Mediterranean spotted fever in child and adult patients: investigation from an endemic region in Bulgaria

OBJECTIVES

Mediterranean spotted fever (MSF) is a tick-borne endemic disease caused by Rickettsia conorii conorii and transmitted to humans by the brown dog tick Rhipicephalus sanguineus. It is characterized by fever, maculopapular rash and a tick bite skin lesion "tache noire". The disease affects all age groups and usually has mild to moderate course. It has long been considered a benign infection. However, very severe "malignant" forms with fatal outcome strongly influenced by the patients' age were also observed. We aimed to reveal the features of MSF in children by comparing them with some of the disease patterns in adults.

METHODS

Our prospective study data are based on the monitoring of all inpatients of the Clinic of Infectious Diseases in Plovdiv City and environs, the largest MSF endemic region in Bulgaria. The total number of patients admitted and treated for MSF over a study period of 10 years is 549, the incidence reaching 9.44/100,000. MSF is confirmed by antibody response to a specific antigen measured by indirect immunofluorescence assay (IFA). IgG ≥ 128 and/or IgM > 64 were considered to be indicative of acute infection.

RESULTS

Eighty-five (15.48%) patients were children up to 14 years of age and 464 (84.52%) were aged 15-85 years. The skin lesion "tache noire" was present in 73.68% of children, and in 76.93% of the older age groups; symptoms as anorexia, nausea, vomiting, abdominal pain, and diarrhoea were more frequent in children, till general weakness and malaise was prevalent in adults. Children accounted approximately for 70% of the disease mild forms. No lethality was registered in this age group. Even though there were isolated cases of severe and malignant forms, children did not undergo the fatal complications seen in adults.

CONCLUSION

Knowledge of the peculiarities of MSF in children will contribute to children's health protection, timely diagnose and disease prevention.

Unusual Maculopapular Rash on the Scalp of a Patient with Mediterranean Spotted Fever

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.

Epidemiologic studies of leptospiroses in the Plovdiv region of Bulgaria

BACKGROUND

The natural habitat of leptospira along the Maritsa river, the high level of development of the land-cultivation and cattle-raising underscore the importance of establishing the exact prevalence of leptospiroses ranking it among the highest in the country. The changes occurring in the economy and land-making of the country following 1990 are reflected in the prevalence of leptospiroses during this period.

MATERIAL AND METHODS

We studied 95 patients of the Infectious Disease Clinic of the Higher Medical Institute of Plovdiv with serological evidence for leptospirosis for the period 1987-1998. The patients were analyzed based on the following criteria: morbidity, age, gender, season, etiologic structure, mechanism and factors for the transmission of disease etc.

RESULTS

The morbidity rate of Leptospira has shown a clear tendency towards increase since 1992. In terms of etiology L. pomona ranked first accounting for 44.22% of the cases as compared with the prevalence of L. tsalapitsa--22.10%. The isolation rates of those who had been infected during contact with animals (swine predominantly) was 40.44%, during plant watering--38.95%, and 17.89% resulted from bathing in the Maritsa river or its tributaries. Patients in the high-risk groups were characteristically 20-39 years old, cattle-raisers, fishermen, land workers. The highest number of registered cases occurred in July through August.

CONCLUSIONS

Based on these results from the epidemiologic study effective measures aimed at the reservoir, mechanism of transmission of the infection and the risk groups can be implemented so that the epidemiologic and epizootic control of leptospiroses can be improved.