Micro Winter 26 Tularemia, Brucellosis, Bartonellosis

Front 1

what organism causes tularemia

where is this disease seen

Back 1

francisella tularenis

seen in northern hemisphere: summer- ticks, winter- rabbits

**multiple forms of disease related to route of infectino

Front 2

what does the route of infection have to do with tularemia infection

Back 2

determines disease form (winter- rabbit, summer- tick) NEVER PERSON TO PERSON

1. arthropod bite: tick, deer fly--> ulceroglandular disease

2. direct animal contact (animal carcus):

3. inhalation of aerosol: pneumonia

4. ingestion of contaminated water or poorly cooked meat: oropharyngeal disease

Front 3

whats teh micro of F tularensis

1. gram
2. aerobic
3. fast
4. intra/extra
5. survival

Back 3

1. gram -
2. aerobic
3. fastidious
4. intracellular- LOVES macro
5. can have extended survival in mud, animal carcus

Front 4

if you get tularemia in the winter what was the vector, what baout summer

tularemia

1. vector
2. reservoir

Back 4

summer- tick
winter- rabbit

VECTOR: ticks, deer fly
Host: rabbit, squirrel, muscrat

Front 5

tularemia is spread through...

1. tick, deer fly bite
2. person to person
3. inhalation
4. direct contact
5. ingestion of water/meat that is contaminated

Back 5

ALL but person to person, tularemia si NOT spread person to person

Front 6

if the clinical presentation of tularemia is... what was the route of infection

1. ulceroglandular
2. pneumonic
3. oropharyngeal
4. oculoglandular
5. thyphoidal

Back 6

1. ulceroglandular: skin abraision, bite from tick or deer fly. MOST COMMON

2. pneumonic: inhalation, SUPER infectios. low infectious dose

3. oropharyngeal: rare

4. oculoglandular: self inoculation, you were infected, toughed it. and then touched your eye

5. thyphoidal: systemic spread after initial infection from a previous

**recall there is NO person to person spread in tularemia

Front 7

what is ulceroglandular tularemia

Back 7

1. most common, get as a result of tick or deer fly bite. RARELY fatal

-they bite you and the bug gets into macro (intracellular) and INHIBITS phago/lysosome fusion.

Front 8

ok so you got bit by a tick in teh northern hemisphere and now you have an ugly ulcer, regional lymphadenopathy, fever, chills, maliase, whats the deal

Back 8

tularemia from arthropod bite- ulceroglandular disease

**can spread to other organs and get abcess, granuloma

**tularemia is intracellualr and prevents phago/lysosomal fision

Front 9

whats mroe deadly ulceroglandular tularemia or pneumonic

Back 9

pneumonic

**low infectious dose is required, get pneumonic infection if you breath in the bug.

**multiple necrotizing granulomas that destroy alv septea

**biowarefare?

Front 10

if you have inhaled something and then you have intracellular bugs in macrophages and you get lung granulomas and hilar LN enlargements, adn patchy infiltrates what can it be.

Back 10

pneumonic tularemia

30% mortality

Front 11

what is teh most deadly form of tulaermia

Back 11

oropharyngeal, its rare and you get it from eating meat. LARGE infectious dose required
**bacteria cross mucosa and get in blood.

fever, sore throat, abd pain, nausea, vomit, diarreha, splenomegaly

Front 12

if you pt gets tularemia and has NV, sore throat, diarrhea, splenomegaly. and you find out they ate an undercooked animal carcus what form do they have and what is teh mortality

Back 12

oropharyngeal, the rare deadly one

mortality >30%

Front 13

if your tularemia sx include: pain/itchy eye, photophobia, intense ocular congestion, lacrimation, and edema of the conjunctive whats the deal

Back 13

oculoglandular tularemia

usually self inoclation bc of dirty hands

Front 14

tell me more about thyphoidal tularemia

Back 14

high mortality, its when you have one from but it gets in the blood.

blood stream involvement, sepsis, often pneumonia

fever, chills, myalgia, weight loss. hard to dx bc no ulcers, no lymphadenopathy

Front 15

what is teh form of tularemia that presnt with fever, chills, myalgia, weight loss adn NO ulcer or lymphadenopathy. it makes it hard to dx

Back 15

its thyphoidal, systmeic

high mortality, susually has blood stream and sepsis

Front 16

how is tularemia dx

Back 16

1. culture on special agar-
2. 4x increase in IgG (AB cross react w/brucella)
3. hx

Front 17

how do you treat tularemia

Back 17

streptomycin

mortality is reduces HUGE with tx. prevent by avoiding vectors/reservoirs.

vaccine that decreases severity

Front 18

are there special precautions for dx tularemia

Back 18

ya its dangerous, small dose for inhaled! use a biohazard hood!

Front 19

tell me about tullaremia vaccine

Back 19

vaccine is NOT preventative BUT will decrease severity of disease

Front 20

what are hte 4 species of brucellosis that cause human disease
(where do they come from)

1. b abortus
2. b canis
3. b suis
4. b melitensis

Back 20

1. b abortus: cattle
2. b canis: dogs
3. b suis: swine
4. b melitensis: goat/sheep

Front 21

if you get bricellosis from... what was the B species you got

1. catle
2. dog
3. pig
4. goats/sheep

Back 21

1. b abortus
2. b canis
3. b suis
4. b melitensis

**passed through un pasturized milk

Front 22

whats the micro of brucella

1. gram
2. aerobic
3. fast
4. intra/extra
5. disease

Back 22

1. gram -
3. aerobic
3. fastidious
4. intracelluarl
5. disease depends on DOSE, virulence, speciesl, host immune system (recall for tularemia it was based on method of entry)
sx: abcess to granulloma to cure

passed through unpasturized milk

Front 23

is brucellosis common in US

Back 23

nope, seen in Tx and CA

**get it from cow, dog, goat, pig. can immunize animals to stop spread to humans

**HIGH RISK- drink unpasturized milk. .

Front 24

who are high risk groups for brucellosis

Back 24

1. ppl who drink unpasturized milk

2. pp who play w/animals: vet, farmer, meat handler

3. lab tech, research

Front 25

how does the disease present if you drink unpasturized milk

Back 25

brucellosis

*disease varies based on what species you get (abortus- cow, canis-dog, suis-pig, melitensis- sheep)

but you eat it or contact it from animal directly adn then it spreads in lymphatics, and multiplies intracellularly in macrophages and then becomes systemic

get an undulant fever

Front 26

what disease has that undulant fever

Back 26

bruceiola, drinking unpast milk

get that insidious onset of maliase, fever, chills, sweats, fatigue, myalgia, arthralgia, lymphadenopathy, non productive cough

persistent disease --> granuloma

Front 27

how long do sx of: Fever, malaise, chills, sweats, fatigue, weakness, myalgias, lymphadenopathy, weight loss, arthralgias, non-productive cough, undulent fever, last in bruceolia

Back 27

months to years ~3% mortality

advance to: GI complaints, srthritis, respiratory issues, heart, skin, neuro bc of granuloma formation

Front 28

is brucella reportable?

whats dx

Back 28

yep! its from unpasturized milk, profession, animal contact

demonstrage bug from several samples (blood, BM, CSF, lesion)

serology: ELISA, agglut, IFA

Front 29

what are some characterisitcs of brucella

Back 29

gram -
aerobe
no capsule
no motility
catalase, oxidase, urease +
intracellular
can last for MONTHS in milk, animan, aborted fetus

Front 30

whats prevention for brucella

Back 30

immunized the animals
kill infected animal
pasturrize your dairy

Front 31

whats tx for brucella

Back 31

doxy w/rifampin/gentimycin to prevent relapse (undulent fever)

**tx 6+ weeks

Front 32

what are the species that cause bartonella

1. baciliformis
quintana
henselae
elizabethae, clarridgeiae

Back 32

1. b baciliformis: oroya fever --> verruga. human host

2. b quintana: trench fever, bacillary angiomatosis, SBE. human host

3. B henselae: cat scratch. cat host

4. b elexabethe, B clarrigeiae: endocarditis

Front 33

whats the micro of bartonella

Back 33

gram -
aerobin
intracellular in RBC (tularemia, brucella and bartonella are ALL intracellular)

Front 34

which bartonella is only in s america

Back 34

bacilliformis. this one causes oroya fever --> verruga

human host

Front 35

what are the vectors

b bacilliformis (in S america)

b quintana (trench feverm bacillary angiomatosis, SBE)

b henselae

Back 35

bacillifromis: sand fly

quintana: body louse

henselae: cat flea, cat scratch fever

*transmission is through arthropod or cat scratch

Front 36

who is at risk for bartonells

Back 36

ppl w/cats

immunocomprimise
poor hygeine

Front 37

what causes oroya fever and verruga

Back 37

bartonella bacilliformis, sand fly, S america

**its biphasic so the acute is oroya, and chronic is verruga

**bug lives in RBC, they replicate and when the RBC are cleared and lysed you get the acute phase, orya fever

Front 38

bartonella caused by baciliformis

Back 38

1. s america, sand fly
2. get acute oroya fever from lysed RBC
3. chronic: verruga

Front 39

what might be the cause of fever, maliase, myalgia, HA and RAPIDLY worsening anemia. say you were in s america 3 weeks ago and got bit by sand fly

what can it progress to

Back 39

oroya fever, bartonella baciliformis

can prgress to chronic phase: verruga, red/purple skin lesion. recurrence for months to years

Front 40

tell meabout infection with B quintana

Back 40

trench fever, transmitted by body louse.

bacteria are intracellular but live in RED CELLS (in baciliformis it lived in RBC)

pt has severe HA, sudden fever, pain in long bones

5 day fever recurrence

Front 41

tell me about cat scratch fever

Back 41

caused by B heneslae, passed through cat scratch

**bacteria infect RES cells. local/regional disease

get a pustule where you get scratched. more common in immunocomprimised

Front 42

what are some of the manifestations of cat scratch after having it for 1-2 months

Back 42

chronic lymphadenopathy, HUGE nodes- hyperplastic, granuloma,

can have fever

HUGE HUGE nodes

can progress to bacilliary angiomatosis on immunocomprimised

Front 43

bacillary angiomatosis is the result of what

Back 43

cat scratch (b heneslea) in immunocomprimised OR quintant

B heneslea: skin, liver, LN, spleen

b quintana: skin, sub q, bone

Front 44

bacillary angiomatosis that involves... is caused by what


1. skin, liver, spleen, LN:
2. bone, sub q, skin

Back 44

1. b henselae, makes sence bc we know this is in RES cells

2. quintina: ehh also in RES (bacilliformis was RBC)

**seen in immunocomprimised

Front 45

how is bartonella dx

Back 45

history
clinical presentation
not really cultured
serology

Front 46

prevention for bartonella

Back 46

avoid sand fly, body louse, and cats

proper sanitation, hygeine