Thursday, June 30, 2011

SCRUB

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SCRUB TYPUS


Causative Agent


The causative organism of scrub typhus is Rickettsia tsutsugamushi. This is a ploemorphic, gram-negative, bacillus shaped, intracellular parasite. This is a special type of parasite called a protelean parasite because its larvae are parasitic, but the adults are predatory. R. tsutsugamushi does not live very long outside of a hosts cell. However, it can be furthered studied in a laboratory by cultivating it into tissues such as embryonated chicken eggs or vertebrate cell cultures. The usual cycle of the parasite is from an arthropod to a wild animal. Humans can become an accidental host by standing in the way and getting bitten. Scrub typhus is also called tropical typhus because it is mostly found in hot, humid areas that are prone to flooding.


Pathogenicity and Disease Symptoms


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The parasite incubates in the new hosts endothelial cells for about 10-1 days. Soon after, the victim can experience headaches, fever, anorexia and general apathy. The site of the infection is a lesion called a chigger bite. The lesion can enlarge to about 8 to 1 mm and the center become dark due to death of tissue cells. About 5 to 8 days after lesion arrival, a dull red rash may appear all over the body. In the endothelium of the small blood vessels of the mammalian host, particularly in the brain and heart, thrombus formation leads to the obstruction of blood flow and escape of red blood cells into surrounding tissues. This damages the surrounding tissue and the endothelial cells, which result in plasma leakage, decrease in blood volume and shock. These damages also lead to additional symptoms such as enlargement of the spleen, nervous disturbances, delirium and death.


Transmission and Epidemiology


The organism is transmitted to humans through the bite from larval tromiculid mites, a family of mites in the genus Leptotrombidium. R. tsutsugamushi is found throughout the mites body, but mostly in the salivary glands. When these mites feed on humans or rodents, such as rats, R. tsutsugamushi is transmitted to the host. The disease serves as a great threat to the people of Southeastern Asia, north Queensland, Australia, and islands of Indian and southwest Pacific Oceans. The mortality rate can range from 1 to 60 percent if left untreated and 5 percent if treated. The disease is rare in the United States but can be found in the tropical areas, such as the Pacific Islands. Death can occur as a direct result of the disease, or from secondary effects, such as bacterial pneumonia, encephalitis, or circulatory failure. If death does occur, it is rapid, usually by the end of the second week of infection. The most recent outbreak was in the 140s during World War II. At this time, Scrub typhus caused more deaths than malaria in many parts of Asia.


Treatment and Control


The disease is detected with the Weil Felix Serologic test. Serologic tests, test immune function, and are performed using the clear yellow liquid part of the blood. The disease can be treated with antibiotics such as tetracycline, chloramphenical, and doxycycline. Transmission of the disease can be controlled by vaccination. So far, only experimental vaccines had been developed, no commercially licensed vaccines are produced in the United States, also the use of repellents and protective clothing and avoidance of vector-infested habitats. If a person is exposed, prompt detection and removal of arthropods on clothing and skin is important.


Current Research


Recently, Scrub typhus was found to be resistant to certain antibiotics. Researchers began to study the scrub typhus study antibiotics looking for differences in time of fever resolution and incidence of relapse. The trials compared tetracycline against chloramphenicol and tetracycline against doxycycline. Doxycycline and tetracycline trial showed little difference in fever resolution time and no relapses occurred with either drug. As of January 00, researchers came to the conclusion that tetracycline and doxycycline were the most effective in treating Scrub typhus.





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