1/2. Imported rickettsial disease: clinical and epidemiologic features.PURPOSE AND methods: The rickettsioses continue to constitute major health problems in many parts of the world. With increasing international travel, recognition of rickettsial diseases by physicians is becoming more important. The clinical features of four cases of rickettsial disease imported into canada over a five-year period are presented; two patients with tick typhus (rickettsia conorii), one patient with scrub typhus (R. tsutsugamushi), and one patient with murine typhus (R. typhi). We also present the North American data over the past 10 years from the Centers for disease Control (CDC) (Atlanta). RESULTS: Since 1983 in the united states, three cases of imported scrub typhus, all after travel to india, were confirmed, as well as six cases of murine typhus after travel to southeast asia. At the CDC, 67 imported cases of tick typhus have been confirmed by indirect fluorescent antibody test since 1976; most illnesses occurred after travel to africa. CONCLUSION: Rickettsial diseases are underrecognized by physicians, who should consider these diagnoses in travelers returning from endemic areas. Since effective treatment is available, prompt diagnosis and treatment are important. In all cases, specific serologic confirmation should be obtained.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. life-threatening scrub typhus with meningoencephalitis and acute respiratory distress syndrome.A 21-year-old man presented with fever, rash, seizure, stiff neck and rapidly progressive bilateral pulmonary infiltrates. cerebrospinal fluid (CSF) study revealed pleocytosis with predominant polymorphonuclear cells, and hypo-glycorrhachia. status epilepticus occurred, followed by acute respiratory distress syndrome with respiratory failure. blood and CSF cultures for bacteria were negative, but an indirect immunofluorescence assay revealed a fourfold rise in antibody to Rickettsia tsutsugamushi in paired serum and a 1:2560 ( ) IgM antibody titer. Severe scrub typhus with meningoencephalitis and extensive pneumonitis was diagnosed. The patient survived after intravenous minocycline therapy and intensive care, including aggressive seizure control, supportive mechanical ventilation and avoidance of fluid overloading. He had a nearly complete recovery. Practicing physicians in taiwan should be aware of this reportable disease and its potentially serious complications if not promptly diagnosed and treated.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |