Gangrene in cases of spotted fever: a report of three cases

Joshi, Harshal Satish; Mathew, Thomas; Warrier, Anup; Kumar, Suresh

doi:10.1136/bcr-2012-007295

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…indica is the agent of Indian tick typhus, a tick-borne rickettsiosis prevalent in India (420,421), with solitary cases reported from Laos (422) and Sri Lanka (423). Clinically, the disease resembles MSF; however, a series of three severe cases complicated by gangrene were reported recently (424). It was isolated in 1950 from R. sanguineus ticks collected in that country, although it has never been isolated in patients there (2).…”

Section: Tick-borne Rickettsiae In Asia Species Identified As Pathogensmentioning

confidence: 99%

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

et al. 2013

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SUMMARY Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia . These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.

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Section: Tick-borne Rickettsiae In Asia Species Identified As Pathogensmentioning

confidence: 99%

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

et al. 2013

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“…Rash appears 5-7 days after onset of symptoms. Rash can be macular, maculopapular, petechial or hemorrhagic [7]. Eschar can be single or multiple or may not be seen in some cases [8].…”

Section: Discussionmentioning

confidence: 99%

“…The classical described tetrad of fever, headache, rash, and a history of tick bite is rarely encountered at this stage of the illness [12]. Hepatic injury manifests as increased aminotransferase levels and occasional jaundice [7]. It is a predictor of mortality and is likely the result of a combination of inflammatory bile ductular obstruction and hemolysis [12].…”

Section: Discussionmentioning

confidence: 99%

Mediterranean Spotted Fever with an Acute Pancreatitis

ELFane¹,

Sodqi²,

Jebbar³

2016

J Antimicrob Agents

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Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii characterized by fever, maculo-papular rash and a black eschar at the site of the tick bite (tache noire). Acute pancreatitis is a rare complication of MSF. We report a 45 year old man admitted with fever, maculopapular rash, and eschar (tache noire). The working diagnosis at admission was MSF. Five day after admission, the patient developed signs of an acute abdomen, amylase and lipase elevation, and ultrasound hypoechoic pancreas. CT scan revealed a stage B pancreatitis. An immunofluorescence antibody test confirmed Rickettsia conorii infection. Diagnosis of MSF was made and treatment with oral doxycycline was started. After five days of therapy, there was completed remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with MSF. Much rarer is pancreatic involvement. Inflammation may play a role in the pathogenesis of pancreatitis. This suggests that pancreas should be explored in MSF patients even in the absence of underlying risk factors.

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“…[8] Recently, there are few published reports of occurrence of gangrene of the extremities in case of ITT, which is an uncommon complication in cases of spotted fever rickettsiosis. [910] Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome such as acute kidney injury, liver dysfunction, delirium, and seizure. [10] Hereby, we present a life-threatening case of ITT presenting with atypical skin manifestations in the form of purpura fulminans (retiform purpura all over the body), bullous eruptions and multiorgan failure.…”

Section: Introductionmentioning

confidence: 99%

“…[910] Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome such as acute kidney injury, liver dysfunction, delirium, and seizure. [10] Hereby, we present a life-threatening case of ITT presenting with atypical skin manifestations in the form of purpura fulminans (retiform purpura all over the body), bullous eruptions and multiorgan failure. The Weil-Felix (W-F) test was very helpful in confirming the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Scrub typhus presenting as Purpura fulminans

Tirumala¹,

Behera²,

Jawalkar³

et al. 2014

Indian Journal of Critical Care Medicine

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Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.

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Gangrene in cases of spotted fever: a report of three cases

Cited by 10 publications

References 10 publications

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

Mediterranean Spotted Fever with an Acute Pancreatitis

Scrub typhus presenting as Purpura fulminans

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