Rickettsial spotted fevers: Difference between revisions

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__NOTOC__
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{{Taxobox
| color = lightgrey
| image = Rickettsia_rickettsii_1.jpg
| name = ''Rickettsia''
| regnum = [[Bacterium|Bacteria]]
| phylum = [[Proteobacteria]]
| classis = Alpha Proteobacteria
| ordo = [[Rickettsiales]]
| familia = [[Rickettsiaceae]]
| genus = '''''Rickettsia'''''
| genus_authority = da Rocha-Lima, 1916
| subdivision_ranks = Species
| subdivision =
''[[Rickettsia felis]]''<br/>
''[[Rickettsia prowazekii]]''<br/>
''[[Rickettsia rickettsii]]''<br/>
''[[Rickettsia typhi]]''<br/>
''[[Rickettsia conorii]]''<br/>
''[[Rickettsia africae]]''<br/>
etc.}}


{{CMG}}  {{AE}} {{IMD}}; {{KS}}  
{{CMG}}  {{AE}} {{IMD}}; {{KS}}  


==Overview==
==Overview==
Rickettsial spotted fevers are a group of typhus [[disease]]s or illnesses [[vector (biology)|transmitted by]] [[tick]]s worldwide. As the incidence of typhus fevers increase and the geographic areas in which they are found expand, it becomes increasingly important for health professionals to be able to distinguish the diverse, and often overlapping, clinical presentations of these diseases.


==Pathophysiology==
'''''Rickettsia''''' is a [[genus]] of [[Motility|non-motile]], [[Gram-negative]], [[Endospore|non-sporeforming]], highly [[pleomorphic]] [[Bacterium|bacteria]] that can present as [[cocci]] (0.1 μm in diameter), rods (1-4 μm long) or thread-like (10 μm long). [[Parasites|Obligate intracellular parasites]], the ''Rickettsia''  depend on entry, growth, and replication within the [[cytoplasm]] of [[eukaryote|eukaryotic]] host cells (typically endothelial cells).<ref name="Barron">{{cite book | author = Walker DH | title = Rickettsiae. ''In:'' Barron's Medical Microbiology ''(Barron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.2078 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref> Because of this, ''Rickettsia'' cannot live in artificial nutrient environments and are grown either in [[Biological tissue|tissue]] or [[embryo]] cultures (typically, chicken embryos are used).  In the past they were regarded as microorganisms positioned somewhere between viruses and true [[bacterium|bacteria]]. The majority of ''Rickettsia'' bacteria are susceptible to [[antibiotic]]s of the [[tetracycline]] group.


Typhus fevers are caused by rickettsia bacterial infections.
''Rickettsia'' species are carried as [[parasite]]s by many [[tick]]s, [[flea]]s, and [[lice]], and cause [[disease]]s such as [[typhus]], [[rickettsialpox]], [[Boutonneuse fever]], [[African Tick Bite Fever]], [[Rocky Mountain spotted fever]], [[Australian Tick Typhus]], [[Flinders Island Spotted Fever]] and [[Queensland Tick Typhus]] <ref>http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=17553271&tool=MedlinePlus</ref> in human beings.  They have also been associated with a range of plant diseases. Like [[virus]]es, they grow only in living cells.  The name ''rickettsia'' is often used for any member of the [[Rickettsiales]]. They are thought to be the closest living relatives to bacteria that were the origin of the [[mitochondria]] organelle that exist in most [[eukaryotic]] cells.  


===Life Cycle and Spread of Rickettsial Disease===
The method of growing ''rickettsia'' in chicken embryos was invented by [[Ernest William Goodpasture]] and colleagues at [[Vanderbilt University]] in the early 1930s. <ref name="Medical Micro">Rickettsiae. Medical Microbiology 4th Edition. http://www.ncbi.nlm.nih.gov/books/NBK7624/ Accessed January 28, 2016. </ref><ref name="RMSF">Spencer R.R., Parker R.R. Studies on Rocky Mountain spotted fever. U.S. G.P.O. Washington, 1930. 16141346. Hygienic Laboratory Bulletin. V-154. http://books.google.com.au/books?id=6C9DAAAAYAAJ}}</ref>


'''General Tick Life Cycle''' <ref name="LCT CDC”">Life Cycle of Ticks that Bite Humans (2015).  http://www.cdc.gov/ticks/life_cycle_and_hosts.html Accessed on December 30, 2015</ref>
[[Image:361px-Ricketts Howard Taylor 1871-1910.jpg|250px|left|thumb|<SMALL>Howard Taylor Ricketts (1871-1910) an American Pathologist credited with the discovery of the Rickettsiacae family of bacteria which causes Rocky Mountain Spotted Fever. He was also credited with the discovery of the tick vector, the Rocky Mountain Wood tick.</SMALL>]]
[[Image:Lifecycle.jpg|left|thumb| This image displays an example of the tick lifecycle, based on stages and the months that they are most likely to occur during.]]
==Etymology==
*A tick's life cycle is composed of four stages: ''hatching'' (egg), ''nymph'' (six legged), ''nymph'' (eight legged), and an ''adult''.
*The genus ''Rickettsia'' is named after [[Howard T. Ricketts|Howard Taylor Ricketts]] ([[1871]]&ndash;[[1910]]), who worked on and eventually died of typhus. <ref name="RMSF">Spencer R.R., Parker R.R. Studies on Rocky Mountain spotted fever. U.S. G.P.O. Washington, 1930. 16141346. Hygienic Laboratory Bulletin. V-154. http://books.google.com.au/books?id=6C9DAAAAYAAJ}}</ref>
*Ticks require blood meal to survive through their life cycle.
*Hosts for tick blood meals include mammals, birds, reptiles, and amphibians. Ticks will most likely transfer between different hosts during the different stages of their life cycle.
*Humans are most often targeted during the nymph and adult stages of the life cycle.  
*Life cycle is also dependent on seasonal variation.
*Ticks will go from eggs to larva during the summer months, infecting bird or rodent host during the larval stage.
*Larva will infect the host from the summer until the following spring, at which point they will progress into the nymph stage.
*During the nymph stage, a tick will most likely seek a mammal host (including humans).
*A nymph will remain with the selected host until the following fall at which point it will progress into an adult.
*As an adult, a tick will feed on a mammalian host. However unlike previous stages, ticks will prefer larger mammals over rodents. 
*The average tick life cycle requires three years for completion.  
**Different species will undergo certain variations within their individual life cycles.
<br>
<br>
<br>
<br>
===Spread of Rickettsial Disease===  
*Ticks require blood meals in order to progress through their life cycles.
*The average tick requires 10 minutes to 2 hours when preparing a blood meal.  
*Once feeding, releases anesthetic properties into its host, via its saliva.
*A feeding tube enters the host followed by an adhesive-like substance, attaching the tick to the host during the blood meal.
*A tick will feed for several days, feeding on the host blood and ingesting the host's pathogens.
*Once feeding is completed, the tick will seek a new host and transfer any pathogens during the next feeding process. <ref name="LCT CDC”">Life Cycle of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/life_cycle_and_hosts.html Accessed on December 30, 2015</ref>


==Epidemiology and Demographics==
==Human pathogenesis==
*Transmission occurs as a result of a bite from an infected tick or mite as well as the fecal content of ''rickettsia'' infected fleas and lice.
*''Rickettsiae'' enter the bloodstream following inoculation.
*Infection usually occurs within the endothelium as well as smooth muscle cells.
*Bacterial infection progresses with binary fission within the cytosol.
*Infected target cells undergo immense damage.
*A host defense includes a T-lymphocyte-mediated immunological response.
*This includes the presence of gamma interferons and tumor necrosis factor alpha.<ref name="Medical Micro">Rickettsiae. Medical Microbiology 4th Edition. http://www.ncbi.nlm.nih.gov/books/NBK7624/ Accessed January 28, 2016. </ref>


===Incidence===
==Genomics==
*Certain segments of ''Rickettsial'' [[genome]]s resemble that of [[mitochondria]].<ref name="Emelyanov_2003">{{cite journal | author=Emelyanov VV | title=Mitochondrial connection to the origin of the eukaryotic cell | journal=Eur J Biochem | year=2003 | pages=1599-618 | volume=270 | issue=8 | id={{PMID|12694174}} }}</ref>
*The deciphered genome of ''R. prowazekii''  is 1,111,523 [[base pair|bp]] long and contains 834 protein-coding [[genes]].<ref name="Andersson_1998">{{cite journal | author=Andersson SG, ''et al'' | title=The genome sequence of Rickettsia prowazekii and the origin of mitochondria | journal=Nature | year=1998 | pages=133-40 | volume=396 | issue=6707 | id={{PMID|9823893}} }}</ref>
*Unlike free-living bacteria, it contains no genes for [[anaerobic]] [[glycolysis]] or genes involved in the biosynthesis and regulation of [[amino acid]]s and [[nucleoside]]s.
*In this regard it is similar to mitochondrial genomes; in both cases, nuclear (host) resources are used. [[Adenosine triphosphate|ATP]] production in ''Rickettsia'' is the same as that in mitochondria.
*In fact, of all the microbes known, the ''Rickettsia'' is probably the closest "relative" (in [[phylogenetic]] sense) to the [[mitochondria]].
*The genome of ''R. prowazekii'' contains a complete set of genes encoding for the [[tricarboxylic acid cycle]] and the [[respiratory-chain]] complex. 
*The genomes of the ''Rickettsia'' as well as the mitochondria are frequently said to be "small, highly derived products of several types of reductive evolution".<ref name="Andersson_1998">{{cite journal | author=Andersson SG, ''et al'' | title=The genome sequence of Rickettsia prowazekii and the origin of mitochondria | journal=Nature | year=1998 | pages=133-40 | volume=396 | issue=6707 | id={{PMID|9823893}} }}</ref>


*Tick based infections are generally non-specific in regards to age, race, or gender. (However babesiosis is more frequently observed in older, male populations. An explanation for this has not yet been formulated.) <ref name="LCT CDC”">Life Cycle of Ticks that Bite Humans (2015).  http://www.cdc.gov/ticks/life_cycle_and_hosts.html Accessed on December 30, 2015</ref>
==Classification of rickettsial diseases==
*Certain tick-borne illnesses will vary within patient populations when an auto-immune deficiency is present.
*Tick bites are more frequently reported during the spring and summer months which are noted to be in correlation with high tick activity.
*Higher risks are associated with individuals traveling within endemic areas.
*Inoculation within endemic areas is usually the result of a tick bite however transmission has been identified as a result of transfusions or transplantation.


===Species and Regions===
{| style="font-size: 85%;"
====United States====
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
 
! style="width: 350px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Organism}}
American Dog Tick (''[[Dermacentor variabilis|Dermacentor Variabilis]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Vector}}
*Pacific Coast and east of the Rocky Mountains.
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Endemic Regions}}
*Transmits tularemia and rocky mountain spotted fever.
*Primarily infects humans during the spring and summer months.
 
Blacklegged tick (''[[Ixodes scapularis|Ixodes Scapularis]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Northeastern and upper Midwest.
*Transmits [[Lyme disease]], [[babesiosis]], [[anaplasmosis]], and [[Powassan disease]].
*Primarily infects humans during the spring, summer, and fall months.
 
Brown dog tick (''[[Rhipicephalus sanguineus|Rhipicephalus Sanguineus]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Widespread throughout the United States.
*Transmits [[Rocky mountain spotted fever]].
 
Gulf Coast Tick (''[[Amblyomma maculatum|Amblyomma Maculatum]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Atlantic Coast and Gulf of Mexico (Along the coast of Northeastern Virginia until the Southern most portions of Florida. From Southeast Florida through the Gulf of Mexico into Texas).
*Transmits Rickettsia parkeri rickettsiosis (spotted fever).
 
Lone Star Tick (''[[Amblyomma americanum|Amblyomma Americanum]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Southeastern and Eastern United States.
*Transmits [[Ehrlichiosis]], [[tularemia]], [[STARI]].
 
[[Rocky Mountain Wood Tick]] (''[[Dermacentor andersoni|Dermacentor Andersoni]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Colorado, Nevada, eastern California, eastern Oregon, eastern Washington, Idaho, Montana, Wyoming, and Utah.
*Transmits [[Rocky mountain spotted fever]], [[Colorado tick fever]], and [[tularemia]].
 
[[Western Blacklegged tick]] (''[[Ixodes pacificus|Ixodes Pacificus]]'') <ref name="Ticks CDC”">Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015</ref>
*Pacific Coast
*Transmits [[Anaplasmosis]] and [[Lyme Disease]].
 
====International====
''Hyalomma Marginatum'' <ref name="Ticks ECDC”">Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015</ref>
*Widespread: North Africa, Europe, and Asia.
*Transmits Crimean-Congo hemorrhagic fever.
 
''Ixodes Ricinus'' <ref name="Ticks ECDC”">Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015</ref>
*Widespread throughout Europe and parts of North Africa.
*Transmits encephalitis and Lyme Disease.
 
''Ixodes Persulcatus'' <ref name="Ticks ECDC”">Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015</ref>
 
''Dermacentor Reticulatus'' <ref name="Ticks ECDC”">Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015</ref>
 
==Tick-borne disease Classification==
 
{|style="font-size: 14px; background: #7D7D7D; text-align:center;" colspan="5d" | '''{{fontcolor|#FFF|Typhus (Rickettsia)}}'''
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Rocky Mountain Spotted Fever]]''' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Rocky Mountain Spotted Fever]]''' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |''Rickettsia Rickettsii''
| style="background: #F5F5F5; padding: 5px;" |''Rickettsia Rickettsii''
| style="background: #DCDCDC; padding: 5px;" |''Wood Tick (Dermacentor Variabilis), D. andersoni''
| style="background: #F5F5F5; padding: 5px;" |''Wood Tick (Dermacentor Variabilis), D. andersoni''
| style="background: #DCDCDC; padding: 5px;" |'''United States:'''
| style="background: #F5F5F5; padding: 5px;" |'''United States:'''
*Eastern Region
*Eastern Region
*Southwest Region
*Southwest Region
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Helvetica Spotted Fever]]'''<ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Helvetica Spotted Fever]]'''<ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia Helvetica''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia Helvetica''
| style="background: #DCDCDC; padding: 5px;" | ''Ixodes Ricinus (European)''
| style="background: #F5F5F5; padding: 5px;" | ''Ixodes Ricinus (European)''
| style="background: #DCDCDC; padding: 5px;" |'''Europe:'''
| style="background: #F5F5F5; padding: 5px;" |'''Europe:'''
*Sweden
*Sweden
*Switzerland
*Switzerland
Line 114: Line 77:
*Laos
*Laos
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Ehrlichiosis Anaplasmosis]]''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Ehrlichiosis Anaplasmosis]]''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Ehrlichia Chaffeensis, E. Equi''
| style="background: #F5F5F5; padding: 5px;" | ''Ehrlichia Chaffeensis, E. Equi''
| style="background: #DCDCDC; padding: 5px;" | ''Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis''
| style="background: #F5F5F5; padding: 5px;" | ''Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis''
| style="background: #DCDCDC; padding: 5px;" | '''United States:'''
| style="background: #F5F5F5; padding: 5px;" | '''United States:'''
*South Atlantic Regions
*South Atlantic Regions
*South-central Regions
*South-central Regions
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Tularemia]]''' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Tularemia]]''' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Francisella Tularensis''
| style="background: #F5F5F5; padding: 5px;" | ''Francisella Tularensis''
| style="background: #DCDCDC; padding: 5px;" | ''D. Andersoni, D. Variabilis''
| style="background: #F5F5F5; padding: 5px;" | ''D. Andersoni, D. Variabilis''
| style="background: #DCDCDC; padding: 5px;" | '''United States:'''  
| style="background: #F5F5F5; padding: 5px;" | '''United States:'''  
*Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
*Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Human neoehrlichiosis''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Human neoehrlichiosis''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Neoehrlichia mikurensis''
| style="background: #F5F5F5; padding: 5px;" | ''Neoehrlichia mikurensis''
| style="background: #DCDCDC; padding: 5px;" |  ''Lone Star Tick (''Amblyomma Americanum)'
| style="background: #F5F5F5; padding: 5px;" |  ''Lone Star Tick (''Amblyomma Americanum)'
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''
*Europe  
*Europe  
*Asia
*Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Rickettsiosis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Rickettsiosis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia''
| style="background: #DCDCDC; padding: 5px;" |  ''No specific species identified''  
| style="background: #F5F5F5; padding: 5px;" |  ''No specific species identified''  
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*South Africa  
*South Africa  
*Morocco
*Morocco
*Mediterranean  
*Mediterranean  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''African tick-bite fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''African tick-bite fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia africae''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia africae''
| style="background: #DCDCDC; padding: 5px;" |  ''Amblyomma, Dermacentor, and Rhipicephalus species''
| style="background: #F5F5F5; padding: 5px;" |  ''Amblyomma, Dermacentor, and Rhipicephalus species''
| style="background: #DCDCDC; padding: 5px;" |'''Africa:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Africa:'''  
*Sub-Saharan
*Sub-Saharan
*West Indies  
*West Indies  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Queensland tick typhus]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Queensland tick typhus]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia austalis''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia austalis''
| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes species''  
| style="background: #F5F5F5; padding: 5px;" |    ''Ixodes species''  
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Australia
*Australia
*Tasmania
*Tasmania
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Q-fever (Typhus-like infection)]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Q-fever (Typhus-like infection)]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>  
| style="background: #DCDCDC; padding: 5px;" | ''Coxiella burnetii (mimics the mechanisms of Rickettsia) ''
| style="background: #F5F5F5; padding: 5px;" | ''Coxiella burnetii (mimics the mechanisms of Rickettsia) ''
| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes holocyclus and Amblyomma triguttatum''  
| style="background: #F5F5F5; padding: 5px;" |    ''Ixodes holocyclus and Amblyomma triguttatum''  
| style="background: #DCDCDC; padding: 5px;" |'''Australia'''  
| style="background: #F5F5F5; padding: 5px;" |'''Australia'''  
*Widespread throughout Australia
*Widespread throughout Australia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever (Boutonneuse fever)''' <ref name="MSF”">Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Mediterranean spotted fever (Boutonneuse fever)''' <ref name="MSF”">Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia conorii''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia conorii''
| style="background: #DCDCDC; padding: 5px;" |  ''Brown Dog Tick (Rhipicephalus sanguineus)''
| style="background: #F5F5F5; padding: 5px;" |  ''Brown Dog Tick (Rhipicephalus sanguineus)''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Southern Europe
*Southern Europe
*Southern and Western Asia   
*Southern and Western Asia   
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|-
|-


| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Far Eastern spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Far Eastern spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia heilong-jiangensis''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia heilong-jiangensis''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Far portions of Eastern Russia  
*Far portions of Eastern Russia  
*Northern portions of China  
*Northern portions of China  
*Eastern Asia
*Eastern Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Aneruptive fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="Aneruptive Fever”">Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Aneruptive fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="Aneruptive Fever”">Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia helvetica''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia helvetica''
| style="background: #DCDCDC; padding: 5px;" |  ''Ixodes species''
| style="background: #F5F5F5; padding: 5px;" |  ''Ixodes species''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Northern and Central portions of Europe  
*Northern and Central portions of Europe  
*Non-specific portions of Asia
*Non-specific portions of Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Flinders Island spotted fever (Thai tick typhus)''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Flinders Island spotted fever (Thai tick typhus)''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia honei''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia honei''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |''' Widespread in Independent Regions'''  
| style="background: #F5F5F5; padding: 5px;" |''' Widespread in Independent Regions'''  
*Australia  
*Australia  
*Thailand
*Thailand
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Japanese spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Japanese spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia japonica''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia japonica''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Japan'''  
| style="background: #F5F5F5; padding: 5px;" |'''Japan'''  
*Widespread yet isolated to portions of Japan
*Widespread yet isolated to portions of Japan
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever-like disease''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Mediterranean spotted fever-like disease''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia massiliae and R. monacensis''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia massiliae and R. monacensis''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
''R.massiliae induced:''
''R.massiliae induced:''
*France
*France
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*North Africa
*North Africa
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Maculatum infection'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Maculatum infection'''
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia parkeri''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia parkeri''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Americas:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Americas:'''  
*United States
*United States
*Portions of Canada
*Portions of Canada
*South America
*South America
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Tick-borne necrosis and lymphadenopathy''' <ref name="TNL”">Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Tick-borne necrosis and lymphadenopathy''' <ref name="TNL”">Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia raoultii''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia raoultii''
| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor marginatus ''
| style="background: #F5F5F5; padding: 5px;" |  ''Dermacentor marginatus ''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Europe
*Europe
*Asia
*Asia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''North Asian Tick Typhus''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''North Asian Tick Typhus''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia sibirica''
| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
| style="background: #F5F5F5; padding: 5px;" |  ''Tick''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Russia
*Russia
*China
*China
*Mongolia
*Mongolia
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Lymphangitis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Lymphangitis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica mogolotimonae''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia sibirica mogolotimonae''
| style="background: #DCDCDC; padding: 5px;" |  'No specific species identified
| style="background: #F5F5F5; padding: 5px;" |  'No specific species identified
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Southern France
*Southern France
*Portugal  
*Portugal  
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*Africa  
*Africa  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''TIBOLA''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="TNL”">TIBOLA acquired in Southwest Germany. Rieg S, Schmoldt S, Theilacker C, et al. Tick borne lymphadenopathy (TIBOLA) acquired in Southwestern Germany. BMC Infect Dis. 2011;11:167. http://www.ncbi.nlm.nih.gov/pubmed/21663601 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''TIBOLA''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="TNL”">TIBOLA acquired in Southwest Germany. Rieg S, Schmoldt S, Theilacker C, et al. Tick borne lymphadenopathy (TIBOLA) acquired in Southwestern Germany. BMC Infect Dis. 2011;11:167. http://www.ncbi.nlm.nih.gov/pubmed/21663601 Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia slovaca''
| style="background: #F5F5F5; padding: 5px;" | ''Rickettsia slovaca''
| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor species''
| style="background: #F5F5F5; padding: 5px;" |  ''Dermacentor species''
| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''  
| style="background: #F5F5F5; padding: 5px;" |'''Widespread:'''  
*Southern and Eastern Europe
*Southern and Eastern Europe
*Asia  
*Asia  
|}
|}


==Differentiating Tick-Borne Diseases==
 
==Differentiating between common rickettsial diseases==


{| style="font-size: 85%;"
{| style="font-size: 85%;"
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Symptoms}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Symptoms}}
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Bacterial Infection'''}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Borreliosis (Lyme Disease)'' <ref name="Lyme CDC”">Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Relapsing Fever'' <ref name="TBRF CDC”">Relapsing Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" |Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever''
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever''
| style="background: #DCDCDC; padding: 5px;" | Fever, alterations in mental state, myalgia, rash, and headaches.
| style="background: #F5F5F5; padding: 5px;" | Fever, alterations in mental state, myalgia, rash, and headaches.
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever'' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever'' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
| style="background: #F5F5F5; padding: 5px;" | Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis'' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis'' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).  
| style="background: #F5F5F5; padding: 5px;" | Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Tularemia'' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Tularemia'' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.  
| style="background: #F5F5F5; padding: 5px;" | Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.  
|}
|}


==Diagnosis==
==Diagnosis==
'''Physical Examination'''


A round red rash with a 2-5 mm central black area (eschar, an area of dead tissue) as shown in the photo is suggestive of a tick bite.  
====Physical examination====
*Characterized by flu-like symptoms and  blistering rashes.
*If the disease is caused by an infected tick, an [[eschar]], or cutaneous necrosis, is visible at the site of inoculation.<ref name="Medical Micro">Rickettsiae. Medical Microbiology 4th Edition. http://www.ncbi.nlm.nih.gov/books/NBK7624/ Accessed January 28, 2016. </ref>


'''Laboratory Findings'''
====Laboratory diagnostics====
*A confirmatory diagnosis requires a comparative analysis of an acute-phase and convalescent-phase serum antibody titers.<ref name="Medical Micro">Rickettsiae. Medical Microbiology 4th Edition. http://www.ncbi.nlm.nih.gov/books/NBK7624/ Accessed January 28, 2016. </ref>


In general, specific laboratory tests are not available to rapidly diagnose tick-borne diseases. Serological tests are frequently performed, but may be unreliable in differentiating acute from chronic conditions.
==Risk Factors==


==Risk Factors==
*The greatest risk factor associated with tick-borne diseases is actually being bitten by a tick.
*Traveling or residing within endemic regions will increase chances of infection.  
*Traveling or residing within endemic regions will increase chances of infection.  
*Tick activity is generally heightened during certain the spring and summer months.  
*Tick activity is generally heightened during certain the spring and summer months.  
Line 311: Line 267:
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Treatment}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Treatment}}
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Bacterial Infection'''}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Borreliosis (Lyme Disease)'' <ref name="Lyme CDC”">Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''
*[[Doxycycline]]
*[[Amoxicillin]] (first-line in pregnancy)
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Relapsing Fever'' <ref name="TBRF CDC”">Relapsing Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''
*[[Erythromycin]] (first-line)
*[[Doxycycline]]
*[[Tetracycline]]
|-
|-
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
| style="font-size: 14px; background: #7d7d7d; text-align: center;" colspan="5d" | {{fontcolor|#FFF|'''Typhus (Rickettsia)'''}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever'' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Rocky Mountain Spotted Fever'' <ref name="RMSF CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''
| style="background: #F5F5F5; padding: 5px;" | '''Antibiotics'''
*[[Doxycycline]]  
*[[Doxycycline]]  
*[[Tetracycline]]
*[[Tetracycline]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |  ''Helvetica Spotted Fever''
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''  
| style="background: #F5F5F5; padding: 5px;" | '''Antibiotics'''  
*Broad-spectrum antibiotic therapy  
*Broad-spectrum antibiotic therapy  
*[[Penicillin]]  
*[[Penicillin]]  
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis'' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Ehrlichiosis Anaplasmosis'' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''  
| style="background: #F5F5F5; padding: 5px;" | '''Antibiotics'''  
*[[Doxycycline]], dosages should begin prior to lab results if ehrlichiosis is suspected.  
*[[Doxycycline]], dosages should begin prior to lab results if ehrlichiosis is suspected.  
:*''Adults:'' 100 mg PO q12h for 7-14 days
:*''Adults:'' 100 mg PO q12h for 7-14 days
:*''Children'' (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days
:*''Children'' (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Tularemia'' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Tularemia'' <ref name="Tulameria CDC”">Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''  
| style="background: #F5F5F5; padding: 5px;" | '''Antibiotics'''  
*[[Streptomycin]]
*[[Streptomycin]]
*[[Gentamicin]]
*[[Gentamicin]]
Line 350: Line 293:
*[[Ciprofloxacin]]
*[[Ciprofloxacin]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ''Other Spotted Fevers (Rickettsia bacterial infections)'' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ''Other Spotted Fevers (Rickettsia bacterial infections)'' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
| style="background: #DCDCDC; padding: 5px;" | '''Antibiotics'''
| style="background: #F5F5F5; padding: 5px;" | '''Antibiotics'''
*[[Doxycycline]]
*[[Doxycycline]]
:*''Adults:'' 100 mg PO q12h for 7-14 days
:*''Adults:'' 100 mg PO q12h for 7-14 days
Line 357: Line 300:
|}
|}


==The best way to remove a tick==
==Prevention==
*Rickettsia infections are most often caused by the bite of an infected mite or tick.
*Tick transmission occurs over the course of a blood meal, therefore the early and proper removal of an infected tick may help evade a potential infection. (For instructions on properly removing a tick, please see "the best way to remove a tick" section below.
*Avoidance of endemic areas is the most effective tactic in preventing a ''rickettsial'' infection.
*If it's impossible to avoid endemic areas, common techniques to limit tick exposure may be found in the "limiting tick exposure" section below.
*Other methods of transmission include the fecal matter of infected lice and mites. Thus prevention would include maintaining proper hygiene.
 
===Limiting tick exposure===
[[Image:SOCKS.jpg|left|thumb|180px|Tuck pants into socks]]
It is unreasonable to assume that a person can completely eliminate activities that may result in tick exposure. Therefore, prevention measures should emphasize personal protection when exposed to natural areas where ticks are present:
 
*Wear light-colored clothing which allows you to see ticks that are crawling on your clothing.
*Tuck your pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.
*Apply repellents to discourage tick attachment. Repellents containing [[permethrin]] can be sprayed on boots and clothing, and will last for several days. Repellents containing [[DEET]] (n, n-diethyl-m-toluamide) can be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with caution on children.  Application of large amounts of DEET on children has been associated with adverse reactions.
*Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Remove any tick you find on your body.
*Parents should check their children for ticks, especially in the [[hair]], when returning from potentially tick-infested areas. 
*Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.<ref name="GenTickDis CDC”">General Tick Disease Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/ticks/symptoms.html  Accessed on December 30, 2015</ref>
<br>
 
===The best way to remove a tick===


#Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
#Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
#Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. (If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.)
#Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouth-parts to break off and remain in the skin. (If this happens, remove mouth-parts with tweezers. Consult your health care provider if illness occurs.)
#After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
#After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
[[Image:Tick removal process.jpg|250px|center|thumb|Tick removal process]]
[[Image:Tick removal process.jpg|250px|center|thumb|Tick removal process]]
Line 367: Line 329:
*Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag. <ref name="Tick Removal CDC”">Tick Removal. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015</ref>
*Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag. <ref name="Tick Removal CDC”">Tick Removal. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015</ref>


==Gallery==
==Future or investigational therapies==
<gallery>
*The recent discovery of another parallel between ''Rickettsia'' and viruses may become a basis for fighting [[HIV]] infection.<ref>{{cite journal | author=Kannangara S, DeSimone JA, Pomerantz RJ | title=Attenuation of HIV-1 infection by other microbial agents | journal=J Infect Dis | year=2005 | pages=1003-9 | volume=192 | issue=6 | id={{PMID|16107952}} }}</ref>  
Image:Tick bite01.jpg|Tick bite. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*Human immune response to the [[scrub typhus]] pathogen, ''[[Orientia tsutsugamushi]]'' rickettsia, appears to provide a beneficial effect against HIV infection progress, negatively influencing the virus replication process.  
Image:Tick bite02.jpg|Tick bite. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*A probable reason for this actively studied phenomenon is a certain degree of [[homology (biology)|homology]] between ''rickettsia'' and the virus - namely, common [[epitope]](s) due to common genome fragment(s) in both pathogens.  
Image:Tick bite03.jpg|Tick bite. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*Another infection reported to be likely to provide the same effect (decrease in viral load) is the virus-caused illness [[dengue fever]].
</gallery>


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
==External links==
* [http://patric.vbi.vt.edu/organism/overview.php?organismId=3 Rickettsia] (from [http://patric.vbi.vt.edu/ PATRIC] the PathoSystems Resource Integration Center, a [http://www3.niaid.nih.gov/ NIAID] Bioinformatics Resource Center)
 
* African Tick Bite Fever [http://www.cdc.gov/ncidod/EID/vol12no09/05-1540.htm] from Centre for Disease Control and Prevention [http://www.cdc.gov/ncidod/eid/]


==Related Chapters==
==Related Chapters==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Spirochaetes]]
[[Category:Spirochaetes]]
[[Category:Infectious disease]]
 
[[Category:Disease]]
[[Category:Disease]]



Latest revision as of 18:39, 18 September 2017

Rickettsia

Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Alpha Proteobacteria
Order: Rickettsiales
Family: Rickettsiaceae
Genus: Rickettsia
da Rocha-Lima, 1916
Species

Rickettsia felis
Rickettsia prowazekii
Rickettsia rickettsii
Rickettsia typhi
Rickettsia conorii
Rickettsia africae
etc.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.; Kiran Singh, M.D. [2]

Overview

Rickettsia is a genus of non-motile, Gram-negative, non-sporeforming, highly pleomorphic bacteria that can present as cocci (0.1 μm in diameter), rods (1-4 μm long) or thread-like (10 μm long). Obligate intracellular parasites, the Rickettsia depend on entry, growth, and replication within the cytoplasm of eukaryotic host cells (typically endothelial cells).[1] Because of this, Rickettsia cannot live in artificial nutrient environments and are grown either in tissue or embryo cultures (typically, chicken embryos are used). In the past they were regarded as microorganisms positioned somewhere between viruses and true bacteria. The majority of Rickettsia bacteria are susceptible to antibiotics of the tetracycline group.

Rickettsia species are carried as parasites by many ticks, fleas, and lice, and cause diseases such as typhus, rickettsialpox, Boutonneuse fever, African Tick Bite Fever, Rocky Mountain spotted fever, Australian Tick Typhus, Flinders Island Spotted Fever and Queensland Tick Typhus [2] in human beings. They have also been associated with a range of plant diseases. Like viruses, they grow only in living cells. The name rickettsia is often used for any member of the Rickettsiales. They are thought to be the closest living relatives to bacteria that were the origin of the mitochondria organelle that exist in most eukaryotic cells.

The method of growing rickettsia in chicken embryos was invented by Ernest William Goodpasture and colleagues at Vanderbilt University in the early 1930s. [3][4]

Howard Taylor Ricketts (1871-1910) an American Pathologist credited with the discovery of the Rickettsiacae family of bacteria which causes Rocky Mountain Spotted Fever. He was also credited with the discovery of the tick vector, the Rocky Mountain Wood tick.

Etymology

Human pathogenesis

  • Transmission occurs as a result of a bite from an infected tick or mite as well as the fecal content of rickettsia infected fleas and lice.
  • Rickettsiae enter the bloodstream following inoculation.
  • Infection usually occurs within the endothelium as well as smooth muscle cells.
  • Bacterial infection progresses with binary fission within the cytosol.
  • Infected target cells undergo immense damage.
  • A host defense includes a T-lymphocyte-mediated immunological response.
  • This includes the presence of gamma interferons and tumor necrosis factor alpha.[3]

Genomics

  • Certain segments of Rickettsial genomes resemble that of mitochondria.[5]
  • The deciphered genome of R. prowazekii is 1,111,523 bp long and contains 834 protein-coding genes.[6]
  • Unlike free-living bacteria, it contains no genes for anaerobic glycolysis or genes involved in the biosynthesis and regulation of amino acids and nucleosides.
  • In this regard it is similar to mitochondrial genomes; in both cases, nuclear (host) resources are used. ATP production in Rickettsia is the same as that in mitochondria.
  • In fact, of all the microbes known, the Rickettsia is probably the closest "relative" (in phylogenetic sense) to the mitochondria.
  • The genome of R. prowazekii contains a complete set of genes encoding for the tricarboxylic acid cycle and the respiratory-chain complex.
  • The genomes of the Rickettsia as well as the mitochondria are frequently said to be "small, highly derived products of several types of reductive evolution".[6]

Classification of rickettsial diseases

Disease Organism Vector Endemic Regions
Rocky Mountain Spotted Fever [7] Rickettsia Rickettsii Wood Tick (Dermacentor Variabilis), D. andersoni United States:
  • Eastern Region
  • Southwest Region
Helvetica Spotted Fever[8] Rickettsia Helvetica Ixodes Ricinus (European) Europe:
  • Sweden
  • Switzerland
  • France
  • Laos
Ehrlichiosis Anaplasmosis [9] Ehrlichia Chaffeensis, E. Equi Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis United States:
  • South Atlantic Regions
  • South-central Regions
Tularemia [10] Francisella Tularensis D. Andersoni, D. Variabilis United States:
  • Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
Human neoehrlichiosis [9] [8] Neoehrlichia mikurensis Lone Star Tick (Amblyomma Americanum)' Widespread:
  • Europe
  • Asia
Rickettsiosis [8] Rickettsia No specific species identified Widespread:
  • South Africa
  • Morocco
  • Mediterranean
African tick-bite fever [8] Rickettsia africae Amblyomma, Dermacentor, and Rhipicephalus species Africa:
  • Sub-Saharan
  • West Indies
Queensland tick typhus [11] [8] Rickettsia austalis Ixodes species Widespread:
  • Australia
  • Tasmania
Q-fever (Typhus-like infection) [11] Coxiella burnetii (mimics the mechanisms of Rickettsia) Ixodes holocyclus and Amblyomma triguttatum Australia
  • Widespread throughout Australia
Mediterranean spotted fever (Boutonneuse fever) [12] [8] Rickettsia conorii Brown Dog Tick (Rhipicephalus sanguineus) Widespread:
  • Southern Europe
  • Southern and Western Asia
  • Africa
  • India
Far Eastern spotted fever [8] Rickettsia heilong-jiangensis Tick Widespread:
  • Far portions of Eastern Russia
  • Northern portions of China
  • Eastern Asia
Aneruptive fever [8] [13] Rickettsia helvetica Ixodes species Widespread:
  • Northern and Central portions of Europe
  • Non-specific portions of Asia
Flinders Island spotted fever (Thai tick typhus) [8] [11] Rickettsia honei Tick Widespread in Independent Regions
  • Australia
  • Thailand
Japanese spotted fever [8] Rickettsia japonica Tick Japan
  • Widespread yet isolated to portions of Japan
Mediterranean spotted fever-like disease [8] Rickettsia massiliae and R. monacensis Tick Widespread:

R.massiliae induced:

  • France
  • Greece
  • Spain
  • Portugal
  • Switzerland
  • Sicily
  • Central Africa
  • Mali

R.monacensis induced:

  • Europe
  • North Africa
Maculatum infection Rickettsia parkeri Tick Americas:
  • United States
  • Portions of Canada
  • South America
Tick-borne necrosis and lymphadenopathy [14] Rickettsia raoultii Dermacentor marginatus Widespread:
  • Europe
  • Asia
North Asian Tick Typhus [8] Rickettsia sibirica Tick Widespread:
  • Russia
  • China
  • Mongolia
Lymphangitis [8] Rickettsia sibirica mogolotimonae 'No specific species identified Widespread:
  • Southern France
  • Portugal
  • China
  • Africa
TIBOLA [8] [14] Rickettsia slovaca Dermacentor species Widespread:
  • Southern and Eastern Europe
  • Asia


Differentiating between common rickettsial diseases

Disease Symptoms
Typhus (Rickettsia)
Rocky Mountain Spotted Fever Fever, alterations in mental state, myalgia, rash, and headaches.
Helvetica Spotted Fever [7] Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis Anaplasmosis [9] Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia [10] Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.

Diagnosis

Physical examination

  • Characterized by flu-like symptoms and blistering rashes.
  • If the disease is caused by an infected tick, an eschar, or cutaneous necrosis, is visible at the site of inoculation.[3]

Laboratory diagnostics

  • A confirmatory diagnosis requires a comparative analysis of an acute-phase and convalescent-phase serum antibody titers.[3]

Risk Factors

  • Traveling or residing within endemic regions will increase chances of infection.
  • Tick activity is generally heightened during certain the spring and summer months.
  • Within endemic regions, tick may choose an animal host, including a domesticated animal such as a dog or cat.
  • Although rare, cases of blood transfusion and organ transplantation have been recorded as methods of transmission.
  • All together, individuals who spend time outdoors and/or have pets that go outdoors in endemic regions are at risk for tick-borne disease. [15]

Treatment

Medical Therapy

  • Antibiotic treatment is often justified based on clinical presentation alone. However all clinical treatments must be tailored according to a patients personal profile; considering age, immunocompetance, pregnancy, allergen profile, splenic function, and current medical status. [16]
  • If there is a collection of pus, the area will need to be incised and drained.
Disease Treatment
Typhus (Rickettsia)
Rocky Mountain Spotted Fever [7] Antibiotics
Helvetica Spotted Fever Antibiotics
Ehrlichiosis Anaplasmosis [9] Antibiotics
  • Doxycycline, dosages should begin prior to lab results if ehrlichiosis is suspected.
  • Adults: 100 mg PO q12h for 7-14 days
  • Children (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days
Tularemia [10] Antibiotics
Other Spotted Fevers (Rickettsia bacterial infections) [8] Antibiotics
  • Adults: 100 mg PO q12h for 7-14 days
  • Children (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days

Prevention

  • Rickettsia infections are most often caused by the bite of an infected mite or tick.
  • Tick transmission occurs over the course of a blood meal, therefore the early and proper removal of an infected tick may help evade a potential infection. (For instructions on properly removing a tick, please see "the best way to remove a tick" section below.
  • Avoidance of endemic areas is the most effective tactic in preventing a rickettsial infection.
  • If it's impossible to avoid endemic areas, common techniques to limit tick exposure may be found in the "limiting tick exposure" section below.
  • Other methods of transmission include the fecal matter of infected lice and mites. Thus prevention would include maintaining proper hygiene.

Limiting tick exposure

Tuck pants into socks

It is unreasonable to assume that a person can completely eliminate activities that may result in tick exposure. Therefore, prevention measures should emphasize personal protection when exposed to natural areas where ticks are present:

  • Wear light-colored clothing which allows you to see ticks that are crawling on your clothing.
  • Tuck your pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.
  • Apply repellents to discourage tick attachment. Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days. Repellents containing DEET (n, n-diethyl-m-toluamide) can be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with caution on children. Application of large amounts of DEET on children has been associated with adverse reactions.
  • Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Remove any tick you find on your body.
  • Parents should check their children for ticks, especially in the hair, when returning from potentially tick-infested areas.
  • Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.[17]


The best way to remove a tick

  1. Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
  2. Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouth-parts to break off and remain in the skin. (If this happens, remove mouth-parts with tweezers. Consult your health care provider if illness occurs.)
  3. After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
Tick removal process
  • Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.
Removal of an embedded tick using fine-tipped tweezers
  • Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag. [18]

Future or investigational therapies

  • The recent discovery of another parallel between Rickettsia and viruses may become a basis for fighting HIV infection.[19]
  • Human immune response to the scrub typhus pathogen, Orientia tsutsugamushi rickettsia, appears to provide a beneficial effect against HIV infection progress, negatively influencing the virus replication process.
  • A probable reason for this actively studied phenomenon is a certain degree of homology between rickettsia and the virus - namely, common epitope(s) due to common genome fragment(s) in both pathogens.
  • Another infection reported to be likely to provide the same effect (decrease in viral load) is the virus-caused illness dengue fever.

References

  1. Walker DH (1996). Rickettsiae. In: Barron's Medical Microbiology (Barron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
  2. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=17553271&tool=MedlinePlus
  3. 3.0 3.1 3.2 3.3 Rickettsiae. Medical Microbiology 4th Edition. http://www.ncbi.nlm.nih.gov/books/NBK7624/ Accessed January 28, 2016.
  4. 4.0 4.1 Spencer R.R., Parker R.R. Studies on Rocky Mountain spotted fever. U.S. G.P.O. Washington, 1930. 16141346. Hygienic Laboratory Bulletin. V-154. http://books.google.com.au/books?id=6C9DAAAAYAAJ}}
  5. Emelyanov VV (2003). "Mitochondrial connection to the origin of the eukaryotic cell". Eur J Biochem. 270 (8): 1599–618. PMID 12694174.
  6. 6.0 6.1 Andersson SG; et al. (1998). "The genome sequence of Rickettsia prowazekii and the origin of mitochondria". Nature. 396 (6707): 133–40. PMID 9823893.
  7. 7.0 7.1 7.2 Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
  8. 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 Disease Index General Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015
  9. 9.0 9.1 9.2 9.3 Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
  10. 10.0 10.1 10.2 Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
  11. 11.0 11.1 11.2 Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz Accessed on December 30, 2015
  12. Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015
  13. Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015
  14. 14.0 14.1 Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015
  15. General Information (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
  16. Tick-borne diseases of the United States. Treatment Information Center for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
  17. General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015
  18. Tick Removal. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015
  19. Kannangara S, DeSimone JA, Pomerantz RJ (2005). "Attenuation of HIV-1 infection by other microbial agents". J Infect Dis. 192 (6): 1003–9. PMID 16107952.

External links

  • Rickettsia (from PATRIC the PathoSystems Resource Integration Center, a NIAID Bioinformatics Resource Center)
  • African Tick Bite Fever [3] from Centre for Disease Control and Prevention [4]

Related Chapters


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