• Clinical science

Collection of zoonotic diseases

Summary

Zoonotic diseases are infections that are transmitted from animals to humans. While animals may transmit infection directly, they usually serve as hosts for a pathogen that is then transmitted to humans by a vector (e.g., ticks, fleas). Zoonoses are usually endemic to certain geographical regions, and peaks in incidence often correlate with the life cycle of the transmitting vector. Common diseases include Q fever, Rocky mountain spotted fever, endemic typhus, ehrlichiosis, and babesiosis. Although these conditions differ in their exact presentation, symptomatic cases typically present with fever, flulike symptoms, and possibly skin rashes. In some cases of fulminant disease, there may be complications such as disseminated intravascular coagulation, shock, and organ failure. Most zoonoses are treated with antibiotics and respond well to treatment.

Q fever

  • Definition: notifiable zoonotic disease with cattle, sheep, and goats as the primary reservoir
  • Pathogen: Coxiella burnetii (gram-negative, intracellular)
  • Epidemiology
    • Worldwide occurrence
    • 160–170 cases of acute Q fever per year in the US
    • 70% of cases occur in men
    • Peak incidence from April to June
  • Route of transmission
    • Inhalation of aerosols from the secretions of infected livestock or animals about to give birth
    • Ingestion of raw milk produced by infected animals
  • Risk groups: slaughterhouse workers, farmers, shepherds, veterinarians
  • Pathophysiology: development of antigens
    • Phase I antigens: seen when C. burnetii is highly infectious
    • Phase II antigens: seen when C. burnetii is less infectious
Type of Q fever Acute Q fever Chronic Q fever
Incubation period
  • 2–6 weeks
  • Months to years
Clinical features
  • Only develops in 1–5% of individuals
  • Low-grade fever
  • Culture-negative endocarditis
  • Culture-negative osteomyelitis
Diagnostics Serology via IFA (best initial test)
  • Anti-phase II antibody IgG titers ≥ 200 and IgM titers ≥ 50
  • In cases of negative IFA but high clinical suspicion, perform PCR on serum or tissue samples before administering antibiotics.
  • Anti-phase I antibody IgG titers > 800 or persistently high levels of anti-phase I antibody 6 months after completing therapy
Additional findings
Treatment
Prevention
  • Avoid consuming unpasteurized milk products

References:[1][2][3][4][5]

Rocky Mountain spotted fever (RMSF)

  • Pathogen: Rickettsia rickettsii; (aerobic, gram-negative, obligate intracellular bacteria )
  • Epidemiology: Rocky mountains, southeastern, and south central US
  • Reservoir: dogs, rodents, ticks
  • Route of transmission: bite of Dermacentor variabilis (dog tick)
  • Clinical features (incubation period ∼ 7 days, or 2–12 days)
    • Fever, headache, myalgia, malaise, conjunctivitis, nausea, and abdominal pain
    • Blanching macular rash; (90% of cases): begins on wrists and ankles → spreads to trunk, palms, and soles → becomes petechial and/or hemorrhagic in 50% of cases
    • Hepatomegaly, splenomegaly
    • Noncardiogenic pulmonary edema with ARDS
  • Diagnosis: empiric diagnosis based on clinical and epidemiological features
  • Treatment: doxycycline

References:[6][7][8][9]

Typhus

Endemic typhus (also known as murine typhus)

  • Definition: An exanthematous typhus fever caused by Rickettsia typhi
  • Etiology: Rickettsia typhi
  • Transmission: : via vector: rat and cat fleas
  • Epidemiology: occurs worldwide, mainly warm coastal regions, southern US
  • Clinical features
    • Incubation period: 8–16 days
    • Fever, severe headache, malaise
    • Maculopapular or petechial rash; erupts on the trunk → spreads to extremities
    • No eschar (scab at site of flea bite)
  • Diagnosis
    • Serology (four-fold rise in antibodies)
    • Positive Weil-Felix reaction
  • Treatment: doxycycline, chloramphenicol

References:[1][10][11]

Ehrlichiosis

  • Pathogen: Ehrlichia; chaffeensis, Ehrlichia ewingii (intracellular, gram-negative bacteria)
  • Epidemiology: southeastern and south central US, mid-Atlantic States
  • Reservoir: white tail deer
  • Route of transmission: bite of the lone star tick; (Amblyomma americanum) → infection of monocytes and macrophages
  • Clinical infection (incubation period of 1–2 weeks)
    • Fever, headaches, malaise, myalgias
    • Similar to RMSF, but usually without a rash (“spotless” RMSF)
    • Possibly neurologic symptoms (altered mental status, stiff neck, clonus)
    • May cause renal failure and GI bleeding
  • Diagnosis
    • Leukopenia, thrombocytopenia, elevated serum transaminases
    • Wright-Giemsa stain of blood smear: detection of morulae inside the infected monocytes
    • Serology via IFA: IgG Ehrlichia titer
  • Treatment: PO doxycycline or tetracycline

References:[12]

Babesiosis


References:[13][14][15]

Plague

References:[16][17]