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Yang Z, Shi Z, Fang K, Ren D. Atypical Rickettsia japonica Infection Involving Critical Illness Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report. Infect Drug Resist 2024; 17:963-967. [PMID: 38495624 PMCID: PMC10944173 DOI: 10.2147/idr.s451404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Rickettsia japonica infection is a rare disease, it is rare to report critical and severe case caused by this disease in Zhejiang Province, China. Patient Concerns We report a patient who initially sought medical attention due to fever and developed coma and convulsions during treatment. The patient did not develop typical eschar and rash. Eventually, the patient needed to be treated in the intensive care unit due to acute respiratory failure. Diagnoses The patient was diagnosed with Rickettsia japonica bloodstream infection by metagenomic next-generation sequencing (mNGS). Outcomes Due to the critical illness, the patient was transferred to the intensive care unit, received doxycycline and other treatments, and rapidly recovered and discharged. Conclusion The patient developed a critical illness after being infected with Rickettsia, when the medical history is unclear and clinical symptoms and signs are atypical, it is necessary to use mNGS examination for diagnosis.
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Affiliation(s)
- Zheng Yang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Zhanli Shi
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Kun Fang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Danhong Ren
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
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Amano S, Suyama S, Nishikura N, Sano C, Ohta R. Complicated Japanese Spotted Fever With Meningitis in an Older Patient: A Case Report. Cureus 2023; 15:e50681. [PMID: 38229818 PMCID: PMC10791036 DOI: 10.7759/cureus.50681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Japanese spotted fever (JSF) poses a significant public health challenge, mainly due to its atypical presentation in specific demographics. This report details a unique case of JSF in an 89-year-old female who was admitted to a rural hospital exhibiting generalized pain and rapid cognitive decline but no rash. Initially misdiagnosed as polymyalgia rheumatica, her condition was complicated by thrombocytopenia and altered mental state, prompting consideration of tick-borne illnesses. Subsequent serological analysis confirmed JSF despite the absence of its hallmark rash. The patient's condition escalated to include bacteremia and aseptic meningitis. Treatment involved a regimen of minocycline and meropenem, along with endoscopic cauterization of a bleeding rectal ulcer. After treatment, the patient showed improvement and was transferred for rehabilitation. This case highlights the criticality of considering JSF in elderly patients within endemic areas, even when classic symptoms like erythema and petechiae are absent. It underscores the necessity for broad diagnostic perspectives, especially in atypical presentations, and the integration of comprehensive care approaches. The involvement of caregivers and relatives in early detection and seeking medical care promptly is crucial. The report illustrates the complexities in diagnosing and managing advanced JSF cases and stresses the importance of early serological testing and adaptive treatment strategies in managing such challenging cases.
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Affiliation(s)
- Shiho Amano
- Community Care, Unnan City Hospital, Unnan, JPN
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Zhou Y, Wang Q, Shen Y, Shen B, Zhang Y, Wang W, Li X. A Case of Critical Japanese Spotted Fever in Zhejiang, China. Infect Drug Resist 2023; 16:3425-3430. [PMID: 37283937 PMCID: PMC10241177 DOI: 10.2147/idr.s408499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
Background Japanese spotted fever (JSF) is a rare disease, caused by Rickettsia japonica; no case has been reported in Zhejiang Province, China. Case Presentation An elderly woman presented to the hospital with abdominal pain and fever. Her condition rapidly worsened with severe complications, such as multiple organ failure and central nervous system damage. The presence of R. japonica was quickly detected by metagenomic next-generation sequencing. On the basis of combined clinical manifestations and laboratory results, critical JSF was diagnosed and treated with doxycycline. The patient showed good prognosis. Typical symptoms (eschar and rash) were not observed in the early stage, consequently increasing the difficulty of clinical diagnosis. Conclusion The delay of treatment caused by non-specific symptoms is an important factor affecting the progression of JSF. As an emerging pathogen detection method, mNGS has been successfully applied for disease diagnosis and treatment, and can be an important complement for the diagnosis of this disease.
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Affiliation(s)
- Yani Zhou
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Qi Wang
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Yujuan Shen
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Bin Shen
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Yan Zhang
- Department of Nursing, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Weihong Wang
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
| | - Xiaofeng Li
- Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China
- Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, People's Republic of China
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Wada T, Mori H, Kida K, Shindo K. Japanese spotted fever with post-infectious encephalitis. IDCases 2022; 31:e01658. [PMID: 36561293 PMCID: PMC9763843 DOI: 10.1016/j.idcr.2022.e01658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Japanese spotted fever (JSF) is a rickettsial disease caused by Rickettsia japonica. To the best of our knowledge, there have only been five reported cases of JSF involving the central nervous system. A 74-year-old man was admitted after 1 week of fever and maculopapular rash. JSF was definitively diagnosed by PCR; however, the patient showed mental disturbance and abnormal behavior. After intravenous immunoglobulin, his mental state and behavior improved. The findings of cerebrospinal fluid analysis, electroencephalography, and 99 mTcHM-PAO single photon computed emission tomography suggested post-infectious encephalitis. JSF causes post-infectious encephalitis and early treatment is recommended.
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Affiliation(s)
- Takafumi Wada
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Hitoshi Mori
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan
| | - Kouji Kida
- Virology Section, Department of Health Science, Okayama Prefectural Institute for Environmental Science and Public Health, Japan, 739–1 Uchio, Okayama Minami-ku, Okayama, 701–0298 Japan
| | - Katsuro Shindo
- Department of Neurology, Kurashiki Central Hospital, Japan, 1–1-1 Miwa, Kurashiki, Okayama, 710–8602 Japan,Corresponding author.
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Hatano Y, Kashima S, Kaihara M, Takase K, Hatakeyama S, Reingold AL, Matsumoto M. Predictive variables for hemodialysis and death in Japanese spotted fever, and the association between distance from rivers and incidence. Ticks Tick Borne Dis 2020; 12:101544. [PMID: 33011438 DOI: 10.1016/j.ttbdis.2020.101544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 07/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
The number of patients with Japanese spotted fever (JSF) and its case fatality rate have been increasing in Japan and other East Asian countries. Better clinical and laboratory biomarkers are needed to avoid misdiagnosing JSF and to predict severe cases. In addition to determining these predictors, we aimed to examine the association between the incidence of JSF and the distance from rivers, in Hiroshima Prefecture, one of the most JSF prevalent areas in Japan. Patients diagnosed with JSF from 2009 to 2017 in two hospitals in Onomichi City in Hiroshima Prefecture were studied, and their clinical characteristics and laboratory data were collected retrospectively from medical charts. A random forest was used to identify predictors of severe JSF leading to hemodialysis or death. A multivariable negative binomial regression model was utilized to analyze the association between the cumulative incidence in each postal code area and the distance from the residential postal code area to the closest river. Out of 82 patients with JSF (mean age at diagnosis, 74.1 ± 10.6 years; 34 (41.5 %) men), 6 cases were regarded as severe (among them 5 hemodialysis patients and 3 deaths). Twenty-eight (34.1 %) patients were misdiagnosed at least once at the initial hospital visit. Laboratory examination showed 34.5 % had atypical lymphocytes, 73.8 % had no eosinophils, 75.6 % had an elevated aspartate aminotransferase (AST) level, and 69.5 % had hyponatremia. Among cases without urine leucocytes, 63.3 % had proteinuria and 63.3 % had hematuria. Low serum total protein was the strongest predictor of severe JSF, followed by high blood urea nitrogen (BUN) and low albumin. Geospatial analysis showed a significant negative association between the cumulative incidence of JSF cases and the distance from rivers in an adjusted model: the cumulative incidence decreased by 0.51 times (95 % CI: 0.30 to 0.86) for every kilometer of distance from the residential postal code area to the closest river. Some laboratory data may be useful in averting misdiagnosis of JSF and in predicting severe cases. Additional studies should be done in order to clarify the mechanism and association of the incidence of JSF with the distance from the nearest river.
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Affiliation(s)
- Yu Hatano
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529, Japan.
| | - Masanobu Kaihara
- Department of Internal Medicine, Onomichi Municipal Hospital, 3-1170-177, Shintakayama, Onomichi-shi, Hiroshima, 722-0055, Japan.
| | - Kenichi Takase
- Department of Clinical Laboratory, Mitsugi General Hospital, 124 Ichi, Mitsugi, Onomichi-shi, Hiroshima, 722-0393, Japan.
| | - Shuji Hatakeyama
- Division of General Internal Medicine/Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Arthur L Reingold
- Division of Epidemiology, University of California, Berkeley, 2121 Berkeley Way, #5302, Berkeley, CA, 94720-7360, United States.
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Dong Z, Yang Y, Wang Q, Xie S, Zhao S, Tan W, Yuan W, Wang Y. A case with neurological abnormalities caused by Rickettsia raoultii in northwestern China. BMC Infect Dis 2019; 19:796. [PMID: 31510926 PMCID: PMC6737699 DOI: 10.1186/s12879-019-4414-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/27/2019] [Indexed: 02/03/2023] Open
Abstract
Background The number of new rickettsial species are rapidly increasing, and increasing numbers of Rickettsia raoultii (R. raoultii) infection cases have been detected in humans. However, neurological abnormalities caused by R. raoultii are rarely reported, especially in northwestern China. Case presentation A 36-year-old Kazakh shepherd with an attached tick on part temporalis, presented with right eyelid droop, lethargy, fever, headache, fever (38.0–41.0 °C) and erythematous rash. The examination of cerebrospinal fluid (CSF) showed cerebrospinal pressure of 200 mm H2O, leukocyte count of 300.0 × 106/L, adenosine deaminase of 2.15 U/L, and total protein concentration of 0.93 g/L. The diagnosis of R. raoultii infection was confirmed by six genetic markers, and semi-quantified by enzyme-linked immunosorbent assay for rickettsial antigen. The patient gradually recovered after treatment with doxycycline and ceftriaxone. R. raoultii DNA was found both in a tick detached from this patient and in 0.18% (2/1107) of blood samples collected from local shepherds. Conclusions This is the first reported case with neurological abnormalities caused by R. raoultii in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by Rickettsia.
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Affiliation(s)
- Zhihui Dong
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Yicheng Yang
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Qian Wang
- Kaifeng Central Hospital, Henan, 475000, China
| | - Songsong Xie
- The First Affiliated Hospital of Shihezi University Medical College, Shihezi, 832002, China
| | - Shanshan Zhao
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Wenbo Tan
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Wumei Yuan
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China
| | - Yuanzhi Wang
- School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang Uygur Autonomous Region, China.
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7
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Sekeyová Z, Danchenko M, Filipčík P, Fournier PE. Rickettsial infections of the central nervous system. PLoS Negl Trop Dis 2019; 13:e0007469. [PMID: 31465452 PMCID: PMC6715168 DOI: 10.1371/journal.pntd.0007469] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
As a result of migrations and globalization, people may face a possible increase in the incidence of central nervous system rickettsial infections (CNS R). These diseases, caused by Rickettsia species and transmitted to humans by arthropod bites, are putatively lethal. However, the diagnosis of CNS R is challenging and often delayed due to their nonspecific clinical presentation and the strict intracellular nature of rickettsiae. Furthermore, transfer of rickettsiae to the brain parenchyma is not yet understood. The aim of this review is to analyze and summarize the features and correlated findings of CNS R in order to focus attention on these intriguing but frequently neglected illnesses. We also incorporated data on CNS infections caused by Rickettsia-related microorganisms.
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Affiliation(s)
- Zuzana Sekeyová
- Institute of Virology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Monika Danchenko
- Institute of Virology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Peter Filipčík
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta, Bratislava, Slovakia
| | - Pierre Edouard Fournier
- Aix-Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Mediterranée-Infection, Marseille, France
- Centre National de Référence des Rickettsia, Coxiella et Bartonella, IHU Mediterranée-Infection, Marseille, France
- * E-mail:
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8
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Quiroz-Castañeda RE, Cobaxin-Cárdenas M, Cuervo-Soto LI. Exploring the diversity, infectivity and metabolomic landscape of Rickettsial infections for developing novel therapeutic intervention strategies. Cytokine 2018; 112:63-74. [PMID: 30072088 DOI: 10.1016/j.cyto.2018.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/25/2022]
Abstract
Rickettsioses are zoonotic infections caused by obligate intracellular bacteria of the genera Rickettsia that affect human health; sometimes humans being considered as accidental hosts. At a molecular level, the rickettsiae infection triggers molecular signaling leading to the secretion of proinflammatory cytokines. These cytokines direct the immune response to the host cell damage and pathogen removal. In this review, we present metabolic aspects of the host cell in the presence of rickettsiae and how this presence triggers an inflammatory response to cope with the pathogen. We also reviewed the secretion of cytokines that modulates host cell response at immune and metabolic levels.
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Affiliation(s)
- Rosa Estela Quiroz-Castañeda
- Unidad de Anaplasmosis, Centro Nacional de Investigación Disciplinaria en Parasitología Veterinaria, (CENID-PAVET, INIFAP), Carretera Federal Cuernavaca Cuautla 8534, Progreso, 62574 Jiutepec, Morelos, Mexico.
| | - Mayra Cobaxin-Cárdenas
- Unidad de Anaplasmosis, Centro Nacional de Investigación Disciplinaria en Parasitología Veterinaria, (CENID-PAVET, INIFAP), Carretera Federal Cuernavaca Cuautla 8534, Progreso, 62574 Jiutepec, Morelos, Mexico.
| | - Laura Inés Cuervo-Soto
- Facultad de Ciencias, Departamento de Biología, Universidad Antonio Nariño, Sede Circunvalar Carrera 3 Este, No. 47 A15, Bogotá, Colombia
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9
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Ocias LF, Dessau RB, Lebech AM, Jørgensen CS, Petersen RF, Krogfelt KA. Evidence of rickettsiae in Danish patients tested for Lyme neuroborreliosis: a retrospective study of archival samples. BMC Infect Dis 2018; 18:325. [PMID: 29996782 PMCID: PMC6042448 DOI: 10.1186/s12879-018-3210-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a prevalence of 4.7-13% in Danish Ixodes ricinus ticks, Rickettsia helvetica is one of the most frequently detected tick-borne organisms in Denmark. Most reports of human exposure have described asymptomatic seroconversion or a mild, self-limiting flu-like illness but it has also been implicated as a cause of subacute lymphocytic meningitis. Because Borrelia burgdorferi sensu lato (Bbsl) and R. helvetica are both found in the same tick species, potential co-transmission is a possibility. We examined 1) the seroprevalence of anti-rickettsia antibodies in patients investigated for Lyme neuroborreliosis (LNB), and 2) the cerebrospinal fluid (CSF) and sera of same patients for the presence of Rickettsia DNA. METHODS Ninety-nine sera and 87 CSF samples from patients with intrathecal synthesis of anti-Borrelia antibodies and 101 sera and 103 CSF samples from patients with no detectable intrathecal synthesis were retrospectively examined for this study. Sera were analyzed for antibodies against spotted fever group (SFG) rickettsiae and both the CSF and sera were tested for Rickettsia DNA using a genus-specific real-time PCR. RESULTS Of the patients tested for LNB, 32% (64/200) had IgG antibodies against SFG rickettsiae. Among patients with confirmed intrathecal synthesis of Borrelia-specific antibodies, 38% (38/99) exhibited IgG antibodies. None of these values were statistically significant when compared with sera from healthy blood donors (p = 0.7 and 0.19). Rickettsia DNA was found in the CSF of 4% (8/190) of patients. CONCLUSION No statistically significant difference was found in the seroprevalence of anti-rickettsia antibodies in patients tested for LNB and healthy blood donors, indicative of a low rate of exposure in this group of patients. Eight patients showed evidence of Rickettsia DNA in the CSF, five of whom had LNB. However, cycle threshold (Ct) values were high, indicating low concentrations of DNA, and no apparent alteration in the clinical manifestations of LNB were noted in the medical records of these patients.
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Affiliation(s)
- Lukas Frans Ocias
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark. .,Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Sværke Jørgensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Randi Føns Petersen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark
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Luce-Fedrow A, Mullins K, Kostik AP, St John HK, Jiang J, Richards AL. Strategies for detecting rickettsiae and diagnosing rickettsial diseases. Future Microbiol 2016; 10:537-64. [PMID: 25865193 DOI: 10.2217/fmb.14.141] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Rickettsial diseases and scrub typhus constitute a group of the oldest known vector-borne diseases. The cosmopolitan distribution of the vectors that transmit rickettsiae and orientiae leads to a worldwide prevalence of these diseases. Despite their significant historical status, detection and diagnosis of these diseases are still evolving today. Serological methods remain among the most prevalent techniques used for the detection/diagnosis of rickettsial diseases and scrub typhus. Molecular techniques have been instrumental in increasing the sensitivity/specificity of diagnosis, identifying new Rickettsia and Orientia species and have enhanced epidemiological capabilities when used in combination with serological methods. In this review, we discuss these techniques and their associated pros and cons.
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Affiliation(s)
- Alison Luce-Fedrow
- Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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11
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Kularatne SAM, Weerakoon KGAD, Rajapakse RPVJ, Madagedara SC, Nanayakkara D, Premaratna R. A case series of spotted fever rickettsiosis with neurological manifestations in Sri Lanka. Int J Infect Dis 2012; 16:e514-7. [PMID: 22541336 DOI: 10.1016/j.ijid.2012.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/05/2012] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations. METHODS The cases were studied prospectively from 2008 at the Teaching Hospital, Peradeniya. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS All had an IFA IgG titer ranging from 1/64 to 1/4096 and a positive IFA IgM titer against Rickettsia conorii antigen; in 10 (59%) cases the IgG titers were ≥ 1/256 (definitive cases). The median age of the patients was 62 years (range 26-82 years); 10 were male and seven female. The median duration of fever was 12 days (range 4-35 days). Neurological manifestations on admission were drowsiness or confusion in 14 (82%) and a semi-comatose state in three (18%). Rigidity of the limbs occurred in 14 (82%), bradykinesia and resting tremors in 12 (71%), which persisted after defervescence, neck stiffness in seven (42%), weakness of the limbs in five (29%), deafness in two (12%), and stupor in three (18%). Electroencephalograms in three (18%) showed generalized slow waves. Cerebrospinal fluid examination showed a cellular reaction, predominantly lymphocytes, in three cases. Two patients died (fatality rate 12%). CONCLUSION We have documented for the first time the neurological features of SFG rickettsioses in the Central Province, Sri Lanka. These were predominantly extrapyramidal features in patients of older age.
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Affiliation(s)
- S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
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12
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Nakata R, Motomura M, Tokuda M, Nakajima H, Masuda T, Fukuda T, Tsujino A, Yoshimura T, Kawakami A. A case of Japanese spotted fever complicated with central nervous system involvement and multiple organ failure. Intern Med 2012; 51:783-6. [PMID: 22466839 DOI: 10.2169/internalmedicine.51.6214] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Japanese spotted fever (JSF), first reported in 1984, is a rickettsial disease characterized by high fever, rash, and eschar formation. A 61-year-old man was admitted to a local hospital in Nagasaki City, Japan, after several days of high fever and generalized skin erythema. His condition deteriorated and laboratory findings indicated disseminated intravascular coagulation (DIC). The patient was transferred to our hospital with mental disturbance and status epilepticus. Treatment included minocycline, and new quinolone. Definitive diagnosis was made with a serological test showing increased antibody levels against Rickettsia japonica. Rickettsial infections are rare, but should be seriously considered for the differential diagnosis of aseptic meningitis and encephalitis, as they show no response to conventional antibiotic treatment.
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Affiliation(s)
- Ruka Nakata
- The First Department of Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan.
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Nilsson K, Elfving K, Pahlson C. Rickettsia helvetica in patient with meningitis, Sweden, 2006. Emerg Infect Dis 2010; 16:490-2. [PMID: 20202426 PMCID: PMC3322002 DOI: 10.3201/eid1603.090184] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pathogenicity of Rickettsia helvetica is relatively unknown. We isolated a spotted fever group rickettsial organism from a patient with subacute meningitis. Nucleotide sequences of the 16S rRNA, ompB, and 17kDa genes identified the isolate as R. helvetica. This organism may be associated with serious infections such as central nervous system disorders.
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Abstract
Tick bites are best prevented by people avoiding tick-infested areas. When this is not possible, tick bites may be prevented by the wearing of long trousers that are tucked into boots. The best method to avoid tick bites is twofold: application of a topical deet (N,N-diethyl-m-toluamide) repellent to exposed skin, and treatment of clothing with permethrin. This system is currently used by the US Army to protect soldiers. Ticks can crawl underneath clothing and bite untreated portions of the body; therefore, treating clothing is imperative. Permethrin is nontoxic to humans, and can be used in any age group. Permethrin is commercially available. Checking clothing regularly while in tick-infested areas is highly recommended to back up the few hours of protection provided by the insect repellents. It is also recommended that the entire body be carefully screened for ticks and other parasites by campers and hunters while they are staying in and after leaving infested areas. Any tick found should be removed immediately. Removing ticks may not be easy. It is best to use blunt, rounded forceps, and a magnifying glass to remove ticks, especially when immature ticks are found. The forceps are used to grasp the mouthparts of the tick as close as possible to the skin, and then the tick is pulled upward, perpendicular to the skin, with a continuous and steady action. Usually any mouth parts of the tick retained in the skin are eliminated uneventfully by the body. Other methods of removing ticks, such as using fingers, lighted cigarettes, petroleum jelly, or suntan oil, should be avoided. Killing the tick in situ may increase the risk of regurgitation by the tick and the transmission of infectious agents. Most stick bites are uncomplicated, and result only in benign cutaneous inflammatory reactions that may be pruritic for a few days. As a result of mouthparts being retained at the feeding site, a granuloma may rarely develop. There are no data to indicate that antimicrobial prophylaxsis is beneficial to the tick-bitten patient to prevent disease. It must be kept in mind that the risk of transmission of disease increases with the duration of attachment and generally requires greater than 24 to 48 hours. The degree of tick engorgement or the time since tick exposure and discovery of the tick may be used to establish the likely duration of attachment and the risk of disease transmission. Reducing and controlling tick populations is difficult. Habitat modifications, including vegetation management by cutting, burning, and herbicide treatment, and drainage of wet areas are one strategy for tick control, but their effects are often short-lived, and they can cause severe ecologic damage. Chemicals used to control ticks may cause environmental contamination, and therefore, toxicity for humans and animals. Biologic control methods for ticks include the promotion of natural predators. Natural predators of ticks are beetles, spiders, and ants, and parasites such as insects, mites and nematodes. Tick control is best based on the concept of integrated pest management, in which different control methods are adapted to one area or against one tick species with due consideration to their environmental effects. Tick-borne diseases are increasing in prevalence. Perhaps it is because people are undertaking more outdoor activities, which result in contact with ticks and their pathogens. Clinicians should be aware of the clinical sign of tick-transmitted diseases, because morbidity and mortality as a result of these diseases increases substantially if there are delays in diagnosis and treatment. Tick-borne illness occur in distinctive geographic areas. The reporting of these illnesses and diseases to the health department enables the gathering of information and statistics. The public should be informed about the risks of disease in tick-infested areas and the means of preventing infections. The most common diseases are caused by Rickettsia, Borrelia, and Ehrichia, but with continued study, new pathogens and diseases will continue to emerge.
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Affiliation(s)
- Barbara Fouts Flicek
- Internal Medicine of Newton County, 4181 Hospital Drive NE, Suite 404, Covington, GA 30014, USA.
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15
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Abstract
Three rickettsial diseases are known to exist in Japan currently: Japanese spotted fever (JSF), Tsutsugamushi disease (TD; scrub typhus), and Q fever. Since April 1999, the system for infection control and prevention in Japan has changed drastically. JSF, Q fever, and TD, as emerging infectious diseases, are designated as national notifiable diseases.The geographic distribution of JSF patients is along the coast of central and southwestern Japan, whereas TD and Q fever occur almost all over the country. The number of JSF patients reported was 216 cases during 1984-1998 and 268 cases, under the revised law, in 1999-2004. About 300-1000 cases of TD occur every year, and 7-46 cases of Q fever in 1999-2004. The number of cases of JSF and its endemic area are gradually increasing. There was only one fatality due to JSF until 2003, whereas two patients died of JSF in 2004, so JSF is still a life-threatening disease in Japan. Treatment of fulminant JSF consists of prompt administration of a combination of tetracycline and quinolone. Recent tick surveys revealed that the most probable vectors of JSF are Haemophysalis flava and Haemophysalis hystericis. In addition to R. japonica, two serotypes or species of spotted fever group rickettsiae have been isolated from ticks in Japan; one is closely related to R. helvetica and the other is a new genotype of unknown genotype AT, which is closely related to a Slovakian genotype. These serotypes are of uncertain clinical significance. Epidemiology of rickettsioses in the Far East is mentioned briefly.
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Affiliation(s)
- Fumihiko Mahara
- Mahara Hospital, 6-1, Aratano, Anan-city, Tokushima, 779-1510, Japan.
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16
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial infections around the world, part 1: pathophysiology and the spotted fever group. J Cutan Med Surg 2006; 9:54-62. [PMID: 16392014 DOI: 10.1007/s10227-005-0133-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. OBJECTIVE In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. METHODS Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. RESULTS Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. CONCLUSIONS At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California, Irvine, California, USA
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17
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Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 2005; 18:719-56. [PMID: 16223955 PMCID: PMC1265907 DOI: 10.1128/cmr.18.4.719-756.2005] [Citation(s) in RCA: 716] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
During most of the 20th century, the epidemiology of tick-borne rickettsioses could be summarized as the occurrence of a single pathogenic rickettsia on each continent. An element of this paradigm suggested that the many other characterized and noncharacterized rickettsiae isolated from ticks were not pathogenic to humans. In this context, it was considered that relatively few tick-borne rickettsiae caused human disease. This concept was modified extensively from 1984 through 2005 by the identification of at least 11 additional rickettsial species or subspecies that cause tick-borne rickettsioses around the world. Of these agents, seven were initially isolated from ticks, often years or decades before a definitive association with human disease was established. We present here the tick-borne rickettsioses described through 2005 and focus on the epidemiological circumstances that have played a role in the emergence of the newly recognized diseases.
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Affiliation(s)
- Philippe Parola
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Université de la Méditerranée, Faculté de Médecine, 13385 Marseille Cedex 5, France
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18
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Wu JJ, Huang DB, Pang KR, Tyring SK. Rickettsial Infections around the World, Part 1: Pathophysiology and the Spotted Fever Group. J Cutan Med Surg 2005. [DOI: 10.1177/120347540500900203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. Objective: In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. Methods: Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. Results: Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. Conclusions: At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.
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Affiliation(s)
- Jashin J. Wu
- Department of Dermatology, University of California, Irvine, California, USA
| | - David B. Huang
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Katie R. Pang
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan, Texas, USA
| | - Stephen K. Tyring
- Department of Dermatology, University of Texas Health Science Center, Houstan, Texas, USA
- Center for Clinical Studies, Houston, Texas, USA
- Center for Clinical Studies, 2060 Space Park Drive, Suite 200, Houston, TX, 77058, USA
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19
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Abstract
PURPOSE OF REVIEW Recent developments in molecular taxonomic methods have led to a reclassification of rickettsial diseases. The agent responsible for scrub typhus (Orientia tsutsugamushi ) has been removed from the genus Rickettsia and a bewildering array of new rickettsial pathogens have been described. An update of recent research findings is therefore particularly timely for the nonspecialist physician. RECENT FINDINGS An estimated one billion people are at risk for scrub typhus and an estimated one million cases occur annually. The disease appears to be re-emerging in Japan, with seasonal transmission. O. tsutsugamushi has evolved a variety of mechanisms to remain viable in its intracellular habitat. Slowing the release of intracellular calcium inhibits apoptosis of macrophages. Subsets of chemokine genes are induced in infected cells, some in response to transcription factor activator protein 1. Cardiac involvement is uncommon and clinical complications are predominantly pulmonary. Serious pneumonitis occurred in 22% of Chinese patients. Dual infections with leptospirosis have been reported. Standardized diagnostic tests are being developed and attempts to improve treatment of women and children are being made. Of the numerous tick-borne rickettsioses identified in recent years, African tick-bite fever appears to be of particular importance to travellers. The newly described flea-borne spotted fever caused by Rickettsia felis may be global in distribution. SUMMARY Rash and fever in a returning traveler could be rickettsial and presumptive doxycycline treatment can be curative. Recent research findings raise more questions than answers and should stimulate much needed research.
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Affiliation(s)
- George Watt
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
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