Skin and joint manifestations of

Size: px

Start display at page:

Download "Skin and joint manifestations of"

Ariel Harvey
5 years ago
Views:

1 Australasian Society for Infectious Diseases Skin and joint manifestations of Arboviruses and Rickettsia Dominic Dwyer Dominic Dwyer Centre for Infectious Diseases and Microbiology ICPMR Westmead Hospital and University of Sydney

2 Viral arthritis Consider by Clinical i l picture it Fever, rash, arthritis Mono or polyarticular l Hepatitis, myalgia or other manifestations Arthritis vsarthralgia Location (travel history) Other history (contact, t IDU, sexual) Epidemic/non epidemic Emerging

3 Viral arthritis Consider by virus Togaviridae Alphavirus Ross River, Barmah Forest, Sindbis, Chikungunya, O nyongo nyong etc Rubivirus rubella Flaviviridae (dengue, HCV) Parvoviridae (B19) Hepadnaviridae (HBV) Retroviridae (HIV, HTLV 1)

4 Arboviruses (Australia) associated with arthritis and rash Virus Location Mosquito Vector Incubation Distinguishing g Period Clinical (days) Features Laboratory Diagnosis Ross River Epidemic Australia(PNG, Ad Aedes sp. and Serology 5-15 polyarthritis, (alphavirus) Pacific) Culex sp. chronicity,rash (NAT, culture) Epidemic Barmah Forest Aedes sp. and polyarthritis, rash Serology Australia 5-15 (alphavirus) Culex sp. more prominent (NAT, culture) than RRv, myalgia Fever, Dengue Asia, Central and ICT, NS1 rash,arthralgias, arthralgias South America, Aedes sp. 4-7 antigen, serology, (flavivirus) DHS in repeat Nth Queensland NAT, (culture) infections Sindbis Europe, Africa, Serology Culex sp. <7 Rash, paraesthesiae (alphavirus) Asia, Australia (culture) Chikungunya Africa, Indian Arthritis Serology, NAT Ocean, South and Aedes sp predominant, (alphavirus) SE Asia lymphadenopathy (culture) (rarely Kunjin/WNV, Kokobera, Alfuy, Edge Hill, Stratford viruses)

10 Clinical features of RRv and BFv Ross River virus BarmahForest virus Maculopapular rash ~100% 90% Vesicular rash uncommon 10% Joint pain >1 month 79 98% 49% Joint pain >6 months 57% >10% Joint swelling, stiffness 61 80% 30% Myalgia 43 79% 70 80% Lymphadenopathy 06 29% 0.6 7% Fatigue 62 94% 80% Fever 20 60% <50% Flexman J et al Med J Aust 1998; 169:159 63

13 Rickettsiae in Australia Typhus Group Rickettsiaprowazekii Rickettsiatyphi epidemic typhus (lice),? no longer present endemic typhus (rodent fleas), widespread Spotted Fever Group (Ixodes ticks) Rickettsiaaustralis Queensland tick typhus (QTT) Rickettsiahonei Flinders Island Spotted Fever (FISF) marmionii strain Rickettsiafelis serology TG/molecular SFG (cat fleas, outbreak in Melbourne) Scrub Typhus Group Orientiatsutsugamushi Scrub typhus (mites), northern tropical Australia

19 Diagnosis ofrickettsial Infections 1. Serology: Indirect fluorescent antibody assay 4 fold increase in titre from acute to convalescent sera limited by cross reactivity within the spotted fever group (R. australis, R. honei) the typhus group (R. typhi, R. prowazekii, R. felis) Scrub typhus (O. tsutsugamushi) does not cross react 2. Culture (BSL 3) gold standard for characterisation cell culture (Vero, L929 etc) typically used 3. Immuno histochemistry on tissue (eschar)

20 Diagnosis of Rickettsial Infections 4. NAT for Rickettsia DNA eg. citrate synthase (glta) gene confirms organism identity Specimens EDTA/Na citrate blood low yield (low organism number) Lesion biopsy *Swab of eschar or vesicular lesion (if present): high yield, large numbers of organisms, non invasive *Wang JM, et al. Emerg Infect Dis 2009; 15: Lee, S H. et al. J ClinMicrobiol 2006; 44:

21 Treatment Ross River and Barmah Forest viruses nil specific NSAIDs RRv vaccine in development Rickettsial infections doxycycline yy azithromycin, ciprofloxacin

African tick typhus. David Mabey

African tick typhus. David Mabey African tick typhus David Mabey 25 year old English man Holiday in Zimbabwe for 3 months Became unwell on plane home Fever Rash Generalised lymphadenopathy This photo was taken 2 days after onset of symptoms