B.Sc. Nursing -Microbiology questions

MTPG&RIHS

B.Sc. Nursing -Microbiology questions

I. Write short notes on following questions.

II. Write point wise. Minimum ten points for each. Draw diagrams or flow diagrams where ever needed.

III. Select you question as per your roll number.  You can Prepare  type notes(word file) /PPT /  hand written notes. Post your preparation on or before 6th April 2020.

IV. Request to read and study the answers prepared by your classmates.

1.      Contributions of Louis Pasteur

2.      Contributions of Robert Koch

3.      contributions of Joseph Lister

4.      Importance of Microbiology in Nursing

5.      Classification of Microorganisms

6.      Prokaryote and Eukaryotes

7.      Classification of Bacteria

8.      Bacterial cell wall

9.      Bacterial flagella

10.  Bacterial spores

11.  Gram staining

12.  Acid fast staining

13.  Types and uses of microscope

14.  Bacterial growth and multiplication

15.  Cultivation of Bacteria

16.  Culture media

17.  Identification of Bacteria

18.  Bacterial toxins

19.  Hot air oven

20.  Autoclave

21.  Pasteurisation

22.  Sterilisation by filtration

23.  Radiations used for sterilisation

24.  Antimicrobial agents

25.  Drug resistance

26.  Antibiotic sensitivity tests

27.  Universal safety precautions

28.  CSSD

29.  Biomedical waste management

30.  Aseptic Techniques

31.  Nosocomial infections

32.  Sources of Infection

33.  Normal flora

34.  Structure and functions of Antibody

35.  Vaccines and Antisera

36.  Brief account of Antigen -Antibody reactions

37.  ELISA

38.  Immediate Hypersensitivity

39.  Delayed hyper sensitivity

40.  Autoimmune diseases

41.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Tuberculosis

42.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Leprosy

43.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Enteric fever

44.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of meningitis

45.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Diphtheria

46.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Tetanus

47.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Gonorrhoea

48.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of food poisoning

49.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Cholera

50.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of UTI

51.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Bacillary dysentery

52.  Etiology, pathogenesis, lab diagnosis, treatment and prophylaxis of Syphilis

53.  Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Staphylococcus

54.  Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Streptococus

55.  Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Haemophilus influenzae

56.   Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Yersinia pestis

57.  Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Bordetella pertussis

58.  Briefly describe the Morphology, classification, pathogenesis, and Lab diagnosis of Escherichia coli

59.  Sexually transmitted diseases

60.  Zoonoses

61.  General characters of Viruses

62.  Classification of Viruses

63.  Cultivation of viruses

64.  Herpes viruses

65.  Hepatitis viruses

66.  Polio virus and vaccines

67.  Influenza viruses

68.  Rabies virus and anti-rabies treatment

69.  Diagnosis of HIV/AIDS

70.  Chikungunaya

71.  Dengue

72.  SARS

73.  Antiviral drugs

74.  General characters of Fungi

75.  Dermatophytosis/Ring worm

76.  Candida albicans

77.  Mycetoma

78.  Aspergillosis

79.  Lab diagnosis of Fungal infections

80.  Vector Borne Infections

*ALL BEST*

PRINCE C P

ASSOCIATE PROFESSOR

DEPARTMENT OF MICROBIOLOGY

MTPG&RIHS

PUDUCHERRY

9345413279

cpprincepni@gmail.com

MICROBIOLOGY for Diploma in Nursing and Diploma in Allied health courses 

First Edition @ 2017

ISBN 978-93-5268-075-7

This book aims to provide a brief outline of Medical microbiology. This book is designed for diploma students in Nursing (GNM and ANM) and other allied health courses like Radiography technician, health inspector, perfusion technologist, dialysis technician, laboratory technician, operation theatre assistant, trauma care technician, Echocardiography technician etc. This book covers the syllabus of Various Board of medical education and Universities in India. The examination oriented point-wise presentation in this book will help the students to prepare for the examination in a short span of time. Model questions and summary provided in the end of the book will further useful for the last minute readers.

I am grateful to my students who suggested making my lecture notes in to a book. These notes were prepared and circulated to the students since the starting of my teaching career. I am thankful to the publishers for their spontaneous response and their meticulous team members for their fast editing and publishing.

Plants That Will Get Rid Of Mosquitoes
There are several plants you can plant in your yard or garden to get rid of mosquitoes. And these plants work very well.
1. Catnip
2. Rosemary
3. Marigolds
4. Citronella Grass also known as lemon grass.
5. Lemon Thyme
All of these plants will work very well to keep away mosquitoes. If you plant a combination of them you should not have any mosquito problems at all. Marigolds will also keep other insect pests out of your yard and garden.
Herbs 101
To get rid of flying insects including mosquitoes plant basil in pots on your porch and in your yard and garden. Most flying insects can not stand basil in any way. It will keep them completly away.
A Grass That Repels Mosquitoes
A very effective substance that repels mosquitoes is citronellla. Citronella can be found in lemon grass and in the natural oil found in the lemon grass it is much stronger than a store bought product. It is also called Thai Grass and should be available in your local garden supply store. It will mosquito proof your yard and garden.
Is A Bat House In Your Future
A small colony of bats will eat thousands of mosquitoes every night.
Get Bats In Your Belfry
If you don't have bats in your neighborhood you might consider purchasing a bat house. Most garden supply stores sell bat houses for about $25.00. Once the bats move in this will eliminate thousands of unwanted mosquitoes every night. Bats will not bother humans however, if you have a pool or birdbath they will swoop in for a drink every now and then.
The Mosquito Hunters
Toads Love To Eat Mosquitoes. So be sure to make any toads in your yard or garden welcome.
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Both toads and bats eat thousands of mosquitos a night. If you live in a area where toads occur and you want them in your yard build them a few toad houses. They love to live in clay flower pots so place a clay flower pot upside down and cut Mr Toad a hole near the top which is now the bottom and Mr Toad will move right in. Place your toad houses where they will not be disturbed. They love the cool dark toad house the clay flower pot provides to get away from the heat of the day.
Add small goldfish to your outdoor pool to take care of the mosquito larvae in it. Depending on how many gold fish you put in the pond you may never need to feed them. If you do need to feed them only feed them lightly so they will stay hungry for the mosquito larvae.
Biology of mosquito
Characteristics of mosquito:
· slender and long mouth parts
· scaly wings
· complete head for larvae
· a pair of spiracles on the dorsal part of the 8th abdominal segment of the larvae
Life cycle: complete metamorphosis with 4 stages (egg, larva, pupa and adult)
Egg:
· Adult mosquito generally lays eggs on water surface or its adjacent sites
· Development of eggs takes 2 to 3 days
Larva:
· Aquatic animal without leg
· With four stages of development
· Comes up to the water surface to take atmospheric air with its spiracle at the 8th segment
Pupa:
· Non-feeding aquatic form
· Has to come up to the water surface to breathe usually
· Life span is 2 to 3 days
Adult:
· Body can be divided as head, thorax and abdomen
· A pair of compound eyes and antennae as well as mouthparts on its head
· A pair of jointed legs on each segment of the thorax and a pair of wings
· The abdomen is composed of ten segments
Behaviour :
Mating: Female mosquito of many species mate 1 to 2 days after hatching. Female adults normally mate only once in its life.
Feeding: Normally only female adults feed on animal blood. Male adults feed on plant juice. Some species are anthropophilic and some are zoophilic.
Egg laying: Female mosquito of most species has to get blood meal for the development of eggs. Breeding place can be permanent stagnant water, flowing water, temporary stagnant water or containers.
Resting: Adult mosquito rests near breeding site for a few hours after hatching. Exophilic mosquito also rests indoors for a short period of time before and after feeding.
Dispersion: Adult mosquito disperses for feeding, finding suitable resting sites, mating and laying eggs. It can disperse through flight, air current or vehicles.
Hibernation: Some mosquitoes (for example most species of Anopheles and Culex) hibernate in winter at adult stage. Aedes over winter at egg stage.
Longevity: Generally male mosquitoes only survive one week but the females can live for two to three weeks.

Mosquito prevention
o Advice
o To the public
The public is advised:
§ To tidy up their premises and check for any accumulation of water inside their premises;
§ To remove all unnecessary water collection and eliminate the sources;
§ To change at least every week the water in flower vases and saucers of potted plants to prevent breeding of mosquitoes. The use of saucers should be avoided whenever possible;
§ To properly cover all containers that hold water to prevent mosquito from accessing the water;
§ To properly dispose articles that are able to contain water such as empty lunch boxes, cans and tyres;
§ To stop storing water along morning walk trails or Government land for irrigation;
§ To make large holes on tyres used as anti-bumping measure in garage to prevent water trapping or use mark(s) on the parking space to prevent bumping instead.
§ To contact the district pest control offices or PCAS of FEHD, or pest control companies for assistance in mosquito control or prevention.
§ To install mosquito screen on windows and doors.
§ To use mosquito net for sleeping if necessary.
§ To apply insect repellant on the clothes.
§ To wear light-coloured long-sleeved clothes and long trousers.
§ To avoid applying odour-producing cosmetics such as perfume/body lotion during outdoor activities.
To the management of construction sites
The management of construction sites is advised:
§ To assign a staff for the control and prevention of mosquito in the site;
§ To tidy up the construction site regularly, at least weekly and check for any accumulation of water inside the site;
§ To remove all unnecessary water collection and eliminate the source(s);
§ To cover all containers that hold water to prevent mosquito from accessing the water;
§ To render the vertical poles in scaffolding unable to hold water by making holes at the ends or filling them up with sand;
§ To dispose articles that are able to contain water such as empty lunch boxes, cans, disused articles and tyres into covered container(s) and remove these articles from the site regularly, at least weekly;
§ To carry out larviciding against mosquito breeding where the breeding sources or potential breeding grounds are inaccessible or could not be eliminated.
§ To contact the district pest control offices or PCAS of FEHD, or pest control companies for assistance in mosquito control or prevention.
Mosquito control
Adult Control
· to use mosquito trap for trapping the mosquito
· to use mosquito coil or aerosol to kill the mosquito directly
· to kill mosquito with electrical device designed for the purpose (Observe the safety precautions in using the device)
Larval Control
· to remove containers with water
· to clear stagnant water
· to pave/fill uneven ground and/or holes
· to apply larvicidal oil or pesticide to kill the larvae
· to keep fish which feeds on mosquito larvae
Figures

Anopheles species
Aedes species
Culex species
Fig. 1 Egg of different mosquito species

Culicines species
Anophelines species
Fig. 2 Posture of mosquito larva of different species in breathing

Fig. 3 A mosquito pupa

Fig. 4 Adult mosquito

What Is a Vaccine?

Chances are you never had diphtheria. You probably don’t know anyone who has suffered from this disease, either. In fact, you may not know what diphtheria is. Similarly, diseases like whooping cough (pertussis), measles, mumps, and German measles (rubella) may be unfamiliar to you. In the 19th and early 20th centuries, these illnesses struck hundreds of thousands of people in India each year, mostly children, and tens of thousands of people died. The names of these diseases were frightening household words. Today, they are all but forgotten. That change happened largely because of vaccines.
Chances are you’ve been vaccinated against diphtheria. You may even have been exposed to the bacterium that causes it, but the vaccine prepared your body to fight off the disease so quickly that you were unaware of the infection. Vaccines take advantage of your body’s natural ability to learn how to combat many disease-causing germs, or microbes, that attack it. What’s more, your body “remembers” how to protect itself from the microbes it has encountered before. Collectively, the parts of your body that remember and repel microbes are called the immune system. Without the immune system, the simplest illness—even the common cold—could quickly turn deadly.
On average, your immune system takes more than a week to learn how to fight off an unfamiliar microbe. Sometimes that isn’t soon enough. Stronger microbes can spread through your body faster than the immune system can fend them off. Your body often gains the upper hand after a few weeks, but in the meantime you are sick. Certain microbes are so powerful, or virulent, that they can overwhelm or escape your body’s natural defenses. In those situations, vaccines can make all the difference.
Traditional vaccines contain either parts of microbes or whole microbes that have been killed or weakened so that they don’t cause disease. When your immune system confronts these harmless versions of the germs, it quickly clears them from your body. In other words, vaccines trick your immune system to teach your body important lessons about how to defeat its opponents.
Vaccine Benefits
Once your immune system is trained to resist a disease, you are said to be immune to it. Before vaccines, the only way to become immune to a disease was to actually get it and, with luck, survive it. This is called naturally acquired immunity. With naturally acquired immunity, you suffer the symptoms of the disease and also risk the complications, which can be quite serious or even deadly. In addition, during certain stages of the illness, you may be contagious and pass the disease to family members, friends, or others who come into contact with you.
Vaccines, which provide artificially acquired immunity, are an easier and less risky way to become immune. Vaccines can prevent a disease from occurring in the first place, rather than attempt to cure it after the fact.
Benefits for You and Others
It is also much cheaper to prevent a disease than to treat it. Vaccines protect not only yourself but also others around you. If your vaccine-primed immune system stops an illness before it starts, you will be contagious for a much shorter period of time, or perhaps not at all. Similarly, when other people are vaccinated, they are less likely to give the disease to you. Vaccines protect not only individuals but entire communities. That is why vaccines are vital to the public health goal of preventing diseases.
If a critical number of people within a community are vaccinated against a particular illness, the entire group becomes less likely to get the disease. This protection is called community, or herd, immunity. On the other hand, if too many people in a community do not get vaccinations, diseases can reappear. In 1989, low vaccination rates allowed a measles outbreak to occur in the United States. The outbreak resulted in more than 55,000 cases of measles and 136 measles-associated deaths.

wishing a happy new year to all readers

TICKS


Ticks are found worldwide. They are blood-sucking, opportunistic parasites that can attach to the skin of a variety of vertebrate hosts. They have no segmentation and are dorsoventrally flat with four pairs of legs .

Although all stages of the tick life cycle can suck blood, it is normally the adult tick that poses a problem for humans. Human tick-associated diseases are most common in the summer months when the likelihood of contact increases during outdoor activities, usually in wooded areas. Being bitten by a tick is often painless and the presence of the tick may not be detected for some time. Often the tick poses no problem for the human host other than an erythromatous papule and it drops off after engorging on blood. Sometimes, the site of attachment may itch and become painful. Secondary infections of the wound site may occur, often as a result of the mouthparts remaining attached after the tick is removed.

Ticks can attach anywhere on the body but are frequently found at the hairline, around the ears, groin, armpits etc.
Whilst the bites of most ticks are inconsequential, they can carry a number of human disease agents including viruses, bacteria and protozoa. There are two families of ticks: the hard ticks (Ixodidae) and the soft ticks (Argasidae) .The Ixodidae attach to their host over a prolonged period of time (several days) while the Argasidae feed rapidly and then drop off. Consequently, they are frequently undetected.
Although most tick-associated problems arise from disease-causing organisms carried by the ticks, in one case – tick paralysis – the problem arises directly from toxins in the tick’s saliva.
Important disease-carrying ticks in the United States are:
Hard ticks:
Dog tick (Dermacentor variabilis) which is found east of the Rocky Mountains and in some areas of the Pacific coast states
Rocky Mountain Wood Tick (Dermacentor andersoni) . As its name suggests, it is found in the Rocky Mountains and also in southwest Canada
Deer Tick (Black-legged tick) (Ixodes scapularis) . This occurs in the north east and north central United States.
Western black legged tick (Ixodes pacificus) which is found in the Pacific coast states of the United States.
Brown dog tick (Rhipicephalus sanuguineus). Also known as the red dog tick . This is found world-wide (all over the US and also southeast Canada) and can complete its entire life cycle indoors. It primarily infests dogs but can feed on other mammals including man.
Lone star tick (Amblyomma americanum) , found in south eastern and south central United States.
Soft ticks:
Various species of Ornithodoros are found in the western United States. The family Argasidae is divided into four genera: Argas, Ornithodoros, Antricola, and Otobius .




DISEASES FOR WHICH HARD TICKS ARE CARRIERS
BACTERIAL DISEASES
ROCKY MOUNTAIN SPOTTED FEVER
There are several hundred reported cases of Rocky Mountain Spotted Fever each year in the United States (ranging, during the past half century, from a low of about 200 to more than 1200 in the early 1980’s). The numbers are again rising (figure 4). Most at risk are children under 15 years of age. Usually, cases occur in the summer because of higher numbers of ticks and more frequent contact of humans with ticks .
EpidemiologyThe causative agent, Ricketsia rickettsii, is carried by the Brown Dog tick and the Rocky Mountain Wood Tick (the two Dermacentor species in the United States). Contrary to its name, only a small proportion of cases are actually reported from the Rocky Mountain states. The highest number of cases in the United States occurs in the south-east and south central regions with the greatest incidence in Oklahoma and North Carolina.
Elsewhere in central and south America, Rhipicephalus sanguineus and Amblyomma cajennense carry Ricketsia rickettsii. The disease is known as fiebre manchada in Mexico; São Paulo fever or fiebre maculosa in Brazil; tick typhus or Tobia fever in Colombia.
SymptomsR. rickettsii is a small bacterium that grows inside cells, particularly endothelial cells that form the walls of small blood vessels . The disease is characterized by nausea, appetite-loss, fever, myalgia and headache. These are followed, 3 to 5 days after the tick bite, by the characteristic rash , which results from leakage of the blood vessels as a result of infected and dying endothelial cells.
Initially, the rash is formed of small, flat, pink, non-itchy macules (spots) on the wrists, forearms, and ankles . Subsequently, the macules become raised on the skin and there is pain (in the abdomen and joints) and diarrhea. The characteristic red rash, which occurs in up to 60% of patients, is found at the extremities (the palms and soles of feet). A minority of patients never progress to this stage. Laboratory tests show thrombocytopenia, hyponatremia and/or elevated levels of liver enzymes. Severe cases require hospitalization and can result in paralysis of the extremities and may even be life-threatening. Very severe sequelae include gangrene that may result in amputation, deafness, and incontinence.
TreatmentTreatment is by antibiotics (doxycycline). Since, if untreated, Rocky Mountain Spotted Fever can be fatal, treatment should be started as soon as this disease is suspected and before any diagnosis is confirmed by laboratory tests.
Laboratory detectionSerologic assays including indirect immunofluorescence microscopy.
PreventionClothes that cover body and anti-tick sprays (often containing DEET) are most often used. It is best to keep away from heavily tick-infested areas. If ticks are discovered on the body, they should be removed immediately using fingers or tweezers.


TULAREMIA

This is also carried by the two Dermacentor species. Tularemia is caused by the bacterium Francisella tularensis, which is carried by rodents, rabbits and hares; as a result tularemia is otherwise known as rabbit fever. One of the several ways that humans can be infected is by being bitten by a tick that has acquired the bacterium after biting one of these animals; however, it can also be inhaled during the handling of infected rodents. There have been no reports to person-to-person transmission. Francisella tularensis is very infectious. Tularemia occurs all across the continental United States but is relatively rare, with about 200 cases being reported each year .
SymptomsThe symptoms of tularemia, which can be fatal if untreated, vary according to the route by which the infection was acquired; often the patient experiences swollen lymph glands, skin ulcers , inflammation of the eyes and throat, diarrhea. This may be followed by atypical pneumonia, pleuritis, and hilar lymphadenopathy. Inhaled tularemia results in rapid fever, chills, headache, myalgia, joint pain, dry cough, and progressive weakness. The pneumonia can result in respiratory distress and failure with blood in the sputum.
Diagnosis is initially from the symptoms but confirmatory laboratory tests using Gram or other stains or immunofluorescence microscopy are used to visualize the infecting bacteria.
TreatmentOral antibitotc treatment using streptomycin, gentamycin, tetracyclines (e.g. doxycycline) or fluoroquinolones, (e.g. ciprofloxacin) is the major form of therapy. Streptomycin or gentamicin can be used intravenously. There is a vaccine that is made from avirulent F. tularensis biovar palaearctica (type B). In addition, antibiotics can be used as post-exposure prophylaxis before the onset of symptoms if infection by F. tularensis is suspected.

Q FEVER

Various farm animals (cattle sheep goats etc) are the primary carriers of the bacterium Coxiella burnetii which causes Q fever. Spread to humans is usually via inhalation of dust containing dried urine, feces etc of infected animals. However, less commonly, the bacterium can be transmitted via the bite of Dermacentor ticks. Ingestion of contaminated milk can also lead to infection. C. burnetii infects macrophages and survives in the phagolysosome, where the bacteria multiply. The bacteria are released by lysis of the cells and phagolysosomes.SymptomsAcute Q feverMany patients, about half, show no signs of infection but in others after an incubation period of 1 - 2 weeks, there is a sudden onset of fever, headache, general malaise, myalgia, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. The patient may also appear confused. Many patients go on to the symptoms of pneumonia and hepatitis but most recover in a month or two without treatment although acute Q fever has a mortality rate of 1-2%.
Chronic Q feverIf the patient fails to resolve the infection, chronic Q fever results. This can occur a few months after primary infection but can also occur many years later. Endocarditis of the aortic heart valves is the major problem that arises. This usually occurs in people with heart valve disease but also at risk are transplant, cancer and kidney disease patients. The chronic form of Q fever has a fatality rate of about 60 - 70%.
DiagnosisSerology to determine the presence of antibodies against Coxiella burnetii is used.
TreatmentAntibiotics such as doxycyline are used to treat acute Q fever. For chronic Q fever, two protocols have been investigated: doxycycline along with quinolones for at least 4 years and doxycycline with hydroxychloroquine for 1.5 to 3 years.
There is a vaccine used in Australia for persons who may come in contact with C. burnettii but it is not commercially available in the United States.

EHRLICHOSIS
HUMAN EHRLICHOSIS

Human ehrlichosis is carried by Dermacentor variabilis and by Amblyomma americanum and is caused by a number of bacteria of the Ehrlichia family, in the United States principally by Ehrlichia chaffeensis. These bacteria are small gram-negative organisms that infect leukocytes . As with many tick-borne diseases, incidence follows vector distribution with higher incidence during the summer months when tick populations and contact with them are higher. The number of cases has been increasing .
SymptomsAfter an incubation of period of a week to 10 days, the patient presents with myalgia, headache and general malaise. There can also be nausea, vomiting, diarrhea, cough, joint pains and the patient may be confused. Sometimes, there is a rash but this is normally only in pediatric cases. If left untreated, more severe manifestations of the infection can occur, including prolonged fever, renal failure, disseminated intravascular coagulopathy, meningoencephalitis, adult respiratory distress syndrome, seizures, or coma. Mortality rate at this stage is 2 - 3%. More at risk are immune-suppressed patients.
DiagnosisMicroscopy using blood smears or serology to detect anti-Ehrlichia antibodies can be used.
TreatmentAntibiotics such as doxycycline are the recommended treatment.

HUMAN GRANULOCYTIC EHRLICHIOSIS
Human granulocytic ehrlichiosis is caused by a species of Ehrlichia similar to species found in animals (Ehrlichia equi and Ehrlichia phagocytophila) and is transmitted by blacklegged ticks (Ixodes scapularis) and western blacklegged ticks (Ixodes pacificus).

LYME DISEASE

Lyme disease is caused by the spirochete bacterium, Borrelia burgdorferi , which typically infects small mammals in the northeast and north central United States. It is transmitted to humans by Ixodid black legged ticks (deer ticks). There are over 20,000 cases per year in the United States making it the most common tick-borne disease in North America. The disease was first described from the town of Old Lyme in Connecticut but is found on both the east and west coasts and in the Mississippi valley . In Europe, a similar disease is caused by Borrelia garinii or Borrelia afzelii.
Symptoms
Fever, headache and malaise and a characteristic rash named erythemia migrans , which can occur in a few days but sometimes only after a few weeks, are typical of Lyme Disease. The rash (which is usually not painful) often has a bull’s eye appearance since as it grows (up to 30 cm across) the central region clears. If left untreated, the infection spreads and can result in Bell’s Palsy (partial paralysis of muscles in one or both sides of the face), meningitis, heart palpitations and severe joint pain. These symptoms usually resolve in a few weeks but after several months about 60% of patients will get severe joint swelling and arthritis. A small minority may also get neurologic symptoms (tingling of the extremities, shooting pains, numbness)
TreatmentEarly administration with antibiotics (doxycycline, amoxicillin, or cefuroxime axetil) is recommended. Some patients continue with neurological and muscle pain problems even after antibiotic treatment. It is not known what causes these but they may be autoimmune in nature.
DiagnosisVarious laboratory tests include Elisa, western blot

SOUTHERN TICK-ASSOCIATED RASH ILLNESS
This rash is similar to that seen in Lyme disease. The causative organism is not known but it is not Borrelia burgdorferi, the Lyme disease agent. The lone star tick, Amblyomma americanum, is the transmission vector.
SymptomsMalaise, fever, myalgia, arthralgia and a “bulls eye” rash at the site of the tick bite. There are no chronic neurological symptoms as are seen with Lyme disease

TreatmentThe usual oral antibiotics are used and the symptoms quickly resolve.


PROTOZOA
BABESIOSIS
Babesiosis is carried by species of Ixodes including the deer tick (Ixodes scapularis) in the north and mid-west of the United States and in other countries, including Europe. Babesia microti is the usual causative organism and is a hemoprotozoan (i.e. it circulates in the bloodstream). Normally, the two hosts of Babesia microti are ticks and peromyscus mice (Peromyscus leucopus). The tick infects the mice with sporozoites, which reproduce asexually in erythrocytes. These escape to the blood stream where they may form male and female gametes that are taken up by the tick during a blood meal. In the tick, the gametes fuse and go through a sporogonic cycle to form more sporozoites. Humans can also acquire sporozoites when bitten by an infected tick and are usually dead-end hosts but babesiosis has been transmitted to other humans via blood transfusions .
In most cases, infection is asymptomatic but after a week to a month, symptoms can appear. These include fever, chills, sweating, myalgias and fatigue. In severe cases, hepatosplenomegaly and hemolytic anemia can occur. Normally, the patient recovers, although severe cases occur in immuno-compromised patients and the elderly.
Disease cause by another protozoan, Babesia divergens, can cause more severe and sometimes fatal cases of babesiosis.
DiagnosisDiagnosis is by serology, immunofluorescence microscopy and by direct observation of the parasite in blood smears in which “Maltese Cross”-like inclusions in erythrocytes are seen . These consist of four budding merozoites attached together.

TreatmentUsual antibiotics used are clindamycin plus quinine or atovaquone plus azithromycin.


VIRUSES
CRIMEAN-CONGO HEMORRHAGIC FEVER
This is caused by a Nairovirus, a member of the Bunyaviridae. It is found in Eastern Europe and throughout the Mediterranean areas of southern Europe, the Middle East, Africa, northwestern China, central and south Asia. Ixorid ticks (genus Hyalomma) spread the virus, which is also carried by numerous species of domestic and wild animals. Person to person transmission through infected blood and other body fluids has been documented.
SymptomsInitially, the patient presents with headache, high fever, back pain, joint pain, stomach pain, and vomiting. There may be flushing, red eyes and throat and small red spots called petechiae on the palate. Hemorrhage ensues after a few days and lasts for a few weeks. this is indicated by severe bruising, nosebleeds, and failure to stop bleedings after a cut or injection. Slow recovery often ensues but mortality can be as high as 50%.

TreatmentSince this is a viral disease, treatment is largely supportive with particular attention to electrolyte balance. Ribavirin has been used. An inactivated vaccine has been used in Eastern Europe.

COLORADO TICK FEVER
This is sometimes confused with a mild case of Rocky Mountain Spotted Fever but Colorado Tick Fever is caused by a coltivirus, a member of the reoviruses. They are endemic to north western North America and are found in Ixodid ticks. The virus distribution closely matches that of its vector, Dermacentor andersoni.
Person-to-person transmission can occur by blood. Prolonged viremia observed in humans and rodents is due to the intraerythrocytic location of virions, which protects them from immune clearance.
SymptomsInfection results in abrupt fever, chills, headache, retro-orbital pain, photophobia, myalgia, abdominal pain, and malaise. Sometimes fever can be diphasic or triphasic, usually lasting for 5 to 10 days. Severe forms of the disease that involve infection of the central nervous system or hemorrhagic fever, pericarditis, myocarditis, and orchitis have been rarely observed, mainly in children. Severity is sufficient to result in hospitalization of approximately 20% of patients. There has been evidence of transmission from mother to child.

FAR EASTERN TICK-BORNE ENCEPHALITIS (Also known as Russian spring-summer encephalitis or Taiga encephalitis)This is caused by a flavivirus which is spread by ixodid ticks (Ixodes persulcatus, I. ricinus and I. cookie). Small animals are the reservoir and the virus is endemic to the former Soviet Union and parts of eastern and central Europe.

SymptomsAbout two weeks after infection, there is a mild influenza-like disease that normally resolves in a few days but which can be followed by meningitis and meningoencephalitis in about one third of cases. In some cases, there may be partial paralysis and mortality may be as high as 25%.

TreatmentSupportive care is normal. There is a vaccine of killed virus that is available in Europe.

POWASSAN ENCEPHALITIS
This is a rare disease caused by a flavivirus carried by Ixodid ticks. There has been less than one case per year reported in the United States but mortality is high. It is widespread in North America and is found in small animal populations including woodchucks.
SymptomsAfter a relatively long incubation period of up to one month, the patient may present with a sore throat, dizziness, headache and confusion. This can proceed to general malaise, vomiting, respiratory distress, fever and convulsions, which then lead to paralysis and possibly coma. Because the virus attacks brain tissue, survivors can have severe neurological problems.
TreatmentSupportive care is indicated.

TICK-BORNE ENCEPHALITIS (Also known as biphasic meningoencephalitis, central European tick-borne encephalitis, Czechoslovak tick-borne encephalitis, diphasic milk fever or viral meningoencephalitis)
This disease results from infection by tick-borne encephalitis virus, which is a member of the Flaviviridae.
SymptomsTick-borne encephalitis starts as mild influenza-like symptoms with fever accompanied by leuko- and thrombocytopenia. This resolves within a few days. However, about one third of patients develop meningitis and meningoencephalitis. This can, in a few cases, be followed by paralysis. The European form of the disease has a mortality rate of under 5%. Most patients recover but about a third may have long-lasting neurological problems.
TreatmentSupportive is indicated. There is an experimental killed vaccine in Europe. In Sweden TBE vaccination is recommended for residents of and regular visitors to TBE endemic areas.
KYASANUR FOREST DISEASE
This disease is similar to Russian spring-summer encephalitis and is also caused by flaviviruses. It is found only in the Kyasanur forest of Northern India. The disease occurs during the dry season as its tick vector (Haemaphyalis spinigera) begins to feed on humans. Local carriers are shrews and monkeys.
LOUPING ILL VIRUS
This is found in the British Isles and is caused by a flavivirus that is carried by pheasants and sheep, among other animals. It can infect many hosts via the tick vector, Ixodes ricinus. It causes mild encephalitis that gives the infected animal an unusual gait (hence its name). However, it can kill livestock and humans not given proper supportive care.

DISEASE CAUSED DIRECTLY BY HARD TICKS
TICK PARALYSIS
In addition to being carriers of disease-causing microorganisms, some ticks (Amblyomma americanum and the two Dermacentor species) can cause tick paralysis. This is a rare disease caused by toxin in the saliva of the tick and results in an acute, ascending, flaccid paralysis caused by reduced acetyl choline or motor neuron action potentials. The paralysis, which is not associated with pain, starts a few days after the bite and comes on gradually over a period of days. The paralysis resolves surprisingly rapidly, usually within a day of the removal of the tick but if the tick is not removed the mortality rate, as a result of respiratory paralysis, can be as high as 10%. Tick paralysis can be confused with other acute neurologic disorders or diseases (e.g., Guillain-Barré syndrome or botulism).





DISEASE FOR WHICH SOFT TICKS ARE CARRIERS
BACTERIA
TICK-BORNE RELAPSING FEVER
Tick-borne relapsing fever is a rare disease (about 25 cases per year in the United States) and is caused by several spirochete bacterial species of the Borelia family. The transmission agents are soft ticks of the genus Ornithodoros. Soft ticks (family Argasidae) differ in many ways from the so-called hard ticks (family Ixodidae), but the most important is that they take brief meals from their host and then drop off. The bite is usually painless. Thus, they are far less likely to be found than the hard ticks that stay attached while feeding for hours. In the wild, these ticks are found in nesting materials when not feeding on their animal host. All stages of the life cycle can take blood meals.
The individual Borrelia species that cause tick-borne relapsing fever are usually associated with specific Ornithodoros tick vectors. B. hermsii is transmitted to humans by Ornithodoros hermsi, B. parkerii is transmitted by Ornithodoros parkeri and B. turicatae is transmitted by Ornithodoros turicata. Each tick is associated with a preferred environment and hosts. Ornithodoros hermsi is found at higher altitudes (1500 – 8000 feet) where it is associated usually with ground squirrels, tree squirrels and chipmunks. Ornithodoros parkeri occurs at lower elevations and inhabit caves and the burrows of ground squirrels, prairie dogs and burrowing owls. Ornithodoros turicata occurs in caves and ground squirrel, prairie dog or burrowing owls burrows in the plains regions of the Southwest United States.
SymptomsInitially, the patient experiences arthralgia, myalgia, headache, chills and fever. This is followed by nausea, cough, photophobia, and dizziness. The patient may be confused. There is often a rash. The incubation period before the onset of the first symptoms is about a week (though it can be shorter or longer). After the onset of disease, symptoms last a few days and then resolve. After a week or two, the symptoms reoccur and in the absence of treatment, recurrence continues for several more episodes. As the fever resolves, the patient may go through a crisis in which first there is a high fever accompanied by confusion and delirium. This “chill phase” lasts up to half an hour. Then there is the “flush phase” in which the temperature drops accompanied by profuse sweating and sometimes a drop in blood pressure.
DiagnosisMicroscope smears of blood, bone marrow or cerebrospinal fluid stained with Giemsa or acridine orange. Serologic testing is also available.
TreatmentAntibiotics are used and symptoms resolve a few days. There can, however, be long-term sequelae including heart and kidney problems, peripheral nerve involvement, ophthalmia, and abortion. Without treatment mortality may be up to 10% of patients.