ID Zoonoses

8/13/2019 ID Zoonoses

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INFECTIOUS DISEASE: ZOONOSES

Disease Transmission/Reservoir

Clinical Findings Diagnosis Treatment

LymeDisease:spirochete

Borreliaburgderfori

1.Deer tickIxodidaescapularis

2.Summermonths in NE US3.White-footedmice (immatureticks)4.White-taileddeer (matureticks)

1.Early localized infectiona.erythema migrans target-shaped; on thigh, groin or axilla

2.Early disseminated infection

a.spreads via lymphatics & bloodstream days to weeksb.intermittent flu-like sx, headaches, neck stiffness,

fever/chills, fatigue, malaise, ms painc.wks later, 15% develop (resolves w/in months) meningitis

(no Brudzinski or Kernig sign), encephalitis, cranial neuritis(bilat facial nerve palsy), peripheral radiculoneuropathy (motoror sensory)d.wks-months later, 8% have cardiac probs (AV block,

pericarditis, carditis), lasts for wks & can recur3.Late persistent infection (mos-yrs later)a.arthritis (60%) large joints esp knees; can be chronic in

someb.chronic CNS disease subacute mild encephalitis, transveremyelitis, axona polyneuropathyc.acrodermatitis chronica atrophicans reddish-purple

lesions & nodules on ext surface of legs

1.Clinical ptw/erythema migrans & hxof tick exposure in

endemic area labconfirmation2.Serology MOSTIMPORTANT TEST TOCONFIRMa.ELISA detects serum

IgM & IgG Abs during 1 st month of illnessb.Western detects + or

equivocal resultsc.IgM Abs peak 3-6 wks

after onset of sxd.IgG Abs slowly increase& stay high in ptsw/disseminated illness;can’t tell if disease is acuteor chronice.pts w/hx of distant Lyme

disease may have high IgGdespite abx txf.IgG Abs cross-react w/T.

pallidum but pts w/Lymedisease won’t have + VDRL

1.Early localized diseasea.confined to skin 10

days of abx

b.beyond skin abx for20-30 daysc.early disease oral

doxycycline (21 days) C/I in pregnancy & kids <12 yod.alt amoxicillin,

cefuroximee.erythromycin can

be given to pregnant Fw/PCN allergies

2.Complicationsa.facial nerve palsy,arthritis, cardiac disease

prolonged abx (30-60days)a.meningitis, CNS IV

abx for 4 wks

RMSF: ICbacteriaRickettsiarickettsie

1.Ticks feeding onvarious mammals2.SE, MW & W US3.Spring &summer months

1.Bug enters host cell via tick bite multiplies in vascularendothelium spreads to diff layers of vasculature2.Damage to vascular endothelium increased vascular perm,activation of complement, microhemorrhages, microinfarcts3.Onset of sx is 1 wk after bite sudden onset of fever, chills,malaise, N/V, myalgias, photophobia, headache4.Papular rash after 4-5 days of fever starts peripherally(wrists, forearms, palms, ankles, soles) to central (rest of limbs,trunk, face) maculopapular petechial6.Can lead to interstitial pneumonitis

1.Clinical can have highLFTs & thrombocytopenia2.Serology, IF skin bx areconfirmatory

1.Doxycycline 7 days;IV if vomiting2.CNS manifestations orpregnant chloramphenicol




Malaria:protozoansP.falciparum,ovale,

vivax,malariae(WORST)

1.Via mosquitobites in endemicareas2.Prevalent intropical climates,

esp Africa, MiddleEast, India

1.Onset is wks-mos after infection but is dependent on specificcause2.Sx fever, chills, myalgias, headache, N/V/D3.Fever patterna.falciparum constant

b.ovale, vivax spikes every 48 hrsc.malariae spikes every 72 hrs

1.ID bug on PBS2.PBS must have Giemsastain

1.No res chloroquinephosphate (res iscommon)2.Res quinine sulfate& tetracycline

a.alt atovaquone-proguanil & mefloquine3.Falciparum IVquinidine & doxycycline4.2 wks of primaquinephosphate if relapse invivax & ovale (dormanthypnozoites liver)5.Prophylaxis chloroquine no res;mefloquine res

Rabies:rabies virus 1.From bite orscratch ofinfected animal orcorneal transplant2.More indevelopingcountries whereanimals haven’tbeen vaccinated

1.Viral encephalitis2.Incubation period 30-90 days3.If sx present fatal4.Sx: pain at bite site prodrome (sore throat, fatigue, N/V)

encephalitis (confusion, combativeness, hyperactivity, fever,seizures) hydrophobia (can’t drink, laryngeal spasmw/drinking, hyper-salivation) coma & death; some presentw/ascending paralysis

1.Virus or Ag can be ID ininfected tissue or saliva2.4x increase in serum Abtiters3.ID Negri bodies histo4.PCR detection of virusRNA

1.Post-exposurea.clean wound w/soapb.wild bites kill animal

& send for IF of braintissuec.healthy animal in

endemic area observefor 10 days if nochange in condition animal doesn’t haverabiesd.known rabies exposure

give human rabies Iginto wound & glutealregion (passive) AND giveanti-rabies vaccine in 3IM doses into deltoid orthigh over 28-days(active)2.Pre-exposurea.rabies vaccine for at-

risk people (vets, etc.)




Leptospirosis:spirocheteLeptospiraspp

1.Contaminatedwater2.Rodents, farm,animals

1.Anicteric rash, lymphadenopathy, high LFTs2.Icteric renal and/or liver failure, vasculitis, vascularcollapse

1.Isolate bug in blood orurine culture

1.Oral abx tetracyclineor doxycycline2.If severe IV PCN G

Ehrlichiosis:Ehrlichiaspp (ICgram – bacteria)

1.Tick bite2.Deer

1.Fever, chills, malaise, +/- rash2.Complications renal failure, GI bleeding

1.Clinical; confirm byserology

1.Oral tetracycline ordoxycycline x 1 wk

Tularemia:Francisellatularensis(small gram

– bacillus)

1.Tick bite, animalbites, handlingcarcass2.Rabbits, otherrodents

1.Fever, headache, nausea2.Ulcer at site of tick bite3.Painful lymphadenopathy

1.Isolate bug in blood orwound culture

1.IM streptomycin orgentamicin

Q fever:

Coxiellaburnetii(gram –)

1.Blood, ingestion

of infected milk,inhalation2.Farm animals

1.Acute constitutional sx, N/V

2.Chronic endocarditis

1.Serology

2.CXR multiple opacitiesin acute illness

1.Acute doxycycline or

fluoroquinolone2.Chronic RIF

Cat scratchdisease:Bartonellahenselae(gram – bacillus)

1.Scratch fromflea-infested cat2.Cats, fleas

1.Lymphadenopathy or lymphadenitis2.Systemic sx are rare

1.Serology, clinical 1.Usually self-limited2.If severe oraldoxycycline orciprofloxacin

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ID Zoonoses