Malignant forms of Mediterranean spotted fever: risk factors for fatal outcomes

Baltadzhiev, Ivan; Popivanova, N; Zaprianov, Z

doi:10.1016/j.bjid.2016.06.002

Cited by 12 publications

(8 citation statements)

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“…Because all deceased patients had a malignant form of the disease, damage to many essential organs and systems was the leading cause of death in the rickettsial infection. In fact, de Souza et al [20] identified ARF as an independent predictor associated with a fatal outcome from MSF, and a recent report by us [11] is consistent with this suggestion. Interstitial nephritis cannot be conclusively demonstrated to contribute to ARF [16].…”

Section: Discussionsupporting

confidence: 79%

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data

2021

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Background: 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 non-endemic countries and regions. Objective: 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: 350 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 two 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% and 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 more than two times less in survivors. The postmortem performed 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.

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Section: Discussionsupporting

confidence: 79%

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data

2021

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“…It should be noted that children did not undergo the fatal complications seen in the adults. In previous publications we have described MSF adult patients with various organ systems damages and severe complications as acute respiratory distress syndrome, gastrointestinal bleeding, haemorrhagic-necrotic pancreatitis, myocarditis, and acute renal failure (16,17). Similar complications were especially seen in the elderly and not observed in the present child contingent.…”

Section: Discussionsupporting

confidence: 61%

Mediterranean spotted fever in child and adult patients: investigation from an endemic region in Bulgaria

Baltadzhiev

Kevorkyan

Popivanova

2020

Cent Eur J Public Health

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Objectives: Mediterranean spotted fever (MSF) is a tick-borne endemic disease caused by Rickettsia conorii conorii and transmitted to humans by the brown dog tick Rhipicephalus sanguineus. It is characterized by fever, maculopapular rash and a tick bite skin lesion "tache noire". The disease affects all age groups and usually has mild to moderate course. It has long been considered a benign infection. However, very severe "malignant" forms with fatal outcome strongly influenced by the patients' age were also observed. We aimed to reveal the features of MSF in children by comparing them with some of the disease patterns in adults.Methods: Our prospective study data are based on the monitoring of all inpatients of the Clinic of Infectious Diseases in Plovdiv City and environs, the largest MSF endemic region in Bulgaria. The total number of patients admitted and treated for MSF over a study period of 10 years is 549, the incidence reaching 9.44/100,000. MSF is confirmed by antibody response to a specific antigen measured by indirect immunofluorescence assay (IFA). IgG ≥ 128 and/or IgM > 64 were considered to be indicative of acute infection.Results: Eighty-five (15.48%) patients were children up to 14 years of age and 464 (84.52%) were aged 15-85 years. The skin lesion "tache noire" was present in 73.68% of children, and in 76.93% of the older age groups; symptoms as anorexia, nausea, vomiting, abdominal pain, and diarrhoea were more frequent in children, till general weakness and malaise was prevalent in adults. Children accounted approximately for 70% of the disease mild forms. No lethality was registered in this age group. Even though there were isolated cases of severe and malignant forms, children did not undergo the fatal complications seen in adults.Conclusion: Knowledge of the peculiarities of MSF in children will contribute to children's health protection, timely diagnose and disease prevention.

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“…The main clinical signs and symptoms of MSF are: a skin eschar (tache noire) at the site of tick bite, fever and flu-like manifestations as headache, adynamia, anorexia, myalgia, etc., emerging 3-5 days before appearing of maculopapular rash involving the trunk and extremities, non-sparing the hands and feet. MSF has long been considered a benign disease, however "malignant" forms including severe complications with lethal outcome have been observed [2,3].…”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic-Necrotizing Pancreatitis – An Unusual Complication of Mediterranean Spotted Fever

Baltadzhiev¹,

Popivanova²,

Zaprianov³

2017

IOSR JDMS

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Malignant forms of Mediterranean spotted fever: risk factors for fatal outcomes

Cited by 12 publications

References 4 publications

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data

Mediterranean spotted fever in child and adult patients: investigation from an endemic region in Bulgaria

Hemorrhagic-Necrotizing Pancreatitis – An Unusual Complication of Mediterranean Spotted Fever

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