Podcasts about rickettsial

In 1901, the state of Montana organised for scientists and doctors to investigate a mysterious illness from the Bitterroot Valley called ‘Black measles' and ‘Black typhus'. People of all ages were affected but predominantly those who worked in the brush and were exposed to tick bites. The investigators called it ‘tick fever' and this particular strain had a mortality rate over eighty percent. Today this disease is known as Rocky Mountain spotted fever. In Australia, it is sometimes called ‘spotted fever' or ‘Queensland tick typhus'. It is caused by an obligate intracellular bacterial micro-organism (needs a cell to survive). This organism is very difficult to culture and can be even more difficult to diagnose but surprisingly easy to treat. Rickettsial disease is an under-recognised infection and important in the differential diagnosis of any patients presenting with fevers, headaches and rash. This is the story of Rickettsia Our special guest: Our special guest is Professor Stephen Graves who is a medical microbiology and founder of the Australian Rickettsial Reference Laboratory (ARRL). He specialises is infectious diseases transmitted by ectoparasites such as ticks, lice, fleas and mites. This Medical Life podcast is available on all podcasting services and Spotify. See omnystudio.com/listener for privacy information.

In this episode, we review the high-yield topic of Rickettsial Diseases from the Infectious Disease section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Dr. John Greene, Chief of Infectious Diseases at Moffitt Cancer Center and Research Institute, shares a photo review of Zoonosis syndromes. Topics presented include tick-borne infections, Bartonellosis, Louse-borne infections, Rickettsioses (Rocky Mountain Spotted Fever, Rickettsial pox, etc), Coxiella, Ehrlichia, and Relapsing Fever. Dr. Greene concludes the talk by covering Tularemia, the Plague (Yersinia Pestis), Orf, and the non-venereal Treponematoses.

Chair of Microbiology and Immunology at the University of South Alabama, Kevin Macaluso, joins the show to discuss something you might not have even heard of: rickettsiology. Tune in to discover: What types of symptoms arise when tick-borne spotted fever goes undetected in the host In what ways rickettsia behave like viruses, and how they use host cell molecules to move around and penetrate neighboring cells What types of vector, host, and pathogenic variables are at play in the transmission biology of rickettsia Rickettsiology is the study of obligate intracellular gram-negative bacteria that was described over 100 years ago by Howard Taylor Ricketts, a physician who set out to study the then-unknown source of a lethal disease often referred to as black measles or spotted fever. Through a series of studies, Ricketts and other researchers figured out that the bacteria causing the disease could be transmitted through tick bites. Over 40 species of rickettsia have been identified worldwide. Ultimately, it is Macaluso's goal to figure out what drives rickettsial diseases and rickettsial infection in order to potentially intervene in the transmission cycle or find a treatment. Macaluso's research is centered around the disease transmission cycle of rickettsia. “Because you're dealing with bacteria that are transmitted by arthropods to vertebrate hosts, they form a triad of vector-borne diseases, and there are a lot of variables associated with that…it's a complex interaction between these three organisms, and we study all aspects of it,” explains Macaluso. He goes on to explain the mechanisms of the bacteria once in the body, including how and where they replicate in the body, how they disseminate in the body, how certain rickettsial pathogens affect the ticks through which transmission occurs, and more. Visit https://www.southalabama.edu/colleges/com/departments/microbiology/ for more info. Available on Apple Podcasts: apple.co/2Os0myK

In this podcast Dr. Stephen Dunlop, an emergency medicine physician with a certificate in tropical medicine and hygiene, addresses fever and other ailments in individuals returning from traveling. Objectives:    Upon completion of this podcast, participants will be able to: Identify what risk factors predispose towards certain tropical diseases/conditions. Apply appropriate differential diagnoses related to a patient with a fever who returned from traveling. Understand the basic work-ups needed in a patient experiencing fever who returned from traveling. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: Fever in the Returned Traveler (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Show Notes: Dr. Steve Dunlop is an emergency physician practicing at Hennepin County Medical Center. He trained at the University of Minnesota in med school, then did his emergency medicine residency at HCMC. Steve has his master's in public health and completed his certificate from the American Society of Tropical Medicine and Hygiene. He's widely published and is an assistant professor of emergency medicine at the University of Minnesota. He's quite the traveling man and is no stranger to sub Saharan Africa and many other parts of the world. Indeed he is an international physician of mystery and we're honored to have him join us to discuss fever in the return traveler. Today's talk will focus primarily on the process of assessing the return traveler and the big, bad uglies that we don't miss in these patients. So, buckle up and enjoy this tropical disease safari with Dr. Dunlop.   CHAPTER 1:     Malaria is a parasitic disease that is transmitted by the anopheles mosquito. Plasmodium falciparum malaria is the most common, and tends to be the most serious. Malaria has an interesting, somewhat complex life cycle and patients present with cyclical fevers, headache, body aches, nausea and other non-specific symptoms. There are over 200 million cases a year and up to 500,000 deaths per year. Up to 2000 cases per year in the United States are reported. After inoculation by an infected mosquito, there is an incubation period of 7-to 30-days.      We'll summarize this first segment with an overview of the general topic of fever in the return traveler as outlined by Dr. Dunlop. As we discussed, there are diagnoses that we in medicine are trained to think about, and while we consider them in our differential diagnosis, they are still considered "zebras" in medicine. These diagnoses happen, but for some reason, causes of febrile illness that would be considered "zebras" seem to be less apt to make it on that differential list, or are basically the, "come on, you're kidding, right?" diagnosis.      In the case of a disease like malaria, especially when it presents in the developed world, patients often are seen 3-times or more before the diagnosis is made.  Different diseases have varying incubation periods and latency periods. These unknowns make the diagnosis, let alone the awareness of these various so-called 'tropical diseases" all the more difficult. We first must ask the relevant questions, which should start with "have you traveled anywhere recently?", "When?", "For how long?", "Where?", and "What did you do there?".      Delusions of parasitosis are not always delusions. As Fred's example of the fish tape worm reveals, one should always perform a careful and detailed exam. With regards to some of the parasite illnesses, the latency periods can be months to years, and a continuous or oscillating fever is not always necessary.      With regard to malaria, for instance, a fever may not be present when the patient shows up with their other non-specific symptoms. Again, the latency period is variable with malaria, not to mention the various causes of malaria.      The topic of tropical diseases is important to Dr. Dunlop because of the realization that the world has become a smaller place. One can easily travel to the other side of the world in a day. Minnesota, for instance, has one of the highest immigrant refugee per capita rates in the country, and consequently one of the largest global health programs in the country. Minnesota alone has over 1-million border crossings per year. Therefore, it is all the more important for general practitioners and other front line providers to have a greater awareness of where these patients recently came from and/or have traveled back to lately.      Seeing and evaluating a refugee immigrant versus other immigrants also carries nuance. Refugees in general undergo a very robust pre-departure screening, treatment and vaccinations. Other migrants however, may not have had the same king of screenings and treatments as refugees.      People travel extensively now, and sometimes forget to tell us about some of the quick stop-over trips that are made in the course of a larger holiday. It's, therefore, important to also consider these extra "side-trips" in the course of the bigger trip and access our resources. Dr. Dunlop refers to the CDC Yellow Book. Specifically, the "clinician view" tab should be accessed. This site allows us to see the most updated travel medicine guidelines regarding vaccines and chemoprophylaxis. As Dr. Dunlop states, fresh water exposure history will clue us in to various parasitic illnesses, such as schistosomiasis. Food intake is also taken into consideration, but this can become murky, and of course can lead to a variety of GI illnesses. Vaccine preventable illnesses, such as Hepatitis A, Typhoid and Yellow Fever, depending on where you are traveling, may be advised. Regarding malaria prophylaxis in particular, chemoprophylaxis regimens need to be given before, during and after an abroad trip. This CDC Yellow Book resource advises specific advice for specific regions and cities in all countries. All the vaccines, chemoprophylaxis, precautions and other considerations are provided here.      Public health programs track various diseases, however, the data gathering is largely backed by wealthier governments. The CDC in particular has surveillance posts throughout the world which monitors health and disease phenomena. WHO [the World Health Organization] takes on the responsibility of disseminating this information, but the efforts do tend to be collaborative.        CHAPTER 2:      VFR travelers, or "visiting friends and relatives" comprise of the majority of malaria cases in our country. Many of these people. for reasons unclear, don't always adhere to chemoprophylaxis during their often extended visits to their home countries. As a side note, malaria was common in the United States until the mid-1800's, and was largely eradicated in the ensuing decades due to DDT. Good for the malaria, bad for the eagles, and a lot of other critters. A pesticide that unfortunately killed a lot of other organisms as well.      Dr. Dunlop presents a case, that Fred and I butcher our way through. Bear in mind, folks, this discussion is meant to be broad, and not super-granular in terms of each tropical illness, although our friendly Dr. Robotvoice that you've already met, will chime in periodically to give us some factoids about some of these diseases we should be considering. So, we have a 35-year old male, VFR traveler who goes back to Ghana. He returns with a fever. While home in Ghana, he stayed in his village; and basically while there, he lived like the locals - so to not stick out like a sore "Americanized" thumb amongst his friends and family. However, as Steve points out, and while we should be ever vigilant for malaria and still test for it, and still consider the other tropical diseases in this patient, it's still prudent to do the tests for the common illnesses. Influenza, pneumonia, strep, UTIs, etc.      How do we test for malaria now? Thick and thin blood smears are still the standard in diagnosis of malaria. But, those smears can also show other diseases, such as African Sleeping Sickness. However, the rapid malaria tests are even more commonly performed now, and will give you a quicker turnaround in the diagnosis. The sensitivity and specificity of the rapid malaria tests are good, and if the patient looks non-septic, perhaps improves with conservative care or some IV fluids, the test is sufficient. It's common to repeat the test several times if the patient continues with symptoms. The thick and thin smears are still warranted, though, in these cases as well. CDC can be helpful, however is not diagnostic of malaria.       In this same patient, if the malaria testing is negative, and other screening of common febrile causes is negative, then throw in some bone pain, joint pain, severe headache and a blanching rash - Dengue Fever is to be considered. Getting Dengue again further down the road can be much worse, such as Dengue Hemorrhagic Fever. Chikungunya is making itself known quite well in recent years too. While there is less likelihood of these and other viral diseases to cause severe illness, they are helpful to track from a public health standpoint. Sex tourism is quite common as well, and STIs must also be considered, such as HIV. In fact, some health systems are doing rapid HIV tests on all-comers. There is about a 0.1% positive rate at Hennepin Ed, for instance, and the significance here is that we're identifying the superinfected hosts who are at the highest likelihood of passing it to others. So, again, besides doing our basic work-ups like a chest x-ray, urinalysis, etc., the work-up for malaria is indicated as directed. A CDC and LFTs can also be helpful. Leukopenia, thrombocytopenia and transaminitis, a lot of vector borne illnesses will exhibit these findings. Rickettsial diseases are included in this.      There is a high incidence of gram negative sepsis with severe malaria, therefore, a comprehensive sepsis work-up and treatment plan with brad spectrum abx is appropriate; even in the setting of a positive malaria test or smear. IV quinidine is approved for use in the United States, although production of this is now an issue. There is hope that other drugs will go through the FDA process, although this is expensive. Artesunate is the IV med for malaria used elsewhere in the world, and the CDC has an investigative provision to use this drug when and if quinidine is not available. Malarone can be given PO or crushed and placed in an NG tube if IV preparations are temporarily unavailable. Doxycycline and Clindamycin do have some utility in malaria treatment as well. So, in the unlikely event that you are treating the sick malaria patient, these can be used as well in a pinch.        CHAPTER 3:      For respiratory patients who have traveled and you don't know the etiology, think respiratory isolation until you have a better sense of what's going on. Most likely, it is not something serious. However, there are serious respiratory illnesses endemic to certain countries and regions, such as MERS and SARS. Again, the Yellow Book can be helpful here. Personal protection including masks for patient and providers/care givers is recommended.      Diarrheal illnesses are also to be considered such as cholera. In general, abx are not always needed. The extreme cases of fever, abdominal pain and severe diarrhea is a different story, though, and abx can be given here. While some of the diarrheal etiologies for travelers are viral, many are bacterial. There is some resistance to certain antibiotics in campylobacter. Traveler's Diarrhea, for instance, does not require antibiotic therapy. Patients at higher risk are often on antacid meds at baseline. Situational needs may warrant antibiotics, such as the need to avoid a bathroom break next to a pride of lions, or a curious hippopotamus. Imodium is helpful, as is bismuth subsalicylate. Warn your patients about the black stools, though, too. Bismuth may be able to be used as prophylaxis as well. Imodium can be helpful for traveler's diarrhea, but it can lead to obstipation and it should be avoided in severe cases. Contacting the CDC for general questions about a tropical illness is an option. Steve also mentions that in the Hennepin service area, the option of contacting the Emergency Physician on duty is also an option. Again, look into the option of having a rapid malaria test available at your shop.      Dr. Dunlop discusses EMR systems, in this case, EPIC showing an improved ability to screen patients based on their demographics, country of origin, travel history, etc. of potential infectious considerations. For instance, what kind of malaria or other travel illnesses to consider based on what the patient's registration information provides.      Follow-up for most patients who have been diagnosed with a travel illness, especially something complex like malaria, it would be best to refer them to someone steeped in this field. As Dr. Dunlop mentions, it's prudent to look up ASTMH certified providers in your area. This information could be obtained from a travel medicine clinic, and would be a good place to start. Health care providers as patients tend to be some of the worst offenders in terms of compliance with travel medicine, chemoprophylaxis, etc. Utilizing a travel medicine clinic will be most prudent, and besides medications, many other topics can be addressed, including issues one wouldn't think of, like vaccinations - that may be problematic for older patients, insurance coverage for medications, etc.  

Why You Should Listen: In this episode, you will learn about EliSpot testing and the various testing options available through ArminLabs in Germany. About My Guest: My guest for this episode is Dr. Armin Schwarzbach. Armin Schwarzbach, MD, PhD is a medical doctor and a specialist in laboratory medicine from the laboratory ArminLabs in Augsburg, Germany. Dr. Schwarzbach began by studying biochemistry at Hoechst AG in Frankfurt, Germany and pharmacy at the University of Mainz in Germany in 1984. In 1985 he studied medicine for 6 years at the University of Mainz and finished his MD in 1991. Dr. Schwarzbach developed the worldwide first Radioimmunoassay (RIA) for human Gastric Inhibitory Polypeptide from 1986 – 1991, getting his PhD in 1992. He is member of the Swiss Association for tick-borne diseases, the German Association of Clinical Chemistry and Laboratory Medicine, and the German Society for Medical Laboratory Specialists. He is an Advisory Board member of AONM London, England, and Board member of German Borreliosis Society, and Member and former Board Member of the International Lyme and Associated Diseases Society (ILADS) and has served as an expert on advisory committees on Lyme Disease in England, Australia, Canada, Ireland, France, and Germany. Dr. Schwarzbach is the founder and CEO of ArminLabs in Augsburg, Germany and has specialized in diagnostic tests and treatment options for patients with tick-borne diseases for over 20 years. Key Takeaways: - What is an EliSpot? - What organisms can be tested for using EliSpot technology? - How specific is the EliSpot in testing for Borrelia, Bartonella, Babesia, and other organisms? - Does the state of the immune system matter when considering EliSpot results? - Which infections are the most persistent? - Can the EliSpot be used to track progress or success of treatment? - What is Yersinia and where might it be encountered? - Can EliSpot testing be used in newborns and infants? - What role do viruses such as EBV, CMV, Coxsackie, and others play in chronic illness? - Can Mast Cell Activation Syndrome be triggered by viruses? - Why are Mycoplasma and Chlamydia so important to explore? - Why is IgA testing a promising new direction in laboratory medicine? - Is CD57 helpful clinically? - What microbes are more commonly associated with specific medical conditions? - How common are Rickettsial organisms? - What is "Post Lyme Syndrome"? Is it real? Connect With My Guest: http://arminlabs.com Interview Date: February 27, 2019 Additional Information: To learn more, visit http://BetterHealthGuy.com. Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

Dr. Raghuram review common rickettsial diseases (Rocky Mountain Spotted Fever,  Typhus, Mediterranean Spotted Fever, African Tick Bite Fever,  and less common species) with a focus on board review. She delves into geography, vectors and pathophysiology of these diseases as well as discussing common look-a-like diseases.

All discussions of energetic imbalances reference certain frequencies an imbalance may be similar to. A frequency is NOT the actual disease; Newly revealed Hereditary imbalances added to the AIM database; Vast majority of imbalances revealed are of the Rickettsial classification; Once on AIM long enough, participants heal imbalances much more quickly due to their vastly improved healing capacity from having self-healed so many of their imbalances; Parasite imbalances (which are acquired, not Hereditary) impact one's healing capacity and rate of healing frequencies, but do not block one's ability to self-heal. Stephen continues to research these frequencies to find balancing energies to assist in healing them; The frequencies behind a disease are not the same as the damage that may have been done by the manifestation of the frequencies. Stephen stressed this, and how the individual benefits when everyone works as a team to contribute their expertise, from healers to doctors, as appropriate. If you missed last night's monthly call with Stephen, the recording will be up on all of our web sites shortly.

Daniel Paris: Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Daniel Paris: Rickettsial Disease Rickettsial diseases such as scrub typhus are important causes of fever in southeast Asia especially in rural communities. Discovered quite recently and not big killers, these diseases are among the most under-reported and under-diagnosed illnesses that are both treatable and preventable. Rickettsial studies at he Mahidol Oxford Tropical Medicine Research Unit (MORU) focus on the epidemiology and incidence of the disease using hospital-based fever studies in Thailand and Laos. Our research unit has developed highly improved acute diagnosis of rickettsial illness. MORU also has ongoing studies to determine the pathophysiological mechanisms of scrub typhus infection.

Pronunciation help from Dr. Ashleigh Newman!

Pronunciation help from Dr. Ashleigh Newman!