The Presence of Eschars, but Not Greater Severity, in Portuguese Patients Infected with Israeli Spotted Fever

Abstract

In Portugal, Mediterranean spotted fever (MSF) is caused by R. conorii Malish and Israeli spotted fever (ISF) strains. It has been suggested that the ISF strain isolated from patients with MSF causes different clinical manifestations compared to those caused by Malish strain, namely the absence of eschar and greater severity. The aim of this study was to analyze the presence or absence of eschar and of fatality in Portuguese patients infected with either Malish or ISF strain. Of 94 patients with a clinical diagnosis of MSF between 1994 to 2004, 47 were infected with Malish strain and 47 with ISF strain. Eschars were reported in 20 patients (49%) infected with Malish strain, and in 17 (39%) with ISF strain. The presence of eschar is not statistically associated to a greater extent with either R. conorii strain (P=0.346). A total of 22 patients died, 9 infected with Malish strain and 13 infected with ISF strain, and no statistically significant difference was found (P=0.330). This study showed that the concepts of absence of the eschar and greater severity in Israeli spotted fever infection should be revised.

Role of the Lizard Teira dugesii as a Potential Host for Ixodes ricinus Tick-Borne Pathogens

“…DNA samples were analyzed by PCR for Rickettsia, Borrelia, and A. phagocytophilum using specific primer pairs targeting two genes for each agent, as previously described (2,4,9,16,19). Additionally, 60 DNA samples extracted from lizard blood prints were tested for A. phagocytophilum.…”

Fatal Case of Israeli Spotted Fever after Mediterranean Cruise

“…Therefore, like MSF, cases of ISF will likely be sporadic (4,5). ISF was fi rst reported in Israel (1) and was also recently described in Portugal and Italy (6)(7)(8). The clinical manifestations of ISF are similar to those of other spotted fever group infections, but an inoculation eschar is rarely observed and a history of tick exposure is not always present (4-6,9).…”

European Network for Neglected Vectors and Vector-Borne Infections COST Action Guidelines: What Is This About and What Is This For?

“…from culture, arthropods, or eschar biopsies. However, the use of nested PCR technique for human specimens such as blood, buffy coat, or plasma with a low level of rickettsiemia is advisable to increase the analytical sensitivity (Fournier and Raoult 2004, Choi et al 2005, De Sousa et al 2005, Santibáñez et al 2013 (Table 4). A comparative study on PCR detection for Rickettsia in different human and animal samples showed that nested PCR sensitivity depends not only on the type of the sample but also on the target gene (Santibáñez et al 2013).…”