Fiebre y erupción en 2 vecinos / Fever and eruption in 2 neighbors

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Espectro de las enfermedades transmitidas por garrapatas / Spectrum of thick-borne diseases

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Rickettsiosis, un caso de TIBOLA / Rickettsia, a case of TIBOLA

Las rickettsiosis están cobrando especial protagonismo a raíz de nuevas especies descritas en los últimos años. La más frecuente en nuestro medio es la infección por Rickettsia conorii, que produce la fiebre botonosa mediterránea. Recientemente se incluye con más frecuencia en el diagnóstico diferencial la denominada TIBOLA (tick-borne lymphadenopathy) o DEBONEL (dermacentor-borne necrosis eritema lymphadenopathy), cuya primera confirmación serológica data de 1997 en Francia y que es transmitida por la garrapata Dermacentor marginatus, producida por R. slovaca, entre otras, y con similares características clínicas a las de la fiebre botonosa mediterránea. Se presenta el caso de una niña de ocho años de edad que acude al Servicio de Urgencias con la presencia de fiebre y una lesión costrosa, de aspecto necrótico, en el cuero cabelludo, así como adenopatías de localización cérvico-occipital y retroauricular, refiriendo la picadura de una garrapata hace 15 días. El diagnóstico se confirma mediante la presentación clínica y serologías cruzadas con Rickettsia conorii. Tras pauta de eritromicina a dosis de 40 mg/kg/día durante ocho días se evidencia la desaparición progresiva de las lesiones a lo largo de un mes (AU)

Rickettsia are gaining special importance following new species discovered in recent years. The most common in our environment is Rickettsia conorii infection, which produces the so-called Mediterranean fever boutonneuse. Recently are included more often in the differential diagnosis the called TIBOLA (tick-borne lymphadenopathy) or also known as DEBONEL (dermacentor-borne necrosis lymphadenopathy erythema), whose first serologic confirmation dates back to 1997 in France and is transmitted by the tick Dermacentor marginatus, produced by R. slovaca among others and has similar clinical features as the Mediterranean spotted fever. The case of an 8 year-old who came to the Emergency Services with the presence of fever and scabby lesion, necrotic scalp and cervical lymphadenopathy of occipital and retroauricular location is presented, referring tick bite 15 days ago. The diagnosis is confirmed by clinical and serological tests Rickettsia conorii cross-presentation. After erythromycin dose regimen of 40 mg/kg/day for 8 days, progressive disappearance of lesions was evident after a month (AU)

Rickettsial infection caused by accidental conjunctival inoculation.

The most common transmission route of tick-borne Rickettsia is through tick bite; nevertheless, other transmission routes should also be considered. We report a case of rickettsial infection in a 15-year-old boy caused by accidental contamination of the conjunctiva through the infected fluid of a crushed engorged tick removed from a dog. Right eye pain, conjunctival hyperaemia with mucopurulent exudate, chemosis and eyelid oedema were the first signs and symptoms. Two days later, the boy developed fever, myalgia, headache, abdominal pain and was vomiting; physical examination showed multiple cervical adenopathies but no rash. He was treated with doxycycline (200 mg/day) for 7 days with progressive resolution of clinical signs. Rickettsial infection was confirmed by immunofluorescence assay with serological seroconversion in two consecutive samples. Rickettsia conorii or Rickettsia massiliae were the possible causal agents since they are the Rickettsia spp found in the Rhipicephalus sanguineus dog tick in Portugal.

[A 2-month-old baby with Mediterranean spotted fever]. / Une fièvre boutonneuse méditerranéenne chez un nourrisson de 2 mois.

INTRODUCTION: Mediterranean spotted fever is an endemic rickettsiosis in southern France. We report here the case of a 2-month-old baby who developed rickettsiosis after a tick bite. CLINICAL FACT: A 2-month-old baby was hospitalized in the pediatric ward for fever with maculopapular rash extending to the palms and plantar surfaces and an eschar after a tick bite. Rickettsiosis serology examined after 48 h of fever was negative, but Rickettsia (spotted group) PCR taken from the lesion at the bite site was positive. A 1-week treatment with clarithromycin was started. Fever and rash disappeared 3 days after treatment initiation. DISCUSSION: Mediterranean spotted fever is endemic in southern France. It is, therefore, important to consider this diagnosis and search for tick bite signs or an eschar when a patient presents with fever and maculopapular rash. The treatment of choice consists in doxycycline or macrolides. CONCLUSION: Around the Mediterranean sea in particular, Mediterranean spotted fever should be considered as a possible cause of febrile disease with rash, to allow for a specific antibiotic treatment as fast as possible and to avoid dangerous complications, even though few cases have been reported below the age of 3 months.

¿Dónde está la garrapata? Crucero & casa (resuelto en Atención Primaria) / Where is the tick? Cruise & home (resolved in primary health care)

Trabajar en Atención Primaria supone pensar en las patologías más frecuentes que se dan en nuestro entorno. Un paciente joven que presenta úlceras genitales nos hace pensar en una infección de transmisión sexual. Sin embargo, la falta de respuesta al tratamiento empírico correcto y los resultados de la serología muestran el diagnóstico definitivo: fiebre botonosa mediterránea, con una localización poco común. Debemos recordar que una enfermedad común en nuestro medio puede parecerse a otra igualmente común, por lo que una correcta historia clínica será fundamental para distinguirlas (AU)

Working in primary health care means thinking about the most common pathologies which we encounter in our workplace. A young patient with genital ulcers makes us think of a sexually transmitted infection. However, the lack of response to the correct empirical treatment and serology results show a definitive diagnosis: Mediterranean spotted fever (also known as boutonneuse fever), with a rare location. It should be remembered that a commonly occurring disease in our environment may resemble another equally common one, thus a correct clinical history is fundamental in order to distinguish them (AU)

[Meningoencephalitis caused by Rickettsia conorii in a young infant]. / Méningoencéphalite àRickettsia conorii chez un nourrisson.

INTRODUCTION: Mediterranean spotted fever is an infectious disease due to Rickettsia conori, endemic in the Mediterranean basin. It is usually considered to be a benign disease; however, severe systemic manifestations have been reported in which neurological involvement occurs. These complications are rare in children. CASE REPORT: We report a case of a 14-month-old boy, who was hospitalized for meningoencephalitis after seven days of high fever and maculopapular rash. On clinical observation there were generalized maculopapular elements and an inoculation eschar tache noire at the right ear. The diagnosis of Mediterranean spotted fever was established by epidemiological and clinical features and was confirmed by elevated IgM antibody titres against R. conorii by indirect immunofluorescence assay. Despite treatment with macrolides and corticosteroids, severe neurological sequelae have remained including decreased vision and epileptic seizures. CONCLUSION: The physiopathology of Mediterranean spotted fever includes diffuse vasculitis with endothelial injury. Early diagnosis and specific antibiotic treatment may reduce the risk of complications.

Síndrome de distrés respiratorio agudo secundario a fiebre botonosa mediterránea maligna / Acute respiratory distress syndrome secondary to malignant Mediterranean botonous fever

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Mordedura por garrapata: transmisión de enfermedades, prevención y abordaje / Tick bite: disease transmission, prevention and approach

Los aficionados a la naturaleza como aquellos que tienen el campo como medio habitual de trabajo, se exponen al riesgo de ser infectados por una garrapata, que puede actuar como vehículo transmisor al hombre de diversas zoonosis. En España se registra un aumento de incidencia de estas enfermedades debido al cambio de las condiciones climáticas y al aumento de la población de animales de compañía.En este artículo se revisan la etiología y las manifestaciones de cuatro enfermedades transmitidas por picadura de garrapata con incidencia en nuestra área geográfica: fiebre botonosa o exantemática mediterránea, borreliosis de Lyme, fiebre Q y tularemia.Asimismo, se describen las medidas de prevención y la actuación una vez que se ha producido la picadura y se resalta la importancia de la educación sanitaria de la población sobre este problema de salud

Outdoor lovers who spend most of their time in nature are at risk of being infected by tick-borne zoonosis. An increased incidence of these di seases has been recorded in Spain due to climatic changes and an increasein pet population.This article revises the aetiology and symptoms of four tick-borne di - seases that are transmitted to humans through bites with incidence in our geographic area: mediterranean spotted fever, Lyme disease (borreliosis),Q fever and tularemia.Additionally, prevention measures and steps to take once the bite has occurred are also described and the importance of the population’s health education on this issue is highlighted (AU)

[Mediterranean spotted fever due to contact with dog-tick]. / Köpek kenesi ile temas sonrasinda gelisen akdeniz benekli atesi.

Mediterranean spotted fever (MSF) is one of the tick-borne rickettsial infections caused by Rickettsia conorii. It is transmitted to humans by brown dog ticks (Rhipicephalus sanguineus). In this case report, a 16-years-old male patient who was diagnosed as MSF after an exposure to dog-tick in Bartin province (located at middle Black Sea region of Turkey) has been presented. His history revealed that, five days before admission to the hospital (on June, 2007) he had cleaned dog-ticks from his dog, and after 12 hours he found a stucked tick on his leg and he took it out right away with a tweezer. High fever, headache and generalized maculopapular rash including soles and palms and a black-colored lesion at the tick bite site developed three days later. In clinical examination, there was a black escar circled with a red-purple colored halo in front of the right tibia at the site of the tick bite showing high similarity to "tache noire" which was specific to MSF. Indirect immunofluorescence assay (IFA) for Rickettsia yielded negative result in the serum sample collected on admission day, however, it was found positive at 1/512 titer in the serum sample collected 10 days after admission. The patient has recovered completely without any complication after 10 days of doxycycline therapy. The aim of this presentation is to point out that MSF should be considered for the differential diagnosis of a patient with a history of tick bite, fever, maculopapular rash, headache, myalgia, arthralgia and especially with black escar during summer months in our country where the incidence of tick-borne infections has been increasing since recent years.

Rickettsia conorii in humans and dogs: a seroepidemiologic survey of two rural villages in Israel.

The prevalence of IgG-antibodies reactive with an Israeli strain of Rickettsia conorii (Israeli strain 487), the agent of Israeli spotted fever, was examined in humans and dogs from two rural villages in Israel where the disease has been reported in humans. Sixty-nine of 85 (81%) canine sera and 14 of 136 (10%) of human sera had anti-R. conorii antibodies. No direct association could be made between seropositivity of people and ownership of a seropositive dog. This study indicates that exposure to spotted fever group rickettsiae was highly prevalent among dogs compared with humans in the two villages examined, probably reflecting a greater exposure rate of canines to the tick vector. These results support a previous suggestion that canine serology could be a sensitive indicator for the presence and magnitude of human exposure to R. conorii.

First detection of spotted fever group rickettsiae in Ixodes ricinus from Italy.

Ixodes ricinus from Italy were examined for the first time to detect whether rickettsiae were present. Using molecular methods, we detected three different spotted fever group rickettsiae, including Rickettsia helvetica. Our results raise the possibility that bacteria other than R. conorii are involved in rickettsial diseases in Italy.

Fiebre maculosa de las Montañas Rocosas

Las rickettsiosis son un grupo de enfermedades producidas por bacterias pleomorfas que se comportan como parásitos intracelulares. Aunque estas enfermedades son raras en nuestro medio, la proliferación de viajes internacionales a zonas endémicas suponen un riesgo de aparición en nuestro país1. Las características generales de estas enfermedades, así como las rickettsiosis más importantes transmitidas por piojos, pulgas y ácaros, han sido descritas en un trabajo anterior. En esta revisión se exponen las características más importantes, en especial aspectos epidemiológicos y clínicos, tanto en adultos como en niños, de las rickettsiosis más frecuentes transmitidas por garrapatas, como son la fiebre de las Montañas Rocosas, la fiebre botonosa mediterránea, la fiebre Q y la ehrlichiosis (AU)

[Spotted fever group rickettsial disease in Argentinean travelers]. / Rickettsioses do grupo das febres maculosas em viajantes argentinos.

During 1996, four patients that returned from South Africa suffering from rickettsiosis were attended at the Traveler's Medicine practice of our hospital. All of them presented fever, headache and cutaneous scar. One of these presented maculopapular rash, while the rest developed a vesicular rash. The Weil-Felix reaction was negative and the immunofluorescence test for Rickettsia conorii was positive in all cases. None of the patients remembered having been bitten by any insects, however all of them had been staying in or going through a wild environment. All the patients were treated with doxycycline and presented a good outcome.

Interleukin-12 in human boutonneuse fever caused by Rickettsia conorii.

Interleukin (IL)-12 contributes to the resistance against a number of intracellular pathogens. We examined the potential biological role of IL-12 by studying peripheral blood mononuclear cells (PBMC), its production and its effect on cytokine synthesis in 20 Sicilian patients with boutonneuse fever (BF) caused by Rickettsia conorii. Data indicate that PBMC from acute BF patients were able to produce IL-12 in response to in vitro stimulation with rickettsial antigen (Ag): this production was higher than that detected in healed patients. Monocytes were the main source of IL-12 by PBMC from BF patients. IL-12 secretion by in vitro Ag-stimulated PBMC from BF patients was potentiated by recombinant interferon gamma (IFN-gamma) or anti-IL-10 monoclonal antibodies (MoAbs). Furthermore, the treatment with anti-IL-12 MoAbs reduced the IFN-gamma synthesis. These results indicate that treatment of PBMC from acute BF patients with IL-12 shifted the response toward a Th1-type cytokine response. Furthermore, IL-12 and IFN-gamma are interdependent and they may be associated with the immunity against rickettsias.