RIKETSIA

GENERAL CHARACTERISTICS
 Rickettsia species are transmitted by the bite of infected
ticks or mites by the feces of infected lice or fleas

 Transmitted to humans by arthropod vectors

 The organisms will not show up on Gram stain, but can be seen
with Giemsa stains

 T-lymphocyte-mediated immune mechanisms and cytokines,

including gamma interferon and tumor necrosis factor alpha,
play a more important role than antibodies.
Classification
RICKETTSIACEAE FAMILY
 General characteristics
 Consists of 3 genera
 Rickettsia
 Ehrlichia

 Coxiella

 Obligate intracellular parasites.

 Small Gram (-) coccobacilli (0.3-0.5 um)
 Cell membrane similar to Gram (-) bacteria with LPS &
peptidoglycan
 Culture : in yolk sacs of embryonated eggs/ Tissue
culture
 DISEASES CARRIED BY TICKS
Diseases:
Bacteria
Anaplasmosis
Anaplasma phagocytophilum
Ehrlichiosis
Ehrlichia
Lyme Disease
Borrelia burgdorferi
Rickettsiosis
Rickettsiae
Rocky Mountain Spotted Fever
Borellia
Southern Tick-Associated Rash Illness
spirochetes
Tickborne relapsing fever
Francisella tularensis
Tularemia
Virus
African Tick Bite Fever
TBEV virus
364D Rickettsiosis
CTF virus
Meningoencephalitis
CCHF virus
Colorado tick fever
Crimean Protozoa
Congo hemorrhagic fever Babesia microti
Babesiosis C. Felis
Cytauxziinosis
Engorged tick attached to back of toddler's Castor bean tick, Ixodes ricinus
head. Adult thumb shown for scale.
Arthropod Vector

Rickettsia
rickettsii
 Table II
Clinical features of the cases
Clinical No. of presenting Percentage (%)
features cases

Fever 155 100

Headache 98 63

Body ache 65 41

Cough 12 7.7

Rash 03 02

Conjunctival Hge 01 0.6

 CLINICAL PRESENTATION
 fever, headache, nausea, malaise, vomiting, abdominal pain
 Severe problems
 Vascular epithelial cell damage by microbial replication
 Vascular inflammation
 Pulmonary edema
 Distal, digital skin necrosis

 Antibody-based laboratory techniques are not sufficient

 Rickettsiae bacteria all cause similar immune responses in humans
 Can be misdiagnosed as Malaria
 CLINICAL PRESENTATION
 Symptoms start 1-2 weeks after
infection
 rash and/or eschar at site of tick
bite
 Rash starts on wrists/ankles and
spreads to the limbs
 Enlarged lymph nodes near
eschar

Photo by Mark Wise, Travel Clinic

PATHOGENESIS
 portal of entry in the skin, rickettsiae spread via the bloodstream to
infect the endothelium and sometimes the vascular smooth muscle cells
 Bacteria multiply at the site & later disseminate via lymphatic system

 Bacteria is phagocytosed by macrophages (1st barrier to rickettsial

multiplication)
 After 7-10 days
 replicate in the nucleus or cytoplasm of endothelial cells causing vasculitis
 Endothelial damage & vasculitis progress causing
 development of maculopapular skin rashes
 perivascular tissue necrosis
 thrombosis & ischemia
Laboratory Diagnosis
Specimen:
Blood & skin biopsy.
 Culture:
Tissue culture or chick embryo.
 Direct detection in clinical specimen:
PCR
Immunofluorescence
 Serological diagnosis:
Detection of rising titer of anti-rickettsial antibodies by ELISA.
Weil-Felix reaction: no longer used because it is non specific.
Pathophysiology
 TREATMENT
 Doxycycline
 200 mg/day
 3-14 days
ROCKY MOUNTAIN SPOTTED FEVER
ROCKY MOUNTAIN SPOTTED FEVER
 Etiologic agent: Rickettsia rickettsiae

 Most common rickettsial disease

 Individuals younger than 19 years old are usually at risk

 Males affected twice as often as females

 It is common during summer months

 Serious disease with 35% mortality rate

 Transmitted by ticks that must remain attached for hours in order to

transmit the disease

 Incubation of 2-6 days

 Followed by a febrile and visceral involvement; symptoms may include

nausea, vomiting, abdominal pain, encephalitis, hypotension, acute
renal failure, and respiratory distress.
 After 2-6 days, a maculopapular rash develops, first on the extremities,
including palms, foot soles, and spreading to the chest and abdomen

 If left untreated, the rash will become petechial with hemorrhages in the
skin and mucous membranes due to vascular damage as the organism
invades the blood vessels

 Death may occur during the end of the second week due to kidney or
heart failure