RESUMEN
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.
Asunto(s)
Fiebre Botonosa , Exantema , Rickettsia , Humanos , Niño , Irán , Exantema/etiología , Fiebre Botonosa/complicaciones , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/tratamiento farmacológico , Dolor Abdominal/etiología , FiebreAsunto(s)
Fiebre Botonosa , Vasculitis Retiniana , Retinitis , Humanos , Vasculitis Retiniana/complicaciones , Vasculitis Retiniana/diagnóstico , Fiebre Botonosa/complicaciones , Fiebre Botonosa/diagnóstico , Tomografía de Coherencia Óptica/métodos , Retinitis/complicaciones , Retinitis/diagnóstico , Angiografía , Angiografía con Fluoresceína/métodos , Vasos Retinianos/diagnóstico por imagenAsunto(s)
Fiebre Botonosa , Humanos , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/complicaciones , MasculinoRESUMEN
Mediterranean spotted fever (MSF) is a tick-borne acute endemic infectious disease caused by Rickettsia conorii. While MSF may progress asymptomatically, it may lead to clinical pictures like severe hemorrhagic fever. In this article, we are presenting an MSF case with signs of high fever, headache, nausea, weakness and generalized maculopapular rash. The diagnosis of the female patient who had a history of contact with a tick-infested dog was confirmed with her clinical and laboratory data. The clinical and laboratory findings of the patient who was given doxycycline by 200 mg/day for 7 days were improved in a short time. Rickettsia conorii serology by indirect immunofluorescence assay method confirmed the diagnosis of MSF. In cases of severe sepsis accompanied by high fever and generalized maculopapular rash where the source of the infection cannot be determined in the short term, carefully questioning exposure to ticks by considering the existing geographical, seasonal and endemic environmental factors may be life-saving in terms of early diagnosis and treatment of MSF, which may become fatal even in the absence of eschars (tache noire). The symptomatology of hemorrhagic fever associated with Rickettsia conorii may be confused with that of sepsis in clinical practice.
Asunto(s)
Fiebre Botonosa , Exantema , Sepsis , Garrapatas , Femenino , Perros , Animales , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/tratamiento farmacológico , Fiebre Botonosa/complicaciones , Doxiciclina/uso terapéutico , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Sepsis/complicaciones , Técnica del Anticuerpo Fluorescente IndirectaRESUMEN
A previously well man in his 50s returned to the UK after a trip to the Mediterranean. The day after returning he developed malaise, fevers, rigors and severe headache. He was hospitalised with sepsis, multiorgan involvement, a maculopapular rash and an eschar on each hip. Serology was positive for Rickettsia spp (spotted fever group) with a rise in titre from 1:64 to 1:1024 eight days later. Blood and tissue PCR were also positive for Rickettsia spp. He had cardiac, pulmonary, renal, ocular and neurological involvement. He completed a 14-day course of doxycycline and recovered well. This is a case of likely Mediterranean spotted fever (MSF) caused by Rickettsia conorii, which is endemic to the Mediterranean basin. We highlight the need for awareness and early treatment to prevent severe complications. This case is also the first to describe Purtscher-like retinopathy in the context of likely MSF.
Asunto(s)
Fiebre Botonosa , Exantema , Rickettsia conorii , Rickettsia , Masculino , Humanos , Fiebre Botonosa/complicaciones , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/tratamiento farmacológico , Doxiciclina/uso terapéutico , Exantema/complicacionesRESUMEN
Mediterranean spotted fever (MSF) caused by the bacterium Rickettsia conorii is one of the oldest known tick-borne diseases. It is transmitted by the brown dog tick Rhipicephalus sanguineus and occurs mainly in the Mediterranean area. MSF usually presents with a skin rash, high fever, and characteristic eschar at the site of the tick bite. The course of this disease may be benign or life-threatening. Focal neurological manifestations are unusual. We report the case of a patient who presented with an isolated peripheral facial nerve palsy complicating R conorii conorii infection.
Asunto(s)
Fiebre Botonosa , Rhipicephalus sanguineus , Rickettsia conorii , Animales , Fiebre Botonosa/complicaciones , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/tratamiento farmacológico , Perros , Nervio Facial , Humanos , Parálisis , Rhipicephalus sanguineus/microbiologíaRESUMEN
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.
Asunto(s)
Fiebre Botonosa , Rickettsia conorii , Choque Séptico , Fiebre Botonosa/complicaciones , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/microbiología , Humanos , Irán , Masculino , Persona de Mediana Edad , Filogenia , Rickettsia conorii/genética , Choque Séptico/diagnósticoRESUMEN
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated acute inflammatory demyelinating disorder, which typically occurs after viral infections or immunisation. We present a case of a man with acute Rickettsia conorii infection whose diagnosis was delayed. He presented with fever, headache, an eschar and an acute paraplegia. The R. conorii IgM serum titre was 1:128. Magnetic resonance imaging showed multifocal lesions in the brain and spinal cord consistent with inflammatory demyelination. The patient responded well to doxycycline and a short course of high-dose corticosteroids. To our knowledge this is the first case of ADEM associated with Mediterranean spotted fever - we found a previous report of ADEM in a child with Rocky Mountain spotted fever, whose diagnosis of rickettsial infection was also delayed. We hypothesise that delayed diagnosis of spotted fever group rickettsial infections could rarely result in ADEM.
Asunto(s)
Fiebre Botonosa/complicaciones , Encefalomielitis Aguda Diseminada/microbiología , Rickettsia conorii , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Fiebre Botonosa/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Doxiciclina/administración & dosificación , Doxiciclina/uso terapéutico , Esquema de Medicación , Quimioterapia Combinada , Encefalomielitis Aguda Diseminada/diagnóstico por imagen , Encefalomielitis Aguda Diseminada/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , NeuroimagenRESUMEN
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.
Asunto(s)
Fiebre Botonosa/diagnóstico , Insuficiencia Renal/complicaciones , Rickettsia conorii/aislamiento & purificación , Vasculitis , Lesión Renal Aguda , Adolescente , Adulto , Anciano , Fiebre Botonosa/complicaciones , Fiebre Botonosa/epidemiología , Creatinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Urea/sangreRESUMEN
The objective of this study is to evaluate the characteristics and outcome of elderly patients with Mediterranean spotted fever (MSF). This study was a prospective observational cohort study of all adult cases with confirmed MSF treated in a teaching hospital (1984-2015) to compare the characteristics of elderly patients (> 65 years) with younger adults. We identified 263 adult patients with MSF, and 53 (20.2%) were elderly. Severe MSF was more frequent in the elderly (26.4% vs. 10.5%; p = 0.002). Gastrointestinal symptoms, impaired consciousness, lung infiltrate, oedema, acute hearing loss, raised alanine transaminase, hyponatremia, and thrombocytopenia occurred more frequently in elderly patients, and arthromyalgia occurred less frequently. Most patients were treated with a single-day doxycycline regimen (two oral doses of 200 mg for 1 day). All patients recovered uneventfully. Fever disappeared 2.55 ± 1.16 days after treatment initiation in elderly patients, and the remaining symptoms disappeared after 3.65 ± 1.42 days. These figures were similar to non-elderly patients. Severe MSF was more frequent in elderly patients. Some clinical manifestations occurred with different frequencies in the elderly compared with younger patients. Single-day doxycycline therapy is an effective and well-tolerated treatment for MSF in elderly patients.
Asunto(s)
Antibacterianos/uso terapéutico , Fiebre Botonosa/complicaciones , Fiebre Botonosa/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Fiebre Botonosa/diagnóstico , Doxiciclina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trombocitopenia , Enfermedades por Picaduras de Garrapatas/microbiología , Resultado del Tratamiento , Adulto JovenAsunto(s)
Fiebre Botonosa/complicaciones , Infecciones Bacterianas del Ojo/complicaciones , Mácula Lútea/patología , Degeneración Retiniana/etiología , Adulto , Atrofia , Fiebre Botonosa/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Degeneración Retiniana/diagnóstico , Tomografía de Coherencia ÓpticaRESUMEN
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.