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Khademi R, Kharaziha M. Antibacterial and Osteogenic Doxycycline Imprinted Bioglass Microspheres to Combat Bone Infection. ACS APPLIED MATERIALS & INTERFACES 2024; 16:31966-31982. [PMID: 38829697 DOI: 10.1021/acsami.4c03501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Currently, postoperative infection is a significant challenge in bone and dental surgical procedures, demanding the exploration of innovative approaches due to the prevalence of antibiotic-resistant bacteria. This study aims to develop a strategy for controlled and smart antibiotic release while accelerating osteogenesis to expedite bone healing. In this regard, temperature-responsive doxycycline (DOX) imprinted bioglass microspheres (BGMs) were synthesized. Following the formation of chitosan-modified BGMs, poly N-isopropylacrylamide (pNIPAm) was used for surface imprinting of DOX. The temperature-responsive molecularly imprinted polymers (MIPs) exhibited pH and temperature dual-responsive adsorption and controlled-release properties for DOX. The temperature-responsive MIP was optimized by investigating the molar ratio of N,N'-methylene bis(acrylamide) (MBA, the cross-linker) to NIPAm. Our results demonstrated that the MIPs showed superior adsorption capacity (96.85 mg/g at 35 °C, pH = 7) than nonimprinted polymers (NIPs) and manifested a favorable selectivity toward DOX. The adsorption behavior of DOX on the MIPs fit well with the Langmuir model and the pseudo-second-order kinetic model. Drug release studies demonstrated a controlled release of DOX due to imprinted cavities, which were fitted with the Korsmeyer-Peppas kinetic model. DOX-imprinted BGMs also revealed comparable antibacterial effects against Staphylococcus aureus and Escherichia coli to the DOX (control). In addition, MIPs promoted viability and osteogenic differentiation of MG63 osteoblast-like cells. Overall, the findings demonstrate the significant potential of DOX-imprinted BGMs for use in bone defects. Nonetheless, further in vitro investigations and subsequent in vivo experiments are warranted to advance this research.
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Affiliation(s)
- Reihaneh Khademi
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
| | - Mahshid Kharaziha
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
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Epidemiology, Clinical Aspects, Laboratory Diagnosis and Treatment of Rickettsial Diseases in the Mediterranean Area During COVID-19 Pandemic: A Review of the Literature. Mediterr J Hematol Infect Dis 2020; 12:e2020056. [PMID: 32952967 PMCID: PMC7485464 DOI: 10.4084/mjhid.2020.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/04/2020] [Indexed: 01/12/2023] Open
Abstract
The purpose of the present review is to give an update regarding the classification, epidemiology, clinical manifestation, diagnoses, and treatment of the Rickettsial diseases present in the Mediterranean area. We performed a comprehensive search, through electronic databases (Pubmed – MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles, reviews, and books). The availability of new diagnostic tools, including Polymerase Chain Reaction and nucleotide sequencing has significantly modified the classification of intracellular bacteria, including the order Rickettsiales with more and more new Rickettsia species recognized as human pathogens. Furthermore, emerging Rickettsia species have been found in several countries and are often associated with unique clinical pictures that may challenge the physician in the early detection of the diseases. Rickettsial infections include a wide spectrum of clinical presentations ranging from a benign to a potentially life treating disease that requires prompt recognition and proper management. Recently, due to the spread of SARS-CoV-2 infection, the differential diagnosis with COVID-19 is of crucial importance. The correct understanding of the clinical features, diagnostic tools, and proper treatment can assist clinicians in the management of Rickettsioses in the Mediterranean area.
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Blanton LS, Wilson NM, Quade BR, Walker DH. Susceptibility of Rickettsia rickettsii to Tigecycline in a Cell Culture Assay and Animal Model for Rocky Mountain Spotted Fever. Am J Trop Med Hyg 2020; 101:1091-1095. [PMID: 31516114 DOI: 10.4269/ajtmh.19-0445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Rocky Mountain spotted fever (RMSF), caused by Rickettsia rickettsii, is a severe tick-borne infection endemic to the Americas. Oral doxycycline is effective, but during severe life-threatening disease, intravenous therapy is recommended. Unfortunately, intravenous formulations of doxycycline are not always available. Therefore, we aimed to determine the susceptibility of R. rickettsii to an alternative parenteral agent, tigecycline, in vitro and in vivo. To determine the minimum inhibitory concentration of tigecycline, R. rickettsii-inoculated Vero cells were incubated with medium containing tigecycline. At various time points, monolayers were collected and R. rickettsii was quantified via real-time polymerase chain reaction (PCR). The growth of R. rickettsii was inhibited in the presence of ≥ 0.5 µg/mL of tigecycline. To determine the effectiveness of tigecycline in vivo, guinea pigs were inoculated with R. rickettsii. Five days after inoculation, they were treated twice daily with subcutaneous tigecycline 3.75 mg/kg or subcutaneous doxycycline 5 mg/kg. Treated animals improved, whereas untreated controls remained ill. Tissues were collected for quantitative PCR-determined bacterial loads on day 8. Median bacterial loads in the tigecycline group were less than those in untreated animals: liver (0 versus 2.9 × 104 copies/mg), lung (0 versus 8.3 × 103 copies/mg), skin (2.6 × 102 versus 2.2 × 105 copies/mg), spleen (0 versus 1.3 × 104 copies/mg), and testes (0 versus 1.0 × 105 copies/mg, respectively). There were no significant differences in the bacterial loads between doxycycline-treated versus tigecycline-treated guinea pigs. These data indicate that tigecycline is effective against R. rickettsii in cell culture and in an animal model of RMSF.
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Affiliation(s)
- Lucas S Blanton
- Department of Internal Medicine-Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
| | - Nicholas M Wilson
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Bethany R Quade
- Department of Internal Medicine-Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
| | - David H Walker
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
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Youssoufou Souley AS, El Ouatassi N, Alsubari A, Zerrouk R, Reda K, Oubaaz A. [Macular atrophy secondary to bilateral involvement in Mediterranean spotted fever]. J Fr Ophtalmol 2019; 42:e47-e50. [PMID: 30683535 DOI: 10.1016/j.jfo.2018.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
- A S Youssoufou Souley
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc.
| | - N El Ouatassi
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc
| | - A Alsubari
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc
| | - R Zerrouk
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc
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Abstract
With advances in molecular genetics, more pathogenic rickettsial species have been identified. Pathogenic rickettsiae are transmitted by vectors, such as arthropods, into the patient's skin and then spread into the microvascular endothelial cells. Clinical manifestations are characterized by fever with headache and myalgias, followed by rash 3 to 5 days later. The undifferentiated nature of clinical symptoms, knowledge of the epidemiology, and the patient's history of travel and exposure to arthropod vectors are critical to the empiric administration of antimicrobial therapy. Doxycycline is currently the most effective antibiotic for treatment of all spotted fever group and typhus group rickettsioses.
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Affiliation(s)
- Rong Fang
- Department of Pathology, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0609, USA
| | - Lucas S Blanton
- Infectious Diseases, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0435, USA
| | - David H Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, The University of Texas Medical Branch, 301 University Boulevard, Keiller Building, Galveston, TX 77555-0609, USA.
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial Infections around the World, Part 2: Rickettsialpox, the Typhus Group, and Bioterrorism. J Cutan Med Surg 2016. [DOI: 10.1177/120347540500900302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jashin J. Wu
- Department of Dermatology, University of California, Irvine, California, USA
| | - David B. Huang
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- University of Texas at Houston School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Katie R. Pang
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Stephen K. Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Clinical Studies, Houston, Texas, USA
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Blanton LS, Walker DH. Treatment of Tropical and Travel Related Rickettsioses. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Botelho-Nevers E, Socolovschi C, Raoult D, Parola P. Treatment of Rickettsia spp. infections: a review. Expert Rev Anti Infect Ther 2013; 10:1425-37. [PMID: 23253320 DOI: 10.1586/eri.12.139] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human rickettsioses caused by intracellular bacteria of the genus Rickettsia are distributed worldwide and are transmitted by arthropod vectors such as ticks, fleas, mites and lice. They have a wide range of manifestations from benign to life-threatening diseases. Mortality rates of up to 30% have been reported for some rickettsioses. Here, the authors will review in vitro and human studies of the various compounds that have been used for the treatment of Rickettsia spp. infections. The authors will also provide recommendations for the treatment of spotted fever and typhus group rickettsioses.
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Affiliation(s)
- Elisabeth Botelho-Nevers
- Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, Aix-Marseille Université, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
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Botelho-Nevers E, Edouard S, Leroy Q, Raoult D. Deleterious effect of ciprofloxacin on Rickettsia conorii-infected cells is linked to toxin-antitoxin module up-regulation. J Antimicrob Chemother 2012; 67:1677-82. [PMID: 22467631 DOI: 10.1093/jac/dks089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To confirm and better understand the deleterious effect of fluoroquinolones reported during Rickettsia conorii infection in humans. METHODS We used a new plaque assay to test the effect of ciprofloxacin on cells infected by R. conorii. Controls were mock-treated infected cells and infected cells treated with doxycycline. We used real-time quantitative RT-PCR to quantify vapC and vapB transcripts in cells infected by R. conorii treated with ciprofloxacin or mock treated. RESULTS By plaque assay, at baseline (0 h) there is no difference in lytic area between cells treated with ciprofloxacin (whatever concentration used) and controls. Ciprofloxacin at 0.5 and 50 mg/L induced a significant increase in lytic areas compared with the control at 2 h, 4 h, 6 h (P<0.0001) and 24 h (P<0.0001 and P=0.035, respectively) when not induced with doxycycline. By real-time quantitative RT-PCR, ciprofloxacin was found to cause an up-regulation of toxin-antitoxin (TA) module transcription. Indeed, the mRNA levels of vapC and vapB were significantly increased at 2 h and 4 h in cells treated with 50 mg/L ciprofloxacin (not with 0.5 mg/L ciprofloxacin) compared with control levels (fold change >2.9). CONCLUSIONS These in vitro findings correlated with our previous clinical findings: fluoroquinolones have a deleterious effect during R. conorii infection, not found with doxycycline. We speculate that the toxic effect of fluoroquinolones on R. conorii-infected cells is mediated by the overexpression of TA, possibly followed by their release into the host cytoplasm as described in Rickettsia felis.
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Affiliation(s)
- Elisabeth Botelho-Nevers
- URMITE UMR 6236, CNRS-IRD, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille cedex 05, France
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Botelho-Nevers E, Rovery C, Richet H, Raoult D. Analysis of risk factors for malignant Mediterranean spotted fever indicates that fluoroquinolone treatment has a deleterious effect. J Antimicrob Chemother 2011; 66:1821-30. [DOI: 10.1093/jac/dkr218] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Dana AN. Diagnosis and treatment of tick infestation and tick-borne diseases with cutaneous manifestations. Dermatol Ther 2009; 22:293-326. [PMID: 19580576 DOI: 10.1111/j.1529-8019.2009.01244.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hard and soft ticks may be associated directly or indirectly with a number of dermatoses, both infectious and inflammatory in origin. Morbidity may occur as a result of tick bites, tick toxicosis, and even infestation. These arthropod vectors may transmit life-threatening protozoan, bacterial, rickettsial, and viral diseases with systemic and cutaneous findings. Additionally, ticks may transmit more than one pathogen with subsequent human coinfection. This article reviews the presentation of tick-borne illnesses and the medical management of these diseases. Among others, diseases such as ehrlichiosis, anaplasmosis, babesiosis, tularemia, borrelioses, tick-borne encephalitides, rickettsial spotted fevers, and tick typhus are discussed in this article. The recognition of skin manifestations associated with these diseases is paramount to early diagnosis and treatment initiation.
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Affiliation(s)
- Ali N Dana
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA.
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Romdhane FB, Loussaief C, Toumi A, Yahia SB, Khaiyrallah M, Bouzouaïa N, Chakroun M. Mediterranean spotted fever: a report of 200 cases in Tunisia. Clin Microbiol Infect 2009; 15 Suppl 2:209-10. [PMID: 19456798 DOI: 10.1111/j.1469-0691.2008.02280.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F B Romdhane
- Department of Infectious Diseases, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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Castelli F, Capone S, Pedruzzi B, Matteelli A. Antimicrobial prevention and therapy for travelers' infection. Expert Rev Anti Infect Ther 2008; 5:1031-48. [PMID: 18039086 DOI: 10.1586/14787210.5.6.1031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
International journeys are increasing and more than 70 million people from industrialized countries cross the borders of tropical countries every year. More than 50% of them will suffer from some form of infectious illness, ranging from mild travelers' diarrhea to severe dengue fever to fatal malaria, with a wide spectrum of microbiological entities. Travel-related respiratory infections, including TB, and sexually transmitted infections are also increasingly reported. Awareness of travel-related risk is not always adequate among international travelers. Specific training on travel medicine-related issues, as well as better diagnostic facilities for imported diseases, is crucial for physicians and nurses in industrialized countries.
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Affiliation(s)
- Francesco Castelli
- University of Brescia, Unit for Tropical and Imported Diseases, Spedali Civili General Hospital, Piazza Spedali Civili, 1 25123 Brescia, Italy.
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial infections around the world, part 1: pathophysiology and the spotted fever group. J Cutan Med Surg 2006; 9:54-62. [PMID: 16392014 DOI: 10.1007/s10227-005-0133-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. OBJECTIVE In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. METHODS Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. RESULTS Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. CONCLUSIONS At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California, Irvine, California, USA
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial Infections Around the World, Part 2: Rickettsialpox, the Typhus Group, and Bioterrorism. J Cutan Med Surg 2005; 9:105-15. [PMID: 16392013 DOI: 10.1007/s10227-005-0134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California, Irvine, California, USA
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Buckingham SC. Tick-borne infections in children: epidemiology, clinical manifestations, and optimal management strategies. Paediatr Drugs 2005; 7:163-76. [PMID: 15977962 DOI: 10.2165/00148581-200507030-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Ticks can transmit bacterial, protozoal, and viral infections to humans. Specific therapy is available for several of these infections. Doxycycline is the antimicrobial treatment of choice for all patients, regardless of age, with Rocky Mountain spotted fever, human monocytic ehrlichiosis, or human granulocytic ehrlichiosis. Chloramphenicol has been used to treat these infections in children but is demonstrably inferior to doxycycline. In patients with Mediterranean spotted fever, doxycycline, chloramphenicol, and newer macrolides all appear to be effective therapies. Therapy of Lyme disease depends on the age of the child and stage of the disease. For early localized disease, amoxicillin (for those aged <8 years) or doxycycline (for those aged >/=8 years) is effective. Doxycycline, penicillin V (phenoxymethylpenicillin) or penicillin G (benzylpenicillin) preparations, and erythromycin are all effective treatments for tick-borne relapsing fever. Hospitalized patients with tularemia should receive gentamicin or streptomycin. Doxycycline and ciprofloxacin have each been investigated for the treatment of tularemia in outpatients; however, these agents do not yet have established roles in the treatment of this disease in children. Combination therapy with clindamycin and quinine is preferred for children with babesiosis; the combination of azithromycin and atovaquone also appears promising. Ribavirin has been recently shown to markedly improve survival in patients with Crimean-Congo hemorrhagic fever. The role of antiviral therapy in the treatment of other tick-borne viral infections, including other hemorrhagic fevers and tick-borne encephalitis, is not yet defined.
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Affiliation(s)
- Steven C Buckingham
- Department of Pediatrics, Division of Infectious Disease, University of Tennessee Health Science Center and Children's Foundation Research Center at Le Bonheur Children's Medical Center, Memphis, Tennessee, USA.
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Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 2005; 18:719-56. [PMID: 16223955 PMCID: PMC1265907 DOI: 10.1128/cmr.18.4.719-756.2005] [Citation(s) in RCA: 727] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
During most of the 20th century, the epidemiology of tick-borne rickettsioses could be summarized as the occurrence of a single pathogenic rickettsia on each continent. An element of this paradigm suggested that the many other characterized and noncharacterized rickettsiae isolated from ticks were not pathogenic to humans. In this context, it was considered that relatively few tick-borne rickettsiae caused human disease. This concept was modified extensively from 1984 through 2005 by the identification of at least 11 additional rickettsial species or subspecies that cause tick-borne rickettsioses around the world. Of these agents, seven were initially isolated from ticks, often years or decades before a definitive association with human disease was established. We present here the tick-borne rickettsioses described through 2005 and focus on the epidemiological circumstances that have played a role in the emergence of the newly recognized diseases.
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Affiliation(s)
- Philippe Parola
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Université de la Méditerranée, Faculté de Médecine, 13385 Marseille Cedex 5, France
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial Infections around the World, Part 1: Pathophysiology and the Spotted Fever Group. J Cutan Med Surg 2005. [DOI: 10.1177/120347540500900203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. Objective: In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. Methods: Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. Results: Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. Conclusions: At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.
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Affiliation(s)
- Jashin J. Wu
- Department of Dermatology, University of California, Irvine, California, USA
| | - David B. Huang
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Katie R. Pang
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan, Texas, USA
| | - Stephen K. Tyring
- Department of Dermatology, University of Texas Health Science Center, Houstan, Texas, USA
- Center for Clinical Studies, Houston, Texas, USA
- Center for Clinical Studies, 2060 Space Park Drive, Suite 200, Houston, TX, 77058, USA
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Amsden JR, Warmack S, Gubbins PO. Tick-Borne Bacterial, Rickettsial, Spirochetal, and Protozoal Infectious Diseases in the United States: A Comprehensive Review. Pharmacotherapy 2005; 25:191-210. [PMID: 15767235 DOI: 10.1592/phco.25.2.191.56948] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 900 tick species exist worldwide, and they parasitize a variety of mammals, including humans; thus, ticks play a significant role in the transmission of infectious diseases. In the United States, tick-borne diseases are seasonally and geographically distributed; they typically occur during spring and summer but can occur throughout the year. Tick-borne diseases are endemic to a variety of geographic regions of the United States, depending on the species of tick commonly found in a specific locale. Specific tick-borne diseases are difficult to diagnose. Most patients have vague constitutional symptoms and nonspecific laboratory findings. Initially, serologic methods are of little benefit because they lack sensitivity early in the disease course. Therefore, a thorough history and physical examination are necessary for establishing a diagnosis. Antimicrobial regimens for tick-borne infections are poorly studied but well established. Tetracyclines and rifampin form the cornerstones of therapy for most tick-borne infections, but these agents may not be suitable for all patient populations. Therefore, no single agent can be chosen empirically to treat all tick-borne diseases. Because pharmacists are the most accessible health care providers, they are often asked how to treat tick-borne diseases. Thus, practitioners should be familiar with the ticks that inhabit their locale.
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Affiliation(s)
- Jarrett R Amsden
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Barrio J, de Diego A, Ripoll C, Perez-Calle JL, Núñez O, Salcedo M, Clemente G. Mediterranean spotted fever in liver transplantation: a case report. Transplant Proc 2002; 34:1255-6. [PMID: 12072332 DOI: 10.1016/s0041-1345(02)02807-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Barrio
- Liver Transplant Unit, University General Hospital Gregorio Marañón, Madrid, Spain.
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24
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Rolain JM, Maurin M, Vestris G, Raoult D. In vitro susceptibilities of 27 rickettsiae to 13 antimicrobials. Antimicrob Agents Chemother 1998; 42:1537-41. [PMID: 9660979 PMCID: PMC105641 DOI: 10.1128/aac.42.7.1537] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The MICs of 13 antibiotics (doxycycline, thiamphenicol, rifampin, amoxicillin, gentamicin, co-trimoxazole, ciprofloxacin, pefloxacin, ofloxacin, erythromycin, josamycin, clarithromycin, and pristinamycin) were determined for 27 available rickettsial species or strains. We used two in vitro cell culture methods described previously: the plaque assay and the microplaque colorimetric assay. Our results confirm the susceptibilities of rickettsiae to doxycycline, thiamphenicol, and fluoroquinolones. Beta-lactams, aminoglycosides, and cotrimoxazole were not active. Typhus group rickettsiae were susceptible to all macrolides tested, whereas the spotted fever group rickettsiae, R. bellii, and R. canada were more resistant, with josamycin, a safe alternative for the treatment of Mediterranean spotted fever, being the most effective compound. Strain Bar 29, R. massiliae, R. montana, R. aeschlimannii, and R. rhipicephali, which are members of the same phylogenetic subgroup, were more resistant to rifampin than the other rickettsiae tested. Heterogeneity in susceptibility to rifampin, which we report for the first time, may explain in vivo discrepancies in the effectiveness of this antibiotic for the treatment of rickettsial diseases. We hypothesize that rifampin resistance and erythromycin susceptibility may reflect a divergence during the evolution of rickettsiae.
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Affiliation(s)
- J M Rolain
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, CNRS UPRES A 6020, Marseille, France
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Abstract
Background: We wish to increase awareness by U.S. physicians of the clinical manifestations and diagnosis of Mediterranean spotted fever (MSF), and to determine the incidence of MSF among travelers returning to the United States from endemic areas. Methods: We report a case of a 56-year-old female physician from New Orleans who returned from a 3-week safari trip to Zimbabwe and Zambia with clinical findings of MSF. The diagnosis was confirmed with a greater than fourfold rise in titer of IgM and IgG antibody to Rickettsia conorii on acute and convalescent sera (16 days apart) using indirect immunofluorescence technique. In addition, we conducted a MEDLINE computer search of published MSF cases in U.S. travelers returning to the United States and obtained the United States data over the past 20 years from the Centers for Disease Control and Prevention (CDC). Results: Less than 50 imported cases of MSF have been reported and confirmed by the CDC. Only seven cases have been published in the literature and none in the last 7 years. Conclusions: Despite the increasing incidence of MSF in Europe, Asia and Africa, and the high number of U.S. citizens traveling to these endemic areas, only a few imported cases of MSF in travelers have been reported in the United States. Physicians in the United States are not familiar with the clinical findings and diagnosis of MSF; therefore this disease is underrecognized in the majority of cases.
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Affiliation(s)
- LA Palau
- Department of Infectious Diseases, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana
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Abstract
RMSF is a potentially life-threatening disease that requires prompt diagnosis and empiric initiation of an appropriate antimicrobial agent. For the clinician treating young children with RMSF, there are few options. The safety and efficacy of fluoroquinolones and orally administered parenteral chloramphenicol have not been established in the pediatric population. Therefore, widespread and casual use of these agents is not recommended. Doxycycline is the most favorable agent for the treatment of RMSF in children younger than 9 years of age because of its documented effectiveness, broader margin of safety, reduced risk of drug-related adverse effects in young children, and convenient dosing schedule. For patients with RMSF reinfection, up to five courses of doxycycline may be administered with minimal risk of dental staining.
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Affiliation(s)
- D F Cale
- McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA
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Guberman D, Vardy DA, Klapholz L, Klaus SN. Vector-borne infections: a hazard for adventure visitors to Israel. ACTA ACUST UNITED AC 1994. [DOI: 10.1580/0953-9859-5.3.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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