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1/7. diagnosis of acute typhus infection using the polymerase chain reaction.

    The first use of the polymerase chain reaction (PCR) for the diagnosis of an acute rickettsial infection is described. A primer pair derived from the 17-kDa antigen sequence of rickettsia rickettsii gave specific amplification of a 434-base pair dna fragment from the genome of rocky mountain spotted fever and endemic and epidemic typhus. The assay could detect as few as 30 rickettsiae. Detection of PCR-amplified dna with a nonradioactive dna probe confirmed an acute infection with rickettsia prowazekii.
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2/7. Possible typhus-group infection in new york State: presentation of four suspect cases.

    Epidemiologic investigations were recently conducted on four cases which were reported in new york State in 1986 and 1987, three of which were within one family. These included hospital chart reviews, case or family interviews, animal trappings, and ectoparasite surveys. serologic tests and immunoblots were performed on blood samples obtained from these patients. All four patients had acute febrile illnesses; two required hospitalization and one died. Microimmunofluorescence test results using rickettsia typhi and R. prowazekii antigens showed a greater than or equal to 4-fold increase in titer with paired sera from three patients. The remaining patient had a single serum titer of 4096 with both antigens. In addition, sera from all patients reacted with R. typhi in the immunoblot test and, from the three patients for whom sera were available, also with R. prowazekii. Results suggest that the four patients were exposed to the typhus-group rickettsiae or to an organism which shares a common epitope(s).
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3/7. Cardiovascular and pulmonary complications of epidemic typhus.

    A case of typhus fever associated with cardiac and pulmonary complications is reported. The patient was a 24-year-old Egyptian female with characteristic clinical presentation of rickettsial infection, though no rash was present throughout the course of the disease. We could not find a report of such complications in the English medical literature.
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4/7. Rickettsial infection presenting as culture-negative meningitis.

    meningitis is an unusual presentation of rickettsial infection. We report a patient who was confirmed by serology to have typhus fever (not scrub), but who presented with the typical findings of culture-negative bacterial meningitis. Neurological manifestations of different types of rickettsial infection are discussed.
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keywords = rickettsia
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5/7. 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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6/7. Evidence of rickettsia prowazekii infections in the united states.

    From January 1976 through January 1979 serum specimens from 1,575 individuals were received at the Center for disease Control and tested for antibodies to rickettsiae. Of these, sera from eight persons gave serological results indicative of recent infections with epidemic typhus rickettsiae (rickettsia prowazekii). Five of the persons were from georgia, and one each was from tennessee, pennsylvania and massachusetts. The illnesses occurred during the winter, chiefly in persons living in a rural environment. The clinical picture was compatible with louse-borne epidemic typhus. There was no apparent contact with human body or head lice, and no cases occurred in patient contacts, indicating that infection was not associated with the classic man-louse-man cycle of epidemic typhus. Two of the eight patients had contact with flying squirrels suggesting that they became infected from this known extrahuman reservoir of R. prowazekii.
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7/7. papilledema in endemic typhus.

    A 21-year-old women developed severe bilateral papilledema during an acute febrile disease. Her optic disk margins were blurred and the disks were elevated up to 5 diopters. Splinter hemorrhages, cotton-wool exudates, cytoid bodies, and sheathing of veins were also present. The pyrexia was caused by murine typhus diagnosed by serologic tests. These tests revealed that proteus OX-19 agglutination titer rose to 1:12800, and a positive complement fixation test titer was 1:640 with Rickettsia mooseri antigens. Neurological examination results, skull roentgenograms, brain scan, electroencephalogram, and the cerebrospinal fluid were all within normal range, thereby excluding intracranial hypertension. After the patient's recovery from the rickettsial disease, the papilledema abated gradually until her fundi reverted to normal.
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