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Rickettsia, Chlamydia and Mycoplasmas
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Comparative study Rickettsiae, Chlamydiae, Mycoplasmas
Features Rickettsiae Clamydiae Mycoplasmas DNA + RNA in cell + Size of cells 5OOnm 3OOnm 1OOnm Intracellular parasite - Growth in living cell Inclusion body Gorwth on media Antibiotic sensivity Transmission by vector
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Rickettsia
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General Characteristics
Small obligate intracellular coccobacilli Gram negative (poorly), better stained with Giemsa (Blue) Have cell wall, bigger than virus but smaller than bacteria Have DNA and RNA Have an ATP transport system that allows them to use host ATP Arthropod reservoirs and vectors ( e.g., ticks, mites, lice or fleas). Sensitive to antibiotics
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Endothelial cells, micro blood vessels
Pathogenic Mechanism Materials: Endotoxin and Phospholipase A Mechanism: Bites or faeces of arthropod Local lymph or micro blood vessels (1st bacteremia) Endothelial cells, micro blood vessels in whole body (2nd bacteremia) Fever, rash, headache, etc Targets: Endothelial cells, micro blood vessels
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Five genera in this class cause human diseases:
Rickettsia Bartonella Coxiella (does NOT cause skin rash) Ehrlichia Orientia
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Diseases Caused by the Rickettsia
Organism Vector Reservoir Rocky Mountain spotted fever R. Rickettsii Tick Tick, wild rodents Scrub typhus R. Tsutsugamushi Laval Mite (chiggers) Mites, wild rodents Epidemic typhus R. Prowazekii Louse Humans, squirrel fleas, flying squirrels Murine typhus R. Thphi Flea Wild rodents Q fever Coxiella Burnetii None Cattle, sheep, goats, cats
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Rickettsia rickettsii in endothelial cells of a blood vessel from a patient
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Orientia tsutsugamushi growing in mouse abdominal macrophages (Giemsa)
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R. Prowazekii Louse Human Human Epidemic typhus
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(much milder than epidemic typhus)
R. Typhi Rodent Flea Rat Tick Flea Human Murine typhus (much milder than epidemic typhus)
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Coxiella Burnetii Q fever(query fever )
Self-limiting flu-like syndrome with high fever (40℃) Primary reservoirs are wild (cattle, sheep, goat etc.) Non-cross reactive antigen with non-motile Proteus (Weil-Felix reaction negative) Live in macrophages of vertebrate host
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Diagnosis and Prevention
Microscopy Serological Test (Weil-Felix reaction, ELISA, IF, PCR) Breaking the infection chain ( controlling and killing the intermediate hosts and reservoir hosts) Inactivated vaccine has protective effect Chloromycetin, tetracycline are helpful for therapy, sulphonamides are not administered (increasing the penetrating of the vessel).
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Chlamydia
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Characteristics Small obligate intracellular parasites
Contain DNA, RNA and ribosome and make their own proteins and nucleic acids, unable to make their own ATP Have special growth cycle and replicate by binary fission Possess a rigid cell wall similar to gram-negative bacteria Sensitive to antibiotic
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A. Elementary bodies (EB)
Special Growth Cycle A. Elementary bodies (EB) small (0.3~0.4 µm) infectious form a rigid outer membrane resistant to harsh environmental conditions outside of eukaryotic host cells bind to receptors on host cells initiate infection.
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Chlamydia inclusion body
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Chlamydia trachomatis
Only infects human epithelial cells (Except Biovar mouse) Three biovars (biological variants): Biovar Trachoma (14 Serologic types) Biovar lymphogranuloma venereum, LGV (4 serologic types) Biovar mouse
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Genital tract infections
C. trachomatis (Biovar trachoma) The most common sexually transmitted bacterial disease C. trachomatis (Biovar: LGV) Humans are the only natural host
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Clinical Syndromes 1. Trachoma Chronic infection or repeated infection
inflammation and follicle formation involving the entire conjunctiva Chlamydial kerato-conjunctivitis
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Clinical Syndromes 2. Inclusion conjunctivitis 3. Infant pneumonia
4. Urogenital infections cervicitis, salpingitis urethritis 5. Reiter's syndrome 6. Lymphogranuloma (LVG)
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Laboratory diagnosis 1. Cytology 2. Culture 3. Serology
Examination of stained cell scrapings for the presence of inclusion bodies 2. Culture the most specific method for diagnosis cultures of susceptible cells iodine-staining inclusion bodies 3. Serology Detection of high titer IgM antibodies is indicative of a recent infection
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Treatment and prevention
Tetracycline Erythromycin Sulfonamides Vaccines are of little value and are not used. Treatment coupled with improved sanitation to prevent reinfection is the best way to control infection.
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Mycoplasmas
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Morphology and Physiology
The smallest free-living organisms Pass through some filters used to remove bacteria Lack of a cell wall Multiple shapes including round, pear shaped and even filamentous
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Require complex media Require sterols for growth and for membrane synthesis Grow slowly (3 weeks) by binary fission and produce "fried egg" or “T strain” (tiny strain) colonies on agar plates
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Pathogenesis Adherence factors
Adherence proteins are one of the major virulence factors Adhesin localizes at tips of the cells and binds to sialic acid residues on host epithelial cells
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Pathogenesis Toxic Metabolic Products
The intimate association provides an environment in which toxic metabolic products accumulate and damage host tissues Products of metabolism : hydrogen peroxide and superoxide -- oxidize host lipids Inhibit host cell catalase
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Pathogenesis Immunopathogenesis M. pneumoniae is a superantigen
Activate macrophages and stimulate cytokine production and lymphocyte activation Host factors contribute to pathogenesis
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Organism Disease M. pneumoniae Upper respiratory tract disease, Tracheobronchitis, atypical pneumonia M. hominis Pyelonephritis, pelvic inflammatory disease, postpartum fever M. genitalium Nongonococcl urethritis (NGU) U. urealyticum Nongonococcl urethritis (NGU)
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M. Pneumoniae Need 10-20% Serum to culture in pH 7.8-8.0
Pathogenesis: P1 protein, capsule and saccharide Spread by close contact via aerosolized droplets Cause tracheobronchitis Cause “primary atypical pneumonia” long duration Antibodies play a role in controlling infection, particularly sIgA Delayed type hypersensitivity spread in confined populations
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M. Pneumoniae Laboratory Diagnosis
Organisms can be cultured from sputum before symptoms occur and throughout the course of the disease. Serology Complement fixation test :A fourfold rise in titer is indicative of a recent infection. Cold agglutinins are IgM antibodies that agglutinate human “O” erythrocytes at 4℃ but not at 37℃ not specific/a presumptive diagnosis ELISA
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M. pneumoniae Treatment and Prevention
The antibiotics of choice are tetracycline (adults only) and erythromycin. Long duration of the disease, hard to isolate patients to avoid close contact for a long period of time. No vaccines are currently available
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