Rickettsial

Zoonoses
(Rickettsial
diseases)
Introduction

• Rickettsial zoonoses are a group of specific communicable diseases

caused by rickettsial organisms and transmitted to man by arthropod
vectors.
• Increasingly it is realised that rickettsial diseases are under diagnosed
and they contribute substantially to the acute febrile burden and
preventive illness in many populations
• Trans ovarian transmission: The disease agent is passed onto the next
generation through the eggs of the insect.
Ex. Scrub typhus in thrombuculid mite

• Trans stadial transmission:

The disease agent is passed from one stage of life cycle to another
and then transmit the disease to man.
Ex. Typhoid in housefly
Classification
• Rickettsial disease may be grouped on the basis of clinical features
and epidemiological aspects as follows
Rickettsial diseases
Diaseses Rickettsial agent Insect vectors Mammalian
reservoirs
1.Typhus group
a.Epidemic typhus R.Prowazekki Louse Humans
b.Murine typhus R.Typhi Flea Rodents
c.Scrub typhus R.Tsutsugamushi Mite Rodents
2.Spotted fever group
a.Indian tick typhus R.Conorii Tick Rodents, dogs
b.Rocky mountain R.Rickettsii Tick Rodents, dogs
spotted fever
c.Rickettsial pox R.Akari Mite Mice
3.Others
a.Q fever C.Burnettii Nil Cattle, sheep, goats
b.Trench fever Rochaimaea Quintana Louse Humans
Causal agents

• Rickettsiae are small bacteria that are

obligate intracellular parasites.
• They are pleomorphic appearing either
as short rods, or as cocci and they occur
singly, in pairs, in short chains, or in
filaments.
• With Giemsa’s stain they stain blue and
are readily visible under microscope.
• They grow readily in the yolk sac of the
embryonated egg.
• Rickettsial growth is enhanced by the
presence of sulphonamides.
Clinical features
• Except for Q fever, in which there is no skin lesion, rickettsial
infections are characterised by fever, headache, malaise, prostration,
skin rash and enlargement of the spleen and liver.
• DOC - Tetracycline
• Long-acting antibiotics (doxycycline, minocycline) now make single
dose treatment possible.
Diagnostic procedures
• These include
• (a) Isolation of rickettsiae
• (b) established serological tests such as indirect fluorescent antibody (IFA)
test, the complement fixation test, and the Weil Felix reaction.
• The newer techniques include ELISA and the fluorescent antibody staining of
frozen tissue sections from rickettsial lesions.
• Among the major groups of rickettioses, the commonly reported diseases in
India are Scrub typhus, Murine flea-born typhus, Indian tick typhus and Q
fever.
• These are considered more in detail
Scrub Typhus
• Distribution
• Of the diseases caused by rickettsiae in man, the most widespread is scrub typhus
• It exist as a zoonoses in nature between certain aspects of trombiculid mites and their
small mammals (e.g filed mice, rats, shrews).
• Scrub typhus is endemic in Northern Japan, South-East Asia, the western Pacific
Islands, Eastern Australia, China, Maritime areas and several parts of South-Central
Russia, India and Sri Lanka.
• More than 1 million cases occur annually.
• Most travel-acquired cases of scrub typhus occur during visits to rural areas in endemic
countries for activities such as camping, hiking or rafting, but urban cases have also
been described.
 Epidemiological determinants
• Agent factors
• (a) Agent : The causative agent of scrub typhus is Rickettsia tsutsugamushi.
• There are several serologically distinct strains.
• (b) Reservoir : The true reservoir of infection is the trombiculid mite.
• The infection is maintained in nature transovarially from one generation of mite
to the next.
• The nymphal and adult stages of the mite are free-living in the soil; they do not
feed on vertebrate hosts
• It is the larvae that feed on vertebrate hosts and picks up the rickettsiae.
• The larval stage serves both as a reservoir, through ovarian transmission, and as a
vector for infecting humans and rodents.
Mode of transmission
• By the bite of infected larval mites. The transmission cycle may be
depicted as follows :

• Mite Rats and mice Mite Rats and mice

Man
• The disease is not directly transmitted from person to person
Incubation period

• Usually 10 to 12 days; varies from 6 to

21 days.
Clinical features
The onset is acute with chills
and fever (104 deg F – 105
Generalised
Scrub typhus resembles deg F), headache, malaise,
lymphadenopathy and
epidemic typhus clinically. prostration and a macular
lymphocytosis are common.
rash appearing around the 5th
day of illness.

One typical feature is the

punched out ulcer covered The pyrexia falls by lysis in The Weil Felix reaction is
with a blackened scab the 3rd week in untreated strongly positive with the
(eschar) which indicates the cases. Proteus strain OXK.
location of the mite bite.
 Control measures
• (a) Treatment : Tetracycline is the drug of choice.
• With proper therapy the mortality is nil.
• (b) Vector Control : Clearing the vegetation where rats and mice live;
application of insecticides such as lindane and chlordane to ground and
vegetation.
• (c) Personal prophylaxis : Impregnating clothes and blankets with miticial
chemicals (benzyl benzoate) and application of mite repellents (diethyl
toluamide) to exposed skin surfaces
• No vaccine exits at present
Murine Typhus
(endemic or flea-borne
typhus)

• Distribution
• Murine typhus (MT) is a zoonoses.
• It is worldwide in distribution especially in areas of
high rat infestation.
• It appears to be more prevalent in South-East Asia
and Western Pacific countries than previously
recognised. In USA, cases tend to be scattered.
• Successful isolation of the causative agent from
rats, fleas and bandicoots was made at many places
in India.
• Focal infections are often associated with docks and
shipping places where rats abound.
Agent factors
• (a) Agent : Rickettsia typhi (R.mooseri).
• (b) Reservoir of infection : Rats are the reservoir (Rattus rattus and
R.norwegicus).
• Infection in rats is inapparent, long lasting and non-fatal.
Mode of transmission
• The infection spreads from rat to rat (X.cheopis) and possibly by the
rat louse.
• The actual mode of transmission is not by the bite of the rat flea, but
by,
• (i) the inoculation into skin of faeces of infected fleas, and
• (ii) possibly by inhalation of dried infective faeces.
• There is no direct man to man transmission.
• Once infected the flea remains so for life.
• The flea cannot transmit the rickettsiae transovarially.
• The transmission cycle may be shown as follows :

• Rat Rat flea Rat Rat flea Rat

Man
Incubation period
• 1 – 2 weeks , commonly 12 days
Clinical features
• The clinical features resemble that of louse – borne typhus, but milder and
rarely fatal.
• The Weil – Felix reaction with Proteus OX-19 becomes positive in the 2nd
week.
Control measures
• (a) Treatment :Tetracycline is the only drug of choice. Since rickettsial
growth is enhanced in the presence of sulphonamides, these drugs should
not be given.
• (b) Control of fleas : Residual insecticides (e.g BHC, malathion) are
effective against rat fleas.
• Rodent control measures should be implemented in the affected areas.
• No murine typhus vaccine is currently available.
Indian Tick Typhus – Epidemiological
determinants
• Agent factors
• (a) Agent – The causative agent is Rickettsia conorii, a member of the spotted fever
group of rickettsiae, the best known member of which is R.rickettsia the causative
agent of Rocky Mountain spotted fever.
• (b) Reservoir of infection : The tick is the reservoir of infection.
• It is infective at all stages of it’s life cycle and remains infective for life (commonly 18
months)
• Various tick genera (e.g Rhipicephalus, Ixodes, Boophilus, Haemaphysalis) have been
incriminated as vectors.
• Infection in nature is maintained by transovarian and trans-stadial passage.
• The rickettsiae can be transmitted to dogs, various rodents and other animals, which
assist in maintaining the disease cycle.
Mode of transmission
• Man is only an accidental host
• He acquires infection by the bite of an infected tick
• Contamination of skin with crushed tissues or faeces of an infected tick may
also cause infection.
• The cycle of transmission is as follows :
Tick Tick Tick Tick

Dog Man

Tick Man
Incubation period
• Usually 3 to 7 days
Clinical features
• The patient usually gives history of a recent tick bite and a careful
examination will reveal a lesion or a eschar at the site of the bite.
• After an interval of 3 to 7 days, there is an acute onset of fever, which may
persist for 2 to 3 weeks, malaise and headache.
• A maculopapular rash appears on the third day.
• Unlike the rash in other rickettsial diseases, the rash appears first on the
extremities (ankles and wrist), moves centripetally and involves the rest of
the body.
• The clinical syndrome may be confused with atypical measles.
Control measures
• (a) Treatment : Broad spectrum antibiotics have proved to be effective.
• (b) Personal prophylaxis : Known tick infested areas should be avoided.
• Daily inspection of the body for ticks is particularly important for those
who are exposed to the risk of infection.
• Disinfection of dogs will minimise the tick population.
• Health education of the people in the mode of transmission by ticks, and
the means of personal protection is equally important.
Q fever
• Distribution
• Q fever is a highly infectious zoonotic disease with world-wide distribution.
• It occurs mainly in persons associated with sheep, goats, cattle or other
domestic animals
Agent factors
• (a) Agent : The causative agent is Coxiella burnetti
• It is fond in ticks which act as vectors as well as reservoir.
• (b) Animal hosts : Cattle, sheep, goats, ticks and some wild animals are natural
reservoirs.
• Infected animals shed the disease agent in the faeces and urine and heavily
contaminate the soil.
• The placenta of infected cows and sheep contain the infectious agent which
may create infectious aerosols during parturition.
• Camel, horses, dogs and many other domestic animals have been shown to be
capable of acting as maintenance hosts.
Mode of transmission
• Q fever differs from other rickettsial infections in that there is no arthropod
involved in it transmission to man.
• Transmission results from
• (i) inhalation of infected dust from soil previously contaminated by urine or
faeces of diseased animals. The organism can also be transmitted through
aerosols.
• (ii) the organism can also gain entry into the body through abrasions,
conjunctivae or ingestion of contaminated foods such as meat, milk and
milk products.
• In most countries, the respiratory route is regarded as most important.
Incubation period
• Usually 2 to 3 weeks
Clinical features
• The disease has an acute onset with fever, chills, general malaise and
headache.
• The clinical picture is one of influenza or non-bacterial pneumonia rather
than a typhus fever.
• There is no rash or local lesion.
• The infection can cause pneumonia, hepatitis, encephalitis and rarely
endocarditis.
• Inapparent infections also occur.
 Control measures

• (a) Treatment : Chronic Q fever requires

prolonged treatment for 18 months of longer.
• Doxycycline is the drug of choice
• (b) Preventive measures : Pasteurization or
boiling of milk to inactivate the causative agent;
providing sanitary cattle sheds; adequate
disinfection and disposal of products.
• An inactivated Coxiella vaccine has also been
prepared to protect occupationally exposed
workers.
• Several purified vaccines are under
development.
Other Rickettsial Infections
• 1.Epidemic Typhus
• Epidemic or louse borne typhus was in the past the most formidable disease caused by
rickettsiae.
• It was the cause of devastating epidemics among military and refugee populations and
in areas affected by famine.
• The advent of modern insecticides has considerably reduced the prevalence of
epidemic typhus today.
• No cases of this disease have been reported from South East Asia since 1978 or from
the Western Pacific since 1969.
• It is till endemic in Africa and South America. All of them are known endemic areas of
the disease.
• The infection is transmitted from man to man by the infected louse
(P.corporis and P.capitis)

• The louse gets infected by feeding on an infectious patient during the

febrile stage.

• The organisms multiply in the cells lining the intestinal tract of the louse
and begin to appear in 3 to 5 days in the louse faeces.
• Man acquires the disease not by the bite of the louse, but
• (i) by scratching and inoculating himself with the infected louse faeces.
• (ii) by crushing an infected louse on this person.
• (iii) possibly by inhalation of infected louse faeces or dust.
• The infected louse after 10 – 14 days of existence dies of the infection.
• In humans, the organism can persist for many years as latent infection
without any symptoms, and the disease may appear later as Brill-Zinsser
disease, and can be transmitted to other humans by the louse.
• The control measures comprise anti-louse measures and improvements in
personal hygiene and living conditions.
• Under the International Health Regulations, louse borne typhus is subject
to international surveillance.
• 2.Rickettsial Pox
• Man gets the infection through the bite of certain infected mites, which
are found on mice (Mus musculus).
• Transovarial transmission occurs in the mite.
• The mouse acts as true reservoir as well as vector.
• Rickettsial pox may be confused with atypical cases of chickenpox.

• 3.Trench fever
• This disease is limited to Central Europe.
• The vector is louse and the disease is transmitted by louse faeces.
• Man is the only known reservoir.