Respiratory Diseases: Scarlet and Q Fever
May 15, 2009
Respiratory Diseases:
Respiratory Diseases are a common form of illness that can be mild or in some instances, life threatening. Two such diseases of the respiratory system are Scarlet Fever and Q Fever. While these diseases are unrelated, Scarlet Fever is a disease of the upper respiratory system and Q Fever a disease of the lower respiratory system, they are both often contracted through airborne pathogens.



Scarlet Fever
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strawberry tongue

By Holly Warner

Abstract:
Scarlet fever is caused by Steptococcus pyogenes that release an erythrogenic toxin that targets the respiratory system as well as the skin. This bacteria first caused a major outbreak in the 1800’s but it still around today and can be treated effectively by antibiotics. The toxin that is released causes a red strawberry-like tongue to appear on the infected and will then spread to the rest of the body unless treated. It causes a variety of symptoms such as the swollen tongue, sore throat, and high fever. It is mostly found in children and can be easily spread by them from touching to eating with the same silverware or just proximity to those infected. If not treated a number of problems could follow as the body’s immune system slowly shuts down and can no longer fight against the bacterial disease.

Introduction:
Scarlet fever is a microbial disease that attacks humans respiratory system. Scarlet fever hasn’t always been of major concern, but did become a pandemic in the 1800’s and the reason has yet to be proven, yet some theories have been made about it. I found this topic interesting because it was something that I have heard of before, yet have never really learned that much information about it. After my research I have learned about what causes it, what the symptoms are, and how to treat it effectively and also what to watch out for in general to not be infected. (Tortora, 2007)

Discussion:
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Streptoccous pyogenes

Scarlet Fever is caused when Streptococcus pyogenes produces an erythrogenic toxin, which causes the reddening. This bacteria is gram positive and has a spherical shaped. It often occurs in the winter months and is prevalent in children, but this bacteria also causes other problems besides scarlet fever. The toxin that is produced causes a rash that is increased as a person becomes more sensitive to the toxin that is circulating throughout their body and also induces a high fever. The tongue starts to look like a strawberry as the upper membrane of the tongue becomes enlarged from the toxin. Once the bacterial disease is finished that strawberry-like red membrane will peel off. (Tortora, 2007)

The epidemic is the 1800’s was long before the invention of antibiotics , so that might have been a major prevention factor. Also, this was a time where America was starting to industrialize, there was a rise in population as well as close living proximity. There was also a lot of people immigrating to America at that time, so new bacteria and diseases are brought with them, which a lot of people may have never encountered before and had not built up any type of immunity. All of these might be factors as to why an outbreak occurred, because many have never had to fight these kind of diseases before and didn’t have the methods, much less a sanitary environment to prevent its spread. (Tortora, 2007) Also, another factor that has to be taken into consideration is that those with a lower immune system will be more susceptible to acquiring scarlet fever and unable to fight it off (McFadden, 1990).

Scarlet Fever is also closely related to Streptococcal pharyngitis, better known as strep throat, because it is also classified as a group
A Streptococcus bacteria. It is also a very fast acting bacteria, and will show signs of infection between 24-48 hours and as mentioned before, will have a fever and also show signs of a sore throat as most respiratory diseases do. You may think that the rash from scarlet fever stays contained to the tongue, but it actually only starts there and then spreads to the rest of the body as the infection continues. Other symptoms that you have to watch out for include: abdominal pains, redness in creases, chills, fever, discomfort, headache, muscle ache, sore throat, swollen red tongue, and vomiting (Vorvick, 2009).
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Treatment of this can be through a physical examination, in the past many went undiagnosed because of money issues, where now people are more likely to go to a doctor if they are experiencing these symptoms. Also, a throat culture can be done which will show exactly which bacteria might be causing you problems or a throat swab (Vovick, 2009). Another way the bacteria can be detected is through a rapid antigen test. This test detects the antigens or proteins that are involved when an individual has that type of infection. This test can be done in one doctors visit, but isn’t as specific as doing a throat culture, which is a more accurate test (Ohio Health, 2009). Many complication can also arise from treatment, but are very rare, but some cases are still seen today. These can include acute fever, ear infections, future bone or joint problems, inflammation of glands, kidney or liver damage, meningitis, pneumonia, or sinusitis (Vorvick, 2009).

This bacteria normally lives in the mouth and nose where there is fluid available and is spread through contact with people who already have it. Since this bacteria can also cause strep throat, it is possible to contract scarlet fever from it also. This is why it is important to not eat or dink from the same silverware or glasses, also to wash your hands if you come in contact with someone who you think might be sick. Scarlet fever can usually be stopped with treatment of antibiotics, which has worked effectively and other medicines can also help with other symptom, such as the sore throat (Kent, 2004).

Children between the ages of 5-15 are more likely to get scarlet fever, mostly because of their surroundings at school since it spreads easily through mere proximity. This is why once a child is infected, schoolmates will follow as well as close family members. The antibiotics that are normally given include: Penicillin, amoxicillin, azithromycin, clarithromycin, clindamycin, A cephalosporin. It is very important for the infected individual to take full amount of antibiotics prescribed and not stop taking them once you feel better. This is a precaution so you don’t get another infection and make sure your body is completely rid of the bacteria. Remedies you might want to try on your own to relieve pain include: ibuprofen, adequate fluid intake, saltwater gargle, humidifier, lozenges, comforting foods, and to avoid irritants that might be in the air or around the patient (Ohio Health, 2009).


Literature Cited:
Tortora, Gerard J., Funke, Berdell R., Case, Christin L. 2007. Microbiology: an introduction. Pearson Education, Inc., San Francisco, 714-715.

Vorvick, Linda. MD. 2009. "Scarlet Fever." Medicine Plus. <http:/www.nlm.nih.gov/medlineplus/ency/article/000974.htm>.

Kent County Health Department. 2004 "Scarlet Fever." Health & Community. <www.accesskent.com>.

McFadden, J.P. "Hypothesis-the natural selection of psoriasis." Clinical & Experimental Dermatology. 15. 1 Jan (1990): 39-43. Academic Search Premiere. EBSCO. Sonoma State University, Rohnert Park, CA. 10 May 2009.
http://0-search.escbohost.com.iii.sonoma.edu/login.aspx?direct=true&db=aph&AN=11521869&loginpage=Login.asp&site=ehost-live&scope=site.

Thompson, Harriet. 1996. LSUMC/MIPDental Microbiology, Immunology & Parasitology.
http://images.google.com/imgres?ingurl=http:www.medschool.Isuhsc.edu/Microbiology/DMIP/gpages.jpg&imgrefurl=http:www.medschool.Isuhsc.edu/Microbiology/DMIP/or_99bxGNLIaftXPkv7IFXfc5UU=&h=289&w=359&sz=72&hI=en&start=10&um=1&tbnid-9UIkXn20eNgKM:&tbnh=97&tbnw=121&pre

Ohio Health Online.2009.Mayo Health Clinic.
http://image.google.com/imgres?imgurl=http:www.ohiohealth.com/mayo/image/image_popup/r7_scarletfever.jpg&imgrefurl=http:
www.ohiohealth.com/bodymayo.cfm%ybK
pp2Y15pTTDn_VvsBNFQw4hiQ=&h=400&w=400&sz=23&hI=enstart=32&um=1&tbnid=KonZajslGS_Q6M:&tbnh=124&tbnw=124&

Ohio Health Online.2009.Mayo Health Clinic
<http://www.ohiohealth.com/bodymayo.cfm?id=6&action=detain&ref=37717.





Q Fever
By: Tania Fuhrman

external image 090130_coxiella-burnetii.jpg
Abstract:
Q Fever is a disease that affects the lower respiratory system in humans. It was first identified is 1930s Australia when individuals presented with symptoms of pneumonia. Originally, the cause of this disease was unknown leading it to be labeled Query Fever. (Tortora 729) Eventually, the cause of Q Fever was found to be, Coxiella burnetii, a parasitic intracellular bacterium that is capable of growing, and reproducing inside the cells of humans and animals. After entering the body, the Coxiella burnetii bacterium targets macrophages where it replicates inside of them, keeping these white blood cells from breaking down these invading pathogens (Whyte). Q Fever causes a wide range of symptoms including some cases that go undiagnosed due to a quick recovery. Q fever is often underreported in many countries around the world because, sixty percent of cases don't produce any symptoms (Tortora 729).

Introduction:
I chose this topic because it was a disease that I had never heard of until I briefly read about it in our microbiology book. I was also interested to see how common it is for this disease to occur in the United States compared to other countries around the world. My research led to findings of where Q Fever originated, the effects it has on humans as well as animals, ways to effectively diagnose and treat this disease, and ways to prevent it from spreading.

Discussion:
Coxiella burnetii is a very contagious pathogen that is resistant to heat, drying, and many disinfectants. It is a zoonotic disease that has the ability to be transfered from animals to humans. While Q Fever has been present around the world since the 1930s, it was not reported in the United States until 1999. As the disease is often underreported due to mild cases with little to no symptoms, it is impossible to know just how many cases have occured throughout the world.(Q Fever, CDC)
sheep with lambs
sheep with lambs


While many animals have been infected with this pathogen, "cattle, sheep, and goats are the primary reservoirs (Q Fever, CDC)," of the Coxiella burnetii bacterium. Infection of the human body often result in acute or chronic cases of Q Fever, yet in animals this disease does not occur. However, C. burnetii has been shown to cause abortion in infected sheep and goats. This bacterium is often transferred between animals through tick bites, and organisms are often excreted from the body in the form of manure, urine, and amniotic fluids from birth. These fluids then end up in dust that accumulates in a barnyard, increasing the transmission of this airborne bacterium to humans who work with these animals on a day to day basis.(Q Fever and Animals, CDC)

Humans often become infected with Coxiella burnetii through the inhalation of the organism in barns. In some instances, the bacterium can be transferred to humans by drinking contaminated milk. Humans are very susceptible to this disease, and often the inhalation of a single pathogen can result in an infection (Tortora 729). Of those infected by this bacterium, only half of the people go on to develop Q Fever. Symptoms generally occur one to three weeks after the initial infection, and can range from slight to very significant. While many cases do not result in any symptoms, acute cases are often presented by the sudden onset of one or a variety of the following symptoms.(Q Fever, CDC).

Symptoms of Acute Cases:

  • High Fevers (104-105ºF)
  • Severe Headache
  • Discomfort and Fatigue
  • Muscle Pain
  • Confusion
  • Sore Throat
  • Cough
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal and/or Chest Pain
Those who develop an acute form of Q Fever often recover in several months without any treatment.(Q Fever, CDC)

Although uncommon, chronic cases of Q Fever do occur. A chronic case is marked by infection that lasts more than six months, and is accompanied by endocarditis (inflammation of the heart valves). Most individuals who develop the chronic form of Q Fever have had a previous heart condition, are transplant recipients, cancer patients, or have kidney disease. It is also possible for a person with an acute case to develop the chronic form one to twenty years following the initial infection.(Q Fever, CDC)

Additional Symptoms of Chronic Cases:

  • Chills
  • Night Sweats
  • Prolonged Fever
  • Shortness of Breath
(Q Fever- All Information, University of Maryland Medical Center)

Diagnosing a person with Q Fever is not always accurate because the symptoms that present themselves are not specific to this disease. If a person presents with endocarditis, flu-like symptoms, hepatitis, or pneumonia their health care provider will suspect an infection of Q Fever (Q Fever- All Information, University of Maryland Medical Center). In order to accurately diagnose a case of Q Fever, serological testing needs to be done. This type of testing measures the body's blood serum to see if antibodies are being produced against Coxiella burnetii antigens.(Q Fever, CDC) If antibodies are being produced, then the presence of Q Fever is confirmed.
A. Normal Chest x-ray        B. Q Fever Pneumonia
A. Normal Chest x-ray B. Q Fever Pneumonia

Antibiotics are available to treat both acute and chronic forms of Q Fever. Acute cases are often treated with 100mg of doxycycline orally twice a day for fifteen to twenty-one days, which works the most effectively within the first few days of contracting the illness. While chronic cases of Q Fever can be treated, it is much harder to do so effectively and often requires the use of multiple antibiotics. Doxycycline is also prescribed in addition to quinolones for a minimum of four years. Another, more effective, form of treatment is hydroxychloroquine plus doxycycline for one and a half to three years. If a relapse occurs, it is important to seek help as soon as possible, and start another course of antibiotics.(Q Fever, CDC)

Individuals who have the highest risk of contracting Q Fever are: farmers, lab workers in contact with Coxiella burnetii, sheep and dairy workers, and veterinarians (University of Maryland, Q Fever Overview). To prevent the possibilty of contracting Q Fever it is necessary for individuals working in these areas to carefully dispose of any animal products. Other methods of prevention include, using disinfectants that are effective against Coxiella burnetii,and drinking milk that has been pasteurized. It is also important to always wash your had thoroughly throughout the course of the day to prevent the spread of Coxiella burnetti as well as other bacteria.(Q Fever- Prevention, Mayo Clinic)

Also currently available in Australia is the Q Fever Vaccine, Q-Vax. This vaccine is given to individuals who work in close contact with cattle, sheep, and goats. After you have received this vaccine your body is able to fight off and destroy any Coxiella burnetii organism your body comes in contact with. The Q-Vax is found to be very effective, and provides protection for many years. Q-Vax is currently distributed only in Australia where the chances of coming in contact with the C. burnetii bacterium are higher than in the United States.(Q-Vax(R) Q Fever Vaccine)

Literature Cited:
Tortora, Gerard J., Funke, Berdell R., Case, Christin L. 2007. Microbiology: An Introduction. Pearson Education, Inc., San Francisco, 729pp.

Whyte, Barry. "Comparative genomics reveals molecular evolution of Q fever pathogen." Virginia Bioinformatics Institute at Virginia Tech. 30 Jan 2009. 12 May 2009.
<http://www.vbi.vt.edu/public_relations/press_release/comparative_genomics_reveals_molecular_evolution_of_q_fever_pathogen>.

European Society of Radiology (ESR). 12 May 2009.
<http://patientinfo.myesr.org/html_frontend/index.php?module=article&action=article_id=36>.

"Q Fever." Centers for Disease Control & Prevention. 12 Feb 2003. 11 May 2009.
<http://www.cdc.gov/ncidod/dvrd/qfever/index.htm>.

"Q Fever and Animals." Centers for Disease Control & Prevention. 11 May 2009.
<http://www.cdc.gov/healthypets/diseases/qfever.htm>.

"Q Fever- Prevention." Mayo Clinic. 06 July 2007. 11 May 2009.
<http://www.mayoclinic.com/health/q-fever/DS00960/DSECTION=prevention>.

"Q Fever- All Information." University of Maryland Medical Center. 28 Sept. 2008. 12 May 2009.
<http://www.umm.edu/ency/article/001337all.htm>.

"Q-Vax(R) Q Fever Vaccine." Better Health Channel. 2007 May. 12 May 2009.
<http://www.betterhealth.vic.gov.au/bhcmed.nsf/pages/cscq-vax/$File/cscq-vax.pdf>.