1. The disease and Panbio product training
Rickettsia
The disease and Panbio product training

2. Infectious Agent Rickettsia sp.
Gram-negative coccoid or rod-shaped bacteria
Obligate intracellular bacteria with an ability to grow in a variety of eukaryotic cells
Do not survive well outside their host environment
Different species cause different diseases

3. Infectious Agent cont...
The Rickettsia are subdivided into three groups of species according to the type of clinical disease they cause:
Typhus Group
Spotted fever Group
Scrub typhus Group
They are further subdivided according to host and arthropod vector.

4. Infectious Agent cont... Spotted Fever Group Typhus Group
R. australis
R. rickettsii (Rocky Mountain spotter fever)
R. conorii (Mediterranean spotted fever)
R. sibirica
Typhus Group
R. prowazekii (Louse-borne typhus)
R. typhi (Murine typhus)
Scrub Typhus Group
Orientia tsutsugamushi

5. Epidemiology Occurrence worldwide Mode of Transmission
Epidemic and endemic regions
Mode of Transmission
Ticks, mites, and fleas

6. Distribution: Spotted fever group

7. Distribution: Typhus group

8. Distribution: Scrub typhus group

9. Clinical: Scrub Typhus
Clinical manifestations:
fever
headache
raised ulcer (eschar)
rash (later in illness)
myalgia
lymphadenopathy
Eschar

10. Clinical: Scrub Typhus
Mortality rates 60% in untreated virulent strains
23% of all fever in endemic regions of Asia
Antigenic diversity of strains exists within this group
Vector - larval trombiculid mites (chiggers)
Host - native rat species
Incubation - 7 to 14 days
Chigger infected foot

11. Clinical: Spotted Fever
Vector - predominantly tick borne
Host - rats, bandicoots
Incubation - 5 to 7 days
Common protein antigens with Typhus
Benign course of infection common, mortality rate of 35% for RMSF
Reactivation may occur

12. Clinical: Typhus Group
R. prowazekii
Vector - body louse
Incubation - 8 to 12 days
Brill-Zinsser typhus (reactivation)

13. Clinical: Typhus Group
R. typhi (Murine/endemic typhus)
R. typhi also known as R. mooseri
Vector - oriental rat flea
Self-inoculation, flea faeces & bites
Non-specific clinical manifestations
Low mortality rate

14. Life cycle of Rocky Mountain spotted fever, rickettsial pox and murine typhus.
A. Life cycle of Rickettsia rickettsii in its tick and mammalian hosts.
B. Rickettsia akari life cycle.
C. Rickettsia typhi life cycle.
Azad A.F. & C.B. Beard (1998) Rickettsial Pathogens and Their Arthropod Vectors. Emerg. Infect. Dis.4:

15. Area where murine typhus is a risk
Areas in which murine typhus poses a risk according to seroepidemiologic studies, case series, or
imported cases in traveller.
Parola, P. (1998) Murine typhus in travelers returning from
Indonesia. Emerg. Infect. Dis. 4:

16. Clinical notes Prevention Treatment
Use of mite repellents to exposed skin surfaces
Elimination of mites from populated areas
Doxycycline has been found to be an effective preventative measure in a small Malaysian trial
An effective vaccine is yet to be developed
Treatment
Doxycycline

17. Antibody response
Antibody levels may be low or absent during early infection.
Antibody response may be delayed or eliminated in some patients being treated with antibiotics.
Elevated or rising IgM and/or IgG antibodies indicate recent or active infection.
Infection results in prolonged immunity to homologous strain.
During a period of months after primary infection, infection with heterologous strain will result in mild disease.

18. Diagnosis Weil Felix Dot blot EIA (Dip-S-Ticks from Panbio)
OX-19 (Typhus)
OX-K strain Proteus mirabilis (Scrub Typhus)
Dot blot EIA (Dip-S-Ticks from Panbio)
IFA (Gold Standard)
Agglutination based assays
indirect haemagglutination (IHA)
latex agglutination (LA)
ELISA

19. Weil Felix Non-specific test that uses various Proteus spp.
Test based on presence of common antigens in both the Rickettsia and Proteus spp.
Lacks both sensitivity and specificity & should no longer be used as better methods available
Leptospirosis and some other febrile illnesses may cause a positive Weil-Felix reaction
Re-infection does not always lead to a rise in Weil-Felix agglutinins

20. Agglutination-based assays
Indirect haemagglutination (IHA) & latex agglutination (LA)
Detect antibodies to Spotted fever and Typhus group.
Uses solubilised antigen from purified rickettsiae absorbed onto untreated red blood cells.
Detects IgG and IgM

21. Panbio Dip-S-TickTM Panbio Dipsticks (Dot EIA) for: Principle:-
R. typhi (Murine typhus) Total IgG
R. rickettsii (RMSF) Total IgG
R. conorii Total IgG
Principle:-
specific antibodies if present in patient’s serum bind to the antigen spotted on membrane
reaction visualised by addition of alkaline phosphatase-conjugated anti-human antibodies which is then reacts with enzyme substrate reagent to form a spot.

22. Panbio IFA Excellent sensitivity & specificity
Panbio has IFA slides for the following:-
Typhus group
Murine Typhus (R. typhi)
Louse-borne typhus (R. prowazekii)
Scrub Typhus Group
Scrub Typhus (O. tsutsugamushi)
Spotted Fever Group
Rocky Mountain Spotted Fever (R. rickettsii)
Mediterranean Spotted Fever (R. conorii)

23. Panbio IFA

24. Panbio Rickettsial ELISA kits
Scrub Typhus Group IgG Cat # E-RST01G
Scrub Typhus Group IgM Cat # E-RST01M
Fast hours total assay time
Spotted Fever Group IgG Cat # E-RSF01G
Spotted Fever Group IgM Cat # E-RSF01M

25. Ordering information

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