Cohen R, Babushkin F, Shapiro M, Uda M, Atiya-Nasagi Y, Klein D, Finn T. Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel.
Emerg Infect Dis 2019;
24:835-840. [PMID:
29664383 PMCID:
PMC5938761 DOI:
10.3201/eid2405.171992]
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Abstract
Genetic sequencing should be used to confirm cases because purpura fulminans is a rare finding.
We report a series of 5 case-patients who had Israeli spotted fever, of whom 2 had purpura fulminans and died. Four case-patients were given a diagnosis on the basis of PCR of skin biopsy specimens 3–4 days after treatment with doxycycline; 1 case-patient was given a diagnosis on the basis of seroconversion. Rickettsia spp. from the 2 case-patients who died were sequenced and identified as Rickettsia conorii subsp. israelensis. Purpura fulminans has been described in association with R. rickettsii and R. indica, but rarely with R. conorii subsp. israelensis.
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