VPH - Quiz 2-4

pbhati17's version from 2017-03-30 22:42


(tee hee hee references)
Question Answer
Agent that czs Q-Fever?Coxiella burnetii (Avenue Q is all about cox)
Why is Q-Fever of public health importance?Highly pathogenic to humans = Bioterrorism agent (Category B)
Risk to vets/students
Pregnant women
Lab staff (BSL3 required)
Why is Coxiella burnetii a bioterrorism agent?Low infectious dose reqd to cz infxn in humans
Easily acquired by humans
Environmentally resistant
Easily aerosolized
Human epidemics of Q-Fever often associated w/?Abortions in goat/sheep
If there is an outbreak, what are some immediate control measures? (4)(1) Vx of sheep & goats
(2) Culling of ALL pregnant animals on infected farms
(3) Restricting animal movements
(4) Prevent visitors to infected farms – zoonotic risk
Where does Q-Fever usually occur?Rural settings
If there is animal involvement in a case of Coxiella burnetii, who do you inform?Area Veterinarian in Charge (AVIC) & State Vet
If there is human involvement in a case of Coxiella burnetii, who do you inform?State Health Dept & CDC
What IS Coxiella burnetii?Intracellular Proteobacteria
Why is Coxiella burnetii so enviro resistant? What CAN kill it?Forms spore-like structures = resistant to environmental conditions & many disinfectants, but can be destroyed by Pasteurization
What is the main reservoir for Coxiella burnetii?Ruminants main reservoirs (but diverse reservoirs of human infxn…wild mammals, birds, arthropods)
Most human czs are linked to what?Occupational hazards:
Is there a control program for Q-Fever?No, only by state
What are the 2 cycles of infxn of Coxiella burnetii that exist independently in nature?Direct Zoonoses: Domestic animal reservoir (usually sm rumi)
Sylvatic Cycle: Btwn wild animals (mainly marsupials, rodents, lagomorphs) & their ectoparasites, esp ticks [Metazoonoses] (Q does 2)
When is infxn of Q-Fever at highest risk?AT PARTURITION
What is Coxiella burnetii excreted in?Feces

of infected animals. In infected animals the organism is also shed notably in the placenta, amniotic fluid & fetal membranes
*What happens if an animal is latently infected w/ Coxiella burnetii?Subclinical infxns can still shed organism
Latent infxns in animals activated late in pregnancy, localize in the uterus & be shed in ↑ numbers at parturition
What are 5 ways that Coxiella burnetii can be xmitted?AEROSOL
Human-human (RARE!!!)
**What is the MAIN route of infxn for Q-Fever? For who?AEROSOL!! For both animal to animal & animal to human (domestic animals). (Q for QUICK, DON'T BREATHE-you don't want to breathe cox) Most commonly via inhalation of aerosols from placental material & amniotic fluid.....aerosol can also come from When infected animals are processed as meat, during necropsies or assisting deliveries, Due to environmental persistence of the agent, dried infective material carried considerable distances by wind & Fomites (wool, bedding, clothing)
How can Q-Fever be orally xmitted?Young ruminants from milk of infected dams...since in milk, NEED TO PASTURIZE MILK
Who does Q-Fever cz abortion in & why does it cz abortion?Abortion bc intrauterine infxn!
Abortion in:
Recently cats
Can Q-Fever cz abortion in humans?Humans are dead-end hosts but some evidence intrauterine xmission may occur tho rare. Some congenital infxns have been reported. Tho not a common cz of human abortion it is still recommended that pregnant women avoid contact w/ sheep & goats that are parturient
How can arthropods be a source of infxn for Q-Fever? Who is susceptible to this?Humans & domestic animals can acquire infxn by entering a sylvatic (usually rodents/lagomorphs) focus; bites from infected ticks. Rare
How do animals usually present when infected w/ Q-Fever?USUALLY asymptomatic /subclinically infected. In SHEEP/GOATS will often see abortion. Sometimes cats will have abortion. Often human cases are Dx 1st & then traced back to a subclinical animal reservoir
How do humans usually present when infected w/ Q-Fever? (IN GENERAL)Humans are considered to be dead-end hosts & most cases asymptomatic. However, humans are the only species known to develop illness regularly from infxn


Question Answer
What are the 3 manifestations of dz in humans?(1) Acute (less than 6 months duration)
(2) Chronic (greater than 6 months duration)
(3) Risk to fetus in pregnant women
Describe the ACUTE manifestation of Q-Fever in humansSudden onset, Self-limiting flu-like (50%):
Non-productive cough
Severe sweats
An often prominent sign is severe retro-ocular pain (Q stuck his cox right behind my eye)
How does Q-Fever affect age differently? What is the mortality? (in humans)Mortality low. Children <10 seem more resistant, people >40 MORE susceptible
Describe the CHRONIC manifestation of Q-Fever in humans & how it differs in WHO it affectsImmunocompromised at risk for chronic (otherwise rare). Primarily affects the CV system thus often get Endocarditis, can also get osteomyelitis, hepatitis or cirrhosis
Humans w/ what problem should especially avoid Coxiella burnetii?Individuals w/ valvular heart dz should not work w/ C. burnetii, bc the chronic form can cz endocarditis
What are the best ways to diagnose Q-Fever?Antigen detection (IHC, Direct FA)
PCR /DNA (not always available)
Serology (test for antibody) - ELISA (not super accurate or sensitive). (Culture is ↑ risk & requires a BSL-3 lab...not the best option)
How do you usually dx Q-Fever in humans?CS
Blood culture
Are animals Tx for Q-Fever?Questionable effectiveness, but Tetracycline has been given in water in the weeks preceding parturition in enzootic herds. This may help reduce shedding into birthing materials = less abortions? So might not eradicate from carrier but might help reduce abortions
How are humans Tx for Q-Fever?Self-limiting illness & most cases resolve w/in days to weeks
For ACUTE: Is self-limiting, but Tx can ↓ the duration of fever & other symptoms. Currently using tetracycline or rifampin. If pneumonia develops, combinations of ABx are often used
For CHRONIC/ENDOCARDITIS: Long term combination ABx are used > 2 years. Surgical valve replacement
Is Q-Fever reportable? For who?Depends on state. Yes in Montana & Washington (animals) (reportable in people to the state authority/vet/CDC)
Is Q-Fever notifiable? For who?CDC has it notifiable as of 2013 for HUMANS
Are there mandatory control programs for Q-Fever?Mandatory control programs only for animals in research institutions
Is there a Vx for Q-Fever?FOR ANIMALS? NO...but Vx a future consideration - tho it does not prevent, may reduce shedding to the environment & human exposure risk
FOR HUMANS? Yes, but It is only given to people employed in ↑ risk occupations & only after they test sero(-) & skin test (-)
What are some methods for general control of Q-Fever in livestock? (9 things... & 2 things to note)NOTE: Good general animal husbandry! Also EDUCATION is important for prevention & control!
(1) Cull / Depop.
(2) Surveillance & replacement stock from flocks screened & free of C. burnetii - Antigen detection
(3) Isolate new animals
(4) Separate pregnant animals from others, especially at birthing
(5) Vx (but this isn't in the US!!!)
(6) Personal Protective Equipment [PPE] - gloves, N95 masks
(7) Placentas, aborted materials, fetal tissues properly disposed of properly. Incinerated, composting or burial in a designated landfill
(8) Lambing areas treat w/ Lysol, bleach, hydrogen peroxide. Ensure equipment & environmental surfaces cleaned using a chemically approved disinfectant
(9) Manure management: compost & rotate soil
What are 2 major reasons for why practical control in ALL LIVESTOCK is difficult?(1) Environmental stability
(2) Many reservoirs-risk of infectivity for wild animals, arthropods & humans
(Q is resistant & loves everyone-so getting rid of him is hard)
Why would it be difficult to maintain a flock of sheep certified free of C. burnetii? (5)(1) Hard to identify infected sheep (usually subclinically infected)
(2) Can be Seronegative w/ latent infxn (why serology is not always the best testing method)
(3) Can be Infected, shedding, but show no dz
(4) No effective animal Vx
(5) Organism environmentally stable
If a vet finds Q-Fever, what should they do?Report /consult w/ State/Federal animal health/health agencies
What’s up w/ Vxs for Q-Fever?None for animals in USA. ↑ RISK VX in people, only if theyre sero/skin test negative & at ↑ risk for the dz. (it’s a Killed Vx)
What are the ↑-risk people & what should they not do?(Pregnant women, immune compromised, prosthetic heart valves) Should not have contact w/ sheep/goat herds or assist in any birthing processes
You can use PPE if you are at an occupational risk. What are the occupational risks?Vets
Lab workers
Sheep/goat farmers especially if breeding
Abattoir workers
What is some PPE you can use to protect yourself w/ in case of Q-Fever being present?N-95 respirator + eye protection: Face shield, goggles to prevent aerosol xmission, disposable shoe covers + gloves + white coats
Which animals would you prefer to use in research if you are worried about Q-Fever?Male & non-preg animals

Zoonotic Chlamydial Species

Question Answer
Chlamydia vs Chlamydophila?These are 2 different genera w/in the order Chlamydiales. THE ONES WE CARE ABOUT ARE CHLAMYDOPHILA
What are the 3 zoonotic species of ChlamyDOPHILA?C. abortus
C. psittaci
C. felis
Chlamydophila psittaci affects who & what is the 1° dz in this host?BIRDS: Conjunctivitis, Respiratory systemic dz
Chlamydophila abortus affects who & what is the 1° dz in this host?SHEEP/GOATS/CATTLE: Abortion, Weak neonates
Chlamydophila felis affects who & what is the 1° dz in this host?CATS: Rhinitis, Conjunctivitis
Which of the zoonotic Chlamydophila is only a minor zoonosis?C. felis
Chlamydophila psittaci → czs what dz in birds? Humans?BIRDS: Get Avian Chlamydiosis
HUMANS: Get Psittacosis (Parrot fever)
Who is at occupational risk for getting Psittacosis?Vets
Poultry workers
Lab workers
Pet store employees
Bird owners
Which Chlamydophila species is a bioterrorism agent & which class?C. psittaci, CDC Class-B
What is the infxn control plan for C. psittaci? (5)(1) Use of approved disinfectants for cages - Lysol, Roccal-D
(2) Ventilation systems to ↓ aerosols in environment
(3) Screening birds
(4) Isolation of new birds; quarantine ill
(5) Use of Personal protective equipment [PPE]
How does a bird w/ Avian Chlamydiosis present?Most infxns in birds are latent & inapparent!!!! Develop dz when stressed. Lethargic, non-specific illness...primarily GI dz, diarrhea common - GREEN TO YELLOWISH DROPPINGS!!! Anorexia/emaciation, ruffled feathers, serous or mucopurulent oculonasal discharge, some respiratory signs, some CNS signs
Is C. psittaci reportable? Notifiable? If so, if WHO gets sick?NOTIFIABLE if in HUMANS (also reportable) (avian-might be reportable, depends on state)
Who regulates bird importation to prevent exotic dzs from going into the US?USDA-APHIS
C. psittaci → Compendium → what are 4 good preventative measure which vets are responsible to tell owners?(1) Isolate & quarantine NEW birds for 6 wks min & refer to an avian vet for screening
(2) Reduce stress
(3) Purchase from breeders who screen for the dz
(4) Practice good husbandry: Hygienic practices
C. psittaci → Compendium → 3 major considerations for treating a bird w/ C. psittaci?(1) Isolate infected birds. Treat all birds in home to ↓ spread
(2) Educate them on zoonotic risk prevention & tell them to go to the MD. Specifically risks to immunosuppressed owners & use of Personal Protective Equipment (PPE)
(3) Advise client to follow Tx protocols for birds Remove Calcium supplements as it ↓ efficacy of meds
If treating birds for C. psittaci, what shouldn't you feed them?Calcium! REMOVE CALCIUM SUPPLEMENTS! These ↓ efficacy of Tx
Where do the majority (>70%) of human exposures to C. psittaci come from?From CAGED PET BIRD exposures
What are the 2 main reservoirs for C. psittaci?(1) Psittaciformes (psittacine birds)
(2) Columbiformes (pigeons, doves)
What are the 3 ways that a human can get C. psittaci from a bird? Which is the MAIN way?(1) *Most common* aerosol/inhalation
(2) Mouth-to-beak contact
(3) In-utero xmission to fetus
Explain how the xmission of C. psittaci through aerosolization/inhalation occur?(1) Dried feces or respiratory secretions of infected birds
(2) From infected bird Carcasses/ feathers. **C. psittaci can be aerosolized on turkey, squab & duck farms & in poultry processing plants
What can precipitate shedding of C. psittaci from infected birds?STRESS
What are 4 ways that there is Bird-to-bird spread of C. psittaci?(1) AEROSOL from feces/nasal discharge of infected birds
(2) Ingestion (coprophagia/cannibalism)
(3) Fomites including contaminated feed or water
(4) Vertical xmission has been occasionally reported
How does a human infected w/ C. psittaci usually present?(NOTE: Anyone who has been in contact w/ birds & develop symptoms consistent w/ Psittacosis should go to the MD!)
(1) Flu-like dz/atypical pneumonia: Many infxns pass asymptomatically, while others vary in severity
(2) Pregnant women birth prematurely, +/-fetal death
(3) Severe multisystemic signs in humans, can be fatal