Rocky Mountain spotted fever and jaundice. Two consecutive cases acquired in Florida and a review of the literature on this complication

Ramphal, Reuben

doi:10.1001/archinte.138.2.260

Cited by 12 publications

(5 citation statements)

References 13 publications

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“…Other features that distinguish R. parkeri rickettsiosis from RMSF include the occurrence of an eschar (identified in 190% of the patients in this series), a vesicular or pustular rash (observed in ∼40% of the patients in this series), and the relative absence of nausea, vomiting, and diarrhea. By comparison, patients with classic RMSF rarely have eschars; there is seldom, if ever, documented vesicular or pustular exanthems; and gastrointestinal manifestations occur in 160% of patients [1,[14][15][16][17][21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Rickettsia parkeriRickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever

et al. 2008

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Closer attention to the distinct clinical features of the various spotted fever syndromes that exist in the United States and other countries of the Western hemisphere, coupled with more frequent use of specific confirmatory assays, may unveil several unique diseases that have been identified collectively as Rocky Mountain spotted fever during the past century. Accurate assessments of these distinct infections will ultimately provide a more valid description of the currently recognized distribution, incidence, and case-fatality rate of Rocky Mountain spotted fever.

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Section: Discussionmentioning

confidence: 99%

Rickettsia parkeriRickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever

et al. 2008

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“…Commonly, the spotted fever rickettsial infection has a typical picture of cutaneous manifestations with arthritis frequently involving ankle joints [5,6]. Delay in diagnosis could cause fatal multiple organ dysfunction involving liver [7,8]. It is not uncommon to see atypical presentations where typical rash-making dilemmas in diagnosis [5].…”

Section: Discussionmentioning

confidence: 99%

“…Among these presentations, acute hepatitis or liver dysfunction as the primary clinical problem has occurred even though unreported. According to the international literature, both Rocky mounted spotted fever and Mediterranean spotted fever has caused liver dysfunction [7,8]. Spotted fever is a group of infections caused by many species of rickettsial agents distributed widely in the world [1,2].…”

Section: Discussionmentioning

confidence: 99%

Spotted Fever Rickettsial Infection in Pregnancy Causing Acute Hepatitis, Fatal Postpartum Hemorrhage and Possible Vertical Transmission

Ratnayake

Wanasinghe

Dissanayake

et al. 2021

AJRID

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We present a rare case of a 31-year-old pregnant mother in 37 weeks of gestation who presented with a 3-day history of vomiting, epigastric pain, and icterus, subsequently diagnosed as a rickettsial disease in pregnancy (with positive IgG titer for SFG) complicated with hepatitis, coagulopathy, pulmonary hemorrhage, and post-partum hemorrhage, who expired despite intensive care management. The newborn baby also had high IgG titer for SFG suggesting a vertical transmission of the disease and recovered following treatment with chloramphenicol. The SFG rickettsial infection can cause diverse clinical manifestations in pregnancy including acute hepatitis and coagulopathy. Therefore, the possibility of SFG rickettsial infection needs to be considered in diagnostic workup in obscure clinical presentations. We postulate possible vertical transmission of SFG to newborns which needs further confirmation.

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“…Rickettsiae may infect the liver sinusoidal endothelial cells but not hepatocytes, leading to mild focal hepatitis and periportal inflammation ( 17 ). In patients with “Rocky Mountain spotted fever” rickettsial infection, jaundice is a predictor of mortality and is likely the result of a combination of inflammatory bile ductular obstruction and hemolysis ( 18 , 19 ). Little has also been reported on the relationship between the elevation of values on liver function tests and DIC in rickettsial infection, including JSF.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Disseminated Intravascular Coagulation by Liver Function Tests in Patients with Japanese Spotted Fever

et al. 2018

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Objective Cases of Japanese spotted fever (JSF) are sometimes complicated by disseminated intravascular coagulation (DIC) with an abnormal liver function, resulting in unfavorable outcomes. The aim of the present study was to clarify the correlation between liver function test results and DIC scores. Methods Twenty patients diagnosed with JSF between April 2010 and April 2014 were enrolled. Age, gender, disturbance of consciousness, body temperature, pulse rate, presence of diffuse erythema, eschar and swelling of lymph nodes, laboratory test results at the time of initial presentation such as blood cell count, C-reactive protein, liver function, renal function and blood coagulation and fibrinolysis, maximum Japanese Association for Acute Medicine (JAAM) DIC score during the course of JSF, treatment and the prognosis were retrospectively reviewed. Results The median age of the patients (8 men, 12 women) was 68.3 years. There were significant differences in the alkaline phosphatase (ALP) and rothrombin time international normalized ratio (PT-INR) between the DIC and non-DIC groups using Mann-Whitney's U test. A multiple logistic regression analysis showed that the ALP and blood urea nitrogen (BUN) levels at the time of initial presentation were independent predictors of the occurrence of DIC. Conclusion We should pay special attention to JSF patients showing high levels of ALP at the initial presentation, since such patients may have a higher likelihood of developing DIC over the course of JSF and unfavorable outcomes than those with lower levels.

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Rocky Mountain spotted fever and jaundice. Two consecutive cases acquired in Florida and a review of the literature on this complication

Cited by 12 publications

References 13 publications

Rickettsia parkeriRickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever

Rickettsia parkeriRickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever

Spotted Fever Rickettsial Infection in Pregnancy Causing Acute Hepatitis, Fatal Postpartum Hemorrhage and Possible Vertical Transmission

Prediction of Disseminated Intravascular Coagulation by Liver Function Tests in Patients with Japanese Spotted Fever

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