protozoans

Symptoms:  fabrile disease/skin rash on extremities

                    widspread in midwest and south central US

Transmission: tick or flea

Specimen:  Biopsy/DFA

                    serum

Typhus

relapsing typhus (Brill-Zinsser disease)

body louse

Murine typhus

fleas

Scrub typhus

not endemic to us

Rocky-Mountain spotted fever

Ticks - Demancentor spp.

Q fever

Bacterial pathogen

Symptoms: Acute: Fever, Atypical pneumonia, hepatitis

                    Chronic: Bacterial endocarditis

Transmission: milk or excreta of cattle, sheep, goats

                        contagious in aerosols

Detection:  Serology

                    phase II antibodies-acute phase

                    Phase I antibodies - chronic phase

Human monocytic ehrlichiosis

Symptoms: non-specific febrile disease to severe systemic infection

                    can be mistaken for toxic shock syndrome

Transmission: tick bite, Southeast, Midwest, and far western U.S.

Detection:  Serology, PCR

Human Granulocytic Anaplasmosis

Symptoms: elevated leukocytes, facial diplegia

Transmission: tick bite, north central and eastern U.S., California

Detection:  indirect immunoflourescence, Serology, PCR

helical shaped bacteria

.1-.3 um in diameter, 5-120 um in length

maintain mobility in high-viscosity fluids

Treponema pallidum

Borrelia

Leptospira

Spirillum

Spirochete

Yaws - chronic non-venereal disease

Central Africa and India

Skin and bones are affected

antibodies cross-react to T. pallidum

Gold Standard - infect rabbit testes

Spirochete

Pinta

skin lesions

South and Central Africa

long term affects only cosmetic

antibodies cross-react to T. pallidum

Gold Standard - infect rabbit testes

Spirochete

Relapsing fever

Symptoms: flu-like symptoms. Remission and recurrence

-sometimes jaundice

-lymphocytic meningitis and facial palsy

-rarely fatal

Transmission: tick or louse

Detection:  direct observation of spirochete in blood

-DFA and PCR

Transmission:

-louse

Overcrowding

Transmission:

-tick

World-wide distribution

Lyme disease

Symptoms

-Stage 1

"bullseye rash"

-Stage 2-acute

Acute arthritis-26%

meningitis-10%

cranial nerve palsies-8%

lesions of eye, hepatitis, myocardial damage

-Stage 3-chronic

chronic skin lesions

neurological symptoms

chronic arthritis

Does not respond well to treatment

Treatment

-antibiotics during early stages

Detection

-DFA or observation of spirochetes

-modified Kelly's medium

-PCR

Serology

-ELISA's

-Western Blot

Spriochete

Obligate aerobic helical rods

Symptoms:

-flu-like symptoms

-eye pain w/o inflammation/photophobia

-aseptic menigitis

Well's disease-fatal systemic disease (renal failure, liver dysfunction

Detection

-Fletcher's or Korthof's medium

-Direct from blood and CSF

Spirochete

Rat-bite fever

tightly coiled sprial rod

Usually in Asia, Rare in U.S.

Symptoms

-flu-like symptoms

-rash at rate-bite

-sometimes-endocarditis

Transmission

-rat bite

Detection

-Direct observation of spirochetes