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Micro - Rickettsiae, Coxiella Burnetti, Mycoplasma (Rickettsiae…

- - - - doesn't appear til several days after symptom onset
  - - - rickettsia prowezekii
      - in Africa, S America, East USA, Mexico, Asia, continental Europe
      - transmitted by human lice
      - rash 100% of time
      - if untxed 20-50% mortality
    - - rickettsia typhi
      - worldwide
      - transmitted by rat/cat/mice fleas
      - rash 80% of time
    - - orientia
      - eschar (necrotic skin lesion) @ site of bite
  - - - no longer used
      - patient serum + proteus mirabilis antigens
      - cross-reactive anti-rickettsial Igs
      - agglutination
- - - - asymptomatic in 50%
      - ILI, atypical pneumonia, hep
      - progresses to chronic in 1-5% of infected people
        
        more likely if pregnant, immunosupressed or have valvular/vasc disease
      - when pregnant increases risk of IU death, growth retardation, premature delivery
    - - culture -ve endocarditis (most common presentation)
        
        listen for mitral murmer
      - osteomyelitis
      - vasc graft rejection
    - - serology
      - NAAT most commonly
      - culture (but biosafety level 3)
    - - doxycycline if acute
      - if chronic doxycycline + rifampicin for long duration
- - - - haemolysis (rarely clinically significant)
      - SJS (exfoliative rash)
      - carditis
      - encephalitis (esp in kids)
  - - - chorioamnionitis
      - PID possibly
      - occasionally non-GUT manifestations
    - - chorioamnionitis
      - postpartum + postabortum fever
      - in neonates: pneumonia, bacteraemia, abscesses