Mediterranean spotted fever and encephalitis: a case report and review of the literature

Duque, Vítor; Ventura, Conceição; Seixas, Daniela; Barai, Arnaldo; Mendonça, Nuno; Martins, Joana; Cunha, Saraiva da; Meliço-Silvestre, A.

doi:10.1007/s10156-011-0295-1

Cited by 22 publications

(25 citation statements)

References 12 publications

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“…Clinical improvement occurred within 48 hours of treatment initiation, and patients usually recovered within 5-7 days without sequelae. Cases complicated by sepsis, shock, and multiple organ failure are rare [2,4,8,11,[21][22][23][24], but they can occur. In the early stages, the diagnosis is clinically based, and if clinical suspicion of rickettsiosis arises, patients should start appropriate therapy without delay to prevent poor outcomes [11].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan

Nafi

Tarawnah

2017

J Infect Dev Ctries

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Introduction: The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan. Methodology: A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected. Results: In total, 35 male and 20 female patients (mean age: 6 years ± 3.6) were included. The incidence of MSF was 7.9 cases/100,000 inhabitants/year; MSF affected 89% of individuals in the summer, 74.5% of those living in a rural area with tent housing, and 100% of those who had contact with animals. All cases presented with fever, and 94.5% had a skin rash. Serological tests were positive in 87.2% of cases, and Rickettsia conorii (the Moroccan strain) was present in all positive cases. All cases had thrombocytopenia, but none had leukocytosis. Hyponatremia was present in 71% of cases, and 49%, 61.8%, and 72.7% had increased urea, alanine transaminase, and aspartate aminotransferase levels, respectively. Doxycycline was administered to all patients, with a cure rate of 96.4% and mortality rate of 3.6%. Conclusions: MSF caused by R. conorii (the Moroccan strain) is prevalent in Jordan, and contact with animals is the route of transmission. The patients' responses to doxycycline were excellent. A high index of suspicion, early diagnosis, and specific treatment considerably decrease mortality. MSF should be considered as a possible cause of febrile disease in those with a rash and in those living in rural areas.

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Section: Discussionmentioning

confidence: 99%

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan

Nafi

Tarawnah

2017

J Infect Dev Ctries

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“…In Portugal, there are two strains of the Rickettsia conorii complex, the Malish and the Israeli tick typhus strain (Sousa et al 2003, 2008). The main vector of the disease is Rhipicephalus sanguineus , the brown dog tick (Rovery et al 2008; Rovery and Raoult 2008; Oliveira and Côrte-Real 1999; Figueira-Coelho et al 2010; Duque et al 2012). The tick itself may acts as a reservoir for Rickettsia, as these bacteria can be maintained in ticks through transtadial and transovarial transmission (Rovery et al 2008; Sousa et al 2003; Duque et al 2012; Sociedade Portuguesa de Pediatria 2005; Parola et al 2013; Brouqui et al 2004).…”

Section: Introductionmentioning

confidence: 99%

“…The main vector of the disease is Rhipicephalus sanguineus , the brown dog tick (Rovery et al 2008; Rovery and Raoult 2008; Oliveira and Côrte-Real 1999; Figueira-Coelho et al 2010; Duque et al 2012). The tick itself may acts as a reservoir for Rickettsia, as these bacteria can be maintained in ticks through transtadial and transovarial transmission (Rovery et al 2008; Sousa et al 2003; Duque et al 2012; Sociedade Portuguesa de Pediatria 2005; Parola et al 2013; Brouqui et al 2004). Other reservoirs are thought to be dogs, rabbits and some small rodents (Rovery et al 2008; Rovery and Raoult 2008; Sociedade Portuguesa de Pediatria 2005), but there is no consensus in this point.…”

Section: Introductionmentioning

confidence: 99%

Mediterranean spotted fever: case series of 24 years (1989–2012)

et al. 2015

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PurposeMediterranean spotted fever (MSF) is the most prevalent zoonosis in Portugal. To characterize it’s evolution between 1989 and 2012, the authors reviewed the cases diagnosed at their unit during this period.MethodsReview of clinical records of patients with MSF diagnosis, between 1989 and 2012.ResultsData from 250 patients was included, 54% male. Mean age at diagnosis was 58 years (11–92). Mean annual incidence was 10 cases, with clear summer predominance. Most patients, 78% lived in rural areas, 34% had contact with dogs and 10% noticed the tick bite. Most common symptoms were: fever (98%), myo-arthralgia (64%) and headache (48%). Maculopapular rash was noticed in 87%, affecting palms in 77% and soles in 69%. Inoculation eschar was found in 60%, mostly located on the trunk. Treatment included doxycycline in 86% and chloramphenicol in 12%, with a mean duration of 8 days. Most frequent blood test abnormalities were C-reactive protein, lactate dehydrogenase, aspartate aminotransferase and alanine transaminase elevations and thrombocytopenia. First serologic evaluation was positive in 37% (78/212), having seroconversion been documented in 85% (72/85). Most frequent complication was acute renal injury. ICU admission occurred in 5%. Average length of hospital stay was 11.2 days (1–106), with a mortality of 3.6%.ConclusionsIn our series, there was clear summer predominance of MSF, which had rural origin in 78%. Most common symptoms were fever, myo-arthralgia and headache. Maculopapular rash was noticed in 87% of cases and inoculation eschar in 60%. Most cases had favourable outcome, having 5% been admitted to ICU. Mortality was 3.6%.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1042-3) contains supplementary material, which is available to authorized users.

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“…23 Multiple organ failure as onset of Mediterranean spotted fever days after symptoms' onset. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Other techniques, as isolation of bacteria and/or molecular polymerase chain reaction (PCR) to genome identification, which can be performed on blood, skin biopsies and ticks, are not routinely used because of their complexity and costs. Therefore, in clinical practice, they are reserved only in cases of extremely high clinical suspicion with all the other tests proving negative.…”

Section: Methods Of Researchmentioning

confidence: 99%

Multiple organ failure as onset of Mediterranean spotted fever: a review based on a case

et al. 2016

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Mediterranean spotted fever (MSF) is an infectious disease endemic in the southern regions of Italy, with an incidence of about 400 cases/year. The bacteria responsible of the disease is Rickettsia conorii, transmitted to humans by Rhipicephalus sanguineus, the common dog tick. The infection usually manifests with a characteristic symptomatologic triad: fever, exanthema and the so called tache noire, which is the typical eschar at the site of the tick bite. Immunoglobulin M (IgM) and IgG enzymelinked immunosorbent assay and the gold standard micro-immunofluorescent assay, allow serological diagnosis. We report the case of a man suffering from MSF, whose atypical presentation and false-negative diagnostic tests delayed consistently diagnosis and therapy. Afterwards we review the literature about this topic. Contributions: PM and AS studied the case, reviewed literature and wrote the paper; AB, TC and GP studied the case; AD'A and CC studied the case and reviewed literature; AC coordinated the study group, reviewed literature and wrote the paper.Conflict of interest: the authors declare no potential conflict of interest.

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Mediterranean spotted fever and encephalitis: a case report and review of the literature

Cited by 22 publications

References 12 publications

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan

Mediterranean spotted fever: case series of 24 years (1989–2012)

Multiple organ failure as onset of Mediterranean spotted fever: a review based on a case

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