Milder than Rocky Mountain spotted fever. Primary cutaneous lesion or eschar at the site

BOUTONNEUSE FIEVRE - Milder than Rocky Mountain spotted fever. Primary cutaneous lesion or eschar at the site of tick bite Regional lymphadenopathy in glands draining the eschar. Maculopapular rash. Fever subsides by lysis in 2nd week RICKETTSIALPOX - caused by R akari, transmitted to man by blood-sucking mite. Fever, eschar and papulovesicular eruption Recovery in 1-2 weeks without sequelae. Diag. - Serology: MIF Rickettsia of the spotted fever group are antigenitically cross-reactive and the same antigen may be used to detect all species. A titre of 128 is diagnostic. Tr. - Doxycycline 200 mg/day, for 1-7 days depending on severity. Q-fever - Casual organism coxiella burnetti. Transmission - is directly from infected animals (goats, sheep or cats). Common route of human infection is inhalation of infected dust or aerosol, however consumption of contaminated milk products from sheep and goats and handling of meat are risk factors. Cl.Fs. - Infection may be asymptomatic, chronic or acute. Incubation period - 2-4 weeks Two major types of acute disease are pneumonia and purely febrile form Other presentations include meningitis, meningoencephalitis, exanthema, myocarditis, pericarditis and jaundice. Complete recovery may take months Chronic - Fever is characterised mainly by blood-culture negative endocarditis Diag - (a) MIF test. (b) Complement fixation - Single tit re of 1:64.Tr. - Doxycyline, rifampicin or ofloxacin for 3 weeks. Immunization - Vaccine consisting of a killed suspension of Rickettsia prowazeki cultured in yolk sac.Course of two injections of 1 ml. each at 7-10 day intervals Immunity relative, lasting for 6-8 months Booster injection of 0.5 ml.every year 10 RABIES Definition - Rabies is an infective disease caused by RNA-containing virus of the Rhabdoviridae family. It is primarily a zoonosis but is occasionally transmitted to man by animal bites, resulting in an encephalomyelitis which is nearly always fatal. Epidemiology - VIRUS - RNA neurotropic virus, genus Lyssavirus.TRANSMISSION -The virus can penetrate broken skin and intact mucous membranes (a) Animal bites - (i) Occurring in wild life and maintained by mammals such as wolves, mongooses, accoons, foxes and jackals, and by bats. (ii) Urban type - in which the dog mainly is responsible though during epidemics other domestic animals such as the cat and cattle may be infected. (b) Inhalation - extremely rare.Visiting caves inhabited by insectivorous bats, or following laboratory accidents with aerosols of fixed virus. (c) Person-to-person - transmission - by corneal grafts. Clinical features - Incubation period -varies from 20 days to 90 days in majority. Varies with - (i) Age - shorter in children (ii) Site of infection - Face about 30 days, hands 40 days, legs 60 days. (iii) Severity of wound. (iv) Animal - shorter period in order - wolf, cat, dog. Prodromal symptoms - Pain and irritation or discomfort at site of bite, fear and anxiety, depression, intolerance to loud sounds Periods of irritability Hoarseness of voice and sense of constriction in throat with difficulty in swallowing.Slight rise of temperature Duration 1 -2 days Subsequently, symptoms of either furious or paralytic rabies develop, depending on whether the spinal cord or brain are predominantly infected Furious rabies - (a) Hydrophobia - a combination of inspirator/ muscle spasm, with or without painful laryngopharyngeal spasm, associated with terror in response to attempts to drink water. Various other stimuli can excite the reaction, including a draught of cold air (aerophobia), and the sight, sound or mere mention of water. Hydrophobic spasms may end in opisthotonos and generalised convulsions with death from respiratory or cardiac arrest. (b) Periods of excitement - are common during which the patient becomes wild and hallucinated alternating with lucid intervals. (c) Other features - include meningism, cranial nerve lesions (especially III, VII, VIII), spasticity, involuntary movements, fluctuating body temperature and blood pressure, signs of autonomic overactivity such as salivation, sweating and tachycardia. Priapism Death may occur during hydrophobic spasm or patient, may lapse into coma and generalised flaccid paralysis. Paralytic rabies - is rare and seen especially in those bitten by vampire bats. Flaccid paralysis often begins in the bitten limb and ascends symmetrically or asymmetrically until it involves muscles of deglutition and respiration killing the patient in 2 or 3 days. Hydrophobia is unusual but a few spasms may occur late in the illness Laboratory Diagnosis - In the animal - responsible for the bite, rabies can be confirmed within a few hours by immunofluorescence of brain impression smears or histological examination for Negri bodies, and in about one week by intracerebral inoculation of mice with a suspension of the animal's brain tissue. In patients - Rabies can be confirmed early in the illness by immunofluorescence of skin biopsy, or corneal impression smear or brain biopsy and by virus isolation from saliva and other secretions. Fluorescent antibodies are not detectable in serum or CSF before the eight day. Management Aim is to neutralise the inoculated virus before it can enter the nervous system 1. Treatment of wound - (a) Scrub with soap (or detergent) and water under a running tap for atleast 5 minutes. (b) Remove foreign material. (c) Rinse with plain water (d) Irrigate with