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Yang Z, Shi Z, Fang K, Ren D. Atypical Rickettsia japonica Infection Involving Critical Illness Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report. Infect Drug Resist 2024; 17:963-967. [PMID: 38495624 PMCID: PMC10944173 DOI: 10.2147/idr.s451404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Rickettsia japonica infection is a rare disease, it is rare to report critical and severe case caused by this disease in Zhejiang Province, China. Patient Concerns We report a patient who initially sought medical attention due to fever and developed coma and convulsions during treatment. The patient did not develop typical eschar and rash. Eventually, the patient needed to be treated in the intensive care unit due to acute respiratory failure. Diagnoses The patient was diagnosed with Rickettsia japonica bloodstream infection by metagenomic next-generation sequencing (mNGS). Outcomes Due to the critical illness, the patient was transferred to the intensive care unit, received doxycycline and other treatments, and rapidly recovered and discharged. Conclusion The patient developed a critical illness after being infected with Rickettsia, when the medical history is unclear and clinical symptoms and signs are atypical, it is necessary to use mNGS examination for diagnosis.
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Affiliation(s)
- Zheng Yang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Zhanli Shi
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Kun Fang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Danhong Ren
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
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2
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Sato R, Yamada N, Kodani N, Makiishi T, Iwashita Y. Prompt diagnosis and appropriate treatment of Japanese spotted fever: A report of three cases. Heliyon 2024; 10:e23462. [PMID: 38173519 PMCID: PMC10761556 DOI: 10.1016/j.heliyon.2023.e23462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Background Japanese Spotted Fever (JSF) is a Spotted Fever Group (SFG) rickettsiosis caused by Rickettsia japonica. More than 300 cases are diagnosed annually in Japan, and the number of reported cases has been increasing. Correct diagnoses depend on the triad of symptoms and signs, including fever, rash, and eschar, which can be seen at the site of vector bites. JSF is not life-threatening if treated appropriately without diagnostic delay but there are some fatal cases every year. This negligence leads to disseminated intravascular coagulation (DIC) and multiple organ failure (MOF), and poor prognoses, consequently. Prompt diagnosis of JSF is difficult when the aforementioned triad of signs and symptoms is not initially present. Case report This report describes three JSF cases: an 87-year-old woman with fever, shock, pancytopenia, DIC, and MOF; a 79-year-old man with fever and difficulty in movement; and a 78-year-old man with fever, general fatigue, and appetite loss. All patients had a rash and eschar, which led to prompt diagnosis and appropriate treatment immediately. All patients were treated without any complications. Why should an emergency physician be aware of this? As mentioned above, JFS can be fatal with delayed diagnoses and treatment initiations. The key for a prompt diagnosis is to recognize the triad of symptoms and signs, which are not often present initially, and it makes JSF diagnosis challenging. Repeated comprehensive physical examinations are essential for prompt diagnosis and improve prognosis of JSF.
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Affiliation(s)
- Rie Sato
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Noriaki Yamada
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Nobuhiro Kodani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Tetsuya Makiishi
- Department of General Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yoshiaki Iwashita
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
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Amano S, Suyama S, Nishikura N, Sano C, Ohta R. Complicated Japanese Spotted Fever With Meningitis in an Older Patient: A Case Report. Cureus 2023; 15:e50681. [PMID: 38229818 PMCID: PMC10791036 DOI: 10.7759/cureus.50681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Japanese spotted fever (JSF) poses a significant public health challenge, mainly due to its atypical presentation in specific demographics. This report details a unique case of JSF in an 89-year-old female who was admitted to a rural hospital exhibiting generalized pain and rapid cognitive decline but no rash. Initially misdiagnosed as polymyalgia rheumatica, her condition was complicated by thrombocytopenia and altered mental state, prompting consideration of tick-borne illnesses. Subsequent serological analysis confirmed JSF despite the absence of its hallmark rash. The patient's condition escalated to include bacteremia and aseptic meningitis. Treatment involved a regimen of minocycline and meropenem, along with endoscopic cauterization of a bleeding rectal ulcer. After treatment, the patient showed improvement and was transferred for rehabilitation. This case highlights the criticality of considering JSF in elderly patients within endemic areas, even when classic symptoms like erythema and petechiae are absent. It underscores the necessity for broad diagnostic perspectives, especially in atypical presentations, and the integration of comprehensive care approaches. The involvement of caregivers and relatives in early detection and seeking medical care promptly is crucial. The report illustrates the complexities in diagnosing and managing advanced JSF cases and stresses the importance of early serological testing and adaptive treatment strategies in managing such challenging cases.
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Affiliation(s)
- Shiho Amano
- Community Care, Unnan City Hospital, Unnan, JPN
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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4
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Zhou Y, Wang Q, Shen Y, Shen B, Zhang Y, Wang W, Li X. A Case of Critical Japanese Spotted Fever in Zhejiang, China. Infect Drug Resist 2023; 16:3425-3430. [PMID: 37283937 PMCID: PMC10241177 DOI: 10.2147/idr.s408499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
Background Japanese spotted fever (JSF) is a rare disease, caused by Rickettsia japonica; no case has been reported in Zhejiang Province, China. Case Presentation An elderly woman presented to the hospital with abdominal pain and fever. Her condition rapidly worsened with severe complications, such as multiple organ failure and central nervous system damage. The presence of R. japonica was quickly detected by metagenomic next-generation sequencing. On the basis of combined clinical manifestations and laboratory results, critical JSF was diagnosed and treated with doxycycline. The patient showed good prognosis. Typical symptoms (eschar and rash) were not observed in the early stage, consequently increasing the difficulty of clinical diagnosis. Conclusion The delay of treatment caused by non-specific symptoms is an important factor affecting the progression of JSF. As an emerging pathogen detection method, mNGS has been successfully applied for disease diagnosis and treatment, and can be an important complement for the diagnosis of this disease.
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Affiliation(s)
- Yani Zhou
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Qi Wang
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Yujuan Shen
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Bin Shen
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Yan Zhang
- Department of Nursing, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Weihong Wang
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Xiaofeng Li
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
- Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, People's Republic of China
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5
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Tanaka E, Oda N, Ota S, Ueki T. Japanese Spotted Fever Associated with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Intern Med 2023; 62:935-938. [PMID: 35945027 PMCID: PMC10076124 DOI: 10.2169/internalmedicine.9685-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman had disseminated intravascular coagulation (DIC) and septic shock caused by Japanese spotted fever (JSF). Following treatment with minocycline, her general condition gradually improved; however, her disorientation persisted. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was diagnosed based on brain magnetic resonance imaging (MRI) showing a hyperintense area in the splenium of the corpus callosum and bilateral cerebral white matter on diffusion-weighted imaging. Thereafter, her consciousness gradually improved, but she continued to experience difficulty concentrating and attention deficits. MERS type II may take longer to improve than type I, and long-term follow-up is required.
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Affiliation(s)
- Emi Tanaka
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Shigeru Ota
- Department of Internal Medicine, Fuji Hospital, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Japan
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6
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Kondo M, Matsushima Y, Nakanishi T, Iida S, Koji H, Yamanaka K. Increasing Risk of Tick-Borne Disease through Growth Stages in Ticks. Clin Pract 2023; 13:246-250. [PMID: 36826164 PMCID: PMC9955134 DOI: 10.3390/clinpract13010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Rickettsia and Coxiella spp. are pathogens transmitted by ticks to humans. However, the developmental stage of the tick carrying the greatest risk of infection is unknown. Detection of pathogen-specific genes proves that ticks carrying Rickettsia or Coxiella spp. constitute a reservoir of infection. However, conventional PCR methods are unable to quantitate the pathogens within ticks. In the present study, we collected ticks in the endemic area of Japanese spotted fever, caused by Rickettsia japonica, and determined the rate of tick-borne pathogens carried by the ticks. As a method of evaluation, next-generation sequencing was used to estimate the proportion of pathogens in 10 adult and 10 larval ticks. Ticks were identified Haemaphysalis longicornis (H.L) from the results of the sequencing of PCR products amplified using tick identification-specific primers. The gene detection rates were 10/10 for Rickettsia sp. and 10/10 for Coxiella sp. among the adult ticks. For the larval ticks, the ratios were 7/10 and 5/10 for Rickettsia sp. and Coxiella sp., respectively. The largest proportion of Coxiella sp.-specific DNA reached 96% in one adult tick. The proportion of Rickettsia sp. genes ranged from 1.76% to 41.81% (mean, 15.56%) in the adult ticks. The proportions of Coxiella and Rickettsia spp. genes in the larvae ranged from 0% to 27.4% (mean 5.86%) and from 0% to 14.6% (mean 3.38%), respectively. When the percentage of Rickettsia sp., out of all pathogens detected via next-generation sequencing, was analyzed between the adult and larval stages of the ticks, a significant difference was observed at p = 0.0254. For Coxiella sp., a highly significant difference (p < 0.0001) was found between the adult and larval stages of the ticks. In conclusion, the detection rates and proportions of Rickettsia and Coxiella spp. genes were highest in adult H.L ticks. The risk of contracting tick-borne infections may increase with bites from adult ticks, especially those harboring Coxiella sp.
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Wada T, Mori H, Kida K, Shindo K. Japanese spotted fever with post-infectious encephalitis. IDCases 2022; 31:e01658. [PMID: 36561293 PMCID: PMC9763843 DOI: 10.1016/j.idcr.2022.e01658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Japanese spotted fever (JSF) is a rickettsial disease caused by Rickettsia japonica. To the best of our knowledge, there have only been five reported cases of JSF involving the central nervous system. A 74-year-old man was admitted after 1 week of fever and maculopapular rash. JSF was definitively diagnosed by PCR; however, the patient showed mental disturbance and abnormal behavior. After intravenous immunoglobulin, his mental state and behavior improved. The findings of cerebrospinal fluid analysis, electroencephalography, and 99 mTcHM-PAO single photon computed emission tomography suggested post-infectious encephalitis. JSF causes post-infectious encephalitis and early treatment is recommended.
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Affiliation(s)
- Takafumi Wada
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Hitoshi Mori
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Kouji Kida
- Virology Section, Department of Health Science, Okayama Prefectural Institute for Environmental Science and Public Health, Japan, 739–1 Uchio, Okayama Minami-ku, Okayama, 701–0298 Japan
| | - Katsuro Shindo
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan,Corresponding author.
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8
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Gao S, Li L, Zhou X, Dai X, Lu L, Chen Y, Han J, Huang X, Xiao Q, He H, Liu Q. Fatal Rickettsia Japonica Infection Complicating Disseminated Intravascular Coagulation in Yichang, China. Infect Drug Resist 2022; 15:6613-6623. [DOI: 10.2147/idr.s383917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
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9
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Kutsuna S, Ohbe H, Matsui H, Yasunaga H. Effectiveness of fluoroquinolone antimicrobials in addition to tetracyclines for Japanese spotted fever: A retrospective analysis using a national inpatient database. Int J Infect Dis 2022; 123:70-75. [PMID: 35987471 DOI: 10.1016/j.ijid.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aim to evaluate the effectiveness of fluoroquinolone (FQ) antimicrobial therapy in combination with tetracyclines (TCs) in patients with Japanese spotted fever (JSF) using a nationwide inpatient database in Japan. METHODS We identified hospitalized patients diagnosed with JSF who were enrolled in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2021. Patients who received FQ plus TC on the day of admission were compared with patients who received TC alone on the day of admission, using inverse probability of treatment weighting. The primary outcome was in-hospital mortality. Secondary outcomes were in-hospital complications, total hospitalization costs, and length of hospital stay. RESULTS We identified 1060 eligible patients. Of these, 434 (41%) received FQ plus TC on the day of admission and 626 (59%) received TC alone on the day of admission. Inverse probability of treatment weighting showed no statistically significant differences between the groups in in-hospital mortality, in-hospital complications, total hospitalization costs, and length of hospital stay. CONCLUSION This study did not show any significantly improved effectiveness using FQ antimicrobials in combination with TCs for treating JSF. Clinicians may need to be cautious in administering FQ and TC antimicrobials concomitantly in routine practice.
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Affiliation(s)
- Satoshi Kutsuna
- Department of Infection Control, Department of Infection Control, Graduate School of Medicine Faculty of Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
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10
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Kondo M, Nishikawa K, Iida S, Nakanishi T, Habe K, Yamanaka K. Japanese Spotted Fever and Irreversible Renal Dysfunction during Immunosuppressive Therapy after a Living-Donor Kidney Transplant. Trop Med Infect Dis 2022; 7:tropicalmed7080175. [PMID: 36006267 PMCID: PMC9413776 DOI: 10.3390/tropicalmed7080175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Ten years ago, a 56-year-old woman with a history of IgA nephropathy who received a living-donor kidney transplant across ABO barriers was managed with immunosuppressive drugs. The kidney transplant donor was her father who had poor kidney function. The patient’s renal function was stable for 10 years. The patient visited our department with a complaint of skin rash, occurring 2 days after an onset of fever. Although a skin rash is atypical for Japanese spotted fever (JSF), we suspected JSF and started treatment with minocycline because we found a scar suggestive of an eschar. Furthermore, the blood test results were similar to those associated with JSF, and the patient lived in a JSF-endemic area. The patient’s symptoms improved after 1 week. She was diagnosed with JSF by serological tests against Rickettsia japonica. JSF usually does not cause any complications after recovery. However, the patient’s renal function did not completely recover. JSF can cause an atypical rash in patients taking excessive immunosuppressive drugs. Early treatment is required for patients with suspected JSF to prevent complications of renal dysfunction after receiving a living-donor kidney transplant.
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Affiliation(s)
- Makoto Kondo
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan; (S.I.); (T.N.); (K.H.); (K.Y.)
- Correspondence: ; Tel.: +81-59-232-1111
| | - Kohei Nishikawa
- Department of Urology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan;
| | - Shohei Iida
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan; (S.I.); (T.N.); (K.H.); (K.Y.)
| | - Takehisa Nakanishi
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan; (S.I.); (T.N.); (K.H.); (K.Y.)
| | - Koji Habe
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan; (S.I.); (T.N.); (K.H.); (K.Y.)
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan; (S.I.); (T.N.); (K.H.); (K.Y.)
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Kobayashi K, Shikino K, Sano H, Shibata T, Higuchi S, Miyamoto M, Ban T. Family cluster of Japanese spotted fever. QJM 2022; 115:169-170. [PMID: 35021228 DOI: 10.1093/qjmed/hcac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Kobayashi
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
| | - K Shikino
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba 260-8677, Japan
| | - H Sano
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
| | - T Shibata
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
| | - S Higuchi
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
| | - M Miyamoto
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
| | - T Ban
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
- Department of Internal Medicine, Isumi Medical Center, 1177, Kariya, Isumi-city, Chiba 298-0123, Japan
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba 260-8677, Japan
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12
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Zhang Y, Jiang L, Yang Y, Xie S, Yuan W, Wang Y. A tick bite patient with fever and meningitis co-infected with Rickettsia raoultii and Tacheng tick virus 1: a case report. BMC Infect Dis 2021; 21:1187. [PMID: 34823477 PMCID: PMC8620164 DOI: 10.1186/s12879-021-06877-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Increasing numbers of tick-borne pathogens are being discovered, including those that infect humans. However, reports on co-infections caused by two or more tick-borne pathogens are scarce. CASE PRESENTATION A 38-year-old male farmer was bitten by a hard tick, presented with fever (37.7 °C), severe headache and ejection vomiting. Lumbar puncture was performed in the lateral decubitus. The cerebrospinal fluid (CSF) was clear, and analysis showed severe increased pressure (320 mm H2O), mild leukocytosis (126.0 × 106/L, mononuclear cells accounting for 73%) and elevated total protein concentration (0.92 g/L). Bacterial cultures of CSF and blood were negative. The diagnosis of Rickettsia raoultii and Tacheng tick virus 1 (TcTV-1) co-infection was confirmed by amplifying four rickettsial genetic markers and the partial small (S) RNA segment of TcTV-1 from the patient's blood. The patient gradually recovered after treatment with levofloxacin and ribavirin. CONCLUSIONS This is the first reported co-infection case with fever and meningitis caused by R. raoultii and TcTV-1. It is vital to screen for multiple pathogens in tick-bitten patients, especially in those with severe complex symptoms.
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Affiliation(s)
- Yu Zhang
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China.,The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China.,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi City, 832002, Xinjiang Uygur Autonomous Region, China
| | - Liang Jiang
- The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Yicheng Yang
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China.,The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Songsong Xie
- The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Wumei Yuan
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Yuanzhi Wang
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China. .,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi City, 832002, Xinjiang Uygur Autonomous Region, China.
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Hatano Y, Kashima S, Kaihara M, Takase K, Hatakeyama S, Reingold AL, Matsumoto M. Predictive variables for hemodialysis and death in Japanese spotted fever, and the association between distance from rivers and incidence. Ticks Tick Borne Dis 2020; 12:101544. [PMID: 33011438 DOI: 10.1016/j.ttbdis.2020.101544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 07/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
The number of patients with Japanese spotted fever (JSF) and its case fatality rate have been increasing in Japan and other East Asian countries. Better clinical and laboratory biomarkers are needed to avoid misdiagnosing JSF and to predict severe cases. In addition to determining these predictors, we aimed to examine the association between the incidence of JSF and the distance from rivers, in Hiroshima Prefecture, one of the most JSF prevalent areas in Japan. Patients diagnosed with JSF from 2009 to 2017 in two hospitals in Onomichi City in Hiroshima Prefecture were studied, and their clinical characteristics and laboratory data were collected retrospectively from medical charts. A random forest was used to identify predictors of severe JSF leading to hemodialysis or death. A multivariable negative binomial regression model was utilized to analyze the association between the cumulative incidence in each postal code area and the distance from the residential postal code area to the closest river. Out of 82 patients with JSF (mean age at diagnosis, 74.1 ± 10.6 years; 34 (41.5 %) men), 6 cases were regarded as severe (among them 5 hemodialysis patients and 3 deaths). Twenty-eight (34.1 %) patients were misdiagnosed at least once at the initial hospital visit. Laboratory examination showed 34.5 % had atypical lymphocytes, 73.8 % had no eosinophils, 75.6 % had an elevated aspartate aminotransferase (AST) level, and 69.5 % had hyponatremia. Among cases without urine leucocytes, 63.3 % had proteinuria and 63.3 % had hematuria. Low serum total protein was the strongest predictor of severe JSF, followed by high blood urea nitrogen (BUN) and low albumin. Geospatial analysis showed a significant negative association between the cumulative incidence of JSF cases and the distance from rivers in an adjusted model: the cumulative incidence decreased by 0.51 times (95 % CI: 0.30 to 0.86) for every kilometer of distance from the residential postal code area to the closest river. Some laboratory data may be useful in averting misdiagnosis of JSF and in predicting severe cases. Additional studies should be done in order to clarify the mechanism and association of the incidence of JSF with the distance from the nearest river.
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Affiliation(s)
- Yu Hatano
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529, Japan.
| | - Masanobu Kaihara
- Department of Internal Medicine, Onomichi Municipal Hospital, 3-1170-177, Shintakayama, Onomichi-shi, Hiroshima, 722-0055, Japan.
| | - Kenichi Takase
- Department of Clinical Laboratory, Mitsugi General Hospital, 124 Ichi, Mitsugi, Onomichi-shi, Hiroshima, 722-0393, Japan.
| | - Shuji Hatakeyama
- Division of General Internal Medicine/Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Arthur L Reingold
- Division of Epidemiology, University of California, Berkeley, 2121 Berkeley Way, #5302, Berkeley, CA, 94720-7360, United States.
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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14
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Sekeyová Z, Danchenko M, Filipčík P, Fournier PE. Rickettsial infections of the central nervous system. PLoS Negl Trop Dis 2019; 13:e0007469. [PMID: 31465452 PMCID: PMC6715168 DOI: 10.1371/journal.pntd.0007469] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
As a result of migrations and globalization, people may face a possible increase in the incidence of central nervous system rickettsial infections (CNS R). These diseases, caused by Rickettsia species and transmitted to humans by arthropod bites, are putatively lethal. However, the diagnosis of CNS R is challenging and often delayed due to their nonspecific clinical presentation and the strict intracellular nature of rickettsiae. Furthermore, transfer of rickettsiae to the brain parenchyma is not yet understood. The aim of this review is to analyze and summarize the features and correlated findings of CNS R in order to focus attention on these intriguing but frequently neglected illnesses. We also incorporated data on CNS infections caused by Rickettsia-related microorganisms.
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Affiliation(s)
- Zuzana Sekeyová
- Institute of Virology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Monika Danchenko
- Institute of Virology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Peter Filipčík
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Pierre Edouard Fournier
- Aix-Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Mediterranée-Infection, Marseille, France
- Centre National de Référence des Rickettsia, Coxiella et Bartonella, IHU Mediterranée-Infection, Marseille, France
- * E-mail:
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15
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Shafi H, Hipolito LG. Murine typhus presenting with status epilepticus. Int J Infect Dis 2019; 83:145-147. [PMID: 31002931 DOI: 10.1016/j.ijid.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
Patients with rickettsial infection usually present with a febrile illness, headache, arthromyalgia and various biochemical abnormalities. Neurologic involvement is rare in murine typhus. Here, we report a case of a patient who presented with status epilepticus secondary to Rickettsia typhi infection.
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Affiliation(s)
- Humaira Shafi
- Department of General Medicine, Department of Infectious Diseases, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Louie Galang Hipolito
- Department of General Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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16
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Ocias LF, Dessau RB, Lebech AM, Jørgensen CS, Petersen RF, Krogfelt KA. Evidence of rickettsiae in Danish patients tested for Lyme neuroborreliosis: a retrospective study of archival samples. BMC Infect Dis 2018; 18:325. [PMID: 29996782 PMCID: PMC6042448 DOI: 10.1186/s12879-018-3210-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a prevalence of 4.7-13% in Danish Ixodes ricinus ticks, Rickettsia helvetica is one of the most frequently detected tick-borne organisms in Denmark. Most reports of human exposure have described asymptomatic seroconversion or a mild, self-limiting flu-like illness but it has also been implicated as a cause of subacute lymphocytic meningitis. Because Borrelia burgdorferi sensu lato (Bbsl) and R. helvetica are both found in the same tick species, potential co-transmission is a possibility. We examined 1) the seroprevalence of anti-rickettsia antibodies in patients investigated for Lyme neuroborreliosis (LNB), and 2) the cerebrospinal fluid (CSF) and sera of same patients for the presence of Rickettsia DNA. METHODS Ninety-nine sera and 87 CSF samples from patients with intrathecal synthesis of anti-Borrelia antibodies and 101 sera and 103 CSF samples from patients with no detectable intrathecal synthesis were retrospectively examined for this study. Sera were analyzed for antibodies against spotted fever group (SFG) rickettsiae and both the CSF and sera were tested for Rickettsia DNA using a genus-specific real-time PCR. RESULTS Of the patients tested for LNB, 32% (64/200) had IgG antibodies against SFG rickettsiae. Among patients with confirmed intrathecal synthesis of Borrelia-specific antibodies, 38% (38/99) exhibited IgG antibodies. None of these values were statistically significant when compared with sera from healthy blood donors (p = 0.7 and 0.19). Rickettsia DNA was found in the CSF of 4% (8/190) of patients. CONCLUSION No statistically significant difference was found in the seroprevalence of anti-rickettsia antibodies in patients tested for LNB and healthy blood donors, indicative of a low rate of exposure in this group of patients. Eight patients showed evidence of Rickettsia DNA in the CSF, five of whom had LNB. However, cycle threshold (Ct) values were high, indicating low concentrations of DNA, and no apparent alteration in the clinical manifestations of LNB were noted in the medical records of these patients.
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Affiliation(s)
- Lukas Frans Ocias
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark. .,Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Sværke Jørgensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Randi Føns Petersen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark
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17
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Noguchi M, Oshita S, Yamazoe N, Miyazaki M, Takemura YC. Important Clinical Features of Japanese Spotted Fever. Am J Trop Med Hyg 2018; 99:466-469. [PMID: 29968555 PMCID: PMC6090369 DOI: 10.4269/ajtmh.17-0576] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Japanese spotted fever (JSF) is a zoonosis transmitted by ticks carrying the pathogen Rickettsia japonica. The classic triad of JSF symptoms is high fever, erythema, and tick bite eschar. About 200 people in Japan develop the disease every year. Japanese spotted fever is also a potentially fatal disease. At Minami-Ise Municipal Hospital in Japan, 55 patients were diagnosed with JSF from 2007 to 2015, which was equivalent to 4.3% of the total JSF cases in Japan. In this retrospective study, we examined the medical records of these 55 JSF cases. Fever, erythema, eschar, and elevated C-reactive protein (CRP) are characteristic clinical features of the disease. We confirmed four of these in the reviewed cases; however, eschar was not present in occasional cases. We confirmed that eosinopenia appeared in nearly all cases. Using fever, erythema, elevated CRP, and eosinopenia in diagnostic screening, our positivity rate was 90.9%. In our clinical practice, including eosinopenia improves the initial diagnosis of JSF.
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Affiliation(s)
- Masamitsu Noguchi
- Department of Family Medicine, Mie University Graduate School of Medicine, Mie, Japan.,Department of Internal Medicine, Minami-Ise Municipal Hospital, Mie, Japan
| | - Shizuka Oshita
- Department of Medical Technology, Minami-Ise Municipal Hospital, Mie, Japan
| | - Naohisa Yamazoe
- Department of Internal Medicine, Minami-Ise Municipal Hospital, Mie, Japan
| | - Mitsukazu Miyazaki
- Department of Internal Medicine, Minami-Ise Municipal Hospital, Mie, Japan
| | - Yousuke C Takemura
- Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, Mie, Japan
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18
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Matsuura H, Yokota K. Case Report: Family Cluster of Japanese Spotted Fever. Am J Trop Med Hyg 2018; 98:835-837. [PMID: 29363442 DOI: 10.4269/ajtmh.17-0199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Spotted fever group rickettsioses are transmitted by several types of arthropods (including ticks, chiggers, fleas, and lice) and are distributed worldwide. Japanese spotted fever (JSF) was discovered as an emerging rickettsiosis in 1984. The annual number of cases has increased 3-fold during the last decade. In Japan, JSF has been mainly reported in an area with warm climate that borders the Pacific Ocean. We describe a family/neighborhood cluster of three cases of JSF in an area of Japan that had previously not been considered endemic.
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Affiliation(s)
- Hiroki Matsuura
- Department of General Internal Medicine, Mitoyo General Hospital, Kanonji, Kagawa, Japan
| | - Kyoko Yokota
- Department of Infectious Disease, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
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19
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Miyashima Y, Iwamuro M, Shibata M, Miyabe Y, Kawai Y, Kaihara M, Mitogawa T, Harada M. Prediction of Disseminated Intravascular Coagulation by Liver Function Tests in Patients with Japanese Spotted Fever. Intern Med 2018; 57:197-202. [PMID: 29021432 PMCID: PMC5820036 DOI: 10.2169/internalmedicine.8420-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Cases of Japanese spotted fever (JSF) are sometimes complicated by disseminated intravascular coagulation (DIC) with an abnormal liver function, resulting in unfavorable outcomes. The aim of the present study was to clarify the correlation between liver function test results and DIC scores. Methods Twenty patients diagnosed with JSF between April 2010 and April 2014 were enrolled. Age, gender, disturbance of consciousness, body temperature, pulse rate, presence of diffuse erythema, eschar and swelling of lymph nodes, laboratory test results at the time of initial presentation such as blood cell count, C-reactive protein, liver function, renal function and blood coagulation and fibrinolysis, maximum Japanese Association for Acute Medicine (JAAM) DIC score during the course of JSF, treatment and the prognosis were retrospectively reviewed. Results The median age of the patients (8 men, 12 women) was 68.3 years. There were significant differences in the alkaline phosphatase (ALP) and rothrombin time international normalized ratio (PT-INR) between the DIC and non-DIC groups using Mann-Whitney's U test. A multiple logistic regression analysis showed that the ALP and blood urea nitrogen (BUN) levels at the time of initial presentation were independent predictors of the occurrence of DIC. Conclusion We should pay special attention to JSF patients showing high levels of ALP at the initial presentation, since such patients may have a higher likelihood of developing DIC over the course of JSF and unfavorable outcomes than those with lower levels.
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Affiliation(s)
- Yuichi Miyashima
- Department of Gastroenterology, Onomichi Municipal Hospital, Japan
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masaya Iwamuro
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yoshio Miyabe
- Department of Gastroenterology, Onomichi Municipal Hospital, Japan
| | - Yoshinari Kawai
- Department of Gastroenterology, Onomichi Municipal Hospital, Japan
| | - Masanobu Kaihara
- Department of Internal Medicine, Onomichi Municipal Hospital, Japan
| | | | - Masaru Harada
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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20
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Kalita J, Mani VE, Bhoi SK, Misra UK. Status epilepticus in scrub typhus. Epilepsia 2016; 57:e125-8. [DOI: 10.1111/epi.13412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jayantee Kalita
- Department of Neurology; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow India
| | - Vinita E. Mani
- Department of Neurology; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow India
| | - Sanjeev K. Bhoi
- Department of Neurology; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow India
| | - Usha K. Misra
- Department of Neurology; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow India
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21
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Carris NW, Pardo J, Montero J, Shaeer KM. Minocycline as A Substitute for Doxycycline in Targeted Scenarios: A Systematic Review. Open Forum Infect Dis 2015; 2:ofv178. [PMID: 26719847 PMCID: PMC4690502 DOI: 10.1093/ofid/ofv178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 01/08/2023] Open
Abstract
Doxycycline remains on intermittent shortage. Evidence supports the substitution of minocycline in skin and soft-tissue infections and carefully selected cases of pneumonia. Minocycline may be carefully considered in Lyme disease prophylaxis and Rickettsial disease in the complete absence of doxycycline. Doxycycline, a commonly prescribed tetracycline, remains on intermittent shortage. We systematically reviewed the literature to assess minocycline as an alternative to doxycycline in select conditions, given doxycycline's continued shortage. We identified 19 studies, 10 of which were published before 2000. Thirteen of the studies were prospective, but only 1 of these studies was randomized. Based on the available data, we found minocycline to be a reasonable substitute for doxycycline in the following scenarios: skin and soft-tissue infections and outpatient treatment of community-acquired pneumonia in young, otherwise healthy patients or in patients with macrolide-resistant Mycoplasma pneumoniae, as well as Lyme disease prophylaxis and select rickettsial disease should doxycycline be unavailable.
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Affiliation(s)
- Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research , University of South Florida College of Pharmacy ; Departments of Family Medicine
| | - Joe Pardo
- Department of Pharmacy , North Florida/South Georgia Veterans Health System , Gainesville
| | - Jose Montero
- Internal Medicine , University of South Florida, Morsani College of Medicine , Tampa
| | - Kristy M Shaeer
- Department of Pharmacotherapeutics and Clinical Research , University of South Florida College of Pharmacy ; Internal Medicine , University of South Florida, Morsani College of Medicine , Tampa
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22
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Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry 2015; 86:761-6. [PMID: 25209416 DOI: 10.1136/jnnp-2014-308722] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the neurological manifestations of scrub typhus and correlate their clinical, EEG and MRI findings. METHODS A cross-sectional study over 2 years included patients with scrub typhus diagnosed by solid phase immunochromatographic assay or Weil-Felix test. A detailed clinical evaluation including Glasgow Coma Scale (GCS) was documented. Blood counts, chemistry, ECG, chest radiograph, cerebrospinal fluid (CSF), EEG and cranial MRI were performed. Outcome on discharge and at 1 month were categorised into good and poor based on modified Rankin Scale. RESULTS Thirty-seven patients with ages ranging between 3 and 71 years were included; 51% of whom were females. All patients had fever and myalgia. Thirty-one (84%) patients had impaired consciousness, and six were deeply comatose (GCS score ≤8). Eight patients presented with status epilepticus. MRI revealed meningeal enhancement in only 1/25 (4%) patient and EEG showed generalised slowing in 6/28 (21.4%). Among 31 patients with altered sensorium, CSF studies were conducted on 28. Nineteen patients had meningoencephalitis and 9 encephalopathy, but no significant differences were observed in clinical, laboratory, EEG and MRI findings. All patients responded within 48 h to doxycycline and had good recovery at 1 month. Patients with low GCS score had significantly more focal neurological deficit (r=0.5; p=0.002), longer hospital stay (r=-0.4; p=0.03) and more disability on discharge (r=-0.4; p=0.01). CONCLUSIONS Meningoencephalitis/encephalopathy may be seen in two-third of patients with scrub typhus. Scrub typhus should be included in the differential diagnosis of febrile encephalopathy.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - J Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - V E Mani
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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