Cases reported "Boutonneuse Fever"

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1/20. 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.
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2/20. Japanese spotted fever involving the central nervous system: two case reports and a literature review.

    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.
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3/20. 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.
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keywords = rickettsia
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4/20. 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.
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ranking = 17
keywords = rickettsia
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5/20. Atypical papulovesicular rash due to infection with rickettsia conorii.

    We present an unusual case of rickettsia conorii infection that was associated with cutaneous papulovesicular lesions on a patient who had returned from the bushveld of south africa. The lesions were diffusely scattered across the trunk, extremities, and both palms. Several recent reports have documented similar papulovesicular or pustulovesicular rashes that occurred on travelers returning from southern Africa. These rashes resemble the lesions of rickettsialpox. Evidence suggests that these atypical exanthems may be due to variant strains of R. conorii or to an unusual host response to infection with this organism; thus, infection with R. conorii should be included in the list of diseases that cause poxlike lesions.
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keywords = rickettsia
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6/20. Anterior ischemic optic neuropathy associated with rickettsia conorii infection.

    A 43-year-old man with fever, headache, and skin rash developed unilateral acute anterior ischemic optic neuropathy. The indirect immunofluorescence test was positive for rickettsia conorii. Although retinal lesions have been described in rickettsia conorii infection, this is the first reported case of ischemic optic neuropathy. This infection should be considered in a patient with nonarteritic anterior ischemic optic neuropathy with high fever or skin rash who inhabits or travels from an endemic area.
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ranking = 4
keywords = rickettsia
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7/20. Laboratory-confirmed Mediterranean spotted fever in a Japanese traveler to kenya.

    A Japanese traveler returning from kenya became ill, presenting with fever and a prominent, generalized rash without an eschar. Results of the immunofluorescence antibody assay of the patient's sera performed in japan were compatible with illness due to a spotted fever group (SFG) rickettsia, and a presumptive diagnosis of African SFG rickettsiosis, probably either Mediterranean spotted fever (MSF) or African tick-bite fever (ATBF), was rendered. To further define the disease diagnosis, sera were examined in france by Western immunoblotting combined with cross-adsorption, which confirmed the diagnosis of MSF but not of ATBF. Because of the need to further characterize the epidemiologic and clinical features of the two African SFG rickettsioses, clinicians are encouraged to contact a specialized laboratory when encountering such cases.
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keywords = rickettsia
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8/20. Rickettsial keratitis in a case of Mediterranean spotted fever.

    The first documented case of infectious keratitis (an ameboid-like corneal ulcer) caused by rickettsia conorii is described. Corneal infection was probably caused by contamination through the tears during systemic rickettsial dissemination. Topical tetracyclin ointment was effective. Rickettsial keratitis should be considered in the differential diagnosis of ameboid-like corneal ulcers in areas where Mediterranean spotted fever is endemic.
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keywords = rickettsia
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9/20. epidemiology of boutonneuse fever in western sicily: accidental laboratory infection with a rickettsial agent isolated from a tick.

    A case is reported of an accidental laboratory infection with a strain of Spotted Fever-Group Rickettsiae freshly isolated from a tick collected in Western sicily. Inoculation into the left thumb of cell-cultured organisms (10(5)/ml) gave rise to clinical signs and symptoms of boutonneuse fever after six days, i.e., a lesion at the point of inoculation, fever, headache, conjunctivitis and myalgias. Rickettsiae were isolated from acute-phase blood samples collected from the infected individual and IgM and IgG response was detected in the patient's serum by indirect immunofluorescence. Complete recovery was obtained after antibiotic treatment. Serologic analysis of the strain, together with analyses of the proteins of the isolate, documented that the isolate was rickettsia conorii and was identical to prototype strain. The relationship of this infection to ongoing studies on the epidemiology of boutonneuse fever in Western sicily is discussed.
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ranking = 4
keywords = rickettsia
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10/20. ARDS associated with boutonneuse fever.

    The adult respiratory disease syndrome is associated with multiple disorders. At least one of the rickettsial diseases, RMSF, has been reported to be associated with noncardiogenic pulmonary edema. We report herein another rickettsial disease, boutonneuse fever, which is produced by rickettsia conorii and is usually a mild disease, that in our patient was associated with ARDS.
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keywords = rickettsia
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