101 Questions
Which tick-borne rickettsial disease is caused by R. japonica and located along the coast of southwestern and central Japan and in northeastern Thailand?
Japanese or Oriental Spotted Fever
What causes epidemic typhus?
Rickettsia prowazekii
Which disease is caused by the bacterium Rickettsia akari and transmitted to humans by mites?
Rickettsialpox
What is the recommended doxycycline dose for children with suspected epidemic typhus?
100-mg single dose
Which disease is characterized by a rash that is frequently purpuric, with eschar rarely found?
Indian tick typhus
What is the primary cause of rickettsialpox?
House mouse mite
What is the causative agent of murine typhus?
Rickettsia typhi
Which group of bacteria causes tick-borne rickettsioses?
Spotted fever group of Rickettsia
What is the primary mode of transmission of rickettsialpox?
Mite bites
Which type of rickettsia causes Astrakhan fever?
R. conorii caspia
Which tick-borne rickettsial disease occurs primarily in Australia and may also occur in Thailand, Sri Lanka, and Italy?
Flinders Islands Spotted Fever
Which tick vectors are associated with Astrakhan fever?
Rh. sanguineus, Rhipicephalus pumilio
Which disease has been reported in several countries including the USA, Ukraine, Croatia, South Korea, Turkey, and The Netherlands?
Rickettsialpox
What is the recommended drug for treating tick-borne rickettsioses?
Doxycycline
What are the typical symptoms of rickettsialpox?
Fever, headache, and rash
What is the distinguishing feature of Indian tick typhus?
Purpuric rash
What is the risk of teeth staining associated with a single dose or short course of doxycycline in young children?
Low risk
What type of infestation is most commonly associated with rickettsialpox?
House mouse infestation
How are humans infected with murine typhus?
Through inoculation of infective rats' flea feces into the flea bite site
What is the mode of transmission for epidemic typhus?
Body lice bites
Is there any particular clinical or epidemiologic feature that distinguishes epidemic typhus in children from that in adults?
No, there is no distinct feature
What are the typical symptoms of rickettsialpox?
Fever, rash, and eschars
What is the mortality rate of spotted fever group with inoculation eschar?
2.5%
How is rickettsialpox transmitted to humans?
By the bite of the house mouse mite
Are there any commercially available vaccines for tick-borne rickettsioses?
No
In which areas is murine typhus widely distributed?
Tropical and sub-tropical areas
Who is most commonly affected by epidemic typhus?
Impoverished or displaced people in cold-weather conditions
Which tick-borne rickettsial disease is caused by R. heilongjiangensis and mostly affects older populations in far-eastern territories of Russia and northern China?
Far-Eastern Tick-Borne Rickettsiosis
Which disease is mainly found in Sub-Saharan Africa and the West Indies?
African Tick-Bite Fever
Which type of rickettsia causes Israeli spotted fever?
R. conorii israelensis
What are the symptoms of Siberian tick typhus?
High fever, headache, myalgia, arthralgia, and an inoculation eschar
Which tick-borne rickettsial disease is caused by R. australis and occurs only down the east coast of Australia?
Queensland Tick Typhus
Which tick vectors are associated with SENLAT?
Dermacentor marginatus, Dermacentor reticulatus
What are the primary reservoirs of R. typhi?
Commensal rats, mainly Rattus rattus and R. norvegicus
Which disease is characterized by a single eschar (95%) at the site of inoculation, as well as a rash with any type of lesion (46%), including maculopapules (24%) and vesiculopustules (21%)?
African Tick-Bite Fever
Which of the following is NOT a common symptom of rickettsialpox?
Nausea
What are the symptoms of epidemic typhus?
Fever, headache, myalgia, rash, vasculitis, and gangrene of extremities
What is the therapy of choice for rickettsialpox?
Doxycycline
How is rickettsialpox diagnosed?
By serology
Where can tick-borne rickettsioses be found?
Globally
Which drug is recommended as the therapy of choice for rickettsialpox?
Doxycycline
What is the best tool for isolating intracellular bacteria in tick-borne rickettsioses?
Shell vial culture
Which type of rickettsia causes Lymphangitis-associated rickettsiosis?
R. sibirica mongolitimonae
What are the main vectors of R. typhi?
Rat flea or cat flea
Which disease has been reported in several countries including the USA, Argentina, Uruguay, and Brazil?
Rickettsia parkeri Rickettsiosis
How is epidemic typhus diagnosed?
Based on both clinical suspicion and serology
Which disease is characterized by a typical scalp eschar with cervical lymphadenopathy, as well as alopecia and chronic fatigue?
SENLAT
Which disease is characterized by a single eschar (74%) at the site of inoculation, as well as a rash with any type of lesion (84%), including maculopapules (79%) and vesiculopustules (62%)?
Queensland Tick Typhus
What is the recommended treatment for epidemic typhus?
A short course of doxycycline
What are the common symptoms of murine typhus?
Fever, headache, and rash
Which disease is caused by Rickettsia and has been reported in central Europe and central and southern Africa?
Mediterranean Spotted Fever
What is African tick-bite fever caused by?
R. africae
Which of the following is an effective antibiotic for rickettsiosis?
Doxycycline
What is the reservoir host of Rickettsia akari?
House mouse
What is the most likely reservoir host of R. akari?
House mice
Which disease occurs predominantly in rural settings during spring and summer months and is generally associated with a rash (100%), eschar (77%), and lymphadenopathy?
Siberian tick typhus
What is the tick vector associated with R. sibirica sibirica?
Dermacentor nuttalli, Dermacentor marginatus, Dermacentor silvarum, Haemaphysalis concinna
Is severe disease common in rickettsialpox?
No
Which disease is mainly found in Australia?
Queensland Tick Typhus
What is Brill-Zinsser disease?
A relapse of the disease that can occur years after initial infection
Who is at risk of developing complications from murine typhus?
Elderly patients and those with glucose-6-phosphate dehydrogenase deficiency
Which antibiotic is recommended for early empirical treatment of tick-borne rickettsioses before laboratory confirmation of the diagnosis?
Doxycycline
What are the common symptoms of African tick-bite fever?
Fever, nausea, headache, and neck myalgias
How soon after the appearance of the eschar do patients typically develop symptoms of rickettsialpox?
Within 2 to 7 days
What is the hallmark of Mediterranean Spotted Fever?
A rash
Which disease is caused by the bacterium Orientia tsutsugamushi and transmitted to humans by mites?
Scrub Typhus
What percentage of patients with African tick-bite fever have multiple eschars?
Up to 54%
Is there a vaccine available for rickettsialpox?
No
What percentage of Mediterranean Spotted Fever cases are associated with severe disease?
5% to 6%
Which disease presents with a classic single eschar and a maculopapular, generalized rash (97%)?
Spotted fever group with inoculation eschar
How is rickettsialpox typically diagnosed?
By serology
How is murine typhus diagnosed?
Based on laboratory diagnostic assays
Which antibiotic can be used as an alternative to doxycycline in children and pregnant women?
Macrolides
Where in the world can epidemic typhus occur?
Potentially worldwide
What causes the emergence and re-emergence of tick-borne rickettsioses?
Changes in environment and human behavior
Which of the following is NOT a recommended treatment for rickettsialpox?
Vancomycin
Which tick-borne rickettsial disease is caused by R. philipi and has been reported in California, mostly in children?
Pacific Coast Tick Fever
What are the treatment options for murine typhus?
Doxycycline and fluoroquinolones (Chloramphenicol is technically an option)
What is a common symptom of African tick-bite fever?
Generalized rash
How can epidemic typhus be controlled?
De-lousing both individuals and populations and providing hygienic conditions
Which disease is similar to Mediterranean spotted fever, but with less frequent eschars?
Israeli spotted fever
Which disease is characterized by a single eschar (46%) at the site of inoculation, as well as a rash with any type of lesion (34%), including maculopapules (34%) and vesiculopustules (not reported)?
Scrub Typhus
What is the best way to prevent rickettsialpox?
Controlling house mice and using acaricides
Which of the following is not a possible sample for diagnosis of rickettsiosis?
Urine
What are some possible differential diagnoses for epidemic typhus?
Typhoid, murine typhus, other rickettsioses, malaria, and hemorrhagic fevers
What are the rare complications of African tick-bite fever?
Long-lasting fever, reactive arthritis, and neuropsychiatric symptoms
What is the alternative therapy for rickettsialpox if doxycycline cannot be used?
Chloramphenicol
How can infection with murine typhus be effectively prevented?
Through flea and rodent control measures
When were vaccines against epidemic typhus first developed?
1920
What is the incubation period of murine typhus?
1-2 weeks
Which type of rickettsia causes Indian tick typhus?
R. conorii indica
In which countries has rickettsialpox been reported?
USA, Ukraine, Croatia, South Korea, Turkey, and The Netherlands
Which group of animals do ticks parasitize?
Vertebrates
Which of the following is not recommended for tick-bite prophylaxis?
Antibiotic prophylaxis
Are there vaccines available for epidemic typhus?
No, there are no vaccines available
Where do most cases of rickettsialpox originate?
Urban settings
What is the reported case fatality rate for rickettsialpox?
0%
Can murine typhus be transmitted from person to person?
No, it can only be transmitted through flea bites
What is the characteristic clinical presentation of rickettsialpox?
Fever, eschars, and rash
How does Mediterranean Spotted Fever cause severe disease?
Disseminated vasculitis
How long can the incubation period for epidemic typhus be?
2-3 weeks
Study Notes
- Epidemic typhus is caused by Rickettsia prowazekii and is transmitted by body lice.
- It mainly affects impoverished or displaced people in cold-weather conditions.
- Symptoms include fever, headache, myalgia, rash, vasculitis, and gangrene of extremities.
- Diagnosis is usually based on clinical suspicion and serology is available.
- Treatment involves a single 200-mg dose or short course of doxycycline.
- Brill-Zinsser disease is a relapse of the disease that can occur years after initial infection.
- Epidemic typhus has a potentially worldwide distribution and outbreaks have been reported in different regions of the world.
- Control efforts should focus on de-lousing both individuals and populations and providing hygienic conditions.
- Differential diagnosis includes typhoid, murine typhus, other rickettsioses, malaria, and hemorrhagic fevers.
- Vaccines against epidemic typhus have existed since 1920, but there is currently no commercially available vaccine.
Test your knowledge on epidemic typhus, a disease caused by Rickettsia prowazekii and transmitted by body lice. This quiz covers its symptoms, diagnosis, treatment, and control, as well as differential diagnosis and potential worldwide distribution. Learn about the importance of de-lousing and providing hygienic conditions to prevent outbreaks. See if you know about Brill-Zinsser disease, a relapse of the disease that can occur years after initial infection, and vaccines against epidemic ty
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