[A fatal case of Mediterranean spotted fever]

[Rickettsiosis associated with cerebral infarction: a new case study]

La fièvre boutonneuse méditerranéenne (FBM) est une rickettsiose du groupe boutonneux due à rickettsia conorii. Cette zoonose est réputée d'évolution bénigne mais peut se compliquer dans les formes sévères d'une atteinte neurologique qui en font parfois toute la gravité. Nous rapportons l'observation d'une patiente âgée de 49 ans ayant présenté au cours de son hospitalisation en dermatologie pour une rickettsiose, une hémiplégie droite massive d'installation brutale. L'angio-IRM cérébrale a objectivé un accident vasculaire cérébral ischémique sylvien profond gauche. Le diagnostic de rickettsiose de type conorii a été retenu sur l'aspect des lésions dermatologiques et la positivité des sérologies par immuno-fluorescence indirecte. L'évolution était favorable sous anti-biothérapie (doxycycline et fluoroquinolone). Exceptionnellement rapporté dans le cadre des manifestations neurologiques des rickettioses, l'infarctus cérébral reste une complication à ne pas méconnaitre surtout en regard d'un bilan étiologique en particulier cardiovasculaire demeuré négatif.

Molecular diagnosis of Rickettsia infection in patients from Tunisia

Diagnosis of rickettsioses had largely benefited from the development of molecular techniques. Unfortunately, in Tunisia, despite the large number of rickettsial cases registered every year, the Rickettsia species remain unidentified. In this study, we aimed to detect the Rickettsia species in clinical samples using molecular tests. A study was established to analyze skin biopsies, cutaneous swabs, and cerebrospinal fluid samples taken from clinically suspected patients to have rickettsial infection. Two molecular techniques were used to detect Rickettsia DNA: quantitative real time PCR (qPCR) and reverse line blot test (RLB). An analysis of the RLB hybridization assay results revealed the presence of Rickettsia DNA in skin biopsies (40.6%) and swabs (46.7%). Rickettsia conorii was the most prevalent identified species among tested samples. Other species of interest include Rickettsia typhi and Rickettsia massiliae. Using qPCR positivity rates in skin biopsies was 63.7% against 80% in swabs. R. conorii was the most frequently detected species, followed by R. typhi. The agreement between the two techniques was 68.6% (kappa=0.33). Molecular tests, especially using specific probes qPCR, allow for a rapid, better and confident diagnosis in clinical practice. They improve the survey of Mediterranean spotted fever which is considered to be the most important rickettsial infection in humans in Tunisia.

Rickettsial meningoencephalitis in a child--a case report

Severe central nervous system involvement has been reported in adults with Rickettsia conorii infection but rarely in children. We report here a serologically documented case of meningoencephalitis in a child caused by spotted group R. conorii. Rickettsial infection is a relatively under-diagnosed entity in children with fever and rash, probably due to low index of suspicion and the lack of definitive diagnostic facilities. Rickettsial infections can be treated effectively with anti-microbials; if they remain undiagnosed and untreated, they are associated with significant morbidity and mortality. This differential diagnosis should be considered when a child is seen with fever and rash.

Une fièvre boutonneuse méditerranéenne compliquée d'une embolie pulmonaire

INTRODUCTION

Thromboembolic complications were uncommon in mediterranean spotted fever.

OBSERVATION

We report a case of 55-years- old man who was admitted for mediterranean spotted fever. Two days later, the patient developed chest pain due to a pulmonary thrombosis confirmed by angio-CT. The outcome was good with heparin therapy. The investigation for another cause of thrombosis was negative.

CONCLUSION

Mediterranean spotted fever is usually a moderately severe self-limited illness. Pulmonary thrombosis was uncommon associated with severe disease.

Mediterranean spotted fever: clinical and laboratory characteristics of 415 Sicilian children

BACKGROUND

Mediterranean spotted fever (MSF) is an acute febrile, zoonotic disease caused by Rickettsia conorii and transmitted to humans by the brown dogtick Rhipicephalus sanguineus. Nearly four hundred cases are reported every year (mainly from June to September) on the Italian island of Sicily. The aim of the study was to analyze the clinical and laboratory characteristics of patients with MSF and the efficacy of the drugs administered.

METHODS

Our study was carried out on 415 children with MSF, during the period January 1997-December 2004, at the "G. Di Cristina" Children's hospital in Palermo, Sicily, Italy. On admission patients' clinical history, physical and laboratory examination and indirect immunofluorescence antibody test (IFAT) for Rickettsia conorii were performed. Diagnosis was considered confirmed if the patients had an MSF diagnostic score greater than or equal to 25 according to the Raoult's scoring system. All patients were treated with chloramphenicol or with macrolides (clarithromycin or azithromycin).

RESULTS

Fever, rash and tache noire were present in 386 (93%), 392 (94.5%) and 263 (63.4%) cases respectively. Eighteen (4.6%) children showed atypical exanthema. Chloramphenicol and newer macrolides all appeared to be effective and safe therapies.

CONCLUSION

Clinical features of 415 children with MSF were similar to those reported by other authors except for a lower incidence of headache, arthralgia and myalgia and a higher frequency of epato-splenomegaly. Concerning therapy, clarithromycin can be considered a valid alternative therapy to tetracyclines or chloramphenicol especially for children aged < eight years.