Cases reported "Insect Bites and Stings"

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1/5. African tick bite fever: a not-so-uncommon illness in international travelers.

    BACKGROUND: African tick bite fever is a rickettsial illness that has recently emerged as a significant disease among international travelers. The vector is the Amblyomma tick, which is endemic to sub-Saharan africa and parts of the eastern Caribbean. OBSERVATIONS: We describe a middle-aged woman who returned from a mission trip to zimbabwe with an influenzalike illness and inoculation eschar; she also had a history of travel to a game farm. biopsy revealed a histopathologic pattern consistent with an infectious pathogenesis. Immunohistochemical staining confirmed the presence of rickettsial organisms. In light of the patient's history, the clinical constellation of signs and symptoms, and the results of ancillary laboratory testing, a diagnosis of African tick bite fever was made. The patient was treated with doxycycline hydrochloride and had an uncomplicated course. CONCLUSIONS: This report further highlights the epidemiological and clinical features of African tick bite fever. With the increase in international travel, it is important to recognize the illness in those who have been to endemic countries and to counsel patients regarding preventive measures for planned travel.
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keywords = rickettsia
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2/5. Spondweni virus infection in a foreign resident of Upper Volta.

    Spondweni virus is a mosquito-borne flavivirus previously reported to cause human disease in Southern and West africa. A serologically confirmed case of Spondweni virus infection in a U.S. citizen residing in Upper Volta is reported. Symptoms included fever, chills, headache, myalgia, nausea, and rash. A greyish mucoid lining was present on the posterior pharynx. The differential diagnosis included rickettsial infection, leptospirosis, typhoid fever, and numerous viral illnesses including lassa fever. Evidence of Spondweni virus infection was also found in two other U.S. citizens residing in gabon and cameroon. Spondweni virus might be a cause of acute febrile illness throughout West africa, and its presence should be considered in the differential diagnosis of febrile illness and in antibody surveys in that region.
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ranking = 0.5
keywords = rickettsia
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3/5. The occurrence of eschars in rocky mountain spotted fever.

    Two patients with fatal, laboratory-confirmed rocky mountain spotted fever (RMSF) were noted early in their course to have a skin lesion characteristic of a rickettsial eschar. Postmortem immunofluorescent and histopathologic studies demonstrated that the lesions were sites of extensive contiguous infection by rickettsia rickettsii with associated injury to numerous local blood vessels. Rickettsial vasculitis and occlusive luminal thrombosis were associated with dermal and epidermal coagulative necrosis forming the eschars. Both eschars were noted to be the sites of a bite. In one case the arthropod was identified as a tick. The clinical importance of the search for an eschar in a patient suspected of having RMSF is that diagnostic skin biopsy immunofluorescent demonstration of R. rickettsii may be performed prior to the onset of the rash.
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ranking = 0.5
keywords = rickettsia
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4/5. Rickettsialpox: report of an outbreak and a contemporary review.

    Rickettsialpox is a mild illness characterized by the appearance of a primary eschar at the site of a mite bite followed by fever, headache, and a papulovesicular rash. It can be confused with a variety of illnesses including several other rickettsial diseases and chickenpox. R. akari, the etiologic agent, is a rickettsia belonging to the spotted fever group (SFG) of rickettsial illnesses. In spite of significant serologic cross-reactivity with other SFG agents, there is no convincing evidence of cross-immunity to these agents after recovery from rickettsialpox. Tetracyclinie is the drug of choice in the treatment of this disease.
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ranking = 2
keywords = rickettsia
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5/5. Peripheral neuropathies after arthropod stings not due to lyme disease: a report of five cases and review of the literature.

    Five patients developed neurologic symptoms a few hours to 2 months after being stung by a non-hooking arthropod with immediate cutaneous reaction. The patients had no clinical or serologic evidence for Lyme borreliosis and rickettsial disease. Clinical and electrophysiologic findings were consistent with a mixed axonal and demyelinating mononeuropathy, a monomelic multiple mononeuropathy, a mononeuropathy multiplex, a radiculoneuritis, and a distal symmetric polyneuropathy. Muscle and nerve biopsies showed lymphoplasmacytic small-vessel vasculitis in all patients, and wallerian degeneration in three. These patients, and 17 others from the literature, indicate a spectrum of peripheral neuropathies occurring after insect and spider stings.
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keywords = rickettsia
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