Coxiella burnetii By R.Teja sri

Introduction Coxiella burnetti is the causative agent of ‘Q-fever’ Obligate intracellular, gram negative bacterium Distributed globally Found in many species of animals

Morphology:- gram negative . Pleomorphic . obligate intracellular pathogen . gram negative . Pleomorphic . size : rods:- 0.2 – 0.4 x 0.4 – 1.0 mc spheres :- 0.3 – 0.4 mc filterable . better stained with GIMINEZ and other rickettsiael stains .

C. burnetii i en.wkipedia.org

Culture Grows well in yolk sac of chick embryos and in various cell cultures .

Ag structure shows phase variation . phase – I ,II . phase – I :- autoagglutinable more immunogenic activity due to periodate sensitive trichloracetic acid-soluble surface carbohydrate . Phase – II :- more suitable for CFT . both phase I ,II elicit good Ab response .

Resistance Resistant to physical and chemical agents In pasteurization flash method is effective Can survive in dust and aerosols Inactivated by 2% formaldehyde 5% H2O2 1% Lysol .

Contd…. Resistant to heat, drying and disinfectants Air samples test positive for 2+ weeks Soil samples test positive for 150+ days Spore formation

PATHOGENESIS

History Q stands for Query or Queensland Origin of disease unknown First reported cases were in Queensland, Australia

Differentiating features : 1. Having smaller size 2. Resistance to heat and drying 3. Major route of transmission is- inhalation/ingestion

* All eukaryotes can be infected Primary Reservoir Goats Cattle Sheep * All eukaryotes can be infected

Bacteria is excreted in: Feces Urine Milk of infected animals

Release Into Environment:- During birthing the organisms are shed in high numbers in amniotic fluids and the placenta 109 bacteria per gram of placenta Do not touch!

Transmission Most common route is inhalation of aerosols Contaminated dust, manure, birthing products Tick bites (rare) Human to human also very rare gsbs.utmb.edu

Contd….. Who’s at risk? Farmers, veterinarians, researchers, abattoir (slaughterhouse) workers etc. People who breed animals Immunocompromised

Acute or Chronic Q fever gsbs.utmb.edu *Bacteria spread through blood

Symptoms Acute Q fever Self-limiting, flu-like disease Fever, nausea, headaches, vomiting, chest/abdominal pain Pneumonia & granulomatous hepatitis

Chronic Q fever (> 6 months) Endocarditis & meningoencephalitis Pre-existing disease

Host interaction Entry via inhalation Alveolar macrophages encounter bacteria C. burnetii phagocytosed Macrophage C. burnetii R Heinzen, NIAID

Host interaction Replication within phagolysosme Low pH needed for metabolism No cellular damage unless lyses occurs Can invade deeper tissue and cause complications

Phagocytosis Binding/entry into macrophages via: Integrin Associated Protein (IAP) Leukocyte Response Integrin (LRI) bacteria macrophage

Binding & Entry Phagocytosis Phagocytic vesicle Phago-lysosome fusion: bacteria survive and multiplies Lysis of phago-lysosome and macrophage

LAB DIAGNOSIS Hard to diagnose because: Asymptomatic in most cases Looks like other disease (Flu or cold) Serology continues to be best method PCR, ELISA and other methods WEIL – FELIX test is negative .

Contd….. Bio safety level 3 (BSL-3) facility Very infectious (one organism causes infection) Listed by the CDC as a potential bioterrorism agent. Isolated in cell cultures or embryonated eggs

Treatment Once infected, humans can have life-long immunity Acute Q fever treated with: doxycycline, chloramphenicol, erythromycin or fluoroquinolones Chronic Q fever treated with: More than one antibiotic tetracycline and cotrimoxazole for 2 years

prepared from formalin killed whole cells attenuated strains Vaccines :- prepared from formalin killed whole cells attenuated strains trichloroacetic acid extracts

Prophylaxis:- Pasteurization and sterilization of milk and other dairy products Disinfect utensils, machines used in farm areas for birthing Regular testing of animals and those who work closely with them Protective Personal Equipment

BARTONELLA

INTRODUCTION Family Bartonellaceae contain two genera Bartonella Grahamella Grahamella does not infect humans

Bartonella contain 3 species: B.bacilliformis B.quintana B.henselae

BARTONELLA BACILLEFORMIS Carrions disease Causes OROYA fever

MORPHOLOGY: Gram negative Pleomorphic strict aerobe motile, small bacillu0.3-0.5x0.2-0.5mc found inside erytrocyte infected persons Opt. temp 25-28 c

CULTURE; Grow in semisolid nutrient agar with 10% rabbit serum 0.5%Hb Growth is slow takes about 10 days

PATHOGENISIS:- Causes OROYA fever Transmitted by SAND flies INCUBATION PERIOD; 3 weeks to 3 months

CLINICAL FEATURES:- Fever Headache Chills Severe anemia Several weeks after recovery pt. develop nodular lesions on the body Secondarily infect produce ulcers – VERUGA PERUANA

Lab diagnosis:- Demonstrated in blood smear by GIEMSA stain Seen in cytoplasm and adhere to cell surface Grown on NA agar contain rabbit serum, Hb Guinea pig inoculation leads to VERUGA PERUANA

TRETMENT:- Susceptible to penicillin streptomycin Tetracycline Chloramphenicol

PREVENTION Insecticides such as DDT should be used to eliminate sand flies

BARTONELLA QUINTANA

MORPHOLOGY:- small gram negative bacillus 0.3-0.5 mc to1.0-1.7 mc Does not posses flagella show twitching movments by fimbriae

CULTURE:- Grows on rabbit /sheep blood agar opt. temp -35 c in 5% CO2 colonies appear after 14 days primary inoculation

PATHOGENESIS:- Formerly called Rochalimaea quintana Causes TRENCH fever also called FIVE DAY fever

Transmission; by body louse vertical transmission does not occur in lice Lice after acquiring infection remain infectious through out life

CLINICAL FEATURES:- Mild symptoms leads to chronic rickttesiaemia Relapse have been observed even after 20 years primary disease

Lab diagnosis:- Detected in the gut of infected lice Isolate from pt. blood by cultur sheep blood agar Weil-felix test negative PCR- detect organism in tissues

BARTONELLA HENSELAE

MORPHOLOGY:- Gram negative Slightly curved Show twitching movments

CULTURE:- Grows on chocolate agar columbia agar with 5%sheep blood tryptic-soy agar opt.temp-35-37 c in 5% CO2

embedded in the agar COLONY MORPHOLOGY:- white, dry, cauliflower like and embedded in the agar

PATHOGENESIS:- Causes CAT-SCRATCH disease Occur by contact with scratch / bite of an infected cat

Cat contact Resolution in weeks to months Dissemination in immuno- (scratch, bite, ? cat flea bite) 1 - 3 weeks Dissemination in immuno- compromised hosts

CLINICAL FEATURES:- Regional lymphadenopathy Fever Endocarditis In AIDS pt. leads to; bacillary angiomatosis

Lab diagnosis:- lymph node biopsy – stained with WARTIN-STARRY SILVER IMPREGNATION –clusters of bacillus Grow on chocolate agar/ columbia agar

TREATMENT:- Self limiting No specific treatment required

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