Cases reported "Rickettsiaceae Infections"

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1/35. Rickettsialpox in north carolina: a case report.

    We report a case of rickettsialpox from north carolina confirmed by serologic testing. To our knowledge, this case is the first to be reported from this region of the united states. Including rickettsialpox in the evaluation of patients with eschars or vesicular rashes is likely to extend the recognized geographic distribution of rickettsia akari, the etiologic agent of this disease. ( info)

2/35. Rickettsialpox in a patient with hiv infection.

    We describe the first case of rickettsialpox in a patient infected with hiv. Immunohistochemical staining of biopsied lesions showed a relatively large number of rickettsiae within the papulovesicular rash. Rickettsialpox is easily treated and may resemble more serious cutaneous eruptions in patients infected with hiv. This diagnosis should be considered in immunocompromised city-dwellers, with fever and a papulovesicular rash. ( info)

3/35. Characterization of a novel Rochalimaea species, R. henselae sp. nov., isolated from blood of a febrile, human immunodeficiency virus-positive patient.

    Isolation of a Rochalimaea-like organism from a febrile patient infected with human immunodeficiency virus was confirmed. Analysis of 16S rRNA gene sequences, together with polymerase chain reaction and restriction endonuclease length polymorphism analysis of a portion of the citrate synthase gene, demonstrated that the agent is closely related to members of the genus Rochalimaea and that the isolate is genotypically identical to the presumptive etiologic agent of bacillary angiomatosis. However, the same genotypic analyses readily differentiated the new isolate from isolates of other recognized Rochalimaea species as well as other genera of bacteria previously suggested as putative etiologic agents of bacillary angiomatosis and related syndromes. We propose that the novel species be referred to as Rochalimaea henselae sp. now. ( info)

4/35. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis.

    BACKGROUND. Bacillary angiomatosis is characterized by vascular lesions, which occur usually in patients infected with the human immunodeficiency virus (hiv). A newly described gram-negative organism, Rochalimaea henselae, has been associated with cutaneous bacillary angiomatosis, but no organism has been isolated and cultivated directly from cutaneous tissue. methods. We used two methods to isolate the infecting bacterium from four hiv-infected patients with cutaneous lesions suggestive of bacillary angiomatosis: cultivation with eukaryotic tissue-culture monolayers and direct plating of homogenized tissue onto agar. The patients' blood was cultured with the lysis-centrifugation method. Isolates recovered from skin and blood were identified by sequencing all or part of the 16S ribosomal rna gene amplified with the polymerase chain reaction. RESULTS. R. quintana, historically known as the agent of trench fever, was isolated from cutaneous lesions in three patients, after tissue homogenates were cultivated with endothelial-cell monolayers; R. henselae was isolated from a cutaneous lesion in one patient. In two patients, R. quintana was isolated from both cutaneous tissue and blood; in one patient it was also isolated from bone. CONCLUSIONS. In bacillary angiomatosis, either of two species of rochalimaea--R. quintana or R. henselae--can be isolated from cutaneous lesions or blood, providing an additional method of diagnosis. ( info)

5/35. Identification of ehrlichia chaffeensis morulae in cerebrospinal fluid mononuclear cells.

    We report a case of ehrlichiosis in a 72-year-old man who developed extreme lethargy, acute renal failure requiring hemodialysis, and respiratory insufficiency requiring intubation. Lumbar puncture performed on the second day of hospitalization revealed significant cellular pleocytosis. Ehrlichia morulae were tentatively identified in mononuclear cells in routinely processed Wright-stained cytospin preparations of cerebrospinal fluid (CSF). Identification was confirmed by a specific immunocytochemical staining procedure. Subsequent identification specifically as ehrlichia chaffeensis morulae was established by polymerase chain reaction analysis, which revealed E. chaffeensis-specific dna in CSF, bone marrow, and blood samples; by indirect fluorescent-antibody analysis, the patient developed an antibody titer of 32,768 against E. chaffeensis antigen. The patient responded to intravenous therapy with doxycycline and dexamethasone. Subsequently, neurologic, hematologic, renal, and pulmonary status had returned to baseline at follow-up 12 weeks after admission. To our knowledge, this is the first identification of E. chaffeensis morulae in CSF cells in an infected patient. ( info)

6/35. Rochalimaea henselae causes bacillary angiomatosis and peliosis hepatis.

    BACKGROUND--Recent studies have demonstrated that a newly described agent of persistent bacteremia, Rochalimaea henselae, and the agent of bacillary angiomatosis are both closely related to Rochalimaea quintana. Bacillary peliosis hepatis seemed likely to have the same etiologic agent as bacillary angiomatosis. We sought these pathologic changes in patients from whom R henselae was cultivated. methods--For two patients whose histopathologic findings we reviewed, additional light and electron microscopy were performed. Their bacterial isolates were compared by electrophoretic patterns of outer membrane proteins, restriction endonuclease digestion patterns of dna, and reaction with murine antiserum. RESULTS--A previously reported human immunodeficiency virus-infected man with persistent bacteremia due to R henselae was found to have bacillary peliosis hepatis. Rochalimaea henselae was also isolated from the spleen of a woman receiving immunosuppressive therapy after allogeneic renal transplantation. She had developed fever, liver and spleen nodules, and periaortic lymphadenopathy. Bacillary peliosis of her liver and spleen, as well as bacillary angiomatosis of liver, spleen, and a lymph node, were found. The bacterial isolates had comparable electrophoretic patterns of outer membrane proteins and of restriction endonuclease-digested dna, which differed from the respective patterns of R quintana. Murine antisera raised to the first isolate reacted strongly with the second by means of immunoblot and immunofluorescence techniques, while reacting only weakly with R quintana. CONCLUSION--Rochalimaea henselae, recently recognized to cause persistent fever and bacteremia in immunocompetent and immunocompromised persons, also causes bacillary angiomatosis and parenchymal bacillary peliosis. ( info)

7/35. Rickettsialpox: report of three cases and a review.

    Rickettsialpox is a rare mite-borne rickettsiosis that is encountered in urban populations in the eastern united states and throughout the world. It is characterized clinically by an eschar, fever, and a papulovesicular eruption. Both of these cutaneous manifestations may be mimicked by infectious diseases that have been designated as bioterrorist agents by the united states Centers for Diseases Control and Prevention: the former by anthrax, and the latter by smallpox. It is thus important for clinicians to be familiar with rickettsialpox. We report 3 cases and review the epidemiology, clinical and laboratory findings, differential diagnosis, and management of this disease. ( info)

8/35. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations.

    Two previously healthy, immunocompetent men had persistent Rochalimaea henselae bacteremia with clinical relapses after courses of antibiotics to which the isolates were ultimately demonstrated susceptible in vitro. Both had sustained tick bites prior to their illnesses, thus demonstrating an association not previously identified, although suspected. The first patient had relapsing fever, constitutional symptoms, and an episode of aseptic meningitis despite therapy with amoxicillin, then with doxycycline, and then with ceftriaxone. Thereafter, he spontaneously became asymptomatic during a span of 2 months of persistent bacteremia. Finally, after 2 weeks of therapy with ceftriaxone plus gentamicin, followed by 4 weeks of therapy with oral ciprofloxacin, his bacteremia was cured. The second man had relapsing fever and constitutional symptoms after courses of tetracycline, then of chloramphenicol, and then of doxycycline. He became permanently asymptomatic after serial 2-week courses of chloramphenicol and erythromycin. The greater efficacy of lysis-centrifugation blood cultures in the recovery of R. henselae was noted. ( info)

9/35. Human ehrlichiosis: a newly recognized tick-borne disease.

    Human ehrlichiosis was first described in the united states in 1986. Since then, more than 215 cases have been reported, including some fatalities. Ehrlichia species belong to the same family as the organism that causes rocky mountain spotted fever. Human ehrlichiosis occurs most frequently in the southern mid-Atlantic and south-central states, during spring and summer months. The clinical presentation is similar to that seen in rocky mountain spotted fever although, with ehrlichiosis, leukopenia is more often found and skin rash is less often noted. Definitive diagnosis is based on acute and convalescent serum antibody titers. ehrlichiosis cannot reliably be distinguished from other common febrile illnesses on the basis of clinical, epidemiologic or laboratory features. Therapy must be initiated empirically in suspected cases. Both ehrlichiosis and rocky mountain spotted fever respond well to tetracycline and chloramphenicol, but not to penicillins or cephalosporins. ( info)

10/35. infection due to ehrlichia canis in children.

    Human ehrlichiosis has a wide spectrum of presentation. This report presents two cases that demonstrate the diversity of the manifestation of ehrlichiosis, from life threatening to a mild viral-like illness. diagnosis requires an understanding of the epidemiology and clinical manifestation of this infection and a high index of suspicion. ( info)
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