Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel

Cohen, Regev; Babushkin, Frida; Shapiro, Marc A.; Uda, Martina; Atiya-Nasagi, Yafit; Klein, Dar; Finn, Talya

doi:10.3201/eid2405.171992

Cited by 16 publications

(28 citation statements)

References 23 publications

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“…Bacillus anthracis 103 Lethal toxin and edema toxin Unknown Israeli spotted fever (Rickettsia conorii subspecies israelensis) 104 Unknown but this sub-species carries a high mortality rate…”

Section: Unknownmentioning

confidence: 99%

“…(see Table 3). [91][92][93][94][95][96][97][98][99][100][101][102][103][104] Like most disciplines in scientific inquiry, attempts at understanding the basic nature of human host response to infection have had its share of miscues, false leads, failed hypotheses, and tragic mistakes. 105,106 The pace of discovery is quickening as technologic advances in molecular biology keep churning out new challenges to established ideas and longstanding hypotheses.…”

Section: Unknownmentioning

confidence: 99%

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Whatever happened to the Shwartzman phenomenon?

Chahin

Opal

2018

Innate Immun

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Ninety years ago, Gregory Shwartzman first reported an unusual discovery following the intradermal injection of sterile culture filtrates from principally Gram-negative strains from bacteria into normal rabbits. If this priming dose was followed in 24 h by a second intravenous challenge (the provocative dose) from same culture filtrate, dermal necrosis at the first injection site would regularly occur. This peculiar, but highly reproducible, event fascinated the microbiologists, hematologists, and immunologists of the time, who set out to determine the mechanisms that underlie the pathogenesis of this reaction. The speed of this reaction seemed to rule out an adaptive, humoral, immune response as its cause. Histopathologic material from within the necrotic center revealed fibrinoid, thrombo-hemorrhagic necrosis within small arterioles and capillaries in the micro-circulation. These pathologic features bore a striking resemblance to a more generalized coagulopathic phenomenon following two repeated endotoxin injections described 4 yr earlier by Sanarelli. This reaction came to be known as the generalized Shwartzman phenomenon, while the dermal reaction was named the localized or dermal Shwartzman reaction. A third category was later added, called the single organ or mono-visceral form of the Shwartzman phenomenon. The occasional occurrence of typical pathological features of the generalized Shwartzman reaction limited to a single organ is notable in many well-known clinical events (e.g., hyper-acute kidney transplant rejection, fulminant hepatic necrosis, or adrenal apoplexy in Waterhouse-Fredrickson syndrome). We will briefly review the history and the significant insights gained from understanding this phenomenon regarding the circuitry and control mechanisms responsible for disseminated intravascular coagulation, the vasculopathy and the immunopathy of sepsis.

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Section: Unknownmentioning

confidence: 99%

Section: Unknownmentioning

confidence: 99%

Whatever happened to the Shwartzman phenomenon?

Chahin

Opal

2018

Innate Immun

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“…For example, R. conorii israelensis, which is endemic to Israel [16], has a higher ICU-admission and case-fatality rates than the R. conorii Malish strain (29% vs. 13%; 36% vs. 22%) [17]. In addition, the infections of the different strains often manifest clinically different according to strain (for example, R. israelensis usually manifests as a fever disease with maculopapular rashes and may result in multi-organ failure and acute encephalitis [18]; R. slovaca is implicated in development of tick-borne lymphadenopathy (TIBOLA) or dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL) [19]; Rickettsia sibirica causes lymphadenopathy and lymphangitis [20]; while Rickesttsia caspia infections are characterized by febrile illness and a generalized maculopapular rash [15]). These clinical distinctions according to strain constitute the motivation and significance of our finding.…”

Section: Discussionmentioning

confidence: 99%

New Spotted Fever Group Rickettsia Isolate, Identified by Sequence Analysis of Conserved Genomic Regions

et al. 2019

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The clinical features of spotted fever group (SFG) Rickettsia induced disease range from a mild to severe illness. The clinical complexity is even greater due to the fact that the disease can be caused by different species with varying degrees of virulence. Current knowledge asserts that the Israeli SFG (ISF) strain Rickettsia conorii israelensis is the only human pathogenic SFG member in Israel. Current diagnostic procedures distinguish between SFG and the typhus group rickettsiosis, assuming all SFG-positive clinical samples positive for ISF. Molecular studies on questing ticks over the past decade have uncovered the existence of other SFG strains besides ISF in Israel and the region. This study describes the first documented analysis of SFG-positive samples from Israeli patients with the goal of distinguishing between ISF and non-ISF SFG strains. We managed to identify a new Rickettsia isolate from three independent clinical samples in Israel which was shown to be an as-yet unknown SFG member, showing no absolute identity with any known Rickettsia species present in the NCBI database.

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“…In 2018, another 5 cases were reported in Israel. Two of them were fatal with fulminant purpura in the course of the disease, which is an atypical symptom (13).…”

Section: Gorączka Astrakhanmentioning

confidence: 98%

“…W 2018 w Izraelu odnotowano kolejnych 5 przypadków. Dwa z nich były śmiertelne i przebiegały z piorunującą plamicą będącą objawem nietypowym (13).…”

Section: Izraelska Gorączka Plamista (Israeli Spotted Fever Isf)unclassified

Tick-borne rickettsioses in Europe – a review

et al. 2020

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Tick-borne rickettsioses are emerging diseases in Europe. The Mediterranean region is endemic for rickettsioses, but the disease can also occur in other European countries. Ticks can be a vector of these bacteria. Spotted fevers caused by rickettsiae have nonspecific symptoms and are difficult to diagnose. The results of serological tests are positive many days after the onset of symptoms. PCR method can be useful in the diagnostic process. In the article we discuss the problem of rickettsia in Europe.

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Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel

Abstract: Genetic sequencing should be used to confirm cases because purpura fulminans is a rare finding.

Cited by 16 publications

References 23 publications

Whatever happened to the Shwartzman phenomenon?

Whatever happened to the Shwartzman phenomenon?

New Spotted Fever Group Rickettsia Isolate, Identified by Sequence Analysis of Conserved Genomic Regions

Tick-borne rickettsioses in Europe – a review

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