1/50. Mediterranean spotted fever in pregnancy. Mediterranean spotted fever has rarely been reported in pregnancy. We report a case occurring in a young pregnant woman, which responded well to treatment with a combination of erythromycin and rifampicin. The treatment of spotted fevers in pregnancy is discussed in detail. ( info) |
2/50. Splenic abscesses caused by actinomyces meyeri in a patient with autoimmune hepatitis. We report a case of actinomycosis with uncommon localizations that was due to actinomyces meyeri. Although penicillin is the standard treatment for this condition, our patient was treated successfully with imipenem. actinomyces organisms are important constituents of the normal flora of mucous membranes and are considered opportunistic pathogens; these organisms may produce infection after local trauma, surgery, or aspiration. The mains forms of actinomycosis are cervicofacial, thoracic, and abdominal; most cases are due to actinomyces israelii, whereas other actinomyces species are occasionally implicated. actinomycosis usually occurs in immunocompetent persons, but may occur in persons with diminished host defenses. ( info) |
3/50. The first fatal case of Mediterranean spotted fever in croatia. The first lethal case of Mediterranean spotted fever in croatia is described. A previously healthy, 58-year-old man was admitted to the hospital with high fever and rash. Several days later, severe anemia, leukopenia and thrombocytopenia developed, and the patient died about eight weeks after the onset of disease. bone marrow biopsy showed hypercellularity of the cortical and trabecular bone structures with morphologically normal cells of all three hematopoietic lineages that were reduced due to regular nodular infiltrates. Serologic findings indicated that rickettsia conorii infection was the etiologic cause of the patient's death. ( info) |
| facial nerve palsy has been occasionally attributed to infectious agents, but Rickettsiae species have not been documented as causative agents. We report two adolescent girls with facial nerve palsy and serological evidence of R conorii infection. These cases indicate that rickettsioses should be included among the causes of facial nerve palsy, particularly in endemic areas. ( info) |
5/50. Primary HIV type-1 infection misdiagnosed as Mediterranean spotted fever. The case studies of four patients, two men and two women between the ages of 42 and 54 years, are described. They presented to a hospital emergency department during the summer months with acute fever and exanthema. These are the primary symptoms of Mediterranean spotted fever (MSF), an endemic rickettsial disease in the Mediterranean basin that is seen particularly during the summer. The patients were clinically diagnosed as having MSF, but their diagnoses were not confirmed by serological testing. One patient was diagnosed with primary human immunodeficiency virus type 1 infection (hiv-1) 10 days later. The remaining three patients were diagnosed with HIV infection years later, but it is very likely that they also had primary HIV infection when MSF was presumed. When a patient develops sudden onset of fever and a maculopapular rash that is characteristic of MSF, the possibility of primary hiv-1 infection should be considered. ( info) |
| Japanese spotted fever (JSF), first reported in 1984, is a rickettsial disease caused by Rickettsia japonica. Until now, affliction of the central nervous system has been rarely reported. Here we report two cases of JSF associated with a central nervous system disorder such as meningoencephalitis. ( info) |
7/50. Mediterranean spotted fever during pregnancy: case presentation and literature review. Mediterranean spotted fever (MSF) is caused by rickettsia conorii, an obligate intracellular parasite of eukaryotic cells. Although, usually this disease has a benign course, a rapidly fatal outcome can occur even in young healthy adults. We describe a case of a 40-year-old Bedouin woman gravida 11, para 10, who was admitted at 36 weeks gestation with this rickettsial disease. During pregnancy, the treatment of choice for Mediterranean spotted fever is chloramphenicol, but it seems that azithromycin could be another possible option. ( info) |
| rickettsia conorii is endemic in Mediterranean area. We describe an unusual sace of R. Conorii infection, which concerns a farmer with clinical, radiological and cytological findings of pleurisy without evidence of malignancy. An elevated antibody titre for R. Conorii was observed, using an indirect immunofluorescent antibody test. After treatment with doxycycline, the patient presented a significant improvement of his clinical and radiological image and a four-fold decrease of the antibody titre for R. conorii. ( info) |
9/50. Isolation of a rickettsia related to Astrakhan fever rickettsia from a patient in chad. We isolated a novel spotted fever group rickettsia from a patient coming back from chad with fever and a maculopapulous rash. In africa, only six pathogenic spotted fever group rickettsiae have been identified, R. conorii, R. africae, R. akari, R. aeschlimannii, "R. mongolotimonae," and R. felis. Our isolate was identified by PCR amplification and sequencing of the 16S rRNA (16S rDNA), citrate synthase (gltA), and rOmpA (ompA) encoding genes. The 16S rDNA, gltA, and ompA sequences of the isolate were found to be 99.7, 99.6, and 99.5% identical with that of Astrakhan fever rickettsia, respectively. This rickettsia is endemic in the Caspian sea area and has also recently been identified in kosovo. Using mouse serotyping, the currently accepted method for the identification of spotted fever group rickettsiae, the chad isolate exhibited a specificity difference of 2 when compared to Astrakhan fever rickettsia and at least 4 when compared with other members of the R. conorii complex. The chad isolate should be considered a variant of Astrakhan fever rickettsia. This is the first description of Astrakhan fever rickettsia outside europe and the bacterium may be responsible for cases of spotted fever in chad. Although Astrakhan fever rickettsia is transmitted by rhipicephalus ticks in europe, further studies are indicated to identify its vector in africa where these ticks are also prevalent. ( info) |
10/50. Report of eight cases of fatal and severe Mediterranean spotted fever in portugal. Mediterranean spotted fever (MSF), endemically present, is associated with a low mortality and morbidity in portugal. Etiological agents are Malish and Israeli tick typhus strains of rickettsia conorii. In the last few years severe forms of MSF have emerged, with patients presenting atypical symptoms, major neurological manifestations, and multiorgan involvement, who have required intensive care facilities. Advanced age, underlying chronic disease, and delay of appropriate treatment are bad prognostic factors. In the acute phase of diagnosis, serological studies are delayed, inconclusive, and often unhelpful. A definitive diagnosis can only be made using isolation or molecular biology which can establish and clearly identify agents. Using evidence-based case reports, clinical and laboratory data were evaluated from patients with severe or fatal MSF observed in Garcia da Orta Hospital-Almada. Of the eight reference cases, four died, three in an acute fulminant stage. Of the survivors, four presented atypical involvement: ocular inoculation, massive gastric hemorrhage, acute respiratory disease (ARDS), and necrotizing vasculitis. diagnosis by isolation of the agent was made in two cases, by immunohistochemistry in three, and by the indirect fluorescent antibody test (IFA) in three others. Israeli tick typhus and Malish R. conorii strains were isolated once each in fatal cases. In early stages, diagnosis continues to be clinical and patients should start appropriate therapy without delay if clinical suspicion of rickettsiosis arises to prevent poor outcome. patients ranged in age from 39 to 71 years (mean 60), apache II ranged from 15 to 38 points and TISS 28 was between 24 and 46 points. In reported cases severity of disease was not obviously related to the usual comorbidities. Accelerated clinical course may not suggest classical MSF. Another relevant factor was prior prescription of an inappropriate antibiotic that contributed to misleading clinical features. The reported complications and atypical manifestations illustrate well the diversity of this disease. ( info) |