Incidence, clinical observations and risk factors in the severe form of mediterranean spotted fever among patients admitted to hospital in Marseilles 1983–1984

Raoult, Didier; Zuchelli, P.; Weiller, Pierre‐Jean; Charrel, Claire-Lise; Marco, J. L. San; Gallais, H; Casanova, Paul

doi:10.1016/s0163-4453(86)93508-5

Cited by 111 publications

(56 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite this therapeutic evolution, RMSF lethality remains high (4%) (13), as does MSF lethality in several countries (44). In Japan, it was suggested that the apparent increasing incidence of rickettsiosis during the 1970s was related to a change in empiric antibiotic therapy for unexplained febrile illness (56).…”

Section: Introductionmentioning

confidence: 99%

“…Since spotless fever has been described both in patients with RMSF (33,58) and in patients with MSF (8), rickettsioses may present early as nonspecific febrile illnesses; these illnesses were previously undiagnosed and were cured by empiric antibiotic therapy, but they developed when beta-lactams began to be used. The delay in administration of an effective antibiotic leads to enhanced mortality (44,46,63). The recent therapeutic use of new quinolone compounds and new macrolides that are active against rickettsiosis may be of importance.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antimicrobial therapy of rickettsial diseases

Raoult¹,

Drancourt²

1991

Antimicrob Agents Chemother

137

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antimicrobial therapy of rickettsial diseases

Raoult¹,

Drancourt²

1991

Antimicrob Agents Chemother

137

View full text Add to dashboard Cite

“…However, severe forms of Rocky Mountain spotted fever and MSF have been described (38,44), especially when appropriate antibiotic treatment was delayed. Whereas acute C. burnetii infections respond to antibiotic therapy with tetracyclines, chronic C. burnetii infections are hard to cure, and we have previously demonstrated that the antibiotic compounds used against C. burnetii have no in vitro bactericidal activity (25).…”

mentioning

confidence: 99%

In vitro susceptibilities of spotted fever group rickettsiae and Coxiella burnetti to clarithromycin

Maurin

Raoult

1993

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The in vitro bacteriostatic activity of clarithromycin, a new macrolide derivative, against Rickettsia rickettsii, Rickettsia conorii, and "Rickettsia israeli" was determined by the plaque assay and the dye uptake assay. Both bacteriostatic and bactericidal activities of clarithromycin against the Nine Mile, Q212, Priscilla, and ME9 strains of Coxiella burnetii were evaluated by using three cell culture systems. Clarithromycin showed improved antibacterial activity compared with that of erythromycin. A bacteriostatic activity was obtained at concentrations below the reported maximum concentration of clarithromycin in human serum (about 4 ,ug/ml) for all tested rickettsiae. MICs ranged from 1 to 2 ,ug/ml for the three Rickettsia species and from 1 to 4 ,ug/ml for the C. burnetii strains. No bactericidal activity against C. burnetii was obtained when clarithromycin was used at 4 ,ug/ml.Rickettsia rickettsii is the etiologic agent of Rocky Mountain spotted fever, Rickettsia conorii is the etiologic agent of Mediterranean spotted fever (MSF), and "Rickettsia israeli" is responsible for a spotted fever without "tache noire" in Israel (20,21). Coxiella burnetii is the etiologic agent of Q fever, a widely distributed zoonosis. C. burnetii infections may present as an acute disease, such as hepatitis, pneumonitis, and self-limited febrile illness, or a chronic disease, mainly endocarditis. Bacteria of the genera Rickettsia and Coxiella are obligate intracellular pathogens, the former being located in the cytoplasm (16,42,45) and the latter being located in the phagolysosomes (1, 22) of infected host cells.Tetracyclines remain the antibiotics of choice for the treatment of rickettsial diseases, with chloramphenicol and the fluoroquinolones used as alternative drugs (27,32,33,37,46). However, severe forms of Rocky Mountain spotted fever and MSF have been described (38, 44), especially when appropriate antibiotic treatment was delayed. Whereas acute C. burnetii infections respond to antibiotic therapy with tetracyclines, chronic C. burnetii infections are hard to cure, and we have previously demonstrated that the antibiotic compounds used against C. burnetii have no in vitro bactericidal activity (25). On the other hand, because of potential adverse effects, tetracyclines and fluoroquinolones are not recommended for use during pregnancy and childhood, and chloramphenicol may be responsible for aplastic anemia.Erythromycin is considered not to be a reliable treatment for diseases caused by R conorii (33). Authors have emphasized the susceptibility heterogeneity among different strains of C. burnetii to macrolides, which may explain why erythromycin may be considered effective or not effective in treating Q fever (31a). More recently, in vitro experiments have shown that the macrolides josamycin and roxithromycin are effective against R. conorii and R. rickettshi (13,35 4 ,ug/ml (9, 19) and that it is highly concentrated within eukaryotic cells (2). MATERIALS AND METHODSAntibiotic preparation. Clarithromycin (Abbott Labora...

show abstract

“…Fatalities occur particularly in patients who are elderly or who have other host-dependent risk factors (33,42). Infection with spotted fever group rickettsial organisms elicits protective im- …”

Section: Discussionmentioning

confidence: 99%

Identification of CD8 T-Lymphocyte Epitopes in OmpB ofRickettsia conorii

Díaz-Montero

Valbuena

et al. 2003

Infect Immun

View full text Add to dashboard Cite

Rickettsiae are small (0.3 by 1.0 m), obligately intracellular bacteria that reside in arthropod hosts in at least part of their life cycle. Tick-transmitted Rocky Mountain spotted fever and louse-borne typhus fever are among the most virulent human infections known. All adequately studied Rickettsia species have a quantitatively major, immunodominant S-layer cell wall protein (OmpB), which is encoded as a 168-kDa precursor that undergoes posttranslational protease modification to the mature 135-kDa molecule (18). The spotted fever group rickettsiae differ from typhus group rickettsiae by possessing an additional major, immunodominant surface protein (OmpA) and have antigenic differences from typhus group rickettsiae in the lipopolysaccharides. OmpA contains a large, central, hydrophilic domain of 6 to 15 nearly identical tandem repeat units comprising 72 to 75 amino acids (aa) each.We have developed mouse models that conform better to the target cells (endothelium) and pathology (disseminated vascular injury) of rickettsial diseases than previously available models, and they offer opportunities for major important advances in the study of rickettsial immunity (16,45,46). Previous studies provided evidence that T lymphocytes are critical in the development of immune protection in rickettsial diseases (9,23,26,28,29,43). Recently performed research showed that adoptive transfer of immune CD4 or CD8 T lymphocytes protects mice against lethal disseminated endothelial infection with Rickettsia conorii (15). Depletion of CD8, but not CD4, T lymphocytes converts infection with an ordinarily sublethal dose of R. conorii into an overwhelming fatal rickettsial infection in the majority of animals and a persistent symptomatic infection in the survivors. Thus, the evidence that T lymphocytes, particularly those of the CD8 subset, are crucial effectors of immunity applies broadly within the genus Rickettsia (45). The potential importance of CD4 and CD8 T lymphocytes in human rickettsial infections is emphasized by the presence of large numbers of these cells in eschars of patients with R. conorii infection at the time of immune clearance of the rickettsiae (20).Vaccination with recombinant OmpA has protected guinea pigs against Rickettsia rickettsii and R. conorii, and purified native OmpB has protected vaccinated guinea pigs against Rickettsia typhi (2,11,38,40). Immunization of mice with recombinant Mycobacterium vaccae expressing rompA or rompA and boosted with the homologous proteins (OmpA or OmpA 703-1288 , respectively) stimulated partial protection against lethal challenge with R. conorii (10). The fragments OmpA 703-1288 , OmpA 1644-2213 , OmpB , and OmpB 754-1308 stimulated T-lymphocyte proliferation and secretion of gamma interferon (IFN-␥) after primary immunization with DNA and booster immunization with the homologous recombinant proteins, and 100% of mice were protected against lethal challenge by immunization with the combination of the four fragments (12). Based on these findings, it was hypothesized that...

show abstract

Incidence, clinical observations and risk factors in the severe form of mediterranean spotted fever among patients admitted to hospital in Marseilles 1983–1984

Cited by 111 publications

References 10 publications

Antimicrobial therapy of rickettsial diseases

Antimicrobial therapy of rickettsial diseases

In vitro susceptibilities of spotted fever group rickettsiae and Coxiella burnetti to clarithromycin

Identification of CD8 T-Lymphocyte Epitopes in OmpB ofRickettsia conorii

Contact Info

Product

Resources

About