Severe clinical forms of Mediterranean Spotted Fever: A case series from an endemic area in Bulgaria

Fatal Case of Mediterranean Spotted Fever Associated with Septic Shock, Iran

A fatal case of Mediterranean spotted fever associated with septic shock was reported in a 61-year-old man living in a village in southeastern Iran. The patient had a history of tick bite a few days before symptom onset. Phylogenetic analysis confirmed infection by Rickettsia conorii subspecies israelensis.

[Possibilities of serological verification of siberian tick borne type with use of test system for identification of antibodies to Rickettsia conorii.]

The real epidemiological impact of Spotted Fever Group rickettsioses including Siberian tick-borne typhus (STT) in Russia is not sufficiently studied. One of the reasons is the actual absence of either certified domestic diagnostic kits or the evidence for using foreign test kits for laboratory verification of this group of tick-borne infections in medical practice. Objective of our study was to study the diagnostic accuracy of the ELISA test system based on Rickettsia conorii antigens for serological verification of STT. The ROC analysis was performed and operational characteristics (sensitivity, specificity, accuracy, likelihood ratio of positive and negative results) of the STT serological verification test to identify IgM to rickettsia at different times from the onset of the disease using a test system to detect antibodies to Rickettsia conorii were calculated based on the results of a survey of two groups of patients comparable by gender and age (34 patients with pathognomonic signs of STT and 76 clinically healthy people). It was found that the detection of IgM antibodies to rickettsia using the Rickettsia conorii IgM/IgG ELISA test system (Vircell) allows the disease to be verified 10-14 days after the onset of clinical symptoms in 72% (56-88%) of STT patients. We recommend the interpretation of results of the test system "Rickettsia conorii ELISA IgM/IgG" for serological verification of STT which differ from the manufacturer's recommendations regarding verification of Mediterranean fever caused by R. conorii in the following way: the diagnosis of STT should be considered laboratory confirmed when the index of IgM antibodies (IAT) exceeds 8.0; if the IAT is less than 5.0 then a repeated examination of the patient after 10-14 days will be necessary; if the IAT is in the range of 5.0-8.0 then the sample should be re-examined and / or the patient should be examined after 10-14 days. The use of the test system "Rickettsia conorii ELISA IgM / IgG" is promising for laboratory diagnosis and seroepidemiological studies of Spotted Fever Group rickettsioses in Russia.