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Blood and Lymphatic Infections. Chapter 28. Tularemia (Rabbit Fever). Symptoms Characterized by development of skin ulcerations and enlargement of regional lymph nodes Other symptoms include Fever Chills Achiness. Tularemia (Rabbit Fever).

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Tularemia rabbit fever l.jpg
Tularemia (Rabbit Fever)

  • Symptoms

    • Characterized by development of skin ulcerations and enlargement of regional lymph nodes

    • Other symptoms include

      • Fever

      • Chills

      • Achiness


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Tularemia (Rabbit Fever)

  • Causative agent - Francisella tularensis (aerobic, Gram- rod)

  • Pathogenesis

    • Causes ulcer at entry sight

    • Lymphatic vessels carry organism to regional lymph nodes, which may rupture

    • Spread to other body sites via lymphatics and blood vessels

    • Pneumonia occurs in 10% -15% of lung infections

      • Mortality rate as high as 30%

    • Multiplies within phagocytes

    • Cell mediated immunity responsible for ridding infection

      • 90% of infected individuals survive in the absence of treatment


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Tularemia (Rabbit Fever)

  • Epidemiology

    • Occurs among wild animals in Northern Hemisphere

    • In eastern U.S. most infections occur in winter

      • Result from skinning hunted rabbits

    • In western U.S. infections increase in summer

      • Due to bites from fleas and ticks

    • Other reservoirs for infection include

      • Muskrats, beavers, squirrels, and deer

        • Animals generally free of illness


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Tularemia (Rabbit Fever)

  • Prevention and Treatment

    • Uses of rubber gloves and goggles when working with animal carcasses

    • Insect repellents and protective clothing

      • Inspect routinely for ticks after exposure

    • Vaccine available for workers at higher risk of exposure

    • Treated with gentamicin


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Brucellosis (Undulant Fever)

  • Symptoms

    • Onset usually gradual and symptoms vague

    • Symptoms include

      • Aches and pains

      • Enlarged lymph nodes

      • Weight loss

    • Without treatment most cases recover within 2 months

      • 15% will be symptomatic for 3 months or longer


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Brucellosis (Undulant Fever)

  • Causative agent

    • Four varieties of genus Brucella cause disease in humans (Gram- rod)

      • All fall into a single species Brucella melitensis

        • Traditionally each variety given own species name depending on preferred host

          • B. abortus cattle

          • B. canis  dogs

          • B. melitensis goats

          • B. suis  pigs


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Brucellosis (Undulant Fever)

  • Pathogenesis

    • Organism penetrates mucous membranes or break in skin

    • Disseminated via lymphatic or blood vessels

      • Generally to heart and kidneys

    • Spleen enlarges in response to infection

      • Organisms resistant to phagocytic killing

        • Can grow within phagocytes

          • These organisms inaccessible to antibodies and some antibiotics

    • Mortality generally due to endocarditis

      • Rate is approximately 2%

    • Osteomyelitis is often serious side effect


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Brucellosis (Undulant Fever)

  • Epidemiology

    • Chronic infection of domestic animals

      • Generally involving the mammary gland and uterus

        • Causes contaminated milk and abortions

          • Abortion not a feature of human disease

    • Occurs in workers in meat packing industry

    • Major problem in animals used for food


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Brucellosis (Undulant Fever)

  • Prevention and Treatment

    • Pasteurization most important control measure

    • Inspection of domestic animals

    • Protective eyewear and gloves when working with animals or animal carcass

    • Attenuated vaccine controls disease in domestic animals

    • Tetracycline combined with rifampin used for treatment

      • Treatment usually given for 6 weeks


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Plague (Black Death)

  • Symptoms

    • Develop abruptly 1 – 6 days post infection

      • Transmission via bite from infected flea

    • Disease characterized by large tender lymph nodes called buboes

    • Other symptoms include

      • High fever

      • Shock

      • Delirium

      • Patchy bleeding under the skin

      • May also have cough and bloody sputum

        • Only in lungs infected

          • Pneumonic plague


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Plague (Black Death)

  • Causative agent - Yersinia pestis

    • Facultative intracellular bacteria

    • Resemble safety pin in stained preparation

    • Has three plasmids

      • Smallest is Pla

        • Causes protective clots to dissolve via activation of plasminogen activator

      • Middle plasmid codes Yops (Yersinia outer-membrane proteins) and regulators of Yops proteins

        • Yops permits entry of organism into macrophageswhere they replicate andinterfere with innate immunity

      • Last is F1

        • Becomes anitphagocytic capsule

        • Used in plague vaccine

        • Not very good and notorious for adverse reactions


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Plague (Black Death)

  • Pathogenesis

    • Masses of organism obstruct digestive tract of rat fleas

    • Flea regurgitates infected material into bite wound

    • Pla is essential to spread from site of entry

    • Organisms multiply within macrophages

      • Produce F1 capsule while in macrophages

    • Macrophages die and release organism

      • Organism encapsulated and produces Yops and other mechanisms that enhance survival

    • Inflammation in nodes results in characteristic swelling

      • Nodes become necrotic and spill organisms

        • Septicemic plague

    • Mortality rate of untreated reaches between 50% and 80%


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Plague (Black Death)

  • Epidemiology

    • Endemic on rodent populations in all continents except Australia

    • Prairie dogs, rock squirrels and their fleas are main reservoir

      • Hundreds of fleas can transmit plague and can remain infectious for a year

    • Can spread person to person by household fleas

    • Organism can remain viable for weeks in dried sputum and flea feces


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Plague (Black Death)

  • Prevention and Treatment

    • Prevention directed by rat control

      • Proper garbage disposal

      • Rat-proof buildings

      • Guards on mooring ropes

      • Extermination programs

    • Killed vaccine gives short-term partial protection

    • Treatment via tetracycline for some exposed individuals to control epidemics

    • Gentimicin, ciprofloxacin and doxycycline effective on disease if given early


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Infectious Mononucleosis

  • Symptoms

    • Appear after long incubation

      • Usually 30 to 60 days post infection

    • Symptoms include fever, sore throat covered with pus, fatigue, enlarged lymph nodes and spleen

    • Most cases fever and sore throat disappear within 2 weeks, lymph node enlargement within 3


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Infectious Mononucleosis

  • Causative agent

    • Caused by Epstein-Barr virus

      • Double stranded DNA virus

      • Belongs to herpesvirus family

  • Pathogenesis

    • Infection begins in cells of throat and mouth and become latent in another cell type

    • Virus carried to lymph nodes after replication in epithelial cells of mouth, saliva producing glands and throat

    • Infects B lymphocytes

      • Infection can be productive or nonproductive

        • Productive – kills cells

        • Nonproductive – virus is latent

    • Virus activates B cells to produce multiple clones

      • Clones produce immunoglobulin



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Infectious Mononucleosis

  • Epidemiology

    • Distributed worldwide

    • Infects individuals in crowded, economically disadvantaged areas

      • Infects at early age without producing symptoms producing immunity

      • More affluent populations missed exposure and lack immunity

    • Occurs almost exclusively in adolescents and adults who lack antibody

    • Virus present in saliva for up to 18 months

      • Mouth-to-mouth kissing important mode of transmission

    • No animal reservoir


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Infectious Mononucleosis

  • Prevention and Treatment

    • Avoiding saliva of another person

    • No vaccine

    • Acyclovir inhibits productive infection

      • Has no activity on latent viruses


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Yellow Fever

  • Symptoms

    • Disease can range from mild to severe

    • Most common form may be only fever and slight headache lasting a day or two

    • Severe disease characterized by high fever, nausea, nose bleeds and bleeding into the skin, black vomit from GI bleeding and jaundice

    • Mortality rate of severe disease can reach 50%

    • Reason for the variation in symptoms is unknown


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Yellow Fever

  • Causative agent

    • Enveloped, single stranded RNA arbovirus

      • Belongs to flavivirus family

    • Virus multiplies in mosquitoes

      • Mosquitoes transmit virus to humans

  • Pathogenesis

    • Introduce via bite of Aedes mosquitoes

    • Multiplies and enters blood stream

      • Carried to liver

        • Jaundice results in liver damage

        • Injury to small blood vessels produces petechiae

    • Kidney failure is a common consequence of disease


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Yellow Fever

  • Epidemiology

    • Reservoir mainly infected mosquitoes and primates in tropical regions of Central and South America and Africa

    • Periodically spread to urban areas via mosquito bite

  • Prevention and Treatment

    • Control achieved by spraying and elimination of breeding sites

      • Control almost impossible in jungle regions

    • Attenuated vaccine available for high risk groups

    • No antiviral treatment


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Malaria

  • Symptoms

    • “flu-like”

    • Includes fever, headache and pain in the joints and muscles

    • Generally begin 2 weeks post infection

      • Transmission via bite of infected mosquito

    • Symptom pattern changes after 2 to 3 weeks

      • Fall into three categories

        • Cold phase – abruptly feels cold and develops shaking

        • Hot phase – follows cold phase

          • Temperature rises steeply reaching 104°F

        • Wet phase – follows hot phase

          • Temperature falls and drenching sweat occurs



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Malaria

  • Causative agent

    • Human malaria caused by four species of genus Plasmodium

      • P. vivax, P. falciparum, P. malatiae, P. ovale

    • Infectious form of parasite injected via mosquito

    • Carried by bloodstream to liver

      • Infects cells of liver

        • Thousands of offspring released to produce infection in erythrocytes


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Malaria

  • Pathogenesis

    • Characteristic feature

      • Recurrent bouts of fever followed by times of wellness

        • Caused by erythrocytic cycle of growth and release of offspring

    • Each species has different incubation periods, degrees of severity and preferred host age and range

    • Spleen enlarges to cope with large amount of foreign material and abnormal RBC

      • Common cause of splenic rupture

    • Parasites cause anemia by destroying red RBC and converting iron from hemoglobin to an unusable form

    • Stimulates immune system

      • Overworked immune system fails and immunodeficiency develops


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Malaria

  • Epidemiology

    • Once common in both temperate and tropical areas

      • Now dominantly disease of warm climate

    • Eliminated from continental U.S. in late 1940s

    • Mosquitoes of genus Anopheles are biological vectors

    • Infected mosquitoes and humans constitute reservoir

    • Transmission via mosquitoes, blood transfusion and sharing of syringes


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Malaria

  • Prevention and Treatment

    • Treatment is complicated

      • Due to different stages of mosquito life cycle

    • Chloroquine

      • Effective against erythrocyte stage

      • Will not cure liver infection

    • Primaquine and tafenoquine

      • Generally effective against exoerythrocyte stage and certain species gametocytes


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