Mediterranean spotted fever (MSF) is endemic in Tunisia. Diagnosis is confirmed retrospectively based on serology. Clinical features are suggestive of diagnosis if the triad (fever, rash, and eschar) is present. Otherwise clinical diagnosis could be difficult. A diagnosis score was already proposed by Raoult et al. The aim of this study was to evaluate this score, considering only clinical parameters, in order to help clinicians in diagnosing MSF before confirmation. We retrospectively analyzed 62 consecutive charts of patients with diagnosis of suspected MSF. Diagnosis confirmation was made by serology (IgG anti-R. conorii exceeding 128 or seroconversion). Epidemiological and clinical features and total score for each patient were reviewed. To validate the clinical score, we calculated sensitivity, specificity and the Youden index for each score in order to establish the ROC curve. SPSS was used for these statistical tests. Area under curve was 0.70 (P = 0.02). The cutoff score with the most predictive value of MSF diagnosis was 18, according to our study (sensitivity 60%, specificity 84,6% and Youden index 0.44). The MSF diagnosis score is a helpful tool to aid the clinician with presumptive management before confirmation. In our study we demonstrated that a score based only on epidemiological and clinical features could be sufficient, but we have to indicate that these results and cutoff score of 18 were from a retrospective study and should be confirmed by a well-designed prospective one.
Le syndrome d'hypersensibilité médicamenteuse ou Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) est une toxidermie rare mais sévère. Nous rapportons trois observations de DRESS syndromes secondaires à la prise de carbamazipine dans deux cas et de salazopyrine dans un cas. Le délai moyen entre la prise médicamenteuse et la survenue du DRESS syndrome était de six semaines. Le médicament incriminé était arrêté d'une façon définitive dans tous les cas. Une corticothérapie par voie générale était instaurée chez tous les patients devant l'atteinte hépatique sévère. L’évolution était favorable avec disparation des lésions cutanées et normalisation du bilan hépatique. Le diagnostic du syndrome DRESS doit être évoqué devant un tableau associant une éruption fébrile et des signes systémiques faisant suite à une prise médicamenteuse. La précocité du diagnostic est fondamentale pour l'arrêt définitif des médicaments suspects. Le traitement n'est pas bien codifié mais repose actuellement sur la corticothérapie générale.
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