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1/19. Acute disseminated encephalomyelitis after rocky mountain spotted fever.

    Although acute disseminated encephalomyelitis has been observed after a variety of viral infections and an occasional bacterial infection, it has not been reported in association with rickettsial infections. Reported is a 7-year-old male with magnetic resonance images and clinical manifestations suggestive of acute disseminated encephalomyelitis after a tick bite and serologically proven rocky mountain spotted fever.
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keywords = rickettsia
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2/19. Evidence of rickettsial spotted fever and ehrlichial infections in a subtropical territory of Jujuy, argentina.

    Between November 1993 and March 1994, a cluster 6 pediatric patients with acute febrile illnesses associated with rashes was identified in Jujuy Province, argentina. Immunohistochemical staining of tissues confirmed spotted fever group rickettsial infection in a patient with fatal disease, and testing of serum of a patient convalescing from the illness by using an indirect immunofluorescence assay (IFA) demonstrated antibodies reactive with spotted fever group rickettsiae. A serosurvey was conducted among 16 households in proximity to the index case. Of 105 healthy subjects evaluated by IFA, 19 (18%) demonstrated antibodies reactive with rickettsiae or ehrlichiae: 4 had antibodies reactive with rickettsia rickettsii, 15 with ehrlichia chaffeensis, and 1 with R. typhi. Amblyomma cajennense, a known vector of R. rickettsii in south america, was collected from pets and horses in the area. These results are the first to document rickettsial spotted fever and ehrlichial infections in argentina.
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keywords = rickettsia
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3/19. family cluster of rocky mountain spotted fever.

    Soon after a patient from tennessee died of rocky mountain spotted fever (RMSF), several family members developed symptoms suggestive of the disease and were treated presumptively for RMSF. Fifty-four persons visiting the index patient's home were interviewed; serum samples were collected from 35. Three additional cases of RMSF were confirmed, all of which occurred in first-degree relatives. time spent at the family home and going into the surrounding woods were significantly associated with developing antibodies to rickettsia rickettsii. ticks were collected and examined for rickettsiae by polymerase chain reaction analysis. Because hyperendemic foci and family clusters of RMSF can occur, when a case is suspected clinicians should be vigilant for signs and symptoms consistent with R. rickettsii infection in other persons who may have been similarly exposed.
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keywords = rickettsia
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4/19. Spotted fever rickettsiosis in Coronel Fabriciano, Minas Gerais State.

    We report cases of spotted fever rickettsiosis in Coronel Fabriciano Municipality of Minas Gerais State, brazil. The cases occurred in May and June of 2000. During this period there were two deaths among children from an area named Pedreira in a periurban area of this municipality. In a boy who died with clinical manifestations of Brazilian spotted fever, a necropsy revealed the presence of a spotted fever group Rickettsia. The serological results confirm the difficulty in the differential diagnosis of patients with symptoms of rickettsial diseases.
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keywords = rickettsia
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5/19. Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the united states.

    ticks, including many that bite humans, are hosts to several obligate intracellular bacteria in the spotted fever group (SFG) of the genus Rickettsia. Only rickettsia rickettsii, the agent of rocky mountain spotted fever, has been definitively associated with disease in humans in the united states. Herein we describe disease in a human caused by Rickettsia parkeri, an SFG rickettsia first identified >60 years ago in Gulf Coast ticks (Amblyomma maculatum) collected from the southern united states. Confirmation of the infection was accomplished using serological testing, immunohistochemical staining, cell culture isolation, and molecular methods. Application of specific laboratory assays to clinical specimens obtained from patients with febrile, eschar-associated illnesses following a tick bite may identify additional cases of R. parkeri rickettsiosis and possibly other novel SFG rickettsioses in the united states.
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6/19. A rickettsial mixed infection in a dermacentor variabilis tick from ohio.

    We present the first report of superinfection in a dermacentor variabilis tick from nature. The single tick, collected in ohio, was found infected with Rickettsia belli, R. nontanensis, and R. rickettsii.
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keywords = rickettsia
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7/19. A focus of rocky mountain spotted fever within new york city.

    In the spring and summer of 1987, four persons acquired rocky mountain spotted fever within new york city, an area in which the disease had not previously been known to be endemic. Three of the four patients were residents of the Soundview area of the Bronx. All diagnoses were confirmed by indirect fluorescent-antibody tests. Environmental investigation revealed that the tick vector for rickettsia rickettsii, dermacentor variabilis, was present in a local park. Of the 66 specimens of D. variabilis collected, 5 (8 percent) were positive for rickettsiae from the spotted fever group. Of an additional 96 specimens of D. variabilis, 5 (5 percent) were found positive for rickettsiae by a more specific monoclonal antibody assay. Eight additional new york city parks in all five boroughs were searched for ticks. D. variabilis was found in only one other park; of the 147 ticks collected there, none were positive for rickettsiae. These findings emphasize the focal nature of rocky mountain spotted fever and the need to consider that disease in the differential diagnosis of any obscure acute febrile illness, even in the absence of a history of travel to known endemic areas.
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ranking = 3
keywords = rickettsia
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8/19. epidemiology and ecology of rickettsial diseases in the People's Republic of china.

    Since 1949, information on rickettsial diseases in the People's Republic of china has been virtually nonexistent in the West. This is the first comprehensive review of the ecology and epidemiology of Chinese rickettsial diseases to be published outside the People's Republic. At least five rickettsioses exist in china: scrub typhus, murine typhus, epidemic typhus, q fever, and one or more spotted fever-group (SFG) rickettsioses. Although epidemic typhus has been controlled and scrub typhus has abated in many areas, murine typhus, q fever, and SFG rickettsiosis are important public health problems. Serologic surveys indicate high prevalences of antibodies to coxiella burnetii, Rickettsia tsutsugamushi, and SFG rickettsiae in some regions; these rickettsiae have been isolated from humans, arthropods, and animals. doxycycline has emerged as the best treatment for murine typhus, epidemic typhus, and scrub typhus. china offers both opportunities and challenges for the investigation and alleviation of the problems of rickettsial diseases.
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ranking = 9
keywords = rickettsia
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9/19. meningoencephalitis as a major manifestation of rocky mountain spotted fever.

    Although our two patients had very different courses, both illustrate the gravity of rickettsial meningoencephalitis. The presence of neurologic signs and symptoms is ominous and should be recognized as a possible manifestation of rocky mountain spotted fever. A high index of suspicion for RMSF needs to be maintained in patients with an acute febrile illness, especially in endemic areas, even during periods other than "tick season," and in patients without a rash.
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ranking = 1
keywords = rickettsia
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10/19. The ocular manifestations of rocky mountain spotted fever.

    To our knowledge, this is the first report of an iris nodule in a case of rocky mountain spotted fever (RMSF). The iris nodule may be similar to the "typhus nodule" of the central nervous system reported at autopsy in patients with typhus rickettsial disease. Previous case reports of RMSF have emphasized either anterior uveitis or retinal vasculitis. In the case reported here, both occurred in our patient as a result of RMSF. Also, we review the ophthalmic literature on rickettsial disease.
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ranking = 2
keywords = rickettsia
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