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Rickettsial Diseases

Infectious Disease

QuestionAnswer
Woods, hikers; macular rash at wrist/ankles then moves up extremities then trunk. After 5 days rash at palms & soles = RMSF (Rickettsia rickettsii)
Target lesion, arthralgia, Bell Palsy Lyme Disease (Borrelia burgdorferi)
Lyme arthritis: 3 disease patterns 40% intermittent monoarticular / oligoarticular process: involves knee +/- other large joints; 20% pattern of waxing / waning polyarthralgias; 10% inflame synovitis: evolves into erosions & joint destruction
Lyme dz: stage 1: 7-10d post bite; erythema migrans (groin, thigh, axilla); 50% flu-like illness
Lyme dz: stage 2: skin, CNS, MS; HA, stiff neck; cardiac (pericard, block) or neuro (Bell, meningitis, encephalitis)
Lyme dz: stage 3: (months-years later); arthritis, chronic synovitis; CNS: encephalopathy, axonal polyneuropathy, leukoencephalitis
Acrodermatitis chronicum atrophicans = bluish-red discoloration of distal extremitis w/atrophy (in Euro, not US); 2/2 Stage 3 Lyme dz
Incidence of arthritis associated with Lyme disease 70% of untreated Lyme disease pts develop arthritis
Human monocytic ehrlichiosis (HME) causative organisms Ehrlichia chaffeensis and Ehrlichia canis
Human granulocytotropic ehrlichiosis (HGE) causative organisms Anaplasma phagocytophilum and Ehrlichia ewingii
Ehrlichiosis organisms are: Tickborne GN obligate intracellular organisms, exhibiting tropism for either macrophages or granulocytes
Major vector for Ehrlichiosis HME: lone star tick (endemic in SE, mid-Atlantic, & S central US). HE: Ixodes deer tick (same geography as Lyme)
RMSF causative organism Rickettsia rickettsia. Primary vector is Dermacentor andersoni (RM wood tick) in west and Dermacentor variabilis (American dog tick) in east
RMSF pathology Rickettsia multiplies within endothelial cells lining small blood vessels
RMSF clinical features 2-14 day incubation (mean 7 days). Rash, rapid high spiking fever; severe HA; cough, pneumonitis, delirium; possible seizure, HSM, myocarditis, necrotizing vasculitis
RMSF rash appears when? Day 2-7 of fever. Initial lesions faint macules that blanch with pressure => maculopapular => petechial. Wrists / ankles => spread centrally but mostly on palms/soles
Lyme pathology Immune complexes accumulate in joints & attract neutrophils that attack antigen-Ab complexes. Neutrophil enzymes attack joints, erode bone => arthralgias. Borrelia O-antigen => macrophage interleukin-1 => collagenase & prostaglandin
Created by: Adam Barnard Adam Barnard