Rickettsienkrankheiten (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q-fever, Busch fever) caused by a group of gram-negative, obligate intracellular bacteria coccoid rods. All except Coxiella burnetii, have an arthropod. The symptoms usually consist of sudden fever with severe headache, malaise, prostration and, in most cases, a characteristic rash. The diagnosis is made clinically and confirmed by Immunfluoreszenzassy or PCR. Treatment is with tetracycline or-except for anaplasmosis and ehrlichiosis – with chloramphenicol.

Rickettsia, Orientia, Ehrlichia, Anaplasma and Coxiella spp. were once as belonging to the same family, but due to genetic analysis, they are now considered as separate entities. Although this group of pathogens require living cells to grow, they are true bacteria because they have metabolic enzymes and a cell wall, use O2 and are sensitive to antibiotics. These organisms usually have an animal reservoir and an arthropod. Exceptions are R. prowazekii, are the primary reservoir for the people, and C. burnetii that do not require arthropod. Specific vectors, reservoirs and endemic areas are very different (see Table: Diseases caused by Rickettsia, Orientia, Ehrlichia, Anaplasma and Coxiella spp).

Rickettsienkrankheiten (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q-fever, Busch fever) caused by a group of gram-negative, obligate intracellular bacteria coccoid rods. All except Coxiella burnetii, have an arthropod. The symptoms usually consist of sudden fever with severe headache, malaise, prostration and, in most cases, a characteristic rash. The diagnosis is made clinically and confirmed by Immunfluoreszenzassy or PCR. Treatment is with tetracycline or-except for anaplasmosis and ehrlichiosis – with chloramphenicol. Rickettsia, Orientia, Ehrlichia, Anaplasma and Coxiella spp. were once as belonging to the same family, but due to genetic analysis, they are now considered as separate entities. Although this group of pathogens require living cells to grow, they are true bacteria because they have metabolic enzymes and a cell wall, use O2 and are sensitive to antibiotics. These organisms usually have an animal reservoir and an arthropod. Exceptions are R. prowazekii, are the primary reservoir for the people, and C. burnetii that do not require arthropod. Specific vectors, reservoirs and endemic areas are very different (see Table: Diseases caused by Rickettsia, Orientia, Ehrlichia, Anaplasma and Coxiella spp). There are lots of Rickettsial but 3 cause most human Rickettsia infections: R. rickettsii R. prowazekii R. typhi diseases caused by Rickettsia, Orientia, Ehrlichia, Anaplasma and Coxiella spp pathogens rash or scabs vector Endemic Region typhus epidemic typhus, Brill-Zinsser disease Rickettsia prowazekii trunk to extremities can b ei Brill-Zinsser disease No scab missing body lice: Worldwide Murine (endemic) typhus R. typhi, R. felis trunk to extremities No scab rat flea, cat flea Worldwide Busch fever typhus (scrub typhus) Orientia tsutsugamushi (formerly R. tsutsugamushi) trunk to extremities scab mites present Trombicullade larvae (larvae mites) Asia-p azifischer space, limited by Japan, Korea, China, India and northern Australia spotted fever Rocky Mountain spotted fever R. rickettsii trunk to extremities No scab ticks especially in the West (hard), including Dermacentor andersoni ( “wood tick”), the US and D. variabilis ( “dog tick”), primarily in the eastern and southern United States Western hemisphere, including much of the United States (except Maine, Hawaii and Alaska); Central and South America North Asian tick-borne rickettsial R. sibirica trunk, extremities, face Versatile scab available ticks Armenia, Central Asia, Siberia, Mongolia, China Queensland tick typhus R. australis trunk, extremities, face scab available ticks Australia African tick bite fever R. africae Vielf √§ltiger scab on the extremities (Tache noir) and at the sites of tick bites ticks sub-Saharan Africa, West Indies Mediterranean spotted fever (boutonneuse fever) * R. conorii trunk, extremities, face scab available Rhipicephalus sanguineus (brown dog tick) Africa, India, Southern Europe, Middle East available near the Mediterranean, Black and Caspian sea rickettsialpox R. akari trunk, extremities, face scab mites USA, Russia, Korea, Africa R. parkeri Rickettsiosis R. parkeri scab golf coast tick (Amblyomma maculatum) south of the US ehrlichiosis and anaplasmosis Monocytic ehrlichiosis Ehrlichia chaffeensis No No scab ticks (A. americanum, known as ixodidae) south-east and south of the US Granulocytic anaplasmosis Anaplasma phagocytophilum No No scab ticks (Ixodes scapularisim East and Midwest of the US, I. pacificus in the western US possible I. ricinus in Europe) in the United States in the Northeast, Mid-Atlantic, the upper Midwest and on the west coast; Europe Q fever Q fever Coxiella burnetii No No No scab vectors necessary Worldwide * Often named after the area where it occurs (eg. As Indian tick typhus, Marseilles fever). Symptoms and complaints Rickettsia multiply in the affected region of the body of arthropods and often lead to the formation of a local lesion (crust). They penetrate the skin or mucous membranes, some (R. rickettsii) proliferate in the endothelial cells of small blood vessels, leading to vasculitis and other replicate in white and red blood cells (Ehrlichia sp in monocytes, Anaplasma sp in granulocytes). A regional lymphadenopathy often occurs together with infection by Orientia sp or members of the spotted fever group (with the exception of R. rickettsii). The Endovaskulitis rickettsii caused by R. leads to a petechial rash (due to focal hemorrhage areas) to signs of encephalitis and gangrene of the skin and tissue. Seriously ill at a Rickettsiosis of typhoid or “Spotted-fever” group patients bruising and skin necrosis, edema (due to increasing vascular permeability), digital gangrene, circulatory collapse, shock, oliguria, anuria, azotemia, anemia, hyponatremia, hypochloraemia, delirium and having coma. Diagnosis Clinical symptoms biopsy of skin rash with fluorescent antibody staining, Acute to recognize the pathogen and current serological tests (serological tests are acutely not make sense) PCR Rickettsia infections from other differentiate rickettsial infections and related diseases must be differentiated from other acute infections, particularly of a meningococcemia and Rubella. Clinical history of louse – or flea contacts, tick bites or stay in a known endemic area are valuable, but are often not available. Doctors should specifically ask about travel to an endemic area within the incubation period of the disease. The clinical presentation may be helpful in distinguishing the disease. Meningococcemia: The rash may be pink in the subacute form, macular, maculopapular or petechial be in brilliant form petechial-confluent or ekchymotisch. The rash develops rapidly in acute meningococcal disease and if it is ekchymotisch, mostly palpation soft. Rubeola: The rash starts on the face, then spreads to the trunk and arms and confluent quickly. Rubella: The rash usually remains discreet. Retroauricular lymph node enlargement and lack of toxicity indicate a rubella. Meningococcemia Image courtesy of Mr. Gust on Public Health Image Library of the Centers for Disease Control and Prevention. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/meningococcemia_orig_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/meningococcemia_orig_de.jpg?la = en & thn = 0 ‘, title:’ meningococcemia ‘description:’ u003Ca id = “v38396594 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eBei fulminant meningococcemia will initially cause petechiae

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