RESUMO
BACKGROUND: Rocky Mountain spotted fever (RMSF) is an acute, serious tick borne illness caused by Rickettsia rickettsi. Frequently, RMSF is manifested by headache, a typical rash and fever but atypical disease is common, making diagnosis difficult. Inflammatory arthritis as a manifestation is rare. The purpose of this study is to describe a patient with serologically proven RMSF who presented in an atypical manner with inflammatory arthritis of the small joints of the hands and to review the previously reported patients with rickettsial infection and inflammatory arthritis. METHODS: An 18-year-old woman presented with a rash that began on the distal extremities and spread centrally, along with hand pain and swelling. She had tenderness and swelling of the metacarpophlangeal joints on examination in addition to an erythematosus macular rash and occasional fever. RESULTS: Acute and convalescent serology demonstrated R rickettsi infection. She was successfully treated with doxycycline. CONCLUSIONS: Inflammatory arthritis is a rare manifestation of RMSF or other rickettsial infection with 8 previously reported patients, only 1 of whom had RMSF. Physician must have a high index of suspicion for RMSF because of atypical presentations.
Assuntos
Artrite/diagnóstico , Artrite/microbiologia , Febre Maculosa das Montanhas Rochosas/complicações , Febre Maculosa das Montanhas Rochosas/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Progressão da Doença , Doxiciclina/uso terapêutico , Feminino , Humanos , Articulação Metacarpofalângica/patologia , Febre Maculosa das Montanhas Rochosas/tratamento farmacológico , Resultado do TratamentoRESUMO
Dogs were experimentally inoculated with Rickettsia rickettsii to characterize the comparative efficacies of chloramphenicol, enrofloxacin, and tetracycline for the treatment of Rocky Mountain spotted fever (RMSF). All three antibiotics were equally effective in abrogating the clinical, hematologic, and vascular indicators of rickettsial infection. Antibiotic treatment for 24 h was sufficient to decrease the rickettsemia to levels below detection by Vero cell culture. Early treatment with all three antibiotics resulted in a similar decrease in antibody titer, but acute and convalescent serum samples taken at appropriate times would have still facilitated an accurate diagnosis of RMSF in all but one dog, which did not seroconvert. We conclude that chloramphenicol, enrofloxacin, and tetracycline are equally efficacious for treating experimental canine RMSF.
Assuntos
Anti-Infecciosos/uso terapêutico , Cloranfenicol/uso terapêutico , Fluoroquinolonas , Quinolonas/uso terapêutico , Febre Maculosa das Montanhas Rochosas/tratamento farmacológico , Tetraciclina/uso terapêutico , Animais , Anticorpos Antibacterianos/análise , Permeabilidade Capilar/fisiologia , Cães , Enrofloxacina , Feminino , Imunofluorescência , Febre Maculosa das Montanhas Rochosas/microbiologia , Febre Maculosa das Montanhas Rochosas/fisiopatologia , Células VeroRESUMO
The author describes the in vitro data for antibiotic susceptibility of Rickettsia and Coxiella burnetti. Tetracyclines are still the first antibiotic choice in spotted fevers, typhus and Q fever. In spotted fever a shortened treatment is suggested and the place of macrolide antibiotics, such as Josamycin, in treating children may be evaluated. In Q fever, according to the new biological data, an association of tetracyclines and Rifampin or Quinolones is suggested.