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Fiore V, Mancini F, Ciervo A, Bagella P, Peruzzu F, Nunnari G, Deiana GA, Rezza G, Babudieri S, Madeddu G. Tache Noire in a Patient with Acute Q Fever. Med Princ Pract 2018; 27:92-94. [PMID: 29298443 PMCID: PMC5968302 DOI: 10.1159/000486573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/24/2017] [Accepted: 01/03/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe a rare case of acute Q fever with tache noire. CLINICAL PRESENTATION AND INTERVENTION A 51-year-old man experienced acute Q fever showing tache noire, generally considered a pathognomonic sign of Mediterranean spotted fever (MSF) and MSF-like illness, but not a clinical feature of Q fever. The patient was treated with doxycycline 100 mg every 12 h. CONCLUSION In the Mediterranean area, tache noire should be considered pathognomonic of MSF but it should not rule out Q fever. Clinical diagnosis should be supported by accurate laboratory diagnostic tests to guide proper management.
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Affiliation(s)
- Vito Fiore
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
- *Vito Fiore (MD), Unit of Infectious Diseases, Department of Clinical and, Experimental Medicine, University of Sassari, Viale San Pietro 43c, Sassari, IT-07100 (Italy), E-Mail
| | - Fabiola Mancini
- Unit of Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome
| | - Alessandra Ciervo
- Unit of Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome
| | - Paola Bagella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
| | - Francesca Peruzzu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
| | - Giuseppe Nunnari
- Units of Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Andrea Deiana
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
| | - Giovanni Rezza
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Rome
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de SOUSA R, FRANÇA A, NÒBREGA SDÓRIA, BELO A, AMARO M, ABREU T, POÇAS J, PROENÇA P, VAZ J, TORGAL J, BACELLAR F, ISMAIL N, WALKER DH. Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. J Infect Dis 2008; 198:576-85. [PMID: 18582199 PMCID: PMC2614375 DOI: 10.1086/590211] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. METHODS This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection. RESULTS A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients. CONCLUSIONS Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.
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Affiliation(s)
- Rita de SOUSA
- Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal. Tel: (351) 217508127,Fax: (351) 217508121 E-mail:
| | | | | | | | | | | | - José POÇAS
- Centro Hospitalar de Setúbal,Hospital de Setúbal, E.P.E., Setúbal
| | | | - José VAZ
- Centro Hospitalar do Baixo Alentejo, Beja
| | - Jorge TORGAL
- Departamento de Saúde Pública, Faculdade de Ciências Médicas de Lisboa, Lisboa
| | - Fátima BACELLAR
- Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal. Tel: (351) 217508127,Fax: (351) 217508121 E-mail:
| | - Nahed ISMAIL
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - David H. WALKER
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
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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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Punda-Polić V, Luksić B, Capkun V. Epidemiological features of Mediterranean spotted fever, murine typhus, and Q fever in Split-Dalmatia County (Croatia), 1982-2002. Epidemiol Infect 2008; 136:972-9. [PMID: 17850690 PMCID: PMC2870890 DOI: 10.1017/s0950268807009491] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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: 11/06/2022] Open
Abstract
We determined the epidemiological features of three zoonoses in hospitalized patients in southern Croatia. Patients were diagnosed by serological testing. Clinical and epidemiological data were also collected. Between 1982 and 2002, Mediterranean spotted fever (MSF) was diagnosed in 126 (incidence rate 1.27/100,000 per year), murine typhus (MT), in 57 (incidence rate 0.57/100,000 per year), and Q fever in 170 (incidence rate 1.7/100,000 per year) patients. MSF and Q fever were characterized by a marked seasonality. Incidences of Q fever and of MSF were higher for males than for females (P<0.0001 and P=0.0024, respectively). The most frequent of the three zoonoses in children was MSF. Q fever and MT cases were mostly seen in the 21-50 years age group. We found no statistically significant differences between season- and gender-specific incidence rates of MT. Whereas infections due to rickettsiae decreased, the incidence of Q fever increased over the last 12 years of the study.
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Affiliation(s)
- V Punda-Polić
- Department of Clinical Microbiology, Split University Medical School and Split University Hospital, Split, Croatia.
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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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Tzavella K, Hatzizisis IS, Vakali A, Mandraveli K, Zioutas D, Alexiou-Daniel S. Severe case of Mediterranean spotted fever in Greece with predominantly neurological features. J Med Microbiol 2006; 55:341-343. [PMID: 16476800 DOI: 10.1099/jmm.0.46337-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rickettsia conorii is endemic in Greece, though only a few cases of infection have been published to date. The case of a 58-year-old man from northern Greece with a severe form of Mediterranean spotted fever and rapid neurological deterioration is presented here. The patient received antibiotic treatment with doxycycline, showing immediate clinical and laboratory improvement. Diagnosis was confirmed later, during the second week after disease onset, by detection of elevated titres of IgM and IgG antibodies against R. conorii using an indirect immunofluorescence assay.
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Abstract
BACKGROUND The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. OBJECTIVE In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. METHODS Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. RESULTS Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. CONCLUSIONS At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California, Irvine, California, USA
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Abstract
Although potential arthropod vectors are abundant in Cameroon, acute febrile illnesses are rarely evaluated for arboviral or rickettsial infections. Serum samples from 234 acutely febrile patients at clinics in Tiko and Buea, Cameroon, were examined for antibodies to Rickettsia africae and African alphaviruses and flaviviruses. These serum samples did not contain antibodies against typhoid, and blood malarial parasites were not detected. Serum samples of 32% contained immunoglobulin M antibodies reactive with R. africae by immunofluorescence assay and were reactive with outer membrane proteins A and B of R. africae by immunoblotting. These findings established a diagnosis of acute rickettsiosis, most likely African tick-bite fever. Hemagglutination inhibition testing of the serum samples also detected antibodies to Chikungunya virus (47%) and flaviviruses (47%). High prevalence of antibodies to arboviruses may represent a major, previously unrecognized public health problem in an area where endemic malaria and typhoid fever have been the principal diagnostic considerations.
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Affiliation(s)
- Lucy M. Ndip
- University of Buea, Buea, South West Province, Cameroon
| | | | | | | | - Robert B. Tesh
- University of Texas Medical Branch, Galveston, Texas, USA
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Ndip LM, Bouyer DH, Travassos Da Rosa APA, Titanji VPK, Tesh RB, Walker DH. Acute spotted fever rickettsiosis among febrile patients, Cameroon. Emerg Infect Dis 2004. [PMID: 15109409 DOI: 10.32012/eid1003.020713] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Although potential arthropod vectors are abundant in Cameroon, acute febrile illnesses are rarely evaluated for arboviral or rickettsial infections. Serum samples from 234 acutely febrile patients at clinics in Tiko and Buea, Cameroon, were examined for antibodies to Rickettsia africae and African alphaviruses and flaviviruses. These serum samples did not contain antibodies against typhoid, and blood malarial parasites were not detected. Serum samples of 32% contained immunoglobulin M antibodies reactive with R. africae by immunofluorescence assay and were reactive with outer membrane proteins A and B of R. africae by immunoblotting. These findings established a diagnosis of acute rickettsiosis, most likely African tick-bite fever. Hemagglutination inhibition testing of the serum samples also detected antibodies to Chikungunya virus (47%) and flaviviruses (47%). High prevalence of antibodies to arboviruses may represent a major, previously unrecognized public health problem in an area where endemic malaria and typhoid fever have been the principal diagnostic considerations.
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Affiliation(s)
- Lucy M Ndip
- University of Buea, Buea, South West Province, Cameroon
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Rizzo M, Mansueto P, Di Lorenzo G, Morselli S, Mansueto S, Rini GB. Rickettsial disease: classical and modern aspects. New Microbiol 2004; 27:87-103. [PMID: 14964412] [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
Rickettsial diseases have been reassessed in recent years since they represent an important field in today's medicine. New agents have been described: some are non-pathogenic agents and the others are associated with well-defined or peculiar clinical patterns. In addition, different species of rickettsiosis are found in relation to the geographic areas of the world. Some agents may be defined as variants of older diseases whereas most of the newly described forms of rickettsiosis represent distinct entities with unique epidemiologial and clinical features. Probably the main news regards the group of the spotted fevers. An additional new aspect is linked to the medicine of travellers and tourists. However, this aspect may not be significant for the rickettsial diseases in relation to other human illnesses, such as malaria. Therefore, an investigation into the geographical origin of patients has to enter our routine medical work.
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Affiliation(s)
- M Rizzo
- Department of Clinical Medicine and Emerging Diseases, University of Palermo, Italy
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Abstract
Mediterranean spotted fever (MSF), endemically present, is associated with a low mortality and morbidity in Portugal. Etiological agents are Malish and Israeli tick typhus strains of Rickettsia conorii. In the last few years severe forms of MSF have emerged, with patients presenting atypical symptoms, major neurological manifestations, and multiorgan involvement, who have required intensive care facilities. Advanced age, underlying chronic disease, and delay of appropriate treatment are bad prognostic factors. In the acute phase of diagnosis, serological studies are delayed, inconclusive, and often unhelpful. A definitive diagnosis can only be made using isolation or molecular biology which can establish and clearly identify agents. Using evidence-based case reports, clinical and laboratory data were evaluated from patients with severe or fatal MSF observed in Garcia da Orta Hospital-Almada. Of the eight reference cases, four died, three in an acute fulminant stage. Of the survivors, four presented atypical involvement: ocular inoculation, massive gastric hemorrhage, acute respiratory disease (ARDS), and necrotizing vasculitis. Diagnosis by isolation of the agent was made in two cases, by immunohistochemistry in three, and by the indirect fluorescent antibody test (IFA) in three others. Israeli tick typhus and Malish R. conorii strains were isolated once each in fatal cases. In early stages, diagnosis continues to be clinical and patients should start appropriate therapy without delay if clinical suspicion of rickettsiosis arises to prevent poor outcome. Patients ranged in age from 39 to 71 years (mean 60), APACHE II ranged from 15 to 38 points and TISS 28 was between 24 and 46 points. In reported cases severity of disease was not obviously related to the usual comorbidities. Accelerated clinical course may not suggest classical MSF. Another relevant factor was prior prescription of an inappropriate antibiotic that contributed to misleading clinical features. The reported complications and atypical manifestations illustrate well the diversity of this disease.
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Affiliation(s)
- M Amaro
- Hospital Garcia de Orta, 2801-501 Almada, Portugal
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Abstract
Japanese spotted fever (JSF), first reported in 1984, is a rickettsial disease caused by Rickettsia japonica. Until now, affliction of the central nervous system has been rarely reported. Here we report two cases of JSF associated with a central nervous system disorder such as meningoencephalitis.
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Affiliation(s)
- Manabu Araki
- Department of Neurology, Kobe City General Hospital, Hyogo, Japan
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Mumcuoglu KY, Keysary A, Gilead L. Mediterranean spotted fever in Israel: a tick-borne disease. Isr Med Assoc J 2002; 4:44-9. [PMID: 11802311] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Kosta Y Mumcuoglu
- Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Regev-Yochay G, Segal E, Rubinstein E. Glucose-6-phosphate dehydrogenase deficiency: possible determinant for a fulminant course of Israeli spotted fever. Isr Med Assoc J 2000; 2:781-2. [PMID: 11344735] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- G Regev-Yochay
- Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Israel.
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Dignat-George F, Tissot-Dupont H, Grau GE, Camoin-Jau L, Raoult D, Sampol J. Differences in levels of soluble E-selectin and VCAM-1 in malignant versus non malignant Mediterranean spotted fever. Thromb Haemost 1999; 82:1610-3. [PMID: 10613643] [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: 02/15/2023]
Abstract
In the present study, we investigated the plasma levels of soluble adhesion molecules E-selectin, P-selectin, intercellular adhesion molecule- (ICAM- ) and vascular cell adhesion molecule-1(VCAM-1) in 24 patients with Mediterranean spotted fever (MSF), 6 of whom with a malignant form. Measurements were performed on blood samples collected before treatment (T1), then twice during treatment (T2 and T3). Before treatment, MSF patients taken as a whole presented elevated levels of sICAM-1 and sVCAM-1 and normal levels of sE-selectin and sP-selectin compared to healthy controls. We found that sICAM-1 was elevated both in mild and malignant MSF. sE-selectin and sVCAM-1 were elevated only in patients with the malignant form and allowed to discriminate the two clinical subgroups. Their levels decreased after treatment with sE-selectin reaching control values at T2 whereas sVCAM-1 remained higher over the course of the malignant form. In patients with mild MSF, sP-selectin steadily increased after treatment, whereas it did not present any modification at any of the two sampling times in patients with the malignant form. Raised plasma levels of sE-selectin and sVCAM-1 reflect endothelial activation in malignant rickettsial disease and may be sufficiently early markers to influence the therapeutic decision.
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Affiliation(s)
- F Dignat-George
- Laboratoire d'Hématologie, Hôpital de La Conception, Marseille, France
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Fujii T, Abe S. [Boutonneuse fever]. Ryoikibetsu Shokogun Shirizu 1999:276-8. [PMID: 10201196] [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: 02/11/2023]
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Popivanova N, Hristova D, Hadjipetrova E. Guillain-Barré polyneuropathy associated with mediterranean spotted fever: case report. Clin Infect Dis 1998; 27:1549. [PMID: 9868689 DOI: 10.1086/517751] [Citation(s) in RCA: 13] [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] [Indexed: 11/03/2022] Open
Affiliation(s)
- N Popivanova
- Department of Infectious Diseases, Higher Medical Institute, Plovdiv, Bulgaria
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Salavert M, Navarro V. [Edemas as a form of presentation of spotted Mediterranean fever]. Enferm Infecc Microbiol Clin 1995; 13:325-6. [PMID: 7779909] [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: 01/27/2023]
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Mora A, Vigueras I, Enríquez R, Escolano CM. [Malignant mediterranean boutonneuse fever: persistence of the parasite vector and prognostic implication]. Rev Clin Esp 1995; 195:62. [PMID: 7878272] [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: 01/27/2023]
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Ruiz Beltrán R, Herrero Herrero JI. Deleterious effect of trimethoprim-sulfamethoxazole in Mediterranean spotted fever. Antimicrob Agents Chemother 1992; 36:1342-3. [PMID: 1416836 PMCID: PMC190344 DOI: 10.1128/aac.36.6.1342] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Sarov B, Manor E, Hanuka N, Sikuler E, Galil A, Sarov I. Comparison of structural polypeptides, detected by immunoblotting technique, in the sera of spotted fever group rickettsia positive cases--symptomatic versus asymptomatic. Acta Virol 1992; 36:57-61. [PMID: 1350173] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
In an attempt to characterize the nature of symptomatic versus asymptomatic spotted fever group rickettsia (SFGR) infection, the immune response to R. conorii (boutonneuse fever) structural polypeptides was studied by Western-blot immunoassay. Sera from immunoperoxidase assay (IPA), SFGR seropositive (titre greater than or equal to 80) individuals, symptomatic and asymptomatic and from SFGR seronegative (IPA titre less than 80) individuals living in a kibbutz community in the desert region of Southern Israel were examined by immunoblot. This community suffered from a very high morbidity rate due to SFGR (21-fold higher than the national reported average). The entire community (n-326) has been followed-up since 1985, with serial serum samples being examined for specific IgG antibodies by IPA. The intensity of the immunoblot reaction correlated with specific IgG antibody titres as determined by IPA. This correlation was also observed between the decrease in the IgG titre and the strength of the antibody-antigen reaction by immunoblot over time for a given individual. IPA seropositive sera from asymptomatic as well as symptomatic spotted fever cases reacted to 8 individual polypeptides. In both cases antibodies to 22 kD, 24 kD, 26 kD, 28 kD, 30 kD, 32 kD, 34 kD, and 37 kD were found. In the IPA seronegative sera, antibodies to polypeptides in the range of 24 kD to 32 kD were not detected. The lack of detectable differences by immunoblotting between SFGR symptomatic vs, asymptomatic cases might be explained by other aspects of the immune response of each infected individual, and/or it is possible that virulent and non-virulent antigenically closely related SFGR strains infected symptomatic vs. asymptomatic individuals.
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Affiliation(s)
- B Sarov
- Epidemiology Unit, Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
Mediterranean Spotted Fever is a disease caused by Rickettsia conorii. It is endemic to the Mediterranean area, where, for the last few years, the number of cases has increased, possibly due, in part, to climatic factors. The main clinical aspects of a prospective series of 246 cases diagnosed from 1983 to 1988 are presented. The most characteristic manifestations were fever, exanthema and tache noire. Other frequent manifestations were headache, myalgia and arthralgia, and with lesser frequency, hepatomegaly, splenomegaly, gastrointestinal symptoms and conjunctivitis. Notable analytical changes are the rise of hepatic and muscular enzymes in a large number of patients. In some cases we have found signs of myositis in muscular biopsy. The evolution of our patients was usually favorable though serious and even deadly forms of the disease have been described. One of the factors that seems to greatly influence the appearance of these forms is delay in the initiation of effective treatment.
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Affiliation(s)
- F Segura-Porta
- Hospital de Sabadell, Servicio de Medicina Interna, Spain
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Soriano V, Sabriá M, Davins J, Farré J, Aramburu J, Manterola JM, Rey-Joly C. [Predictive value of neopterin in boutonneuse fever]. Rev Clin Esp 1989; 185:396-8. [PMID: 2623265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neopterin is an intermediate purine metabolite which can be determined in serum and has been shown to be elevated in processes that stimulate cell mediated immunity. Neopterin serum levels have been measured in 37 patients diagnosed of boutonneuse mediterranean fever. Serum titers were higher during the acute phase than during the convalescence in 97.2% of patients. Neopterin levels normalized as the disease improved clinically. On the other hand, the highest levels were found in patients with a torpid evolution and appearance of complications.
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Raoult D, Zuchelli P, Weiller PJ, Charrel C, San Marco JL, Gallais H, Casanova P. Incidence, clinical observations and risk factors in the severe form of Mediterranean spotted fever among patients admitted to hospital in Marseilles 1983-1984. J Infect 1986; 12:111-6. [PMID: 3701097 DOI: 10.1016/s0163-4453(86)93508-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Seven of 142 cases (5%) of Mediterranean spotted fever admitted to hospital in Marseilles in 1983 and 1984 were severe. All of them were confirmed by specific laboratory tests. The disease resembles Rocky Mountain spotted fever with purpuric exanthem, confusion, renal insufficiency, hypoxaemia, thrombocytopenia, hyponatraemia and hypocalcaemia. Two patients died. The predisposing factors for severity were old age, alcoholism, heavy smoking, respiratory insufficiency and glucose-6-phosphate dehydrogenase deficiency.
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Texier P, Rousselot JM, Quillerou D, Aufrant C, Robain D, Foucaud P. [Mediterranean boutonneuse fever. Apropos of a fatal case in a newborn infant]. Arch Fr Pediatr 1984; 41:51-3. [PMID: 6721652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The authors report the case of a 20 day-old neonate who presented with boutonneuse fever. According to their knowledge, this is the first reported case occurring in a neonate. In this child, the infection seemed to be unusually severe with rapid evolution and encephalic signs.
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