- Mycoplasma and Ureaplasma - Rickettsia · Morphology and Physiology • Smallest free-living...
Transcript of - Mycoplasma and Ureaplasma - Rickettsia · Morphology and Physiology • Smallest free-living...
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- Mycoplasma and Ureaplasma
- Rickettsia
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Mycoplasma and Ureaplasma
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Family: Mycoplasmataceae
• Genus: Mycoplasma
– Species: M. pneumoniae
– Species: M. hominis
– Species: M. genitalium
• Genus: Ureaplasma
– Species: U. urealyticum
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Morphology and Physiology
• Smallest free-living bacteria (0.2 - 0.8 µm)
– Require complex media for growth, PPL4.
• Facultative anaerobes
– Except M. pneumoniae - strict aerobe
• Lack a cell wall?
• Part of Normal flora
• Cytoplasmic and cell membrane rich in
cholesterol and GLYCOLIPIDS
• P1 antigen? Binds to RBCs I antigen
• Fried egg” colonies
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“Fried Egg” Colonies of Mycoplasmas
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Pathogenesis - Mycoplasma
• Adherence
– P1 pili (M. pneumoniae)
– Movement of cilia ceases
– Clearance mechanism stops
resulting in cough
– glycolipids
• Glycolipids: Brain cells cross
antigenicity
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Organism Disease
M. pneumoniae Upper respiratory tract disease,tracheobronchitis, atypicalpneumonia, (chronic asthma??)
M. hominis Pyleonephritis, pelvicinflammatory disease,postpartum fever
M. genitalium Nongonococcal urethritis
U. urealyticum Nongonococcal urethritis,(pneumonia and chronic lungdisease in premature infants??)
Diseases Caused by Mycoplasma
N.B. Other organisms infect humans but their disease association is not known.
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Mycoplasma pneumoniae
• Tracheobronchitis
• Atypical pneumonia (walking pneumonia)
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Epidemiology - M. pneumoniae
• Occurs worldwide
• No seasonal
variation
– Proportionally
higher in summer
and fall
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Clinical Syndrome - M. pneumoniae
• Incubation - 2-3 weeks
• Fever, headache and malaise
• Persistent non-productive cough
• Respiratory symptoms
– Radiological signs precede symptoms
• Slow resolution
• Rarely fatal
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Laboratory Diagnosis - M. pneumoniae
• Microscopy
– Difficult to stain
– Can help eliminate other organisms
• Culture (definitive diagnosis)
• May take 2-3 weeks
• Serology
• PCR
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Treatment and Prevention
M. pneumoniae
• Treatment
– Tetracycline or erythromycin
• Newer fluoroquinolones
– Can’t use cell wall synthesis inhibitors
• Prevention
– Avoid close contact
– No vaccine
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Rickettsia and Orientia
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• Small obligate intracellular parasites
• Once considered to be viruses
• Gram-negative bacteria
– Stain poorly with Gram stain (Giemsa)
• Reservoirs - animals, insects and humans
• Arthropod vectors
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Disease Organism Vector Reservoir
Rocky Mountain R. rickettsii Tick Ticks, rodents
spotted fever
Scrub typhus O. tsutsugamushi Mite Mites, rodents
Epidemic typhus R. prowazekii Louse Humans,
squirrel
fleas,
Murine typhus R. thypi Flea Rodents
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Rickettsia and Orientia
N.B. Orientia was formerly Rickettsia
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Replication of Rickettsia and Orientia
• Infect endothelial in small blood vessels - Induced phagocytosis
• Lysis of phagosome and entry into cytoplasm - Phospholipase
• Replication
• Release
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Spotted Fever Group
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Rickettsia rickettsii
• spotted fever
Vector – Tick قرادFluorescent Ab staining
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Clinical Syndrome - Rocky
Mountain Spotted Fever
• Incubation period - 2 to 12 days
• Abrupt onset fever, chills, headache and myalgia
• Rash appears 2 -3 days later in most (90%) patients
– Begins on hands and feet and spreads to trunk (centripetal
spread)
– Palms and soles common
– Maculopapular but can become petechial or hemorrhagic
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Rash of Rocky Mountain Spotted Fever
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Clinical Syndrome - Rocky
Mountain Spotted Fever
• Complications from widespread vasculitis
– Gastrointestinal, respiratory, seizures, coma, renal failure
– Most common when rash does not appear
• Mortality in untreated cases - 20%
• Incubation period - 2 to 12 days
• Abrupt onset fever, chills headache and myalgia
• Rash appears 2 -3 days later in most (90%) patients
– Begins on hands and feet and spreads to trunk (centripetal
spread)
– Palms and soles common
– Maculopapular but can become petechial or hemorrhagic
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Laboratory Diagnosis - R. rickettsii
• Initial diagnosis - clinical grounds
• Fluorescent Ab test for Ag in punch biopsy
- reference labs
• PCR based tests - reference labs
• Serology
– Indirect fluorescent Ab test for Ab
– Latex agglutination test for Ab
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Treatment, Prevention and Control
R. rickettsii
• Tetracycline
– Prompt treatment reduces morbidity and
mortality
• No vaccine
• Prevention of tick bites (protective clothing,
insect repellents)
• Prompt removal of ticks
• Can’t control the reservoir
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Typhus Group
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Rickettsia prowazekii
• Epidemic typhus
• Brill-Zinsser disease
Fluorescent-Ab staining Vector - Louse
From: G. Wistreich, Microbiology
Perspectives, Prentice Hall
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Clinical Syndrome - Epidemic typhus
• Incubation period approximately 1 week
• Sudden onset of fever, chills, headache and myalgia
• After 1 week rash
– Maculopapular progressing to petechial or hemorrhagic
– First on trunk and spreads to extremities (centrifugal
spread)
• Complications
– Myocarditis, stupor, delirium (Greek “typhos” = smoke)
• Recovery may take months
• Mortality rate can be high (60-70%)
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Laboratory Diagnosis - R. prowazekii
• Isolation possible but dangerous
• Serology
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Treatment, prevention and Control
R. prowazekii
• Tetracycline
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Rickettsia typhi
• Murine or endemic typhus
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Epidemiology - R. typhiMurine or endemic typhus
• Occurs worldwide
• Vector - rat flea برغوث
– Bacteria in feces
• Reservoir - rats
– No transovarian transmission
– Normal cycle - rat to flea to rat
• Humans accidentally infected
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Flea
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Clinical Syndrome- Murine Typhus
• Incubation period 1 - 2 weeks
• Sudden onset of fever, chills, headache and
myalgia
• Rash in most cases
– Begins on trunk and spreads to extremities
(centrifugal spread)
• Mild disease - resolves even if untreated
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Laboratory Diagnosis - R. typhi
• Serology
– Indirect fluorescent antibody test
– Treatment: doxycycline
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