RICKETTSIA, SCRUB TYPHUS,

AND Q FEVER

DR. RINA DAS

ASSOCIATE PROFESSOR
MICROBIOLOGY DEPARTMENT
CNMC
 SPECIFIC LEARING OBJECTIVES
• DISEASE CAUSED BY DIFFERENT RICKETTSIAE
• BRILL- ZINSSER DISEASE
• LABORATORY DIAGNOSIS OF RICKETTSIAL
INFECTIONS
• WEIL FELIX TEST
• NEIL MOOSER REACTION
• Q FEVER
• SCRUB TYPHUS
 RICKETTSIA
• Coccobacillary obligate intracellular gram
negative organisms,do not grow on cell free
media, need arthopods for tramission of
diseases.
• Confused with virus initially
They have characters similar to bacteria:
• Gram negative
• Cell wall contains muramic acid
 Cont.
• Have DNA and RNA
• Have enzymes
• Divide by binary fission
• Seen under light microscope
• Held back by bacterial filters
• Susceptible to antibiotics(Doxycyclin,Chloramphenicol
etc.)
Named after Ricketts who first observed organism in
Rocky Mountain spotted fever and died due to this
disease.
Reason for obligate intracellular survival and
pathogenesis
• Rickettsia lack many enzymes required for glycolysis,
pentose phosphate, purine and pyrimidine pathways
and also lack genes for several amino acids.
• Although they can produce their own adenosine
triphosphate (ATP), prefer to use host cell ATP.
• They enter the body at the site of bite,multiply locally
then enter the blood vessel, damage the endothelial
cells by lipid peroxidation of host cell membrane.
Vascular endothelial cells enlarge, degenerate and
cause thrombosis and necrosis.
 CLASSIFICATION
• FAMILY: Rickettsiaceae
• GENERA: Rickettsia and Orientia
Rickettsia contains the agents of
1. Typhus fevers (Greek word means smoky or hazy,
describing the state of CNS)
2. Spotted fever
Orientia causes Scrub typhus
Coxiella and Ehrlichia are excluded from this family.
 RICKETTSIAL DISEASES
GENUS SPECIES DISEASES INSECT
VECTOR
Rickettsia R.prowazekii Epidemic typhus,Brill-Zinsser disease Human
body
louse
R.Typhi(R.mooseri) Endemic typhus Rat flea

R.rickettsii Rocky-Mountain spotted fever Ixodid tick

R.conori Boutonneuse fever Ixodid tick

R.australis Australian tick typhus Ixodid tick

R.akari Rickettsial Pox Mites

Orientia O. tsutsugamushi Scrub typhus Trombiculi

dmites
EPIDEMIC TYPHUS (LOUSE BORNE)
• Causative agent R.prowazekii
• VECTOR: Human body louse Pediculosis
humanus corporis,
• MODE OF TRANSMISSION:
1. autoinoculation of louse faeces following
rubbing or scratchingon skin or mucosa
2. By inhalation
• IP: 1-2 WEEKS
 • CLINICAL FEATURES:headache ,myalgia,eye discharge
and rashes(generalised except face,palm and sole).

• COMPLICATIONS: Interstitial pneumonia, CNS

involvement like mental confusion,myocarditis, and
acute renal failure.
• Outbreaks occur in refugee camps , prisons and over
crowded communities due to unhygienic condition.
• Brill-zinsser disease: Recrudescent illness occurring
years after acute epidemic typhus. Due to waning
immunity its reactivation occurs and sporadic
outbreaks seen.
 ENDEMIC TYPHUS (FLEA-BORNE)
• Caused by R.typhi
• VECTOR :Flea (Xenopsylla cheopis)
• MODE OF TRANSMISSION: Dried feces ,bites
• IP-1-2 weeks (avarage11days)
• Reservoir: rodents
• CLINICAL FEATURES: fever, myalgia, headache, rash
but milder form.
• Endemic in Kashmir Simla, Mumbai,Jabalpur,
Lucknow and Pune
 ROCKY MOUNTAIN SPOTTED FEVER
• Caused by R.rickettii
• VECTORT : Tick, Dermacentor andersoni
• MODE OF TRANSMISSION: Bites
• IP -4-14 days
• CLINICAL FEATURES: fever, headache and rash
(initially maculopapular,later on hemorrhagic)
• It is the most fatal rickettsial disease.
 SCRUB TYPHUS (CHIGGEROSIS)
• Causative Agent- O. tsutsugamushi.
• Transmitted by mite - Trombiculid deliniensis
(Chiggers-larval form of mite)
IP-7-10 Days
Clinical features –necrotic leison (Eschar) at the site of bite
on skin. Other features are lymphadenopathy,
maculopapular rash. Non specific features are headache,
chills, fever, conjunctivitis and maculopapular rash,
spleenomegaly.
Diagnosed by Weil felix reaction.
 COMPLICATIONS:Encephalitis,Interstitial pneumonia.

• It is most widespread disease among rickettsial

diseases.
Zoonotic tetrad: four elements essential to maintain
O.tsutsugamushi in nature
1.Trombiculid mites
2.Small mammals( field mice, rats, shrews)
3.Secondary scrub vegetations (hence the name is
SCRUB TYPHUS)
4.Wet season( when mites lay eggs)
 Q FEVER
• Family Coxiellacaeae
• Initially aetiology was unknown,it was reffered to as
Query or Q fever
• Causative Agent-Coxiella burnetii
• Cox isolated the agent
• Transmissible without arthropod vectors
• Primarily a zoonosis, transmitted to human by inhalation,
ingestion of milk etc.
• No skin rash
• IFA is method of choice.
LABORATORY DIAGNOSIS OF RICKETTSIOSIS

• ANTIBODY DETECTION IS THE MAIN STAY OF DIAGNOSIS

• WEIL FELIX TEST (nonsp.Ag)
Heterophilic agglutination reaction due to antigenic cross
reactivity
Group specific alkali stable lipopolysaccharide antigen of
some rickettsia is also shared by some non motile strains
of proteus (OX2,OX19 strains of P. vulgaris and OX K of
strain of P. mirabilis).
Rickettsial Ab is detected by Proteus Ag( 4 fold rise of titre
is meaningful).
 RESULT:Epidemic and Endemic typhus:OX2++ andOX19++,
Rocky mountain spotted fever :OX2+++ and OX 19+
Scrub typhus: OXK++. Test negative in R. pox and Q fever.
• Specific Ab test: This is detected byIFA,CFT,LAT,ELISA.
• NEIL MOOSER REACTION ( TUNICA REACTION): The
specimen of rickettsial patients is inoculated
intraperitoneally into male guineapigs and observed for
3-4 weeks.
• R. rickettsii produces scrotal necrosis
• R.prowazekii produces only fever ,no testicular swelling.
• R.typhi,R.conori and R. akari produce fever and
testicular swelling,inflammation.
• PCR : identify 16s rRNA and OMP genes.
THANK YOU