Mediterranean spotted fever in pregnancy.

Mediterranean spotted fever has rarely been reported in pregnancy. We report a case occurring in a young pregnant woman, which responded well to treatment with a combination of erythromycin and rifampicin. The treatment of spotted fevers in pregnancy is discussed in detail.     

Mediterranean spotted fever

Rickettsial disease has recently undergone an important evolution, particularly in the field of molecular genetics. This development includes Mediterranean spotted fever (MSF), a tick-borne disease caused by Rickettsia conorii. Important changes have occurred in ecologic and epidemiologic comprehension of the disease, and in the occurrence of severe forms. However, many questions still remain, including the identity of the real vector and reservoir of R conorii, and whether other risk factors exist for a severe form of MSF.     

Arthritis in Mediterranean spotted fever

Summary Although arthralgia is a common complaint in Mediterranean spotted fever, frank arthritis is very unusual. We report two cases of this condition during the course of Mediterranean spotted fever. Synovial fluid was inflammatory in both patients and the disease resolved after doxycycline therapy. Immunofluorescence test forRickettsia conorii in synovial fluid was negative, suggesting a reactive arthritis.

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Arthritis bei Mittelmeer-Fleckfieber

Zusammenfassung Gelenkschmerzen treten bei Mittelmeer-Fleckfieber häufig auf, doch kommt es sehr selten zur Arthritis, wie in zwei Fällen berichtet wird. Bei beiden Patienten war die Gelenkflüssigkeit entzündlich verändert; Doxycyclin-Therapie führte zur Heilung.Rickettsia conorii konnte immunfluoreszenzmikroskopisch nicht in der Gelenkflüssigkeit nachgewiesen werden, was auf eine reaktive Arthritis schließen läßt.

     

Clusters of Mediterranean spotted fever in Israel

Mediterranean spotted fever (MSF) usually occurs as sporadic cases. We report five clusters of MSF in Israel. Each cluster consisted of two to three patients. In two clusters, one patient died while the other recovered. In the other three clusters the patients presented with a benign course of the disease. The diagnosis of MSF in the fatal cases was confirmed by nested-polymerase chain reaction (PCR) tests performed on samples obtained from internal organs. Rickettsial DNA was also found in a tick obtained from a dog owned by one of the patients. MSF was diagnosed in the recovered patients by serology. The diagnosis of MSF fever in one family member should raise the awareness to the possibility of other cases in the vicinity.     

Mediterranean spotted fever in an American woman

Mediterranean spotted fever is common in southern Europe, the Middle East, and North Africa, but is unknown in the United States. It has a clinical picture resembling Rocky Mountain spotted fever, but it is a milder disease. We report a case of Mediterranean spotted fever in a young American woman returning from Morocco and review the clinical picture of this disease.     

Polymerase chain reaction-based diagnosis of Mediterranean spotted fever in serum and tissue samples

A nested polymerase chain reaction (PCR) assay has been developed and used in the diagnosis of fatal and benign cases of Mediterranean spotted fever (MSF). The test was based on specific primers derived from a Rickettsia conorii 17-kD protein gene. A positive signal was obtained from spotted fever group (SFG) and typhus group (TG) rickettsiae. Discrimination between SFG and TG rickettsiae was based on a restriction fragment length polymorphism test. Other gram-negative bacterial species tested did not generate a signal, attesting for the specificity of the assay. The SFG-specific DNA fragment was detected in four of 29 acute-phase sera from serologically confirmed patients with MSF, while acute-phase sera from 25 patients without MSF were PCR negative. Acute-phase sera samples (five of five) and tissue autopsies (six of seven) from fatal suspected cases of MSF were PCR positive. The results demonstrate that sera and tissue samples are suitable specimens for the nested PCR tests, especially in fatal cases.     

T lymphocyte subsets in Mediterranean spotted fever

Several studies have previously suggested the possible role of a T lymphocyte suppressor population in infections by species of the genus Rickettsia. In 15 patients with Mediterranean spotted fever (MSF), we quantified, during the acute and convalescent phases of the disease, the peripheral blood lymphocyte populations using monoclonal antibodies that recognize CD3+, CD4+, CD8+, CD38+ and CD20+ cells. In three cases a reversal in the normal ratio of T lymphocyte helper-inducer/suppressor-cytotoxic subsets was detected lasting, in two of them, up to the fifth week of the disease. This disturbance was always weak and lacked clinical significance.     

Mediterranean spotted fever presenting as an acute pancreatitis

Mediterranean spotted fever (MSF) is an infectious disease, caused by Rickettsia conorii. It can have a serious course, even deadly, with many types of complications. Described is a case of a 70-year-old man, hospitalized for fever, abdominal pain, amylase and lipase elevation, and ultrasound hypoechoic pancreas. The working diagnosis at admission was acute pancreatitis. 2 days after admission, the patient developed signs of MSF: fever, maculopapular rash, and "tache noire". Treatment with oral doxycycline was started. After 5 days of therapy, there was complete remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with Mediterranean spotted fever. Much more rare is pancreatic involvement.     

Pulmonary thrombosis as a complication of Mediterranean spotted fever

INTRODUCTION: Thromboembolic complications were uncommon in mediterranean spotted fever. OBSERVATION: We report a case of 55-years- old man who was admitted for mediterranean spotted fever. Two days later, the patient developed chest pain due to a pulmonary thrombosis confirmed by angio-CT. The outcome was good with heparin therapy. The investigation for another cause of thrombosis was negative. CONCLUSION: Mediterranean spotted fever is usually a moderately severe self-limited illness. Pulmonary thrombosis was uncommon associated with severe disease.     

Laboratory-confirmed Mediterranean spotted fever in a Japanese traveler to Kenya

A Japanese traveler returning from Kenya became ill, presenting with fever and a prominent, generalized rash without an eschar. Results of the immunofluorescence antibody assay of the patient's sera performed in Japan were compatible with illness due to a spotted fever group (SFG) rickettsia, and a presumptive diagnosis of African SFG rickettsiosis, probably either Mediterranean spotted fever (MSF) or African tick-bite fever (ATBF), was rendered. To further define the disease diagnosis, sera were examined in France by Western immunoblotting combined with cross-adsorption, which confirmed the diagnosis of MSF but not of ATBF. Because of the need to further characterize the epidemiologic and clinical features of the two African SFG rickettsioses, clinicians are encouraged to contact a specialized laboratory when encountering such cases.     

Cerebral infarction: an unusual complication of Mediterranean spotted fever

Mediterranean spotted fever is a rickettsiosis caused by Rickettsia conorii and transmitted by the brown dog tick. It is considered as a benign disease but 5% to 10% of patients present with a malignant form which is the result of a diffuse vasculitis. We report here the first case of Mediterranean spotted fever with cerebral vasculitis and thrombosis leading to a massive cerebral infarct and death.     

Mediterranean spotted fever: a cooperative study of 227 cases

The clinical manifestations of 227 cases of Mediterranean spotted fever (Boutonneuse fever) were reviewed, and the epidemiologic aspects of 170 cases from the Vallés Occidental region in the county of Barcelona, Spain, were analyzed. In this area an increase in the incidence of the disease has been noticed during the last several years. The patients evaluated presented with high fever and a generalized maculopapular rash. The tache noire at the site of the tick bite was seen in 166 cases (73%). Other common clinical manifestations were myalgia (73%), headache (69%), conjunctivitis (32%), hepatomegaly (44%), and splenomegaly (19%). Hepatic function tests (serum glutamic-pyruvic transaminase, serum glutamic-oxaloacetic transaminase) gave abnormal results in 55% of all cases. The Weil-Felix reaction was positive in 79% of the cases; the OX19 strain of Proteus vulgaris was the strain most frequently agglutinated. Treatment with oral oxytetracycline or chloramphenicol was effective in all cases.