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Fernández Álvarez I, Fernández Lorenzo J, de Sá JME. Rickettsia conorii: Unusual case of acute aortic thrombosis. Vascular 2024; 32:28-31. [PMID: 36052837 DOI: 10.1177/17085381221124986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mediterranean spotted fever is a common zoonosis in Europe caused by Rickettsia conorii bacterium. Among its wide range of clinical presentations, arterial thrombosis of large vessels has never been described before. METHODS We report a case of a complete acute infrarenal aortic thrombosis in a 61-year-old male with R. conorii infection. RESULTS AND CONCLUSION The patient was successfully operated using open aortic surgery and subsequent treatment with doxycycline. To our knowledge, this is the first report of aortic thrombosis associated with infection by this parasite, extending the clinical spectrum of the disease.
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Hosseininasab A, MoradKasani S, Mostafavi E, Baseri N, Sadeghi M, Esmaeili S. Rickettsia conorii subsp. israelensis infection in a pediatric patient presenting skin rash and abdominal pain: a case report from Southeast Iran. BMC Infect Dis 2024; 24:114. [PMID: 38254000 PMCID: PMC10804630 DOI: 10.1186/s12879-024-09002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The healthcare system in Iran appears to overlook Mediterranean spotted fever (MSF) as an endemic disease, particularly in pediatric cases, indicating the need for greater attention and awareness. CASE PRESENTATION A six-year-old patient with fever, abdominal pain, headache, skin rashes, diarrhea, vomiting, and black eschar (tache noire) from southeast Iran was identified as a rickettsiosis caused by Rickettsia conorii subsp. israelensis through clinical and laboratory assessments, including IFA and real-time PCR. The patient was successfully treated with doxycycline. CONCLUSIONS Symptoms like rash, edema, eschar, and abdominal pain may indicate the possibility of MSF during the assessment of acute febrile illness, IFA and real-time PCR are the primary diagnostic methods for this disease.
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Affiliation(s)
- Ali Hosseininasab
- Research Center of Tropical and Infectious Diseases, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Safoura MoradKasani
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
| | - Ehsan Mostafavi
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Neda Baseri
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- , Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Iran
| | - Maryam Sadeghi
- Research Center of Tropical and Infectious Diseases, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Saber Esmaeili
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Kabudar Ahang, Akanlu, Hamadan, Iran.
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
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Gargouri S, Kaibi I, Maaloul K, Sehli M, Abid I, Trigui A. Swept-source optical coherence tomography angiography in Mediterranean spotted fever retinitis with retinal vasculitis. J Fr Ophtalmol 2024; 47:103908. [PMID: 37620194 DOI: 10.1016/j.jfo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 08/26/2023]
Affiliation(s)
- S Gargouri
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - I Kaibi
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - K Maaloul
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
| | - M Sehli
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - I Abid
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - A Trigui
- Department of Ophtalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
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Manor U, Kfir J, Livneh N, Zilberman T, Yelin D, Meltzer E. Concurrent Visual and Auditory Deficits in a Patient with Rickettsia conorii Infection. Am J Trop Med Hyg 2023; 109:501-502. [PMID: 37400067 PMCID: PMC10484261 DOI: 10.4269/ajtmh.23-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Uri Manor
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Kfir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel HaShomer, Israel
| | - Nir Livneh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Sheba Medical Center, Tel HaShomer, Israel
| | - Tal Zilberman
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Infectious Disease Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Dana Yelin
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Infectious Disease Unit, Sheba Medical Center, Tel HaShomer, Israel
| | - Eyal Meltzer
- Internal Medicine C, Sheba Medical Center, Tel HaShomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Orts Paco JF, Sánchez Llinares JR, Cano Gracia H. [Hemophagocytic syndrome secondary to Mediterranean spotted fever]. Med Clin (Barc) 2023; 161:180. [PMID: 37244859 DOI: 10.1016/j.medcli.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/29/2023]
Affiliation(s)
| | | | - Horacio Cano Gracia
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Murcia, España
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Esmaeili S, Latifian M, Khalili M, Farrokhnia M, Stenos J, Shafiei M, Mostafavi E. Fatal Case of Mediterranean Spotted Fever Associated with Septic Shock, Iran. Emerg Infect Dis 2022; 28:485-488. [PMID: 35076374 PMCID: PMC8798672 DOI: 10.3201/eid2802.211023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A fatal case of Mediterranean spotted fever associated with septic shock was reported in a 61-year-old man living in a village in southeastern Iran. The patient had a history of tick bite a few days before symptom onset. Phylogenetic analysis confirmed infection by Rickettsia conorii subspecies israelensis.
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Salazar Alarcón E, Guillén-Martín S, Callejas-Caballero I, Valero-Arenas A. Clinical case report: Not all rickettsiosis are mediterranean spotted fever. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:44-45. [PMID: 34732342 DOI: 10.1016/j.eimce.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | - Ana Valero-Arenas
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
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Baltadzhiev I, Zaprianov Z, Baltadjiev A. Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data. Med Princ Pract 2021; 30:369-375. [PMID: 33780958 PMCID: PMC8436609 DOI: 10.1159/000516167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Mediterranean spotted fever (MSF) is a tick-borne rickettsial infection endemic to the Mediterranean coastline countries. As a result of growing tourism, imported cases have been registered in many nonendemic countries and regions. We present clinical laboratory parameters and histopathological data on renal impairment in patients with MSF. The study meets our goal of identifying kidney involvement and detecting renal damage in people with MSF. SUBJECTS AND METHODS Three hundred fifty patients with MSF with a diagnosis confirmed by immunofluorescence analysis were tested for serum urea, creatinine, and albumin. Fifty-five patients with malignant form of MSF were divided into 2 groups: 19 fatalities and 36 survivors. The percentage of patients with acute renal failure (ARF) was compared in both groups. RESULTS Subjects with elevated urea and creatinine levels increased from 5.21 to 3.47% in mild to 48.78 and 29.26% in severe MSF, respectively. Loss of serum albumin also increased from mild to severe MSF. Renal impairment comprised 60% of the cohort of 55 patients with malignant MSF: 89.4% in the group of deaths and almost twice less in the survivors. ARF developed in 84.2% of fatal cases and was >2 times less in survivors. Postmortem light microscopy of renal samples of 9 fatal cases revealed perivascular mononuclear inflammatory infiltrates, vasculitis with fibrinoid necrosis, acute tubular necrosis, interstitial edema, hemorrhage, and thrombosis. CONCLUSION Renal pathology associated with MSF rickettsial infection consists of systemic small vessel vasculitis and vascular injury, leading to ARF in the most severe cases.
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Affiliation(s)
- Ivan Baltadzhiev
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University and Infectious Disease Clinic, University Hospital St. George, Plovdiv, Bulgaria
| | - Zaprian Zaprianov
- Department of General and Clinical Pathology, Faculty of Medicine, Medical University and General and Clinical Pathology Clinic, University Hospital St. George, Plovdiv, Bulgaria
| | - Atanas Baltadjiev
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
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Baltadzhiev I, Popivanova N. Unusual Maculopapular Rash on the Scalp of a Patient with Mediterranean Spotted Fever. Med Princ Pract 2019; 28:291-293. [PMID: 30508810 PMCID: PMC6597933 DOI: 10.1159/000495938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a rare case of maculopapular rash on the scalp in a patient with Mediterranean spotted fever (MSF). CLINICAL PRESENTATION AND INTERVENTION A 58-year-old woman with breast cancer and chemotherapy-induced alopecia contracted MSF. Her clinical features were typical, except for a maculopapular rash covering the scalp. The diagnosis of MSF was confirmed by immunofluorescent assay. The disease had a favorable course and the patient was discharged in good condition. CONCLUSION The rash on the scalp described in this report enriches our knowledge on the clinical characteristics of MSF.
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Affiliation(s)
- Ivan Baltadzhiev
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, and Clinic of Infectious Diseases, St. George University Hospital, Plovdiv, Bulgaria,
| | - Nedialka Popivanova
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, and Clinic of Infectious Diseases, St. George University Hospital, Plovdiv, Bulgaria
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Bertrand AS, Fondain M, Rullier P, Fontaine C, Guillot B. [Haemophagocytic syndrome secondary to Mediterranean spotted fever]. Ann Dermatol Venereol 2018; 145:516-520. [PMID: 30006110 DOI: 10.1016/j.annder.2017.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/03/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Haemophagocytic syndrome (HS) is a rare disease with a severe prognosis that is defined by clinical, laboratory and histopathological criteria. Infections represent the classical cause of HS. HS secondary to Mediterranean spotted fever (MSF) is rare with only a few cases being reported in the literature. OBSERVATIONS We report two cases of HS secondary to MSF in 2 men aged 77 and 63 years presenting a febrile maculo-purpuric eruption with inoculation ulcer associated with laboratory abnormalities (cytopenia, elevated ferritin, hypertriglyceridaemia). Haemophagocytosis was present in 2 cases. Serology and PCR for Rickettsia conorii were positive and militated in favour of recent infection responsible for the diagnosis of MSF. DISCUSSION The first case of HS was described in 1979. Sixteen cases of HS secondary to MSF are described in the literature. Cytopenia associated with hyperferritinaemia and hypertriglyceridaemia strongly suggests MSF complicated by HS. The prognosis depends on the time elapsed since diagnosis and host-specific factors. Immunosuppressants and antibiotics may be necessary to ensure healing. CONCLUSION Rickettsioses can induce HS, and this potential complication with a severe prognosis must be known.
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Affiliation(s)
- A-S Bertrand
- Département de dermatologie, CHU St-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - M Fondain
- Département de dermatologie, CHU St-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - P Rullier
- Département de médecine interne, diagora, CHU St-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - C Fontaine
- Service de médecine interne, clinique Beausoleil, 119, avenue de Lodeve, 34070 Montpellier, France
| | - B Guillot
- Département de dermatologie, CHU St-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
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11
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Magaz Martínez M, Ramos A, Masegosa J, Abreu L. Rickettsia conorii: Unusual cause of diarrhoea. Gastroenterol Hepatol 2018; 41:165-166. [PMID: 28427729 DOI: 10.1016/j.gastrohep.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Marta Magaz Martínez
- Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.
| | - Antonio Ramos
- Unidad de Infecciosas, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Jose Masegosa
- Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Luis Abreu
- Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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Smaoui F, Koubaa M, Rekik K, Mejdoub Y, Mezghani S, Maaloul I, Hammami A, Marrakchi C, Ben Jemaa M. [Symmetrical peripheral gangrene: 4 cases]. Ann Dermatol Venereol 2017; 145:95-99. [PMID: 29169658 DOI: 10.1016/j.annder.2017.09.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/28/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. PATIENTS AND METHODS We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction. RESULTS Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes. CONCLUSION SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.
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Affiliation(s)
- F Smaoui
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - M Koubaa
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - K Rekik
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - Y Mejdoub
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - S Mezghani
- Laboratoire de microbiologie, université de Sfax, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Maaloul
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - A Hammami
- Laboratoire de microbiologie, université de Sfax, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - C Marrakchi
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - M Ben Jemaa
- Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie
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Pardal-Fernández JM, Segura JC, Grande A, Segura T. [Guillain-Barré syndrome. Early ultrasound findings]. Rev Neurol 2015; 61:471. [PMID: 26553178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Ben Dhaou B, Aydi Z, Boussema F, Kochbati S, Baili L, Rokbani L. [Acute kidney failure in association with Mediterranean spotted fever]. Tunis Med 2013; 91:418-419. [PMID: 23868045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
Gangrene is an uncommon complication in cases of rickettsial spotted fever. We report three cases of spotted fever from south India, presumably caused by Rickettsia conorii subspecies indica. Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome (MODS) like acute kidney injury, liver dysfunction, delirium and seizure. One patient died while the other two recovered well. This case series is being reported to highlight the occurrence of gangrene in spotted fever rickettsiosis and the importance of appropriate management at the earliest.
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Affiliation(s)
- Harshal Satish Joshi
- Department of Internal Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
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Kularatne SAM, Weerakoon KGAD, Rajapakse RPVJ, Madagedara SC, Nanayakkara D, Premaratna R. A case series of spotted fever rickettsiosis with neurological manifestations in Sri Lanka. Int J Infect Dis 2012; 16:e514-7. [PMID: 22541336 DOI: 10.1016/j.ijid.2012.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/05/2012] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations. METHODS The cases were studied prospectively from 2008 at the Teaching Hospital, Peradeniya. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS All had an IFA IgG titer ranging from 1/64 to 1/4096 and a positive IFA IgM titer against Rickettsia conorii antigen; in 10 (59%) cases the IgG titers were ≥ 1/256 (definitive cases). The median age of the patients was 62 years (range 26-82 years); 10 were male and seven female. The median duration of fever was 12 days (range 4-35 days). Neurological manifestations on admission were drowsiness or confusion in 14 (82%) and a semi-comatose state in three (18%). Rigidity of the limbs occurred in 14 (82%), bradykinesia and resting tremors in 12 (71%), which persisted after defervescence, neck stiffness in seven (42%), weakness of the limbs in five (29%), deafness in two (12%), and stupor in three (18%). Electroencephalograms in three (18%) showed generalized slow waves. Cerebrospinal fluid examination showed a cellular reaction, predominantly lymphocytes, in three cases. Two patients died (fatality rate 12%). CONCLUSION We have documented for the first time the neurological features of SFG rickettsioses in the Central Province, Sri Lanka. These were predominantly extrapyramidal features in patients of older age.
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Affiliation(s)
- S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
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Cascio A, Maggio MC, Cardella F, Zangara V, Accomando S, Costa A, Iaria C, Mansueto P, Giordano S. Coronary involvement in Mediterranean spotted fever. New Microbiol 2011; 34:421-424. [PMID: 22143818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, a maculo-papular rash and a black eschar at the site of the tick bite. We describe the case of a 3-year-old boy with MSF who developed a transient right coronary artery ectasia. The patient was brought to the hospital after four days of fever and mild myalgia of the legs. The suspicion of MSF arose due to the presence of a maculo-papular skin rash and treatment with oral clarithromycin was started. After four days fever persisted and the differential diagnosis of Kawasaki syndrome was considered. Echocardiography showed a dilated right coronary artery with hyperreflective walls. Treatment with intravenous immunoglobulin was initiated while clarithromycin was continued. After one day the fever disappeared. An immunofluorescent antibody test performed after four weeks confirmed a R. conorii infection. A follow-up echocardiography was normal six weeks and six months later. We suggest that ectasia of the coronary arteries may be a manifestation of rickettsial vasculitis. Prospective studies are needed to understand the frequency and the possible consequences of this phenomenon in the course of MSF.
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Affiliation(s)
- Antonio Cascio
- Dipartimento di Patologia Umana, Università di Messina, Messina, Italy.
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Schmulewitz L, Moumile K, Patey-Mariaud de Serre N, Poirée S, Gouin E, Mechaï F, Cocard V, Mamzer-Bruneel MF, Abachin E, Berche P, Lortholary O, Lecuit M. Splenic rupture and malignant Mediterranean spotted fever. Emerg Infect Dis 2008; 14:995-7. [PMID: 18507929 PMCID: PMC2600289 DOI: 10.3201/eid1406.071295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Laura Schmulewitz
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Kaoutar Moumile
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Sylvain Poirée
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Frédéric Mechaï
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Véronique Cocard
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Eric Abachin
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Patrick Berche
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Paris, France
| | - Marc Lecuit
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Paris, France
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19
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Godoy P, Picco G, Clotet C, Gómez F, Peralba MA. [Outbreak of Mediterranean exanthematic fever due to tick bites in a public square]. Aten Primaria 2008; 40:371-3. [PMID: 18620641 DOI: 10.1157/13124133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Jiménez-Caballero PE. [Peripheral facial palsy in Mediterranian spotted fever]. Rev Neurol 2008; 46:125-126. [PMID: 18247288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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21
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Micalizzi A, La Spada E, Corsale S, Arculeo A, La Spada M, Quartararo P, Giannitrapani L, Soresi M, Affronti M, Montalto G. [Abnormal liver function in Mediterranean spotted fever]. Infez Med 2007; 15:105-10. [PMID: 17598997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this study we retrospectively assessed the prevalence of impaired liver function in all 49 patients suffering from Mediterranean Spotted Fever (MSF) consecutively admitted to our department over the last four years. The main parameters of liver function and ultrasound of upper abdomen were performed at entry and at the end of treatment. At admission mean values of transaminases were above the normal limits and significantly higher when compared to mean serum levels at recovery. 55% and 51% of patients had serum values of GOT and GPT, respectively, above the normal limits versus 1% and 2% at the end of treatment. Mean serum values of alkaline phosphatase (AP) were within the normal limits at entry in hospital, but 22 of them had serum values above the normal limits. The same proportion was seen for gamma glutamiltranspeptidase values. Eighteen patients (36.7%) had both transaminases and AP above the normal limits. There were no significant differences among serum values of albumin, bilirubin and gamma globulin before and after therapy. Platelet count, on the contrary, was significantly reduced at admission (p < 0.0001). At ultrasound half of the patients showed hepatomegaly with a hepatitis-like pattern and 39% of patients had splenomegaly. In conclusion, this study confirms previous data from the literature showing a high frequency of liver impairment during the course of MSF, which is usually mild-moderate. In a few cases, however, the increase of transaminases could be serious and the recovery delayed, but never, in our experience, has there been progression toward chronic liver disease.
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Affiliation(s)
- Anna Micalizzi
- Cattedra di Medicina Interna e Divisione di Malattie Infettive, Dipartimento di Patologia Clinica e delle Patologie Emergenti, Universita di Palermo, Italy
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22
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Caroleo S, Longo C, Pirritano D, Nisticò R, Valentino P, Iocco M, Santangelo E, Amantea B. A case of acute quadriplegia complicating Mediterranean spotted fever. Clin Neurol Neurosurg 2007; 109:463-5. [PMID: 17382465 DOI: 10.1016/j.clineuro.2007.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/14/2007] [Accepted: 02/15/2007] [Indexed: 11/18/2022]
Abstract
Mediterranean spotted fever is a rickettsiosis caused by Rickettsia conorii. Mediterranean spotted fever is considered to be a benign disease, however, approximately 10% of patients present with a severe systemic manifestation in which neurologic involvement occurs. We present a case of an 80-year-old man with a R. conorii infection who developed an acute quadriplegia secondary to an axonal polyneuropathy. The characteristic tache noire was observed on the lateral region of the thigh and elevated IgM antibody titres against R. conorii were detected by an indirect immunofluorescence test.
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Affiliation(s)
- Santo Caroleo
- Institute of Anaesthesiology, Reanimation and Intensive Care Medicine, University Magna Graecia, Catanzaro, Italy.
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23
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Curiel Balsera E, Prieto Palomino MA, Mora Ordóñez J, Muñoz Bono J. Fiebre botonosa con afectación neurologica severa. Med Intensiva 2007; 31:104. [PMID: 17433189 DOI: 10.1016/s0210-5691(07)74783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Ben Brahim H, Loussaief C, Addad F, Ben Romdhane F, Chakroun M, Bouzouaia N, Ben Farhat M. Une fièvre boutonneuse méditerranéenne compliquée d'une embolie pulmonaire. Rev Med Interne 2006; 27:973-5. [PMID: 17030488 DOI: 10.1016/j.revmed.2006.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 07/07/2006] [Accepted: 07/19/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Thromboembolic complications were uncommon in mediterranean spotted fever. OBSERVATION We report a case of 55-years- old man who was admitted for mediterranean spotted fever. Two days later, the patient developed chest pain due to a pulmonary thrombosis confirmed by angio-CT. The outcome was good with heparin therapy. The investigation for another cause of thrombosis was negative. CONCLUSION Mediterranean spotted fever is usually a moderately severe self-limited illness. Pulmonary thrombosis was uncommon associated with severe disease.
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Affiliation(s)
- H Ben Brahim
- Service de maladies infectieuses, CHU de Monastir, Tunisie
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25
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Ozkan A, Ozkalemkas F, Ali R, Karadogan S, Ozkocaman V, Ozcelik T, Tunali A. Mediterranean spotted fever: presentation with pancytopenia. Am J Hematol 2006; 81:646-7. [PMID: 16823824 DOI: 10.1002/ajh.20628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Cascio A, Iaria C. Epidemiology and clinical features of Mediterranean spotted fever in Italy. Parassitologia 2006; 48:131-3. [PMID: 16881414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Mediterranean Spotted Fever is caused by Rickettsia conorii and is transmitted to humans by Rhipicephalus sanguineus, the common dog tick. It is characterized by the symptomatologic triad: fever, exanthema and "tache noire", the typical eschar at the site of the tick bite. In Italy the most affected region is Sicily. The seasonal peak of the disease (from June through September) occurs during maximal activity of immature stage ticks. Severe forms of the disease have been reported in 6% of patients, especially adults with one of the following conditions: diabetes, cardiac disease, chronic alcoholism, glucose-6-phosphate dehydrogenase deficiency, end stage kidney disease. The mortality rate may reach 2.5%. Oral or parenteral administration of tetracyclines or chloramphenicol represent the standard treatment. Recent studies indicate that oral clarithromycin and azithromycin could constitute an acceptable alternative for the treatment of the disease in children; furthermore, they could be recommended during pregnancy.
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Affiliation(s)
- A Cascio
- Clinica delle Malattie Infettive, Dipartimento di Patologia Umana, Università di Messina, Italy
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27
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Escolano-Fernández B, Maestre-Muñiz M, Ríos-Villegas MJ, Muniain-Ezcurra MA. [Multiple cerebral ischemic infarcts as a complication of boutonneuse fever]. Enferm Infecc Microbiol Clin 2005; 23:634-6. [PMID: 16324558 DOI: 10.1016/s0213-005x(05)75048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Ruiz-Ruiz FJ, Pérez-Calvo JI, Hualde Enguita AM, Amores Ferreras M. [Fever and cutaneous necrotic lesion]. Rev Clin Esp 2005; 205:565-6. [PMID: 16324530 DOI: 10.1016/s0014-2565(05)72639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F J Ruiz-Ruiz
- Servicio de Medicina Interna B, Hospital Clínico Universitario Lozano Blesa, Zaragoza
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30
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Charra B, Berrada J, Hachimi A, Judate I, Nejmi H, Motaouakkil S. [A fatal case of Mediterranean spotted fever]. Med Mal Infect 2005; 35:374-5. [PMID: 15975750 DOI: 10.1016/j.medmal.2005.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 03/02/2005] [Indexed: 11/20/2022]
Affiliation(s)
- B Charra
- Service de réanimation médicale, CHU Ibn-Rochd, Casablanca, Morocco
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31
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Hemmersbach-Miller M, Parola P, Raoult D, Brouqui P. A homeless man with maculopapular rash who died in Marseille, France. Clin Infect Dis 2004; 38:1412, 1493-4. [PMID: 15164735 DOI: 10.1086/420747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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32
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Granel B, Bagneres D, Rossi P, Demoux AL, Aissi K, Bonin-Guillaume S, Frances Y. Un hématome sous-dural fébrile. Rev Med Interne 2004; 25 Suppl 2:S304-5. [PMID: 15460491 DOI: 10.1016/s0248-8663(04)80044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B Granel
- Service de médecine interne, hôpital Nord, 13915 Marseille, France
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33
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Alioua Z, Bourazza A, Lamsyah H, Erragragui Y, Boudi O, Karouach K, Ghfir M, Mossedaq R, Sedrati O. [Neurological feature of Mediterranean spotted fever: a study of four cases]. Rev Med Interne 2004; 24:824-9. [PMID: 14656643 DOI: 10.1016/j.revmed.2003.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rickettsia conorii is the etiologic agent of Mediterranean spotted fever that is endemic in Mediterranean. EXEGESIS We report four cases of serious form of Mediterranean spotted fever with neurological feature. Two of them 56 and 62 years old had meningoencephalitis. Two others had cerebellitis, they are aged 43 and 56. The course has been favourable with ciprofloxacin. CONCLUSION It is a benign well-known illness in spite of apparition of severe visceral complications, which can drag the death in 2.5% of cases. Neurological feature is more frequent and present in 28% of cases. Precocious treatment prevents this unfavourable evolution.
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Affiliation(s)
- Z Alioua
- Service de dermatologie, hôpital militaire d'instruction Mohammed V, BP 1018, Rabat, Maroc.
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34
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Thijssen HS, Leroy PL, van 't Hek LG, Hurkx GA. [An unsuspected imported disease: meningo-encephalitis contracted in Spain]. Ned Tijdschr Geneeskd 2004; 148:113-7. [PMID: 14964019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
A 13-year-old boy consulted a doctor during a holiday in Spain because of high fever, headache and exanthema. A local physician prescribed josamycin, but the medication was lost due to vomiting. A few days later, shortly after returning to the Netherlands, he was hospitalised with a life-threatening neurologic and multi-organ failure. It took two weeks before the diagnosis 'Mediterranean spotted fever' was made and an appropriate antibiotic treatment was started. The patient made a slow but successful recovery. Rereading the hand-written Spanish medical report revealed that it had mentioned a correct diagnosis and adequate treatment. An apparently safe holiday destination thus does not exclude an imported disease. Knowledge of local epidemiology and good communication with the locally consulted medical system are essential for a correct diagnosis and therefore for appropriate treatment and a good prognosis.
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Affiliation(s)
- H S Thijssen
- Atrium Medisch Centrum Heerlen, afd. Kindergeneeskunde, Heerlen
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35
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Skhiri H, Zellama D, Aloui S, Bouraoui S, Frih MA, Achour A, Ben Dhia N, ElMay M. [Acute renal insufficiency in Boutonneuse Mediterranean fever: description of three cases]. Med Trop (Mars) 2004; 64:58-60. [PMID: 15224560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Boutonneuse fever is a bacterial infection caused by Rickettsia conorii. It occurs mainly in countries around the Mediterranean basin. Most cases are benign. However severe forms with major morbidity and a high mortality risk have been described. Severe forms often involve altered mental status, hepatic cytolysis, hemostatic disturbances, pneumopathy, and kidney failure. The causes of renal complications are unclear. The purpose of this report is to describe three cases of boutonneuse fever associated with acute kidney failure due to different underlying mechanisms, i.e., acute renal function failure, acute tubular necrosis, and extracapillary glomerulonephritis. While the first two mechanisms of kidney failure have been reported frequently in association with Boutonneuse fever, extracapillary glomerulonephritis has, to our knowledge, been mentioned only once. This case supports speculation that Rickettsia conorii has a toxic effect on glomeruli.
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Affiliation(s)
- H Skhiri
- Service de néphrologie et de médecine interne, CHU Fattouma Bourguiba, Monastir 5000, Tunisie
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36
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Huerta M, Castel H, Grotto I, Shpilberg O, Alkan M, Harman-Boehm I. Clinical and epidemiologic investigation of two Legionella-Rickettsia co-infections. Isr Med Assoc J 2003; 5:560-3. [PMID: 12929293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND We treated two patients diagnosed with legionellosis and simultaneous Rickettsia conorii co-infection. OBJECTIVES To report the clinical and laboratory characteristics of this unusual combination, and to describe the execution and results of our environmental and epidemiologic investigations. METHODS Serial serologic testing was conducted 1, 4 and 7 weeks after initial presentation. Water samples from the patients' residence were cultured for Legionella. Follow-up cultures were taken from identical points at 2 weeks and at 3 months after the initial survey. RESULTS Both patients initially expressed a non-specific rise in anti-Legionella immunoglobulin M titers to multiple serotypes. By week 4 a definite pattern of specifically elevated IgG titers became apparent, with patient 1 demonstrating a rise in specific anti-L. pneumophila 12 IgG titer and patient 2 an identical response to L. jordanis. At 4 weeks both patients were positive for both IgM and IgG anti-R. conorii antibodies at a titer > or = 1:100. Heavy growth of Legionella was found in water sampled from the shower heads in the rooms of both patients. Indirect immunofluorescence of water cultures was positive for L. pneumophila 12 and for L. jordanis. CONCLUSIONS Although most cases of community-acquired Legionella pneumonia in our region appear simultaneously with at least one other causative agent, co-infection with R. conorii is unusual and has not been reported to date. This report illustrates the importance of cooperation between clinicians and public health practitioners.
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Affiliation(s)
- Michael Huerta
- Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Abstract
Rickettsia conorii is endemic in Mediterranean area. We describe an unusual sace of R. Conorii infection, which concerns a farmer with clinical, radiological and cytological findings of pleurisy without evidence of malignancy. An elevated antibody titre for R. Conorii was observed, using an indirect immunofluorescent antibody test. After treatment with Doxycycline, the patient presented a significant improvement of his clinical and radiological image and a four-fold decrease of the antibody titre for R. conorii.
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Affiliation(s)
- S Alexiou-Daniel
- First Department of Microbiology, School of Medicine, Aristotelian University of Thessaloniki, Thessaloniki 54006, Greece.
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38
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Parra-Martínez J, Sancho-Rieger J, Ortiz-Sánchez P, Peset V, Brocalero A, Castillo A, López-Trigo J. [Encephalitis caused by Rickettsia conorii without exanthema]. Rev Neurol 2002; 35:731-4. [PMID: 12402224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Mediterranean boutonneuse fever, caused by Rickettsia conorii, is an endemic disease in the Mediterranean area. The serious forms of the disease, which include encephalitis, are infrequent but are associated with a high mortality rate. Diagnostic suspicion is backed up by the development of exanthema. We report the case of a patient who developed encephalitis caused by Rickettsia conorii without exanthema. Clinical case. A 27 year old woman who had nauseas, headache, fever, abdominal upset and generalised pain during the days before being admitted to hospital. On the day she was admitted, she noticed reduced strength in the left limbs, together with numbness and pins and needles in the left side of the body. In the casualty department she presented tonic seizures in the left extremities and later generalised tonic clonic seizures. Exploration showed facial paresis and 4/5 hemiparesis on the left side. Complementary tests carried out in casualty, including cerebrospinal fluid (CSF), did not reveal any significant findings. She was admitted after a loading dose of phenytoin. After 48 hours she presented fever and repeated complex partial seizures. A new CSF analysis was normal. She was treated with valproate, clonazepam, ceftriaxone, doxycycline and acyclovir. An electroencephalogram (EEG) showed theta activity in the left centroparietal areas and slow delta waves in the right temporal regions. Magnetic resonance imaging (MRI) of the brain showed contrast enhancement in the meninges. 24 later, due to the frequency of the seizures, phenobarbital and methylprednisolone were added, which enabled the seizures to be controlled. The posterior brain MRI revealed a right parasylvian lesion. Serological Rickettsia conorii IgM +, IgG 1/256 was administered. After eight months, she has presented no seizures or neurological deficit. CONCLUSIONS There are cases of encephalitis from Rickettsia conorii that can present without exanthema. This means that in endemic areas early treatment with doxycycline could be advisable when faced with encephalitis of unknown aetiology, bearing in mind the high mortality rate that occurs when no early treatment is administered and the good tolerance to doxycycline.
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Bellissima P, Bonfante S, La Spina G, Turturici MA, Bellissima G, Tricoli D. [Complications of mediterranean spotted fever]. Infez Med 2001; 9:158-62. [PMID: 12087217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Mediterranean spotted fever is an infectious disease due to Rickettsia conori transmitted to man by the dog tick Rhipicephalus sanguineus. The review of a consecutive series of 525 cases, admitted to Caltagirone hospital in the last 20 years, permits the classic clinical picture to be identified by fever, maculopapular eruption and tache noire, and any complications to be visualized. Usually the course of the disease is good, but 12.7% of our cases reported complications such as renal failure, myocarditis, pneumonia, encephalitis, anicteric hepatitis, gastrointestinal bleeding, anaemia and impaired glucose tolerance. The development of a systemic vasculite is the main pathogenetic factor in the origin of systemic complications. Early diagnosis and specific antibiotic treatment may reduce the risk of complications.
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Affiliation(s)
- P Bellissima
- U.O. di Malattie Infettive, Azienda Ospedaliera Gravina, Caltagirone, Catania, Italy
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40
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Kafetzis DA, Maltezou HC, Constantopoulou I, Antonaki G, Liapi G, Mathioudakis I. Lack of association between Kawasaki syndrome and infection with Rickettsia conorii, Rickettsia typhi, Coxiella burnetii or Ehrlichia phagocytophila group. Pediatr Infect Dis J 2001; 20:703-6. [PMID: 11465844 DOI: 10.1097/00006454-200107000-00012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The etiology of Kawasaki syndrome (KS) is unknown. Rickettsiae, intracellular microorganisms that invade the vascular endothelium, might cause KS. OBJECTIVES To investigate whether there is an association between KS and infection with Rickettsia conorii, Rickettsia typhi, Coxiella burnetii or Ehrlichia phagocytophila group. METHODS All children who were diagnosed with KS at the University of Athens Second Department of Pediatrics from December, 1999, through November, 2000, were prospectively studied. Paired serum specimens were obtained from all patients and antibody titers against R. conorii, R. typhi, C. burnetii and E. phagocytophila group were assessed by microimmunofluorescence assay. RESULTS Eleven children with a median age of 2.5 years were included in the study. A 15-month-old child had a 4-fold rise of antibody titers against C. burnetii, which is indicative of acute Q fever. The patient had a history of recent exposure to possible sources of C. burnetii. The remaining patients tested negative for the presence of antibodies against R. conorii, R. typhi, C. burnetii and E. phagocytophila group. CONCLUSIONS Our study does not provide serologic evidence that KS is the result of infection with R. conorii, R. typhi, C. burnetii or E. phagocytophila group. It is suggested that C. burnetii may cause a KS-like illness in young children.
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Affiliation(s)
- D A Kafetzis
- Second Department of Pediatrics, University of Athens, P&A Kyriakou Children's Hospital, Greece.
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41
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Abstract
Facial nerve palsy has been occasionally attributed to infectious agents, but Rickettsiae species have not been documented as causative agents. We report two adolescent girls with facial nerve palsy and serological evidence of R conorii infection. These cases indicate that rickettsioses should be included among the causes of facial nerve palsy, particularly in endemic areas.
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Affiliation(s)
- M Bitsori
- Department of Paediatrics, University Hospital of Heraklion, Crete, Greece
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42
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Behar DM, Ben-Ami H. Myositis accompanying Rickettsia conorii infection. Isr Med Assoc J 2001; 3:471-2. [PMID: 11433656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Mekhloufi EY, Ait-Abbas N. [Mediterranean spotted fever complicated by myocarditis]. Presse Med 2001; 30:586. [PMID: 11317917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Leal Hernández M, Abellán Alemán J, Martínez Crespo J, Vicente Martínez R. [Unexplained fever in patient with Down's syndrome]. Aten Primaria 2001; 28:141-3. [PMID: 11440654 PMCID: PMC7675942 DOI: 10.1016/s0212-6567(01)78916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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45
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Cabiddu G, Altieri P, Pani A, Melis P, Conti M, Ledda O, Bolasco PG. Mediterranean spotted fever with acute renal failure stimulating a relapse in C-ANCA vasculitis. Nephron Clin Pract 2000; 79:241-2. [PMID: 9647517 DOI: 10.1159/000045041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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46
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Moulaire V, Corne P, Landreau L, Capelle P, Jonquet O. [Acute respiratory distress revealing Mediterranean spotted fever]. Presse Med 2000; 29:1175-6. [PMID: 10906938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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47
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Priego M, Blázquez JC, Serrano C, de Teresa L. [Retinal vasculitis secondary to Mediterranean boutonneuse fever]. Enferm Infecc Microbiol Clin 2000; 18:249-50. [PMID: 10974777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
Rocky Mountain spotted fever and Mediterranean spotted fever are rickettsial infections primarily of endothelial cells that normally have a potent anticoagulant function. As a result of endothelial cell infection and injury, the hemostatic system is perturbed and shows changes that vary widely from a minor reduction in the platelet count (frequently) to severe coagulopathies, such as deep venous thrombosis and disseminated intravascular coagulation (rarely). Changes favoring a hypercoagulable state include endothelial injury and release of procoagulant components, activation of the coagulation cascade with thrombin generation, platelet activation, increased antifibrinolytic factors, consumption of natural anticoagulants, and possibly high levels of coagulation-promoting cytokines. Yet, most studies have been performed on endothelial cell cultures that provide nonphysiologic, reductionistic, experimental conditions. The lack of flow, platelets, and WBCs makes these experiments far from simulating the response of endothelial cells in the human body. Coagulopathies and thrombotic events should be considered as potential complications of severe Rocky Mountain spotted fever and Mediterranean spotted fever.
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Affiliation(s)
- M T Elghetany
- University of Texas Medical Branch, Galveston 77555-0609, USA
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Uriz MS, Gorina N, Martínez-Mejías A, López-Liñán MJ, Bella F. [Arthritis as complication of Mediterranean boutonneuse fever in infancy]. Enferm Infecc Microbiol Clin 1999; 17:316-8. [PMID: 10439549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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de Galan BE, van Kasteren BJ, van den Wall Bake AW, Vreugdenhil G. A case of Guillain-Barré syndrome due to infection with Rickettsia conorii. Eur J Clin Microbiol Infect Dis 1999; 18:79-80. [PMID: 10192725 DOI: 10.1007/pl00011228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B E de Galan
- Department of Internal Medicine 541, University Hospital Nijmegen, The Netherlands.
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