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7. Bacterial diseases
Eruptive rickettsioses
E rup tive fevers caused by bacteria o f the genus Rickettsia and transm itted to m an by an
arthro p o d vecto r. T hree m ain gro up s are d istinguished : ty p hus gro up , sp o tted fever
gro up
and scrub ty p hus gro up .
Clinical features: see next p age
Laboratory
D etectio n o f sp ecific IgM o f each gro up by ind irect im m uno fluo rescence. T he
d iagno sis is
co nfirm ed by 2 sero lo gical tests at an interval o f 1 0 d ay s. In p ractice, clinical signs and
the
ep id em io lo gical co ntext are sufficient to suggest the d iagno sis and start treatm ent.
Treatment
– S y m p to m atic treatm ent:
• H y d ratio n (P O o r IV if the p atient is unable to d rink )
– Ad•oFixnnyetdcivbyiecicoral:itntehepdeaPrradacpOueetyatm(oeofoxlthcPree7pOristdkian(syoceshef iohldFarereuevmnnetrui,lon2pdrradehgraae8gye2s.y6aef)ta.erArstahcneedtfyepvlserarelihgcanysalincdtiaoscairpdbpr(eaasepsatr-eirfdiene:)disincgo ntra -
17
wo m en):
C hild ren o ver 8 y ears: 1 0 0 to 2 0 0 m g o nce d aily o r in 2 d ivid ed d o ses
A d ults: 2 0 0 m g o nce d aily o r in 2 d ivid ed d o ses
o r chloramphenicol P O (excep t in p regnant o r breast-feed ing wo m en)
jCAosahdmiuldyltcrsien:n2P: 5gO0/ dt:oa3y7gin5/ 3dmadygiv/iindk3egd/dddivoaidyseeidns d3 odsiveisd feodr d8odsaeyss
– In p regnant o r breast-feed ing wo m en:
2
Note: d o xy cy cline is usually co ntraind icated in child ren und er 8 y ears and in p regnant o r
– In a co ntext o f epidemic typhus, doxycycline P O 2 0 0 m g as a single d o se is the cho ice
treatm ent, but there is a risk o f recurrence.
breast-feed ing wo m en. H o wever, the ad m inistratio n o f a single d o se sho uld no t, in
theo ry ,
p ro vo k e ad verse effects. C heck natio nal reco m m end atio ns.
Prevention
– E p id em ic ty p hus: co ntro l o f bo d y lice (p age 1 0 1 ).
– M urine ty p hus: co ntro l o f fleas and then rats.
– S p o tted fevers: avo id tick bites by wearing clo thing and using rep ellents.
– SUnclirkuebbtoyrrpeliohsuess:, uasnetiboiotficretrpeaetmlleennttso,f crhicekemttsiooseps rdooeps hnyotlapxriosvowkietha dJaorxisycchy-cHleinrxehPeimOer r(e2ac0tio0n.m g
o nce
week ly in ad ults).
Only some macrolides can be used. Erythromycin is not effective.
1
However, the geographical distribution of borrelioses and rickettsioses may overlap, and thus a reaction may
occur due to a possible co-infection (see Borrelioses, page 182).
2
Eruptive rickettsioses
E rup tive fevers caused by bacteria o f the genus Rickettsia and transm itted to m an by an
arthro p o d vecto r. T hree m ain gro up s are d istinguished : ty p hus gro up , sp o tted fever
gro up
and scrub ty p hus gro up .
Clinical features: see next p age
Laboratory
D etectio n o f sp ecific IgM o f each gro up by ind irect im m uno fluo rescence. T he
d iagno sis is
co nfirm ed by 2 sero lo gical tests at an interval o f 1 0 d ay s. In p ractice, clinical signs and
the
ep id em io lo gical co ntext are sufficient to suggest the d iagno sis and start treatm ent.
Treatment
– S y m p to m atic treatm ent:
• H y d ratio n (P O o r IV if the p atient is unable to d rink )
– Ad•oFixnnyetdcivbyiecicoral:itntehepdeaPrradacpOueetyatm(oeofoxlthcPree7pOristdkian(syoceshef iohldFarereuevmnnetrui,lon2pdrradehgraae8gye2s.y6aef)ta.erArstahcneedtfyepvlserarelihgcanysalincdtiaoscairpdbpr(eaasepsatr-eirfdiene:)disincgo ntra -
17
wo m en):
C hild ren o ver 8 y ears: 1 0 0 to 2 0 0 m g o nce d aily o r in 2 d ivid ed d o ses
A d ults: 2 0 0 m g o nce d aily o r in 2 d ivid ed d o ses
o r chloramphenicol P O (excep t in p regnant o r breast-feed ing wo m en)
jCAosahdmiuldyltcrsien:n2P: 5gO0/ dt:oa3y7gin5/ 3dmadygiv/iindk3egd/dddivoaidyseeidns d3 odsiveisd feodr d8odsaeyss
– In p regnant o r breast-feed ing wo m en:
2
Note: d o xy cy cline is usually co ntraind icated in child ren und er 8 y ears and in p regnant o r
– In a co ntext o f epidemic typhus, doxycycline P O 2 0 0 m g as a single d o se is the cho ice
treatm ent, but there is a risk o f recurrence.
breast-feed ing wo m en. H o wever, the ad m inistratio n o f a single d o se sho uld no t, in
theo ry ,
p ro vo k e ad verse effects. C heck natio nal reco m m end atio ns.
Prevention
– E p id em ic ty p hus: co ntro l o f bo d y lice (p age 1 0 1 ).
– M urine ty p hus: co ntro l o f fleas and then rats.
– S p o tted fevers: avo id tick bites by wearing clo thing and using rep ellents.
– SUnclirkuebbtoyrrpeliohsuess:, uasnetiboiotficretrpeaetmlleennttso,f crhicekemttsiooseps rdooeps hnyotlapxriosvowkietha dJaorxisycchy-cHleinrxehPeimOer r(e2ac0tio0n.m g
o nce
week ly in ad ults).
Only some macrolides can be used. Erythromycin is not effective.
1
However, the geographical distribution of borrelioses and rickettsioses may overlap, and thus a reaction may
occur due to a possible co-infection (see Borrelioses, page 182).
2
