1/2. Atypical fulminant rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and adult respiratory distress syndrome.Brazilian spotted fever, caused by rickettsia rickettsii, has been increasingly reported in brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with adult Respiratory Distress syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. African tick-bite fever. An imported spotless rickettsiosis.OBJECTIVES: To characterize the clinical presentation and course of African tick-bite fever, a recently rediscovered rickettsiosis caused by Rickettsia africae (a new species within the spotted fever group of rickettsiae), to establish its relationship with Amblyomma tick species, and to discuss its role in the etiology of fever in patients who are returning from the tropics. patients: Seven patients who returned from zimbabwe of the Republic of south africa and presented with fever. methods: Cases were recognized clinically by the presence of multiple taches noire and were diagnosed as having a rickettsial infection by identification of the organisms in circulating endothelial cells. The causative role of R africae was further demonstrated using cross-absorption and immunoblotting of patients' serum samples and isolation of the agent from blood and skin biopsy specimens. Isolates were characterized using the restriction fragment length polymorphism-polymerase chain reaction and sequence analysis of the gene that encodes for the 190-kd Rickettsia-specific antigen. RESULTS: All 7 patients presented with fever and multiple taches noire. Further physical examination of patients revealed lymphadenopathy, lymphangitis, and edema, but there were virtually no signs of a rash. These findings are characteristic of R africae-infected patients and are distinct from those observed in patients with rickettsia conorii-induced Mediterranean spotted fever. All 7 patients were infected with R africae as demonstrated by immunoblotting or isolation of the agent, and all were cured. CONCLUSIONS: With increasing international travel, a need for the recognition of rickettsial diseases by physicians is becoming more important. Tick-bite fever, a disease caused by R africae and transmitted by Amblyomma ticks, is characterized by multiple taches noire, lymphadenopathy, lymphangitis, and edema, but no rash or a discrete rash. It is a frequent but benign disease that physicians should consider when presented with febrile patients returning from southern Africa.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |