[Clinical characteristics and therapeutic perspectives of boutonneuse fever. Assessment of a caseload of 39 patients]. / Aspetti clinici e prospettive terapeutiche della febbre bottonosa. Valutazione di una casistica di 39 pazienti.

ABSTRACT

Rickettsia conorii is the etiologic agent of Boutonneuse fever, a rickettsiosis of the spotted fever group that is endemic in Southern Italy. Chloramphenicol or tetracyclines are still the treatment of choice for this disease, and recently quinolones have also been utilized with success. In 1994-95, 39 otherwise healthy patients were admitted to our unit for Boutonneuse fever. They were treated, in random order, with quinolones (10 subjects received ciprofloxacin, 500 mg/12 h per os; 8 subjects received intravenous pefloxacin, 200 mg/12 h), or tetracyclines (21 subjects received intravenous rolitetracycline, 275 mg/12 h). Outcome was favorable in all cases and no significant complications were observed. However, in a significant number of cases, increased blood concentrations of glutamic-oxalacetic (68.4%) and glutamic-pyruvic (60.5%) transaminases were found. Above normal blood creatinine values were observed in 29.7% of the cases, and urinanalysis disclosed blood in 35.9% and proteins in 56.4% of the cases. Both tetracyclines and quinolones were well tolerated and effective, with apyrexia achieved after 2.7 +/- 0.1 days (mean +/- SEM). All patients were discharged after an average of 7.1 +/- 0.4 days. Liver and kidney function derangements seem to occur to some extent in the acute phase of Boutonneuse fever. This finding might partially explain the increased mortality rate reported for subjects with simultaneous systemic or organ diseases or when the administration of an effective antibiotic is delayed. Together with chloramphenicol and tetracyclines, quinolones might be considered as first line antibiotics.