents with
varying degrees of renal insufficiency, particularly if eschar exists.
12. Severe complications:
• Fulminant course seen particularly with spotted fever group in patients with
glucose-6-phosphate dehydrogenase (G6PD) deficiency.
i. Noncardiogenic pulmonary edema secondary to pulmonary microvascular
leakage.
ii. Meningoencephalitic syndrome and Long-term neurologic sequelae in
children who have survived severe disease.
iii. Acute renal failure is associated with bad prognosis
iv. Disseminated intravascular coagulation like syndrome and gangrene.
13. Investigations
Suggestive Laboratory Features For Rickettsial Infections
• Normal to low total leukocyte count in early stages and leukocytosis in
severe.
• Thrombocytopenia
• Raised ESR and CRP
• Hyponatremia
• Hypoalbuminemia and
• Elevated hepatic transaminases (SGPT)
14. Scoring system
Total score of 35, Cut-off set at 14
with sensitivity of 96% and specificity of 99%
Rathi - Goodman - Aghai Scoring System
15. Geisma/ castaneda stain Demonstrate basophilic inclusion bodies inside endothelial cells.
Cultivation Using laboratory animals (guinea pig, known as Neil Mooser
reaction). Intraperitoneal inoculation of patients blood into
guinea pigs leads to scrotal inflammation (enlarged with
adhesions and testes cannot be pushed back into abdomen).
Spotted fever: Scrotal necrosis.
Others: Scrotal swelling
Serology test Four fold rise in two serum samples, 2–4 weeks apart.
Weil-Felix: Single titer > 1:80 suggest possible infection.
Immunoglobulin M (IgM) enzyme-linked immuno sorbent assay
(ELISA)- high sensitivity and high specificity.
Immunofluorescence antibody (IFA)- gold standard.
16. Polymerase chain reaction
(PCR)
In first week of diagnosis
Done on whole blood, eschar or skin biopsy and eschar
scrapings.
Immunoperoxidase assay (IPA) Not routinely available
Imaging Chest X-ray shows infiltrates, mostly bilateral.
Nonspecific “starry sky” appearance on brain MRI.
“starry sky” appearance on brain MRI.
17. WEIL-FELIX REACTION
Heterophile agglutination test.
Principle: Based on cross-reactions occur between antibodies produced in acute rickettsial infections
with antigens of OX (OX 19, OX 2, and OXK) strains of Proteus species.
Procedure: Done as either a slide or a tube test. Antigens necessary (OX2, OX19, and OXK) can be
obtained commercially.
i. Slide method- 50–100µl of patient serum on the slide, Add a drop of desired antigen (Proteus
OX19 or OX2 or OXK), Mix the suspension by rotating the slide for 1 minutes, Visible
agglutination indicates the positive test.
ii. Tube method- Using 0.25% phenol saline as a diluent, series of tubes containing two fold
dilutions of patient serum are made with a final volume of 1 mL. A drop of antigen suspension is
added to each tube, and the mixture is incubated at 50–55 °C for 4–6 hours. A positive tube would
show visible flocculation or granulation. Generally, a titer of ≥1:320 is considered diagnostic
19. Limitation of Weil-Felix test: Poor sensitivity and specificity (overall sensitivity
as low as 33% and specificity of 46%)
i. Low sensitivity, i.e. it gives a high percentage of false-negative results,
common in scrub typhus.
ii. Low specificity, i.e. false-positive results are obtained in other diseases such
as leptospirosis, UTI, Proteus infections, brucellosis, and acute febrile
illness.
20. Case Definitions
1 Suspected/
clinical case
• Acute undifferentiated febrile illness of 5 days or more and compatible with
Boxes 1 and 2; in the absence of alternate diagnosis.
2 Probable case • Suspected case with/without eschar or having rapid (<48hours) defervescence
with anti-rickettsial therapy
• Or Having Weil Felix test positive with titer of 1:80 or more
• Or Positive IgM ELISA for rickettsia
3 Confirmed case • Rickettsial DNA is detected in eschar sample or whole blood by PCR
• Or Four fold rise in antibody titers on acute and convalescent sera by IFA or IPA
21. BOX 1
Compatible Clinical Scenario for Rickettsial Infection
One or more of the following:
1. Undifferentiated fever of more
than 5 days.
2. Sepsis of unclear etiology.
3. Fever with rash.
4. Fever with edema.
5. Dengue-like disease.
6. Fever with headache and myalgia.
7. Fever with hepatosplenomegaly
and / or lymphadenopathy.
8. Aseptic meningitis /
meningoencephalitis / acute
encephalitic syndrome.
9. Fever with cough and pulmonary
infiltrates or community acquired
pneumonia.
10. Fever with acute kidney injury.
11. Fever with acute gastrointestinal
or
hepatic involvement.
22. BOX 2
Suggestive Epidemiological Features for Rickettsial Infections
One or more of the following within 14 days of
illness onset:
• Tick bite.
• Ticks seen on clothes or in and around homes.
• Visit to areas which are common habitats of
vectors (where rodents share habitats with
animals).
• Animal sheds in proximity of homes.
• Exposure to rodents.
• Contact with pet or stray dog infested
with ticks.
• Living in or travel to areas endemic for
rickettsial diseases.
• Occurrence of similar clinical cases
simultaneously or sequentially in family
members, coworkers, neighbourhood or
pets.
23.
24. Diagnosis
• No rapid laboratory tests are available to diagnose early in the course of
disease.
• Only crucial factor for early diagnosis is high index of suspicion.
• Following factors taken together for diagnosis, which can then be confirmed
with serology.
1. Compatible clinical presentations.
2. Tick bite or tick exposure.
3. Epidemiological data.
4. Suggestive laboratory features.
5. Rapid defervescence with appropriate antibiotics.
25. Treatment
• Start empiric treatment without waiting for laboratory confirmation. Do not
stop treatment on basis of negative test results.
• Doxycycline is the drug of choice: Oral or intravenous. Dose: <40 kg- 2.2-4
mg/kg twice daily, >40 kg- 100 mg twice daily.
• Therapy should be continued for a minimum of 5-7 days and until the patient
has been afebrile for at least 3 days.
• If fever do not subside in 48 hours, consider alternate diagnosis or
doxycycline resistant strains
26. Sr.No Name of drug Dose, route and duration Comments
1. Doxycycline 4 mg/kg/dose BD per oral or
IV(maximum200mg)
5–7days or for atleast 3 days until
the patient is afebrile
Drug of choice
Rapid defervesce within 48hours
IV formulation for sick patients
2. Tetracycline 25–50mg/kg/dose every 6hourly
per oral (maximum 2g/ day)
Rapid defervesce within 48hours
IV formulation for sick patients
3. Chloramphenicol 50–100mg/kg/day every 6hourly
(maximum3g/day)
Most common adverse effect is
agranulocytosis
4. Azithromycin 10mg/kg/dayoncedaily
(maximum 500mg)
Preferred drug in pregnancy
Recommended when doxycycline
resistance
5. Clarithromycin 15mg/kg/dayBD Doxycycline resistance.
27. Differential Diagnosis
Rickettsial diseases can be easily confused with a variety of
• Viral (measles, enteroviral exanthems, dengue, infectious mononucleosis),
• Protozoal (malaria),
• Bacterial (meningococcemia, typhoid, leptospirosis, toxic shock syndrome,
scarlet fever),
• Collagen vascular (Kawasaki disease, other vasculitis) diseases,
• Adverse drug reactions,
• Invasive meningococcal disease.
29. Prevention
Vaccine and post-exposure prophylaxis is not available for clinical use.
Vector control: controlling rodents and cutting, burning and bulldozing vegetations
with heavy spraying of insecticides such as lindane.
Preventing vector bite: most effective strategy.
• Avoid exposure to vector infested habitats. Regular tick checks should be performed
after spending time with tick infested animals or in tick infested habitats.
• Closed toe shoes and light coloured (for tick visibility) long pants and long sleeves
cloths with shirt tucked into pants and pants tucked into socks or boots.
• Permethrin based (on cloths) and 20-50% DEET (N, N-diethyl-m-toluamide) based
(on skin) insect repellants.
• Hot water washing and hot drying effectively kills ticks on cloths.
• Pets should be protected with medications or tick collars and periodic de-ticking.
30. Prompt removal of attached ticks:
• Ticks need minimum 4-6 hours of attachment before they transmit infection.
• Bathing soon after exposure is effective.
• proper technique of tick removal using tweezers, grasp ticks head as close to skin surface as
possible and gently pull upwards with constant pressure.
• Attachment area should be immediately cleaned with soap and water or alcohol or an iodine
scrub.
• Ticks should neither be removed nor be crushed with bare fingers.
• Gasoline, nail polish, kerosene, petroleum jelly or lit matchsticks should not be used.
• Incineration of ticks after removal, rather than flushing down the sewer system is
recommended.
Pre-exposure chemoprophylaxis: Weekly doxycycline started before and for 6 weeks after
exposure is recommended.
31. Future Prospects
Research and development should focus on
1. Vaccines for rickettsial diseases
2. Rapid diagnostic card test combining antigen and antibody
3. Robust surveillance and reporting system.