scholarly journals Mediterranean Spotted Fever: Current Knowledge and Recent Advances

2021 ◽  
Vol 6 (4) ◽  
pp. 172
Author(s):  
Nikolaos Spernovasilis ◽  
Ioulia Markaki ◽  
Michail Papadakis ◽  
Nikolaos Mazonakis ◽  
Despo Ierodiakonou
Keyword(s):  
Clinical Features ◽  
Current Knowledge ◽  
Spotted Fever ◽  
Rhipicephalus Sanguineus ◽  
Molecular Techniques ◽  
Rickettsia Conorii ◽  
Mediterranean Spotted Fever ◽  
Spotted Fever Group ◽  
Serological Tests ◽  
True Nature

Mediterranean spotted fever (MSF) is an emerging tick-borne rickettsiosis of the spotted fever group (SFG), endemic in the Mediterranean basin. By virtue of technological innovations in molecular genetics, it has been determined that the causative agent of MSF is Rickettsia conorii subspecies conorii. The arthropod vector of this bacterium is the brown dog tick Rhipicephalus sanguineus. The true nature of the reservoir of R. conorii conorii has not been completely deciphered yet, although many authors theorize that the canine population, other mammals, and the ticks themselves could potentially contribute as reservoirs. Typical symptoms of MSF include fever, maculopapular rash, and a characteristic eschar (“tache noire”). Atypical clinical features and severe multi-organ complications may also be present. All of these manifestations arise from the disseminated infection of the endothelium by R. conorii conorii. Several methods exist for the diagnosis of MSF. Serological tests are widely used and molecular techniques have become increasingly available. Doxycycline remains the treatment of choice, while preventive measures are focused on modification of human behavior and vector control strategies. The purpose of this review is to summarize the current knowledge on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of MSF.

Rickettsiosis

2015 ◽  
Author(s):  
Emmanuel A. Burdmann ◽  
Vivekanad Jha
Keyword(s):  
Serum Creatinine ◽  
Spotted Fever ◽  
Renal Involvement ◽  
Adverse Outcomes ◽  
Rickettsia Conorii ◽  
Mediterranean Spotted Fever ◽  
Spotted Fever Group ◽  
Rocky Mountain Spotted Fever ◽  
Murine Typhus ◽  
Epidemic Typhus

Rickettsiae are obligate intracellular bacteria transmitted by arthropods to a vertebrate host. Clinically relevant rickettsioses have a similar clinical pattern, manifesting as an acute febrile disease accompanied by headache, articular and muscle pain, and malaise.Epidemic typhus is a worldwide distributed disease caused by the Rickettsia prowazekii, with a human louse as a vector. Data on epidemic typhus-related renal injury is extremely scarce.Murine typhus is caused by the Rickettsia typhi and has a rodent flea as the vector. It is one of the most frequent rickettsioses, and is usually a self-limited febrile illness. Proteinuria, haematuria, elevations in serum creatinine (SCr) and/or blood urea nitrogen (BUN) and AKI have been reported. The real frequency of renal involvement in murine typhus is unknown. Renal abnormalities recover after the infectious disease resolution.Scrub typhus, caused by the Orientia tsutsugamushi, has the Leptotrombidium mite larva as vector. It is endemic in the Tsutsugamushi triangle delimited by Japan, Australia, India, and Siberia. It can manifest either as a self-limiting disease or as a severe, life-threatening multiorgan illness. Early administration of adequate antibiotics is essential to prevent adverse outcomes. Proteinuria, haematuria, and acute kidney injury (AKI) are frequent.Tick-borne rickettsioses are caused by bacteria from the spotted fever group and have ticks as vectors. Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii. It is the most severe of the spotted fever rickettsial diseases, causing significant morbidity and lethality. RMSF occurs in North, Central, and South America. Renal impairment is frequent in severe forms of RMSF. Mediterranean spotted fever is caused by Rickettsia conorii, and is endemic in the Mediterranean area. It is usually a benign disease, but may have a severe course, clinically similar to RMSF. Haematuria, proteinuria, increased serum creatinine, and AKI may occur. Japanese spotted fever is caused by Rickettsia japonica. Lethal cases are reported yearly and AKI has occurred in the context of multiple organ failure.

scholarly journals Levels of certain endothelial biomarkers during the acute phase and convalescence in patients with different severity of mediterranean spotted fever

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 17-25 ◽  
Author(s):  
Ivan G. Baltadzhiev ◽  
Mariana A. Murdjeva
Keyword(s):  
Adhesion Molecules ◽  
Spotted Fever ◽  
Rhipicephalus Sanguineus ◽  
Cellular Adhesion ◽  
Acute Stage ◽  
Rickettsia Conorii ◽  
Mediterranean Spotted Fever ◽  
Serum Samples ◽  
Monocyte Chemoattractant Protein 1 ◽  
Cellular Adhesion Molecules

ABSTRACT INTRODUCTION: Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii subspp. conorii. It is transmitted by the bite of the tick Rhipicephalus sanguineus. Modified by the rickettsial invasion, the micro-vascular endothelium acquires an activated inflammatory phenotype and initiates secretion of cytokines and expression of cell adhesion molecules (CAMs) and chemoattractans. AIM: This study aims at investigating the alterations in the soluble cellular adhesion molecules (sCAMs) and chemokine MCP-1 levels in patients with MSF of varying severity in the acute and convalescence stage in order to assess their diagnostic and prognostic value. MATERIALS AND METHODS: The soluble forms of cellular adhesion molecules (sCAMs) - sЕ- selectin and sР-selectin, the intercellular (sICAM-1) and vascular (sVCAM-1) adhesion molecules as well as the monocyte chemoattractant protein-1 (MCP-1) were studied in the sera of 80 patients with MSF. The presence of MSF was confirmed serologically by indirect fluorescence assay (IFA). In order to study disease dynamics, serum samples from 80 patients were drawn on day 1 following the onset of rash; in 60 patients (part of the surveyed 80) a second sample was taken in the convalescence period - 14 days post hospital discharge. The investigation was focused on mild, moderate and severe forms of MSF. Enzyme linked immune-sorbent assay was used for sCAMs determination (Quantikine IVD colorimetric ELISA). RESULTS: Overall, in the acute stage, patients presented with increased levels of sЕ-selectin, sICAM-1, sVCAM-1 and MCP-1, whereas sР-selectin level was decreased. The levels of sЕ-selectin, sICAM-1 and sVCAМ-1 were significantly elevated in mild, moderate and severe forms of the disease with sE-selectin level exhibiting a plateau tendency and sICAM and sVCAM levels demonstrating an upward trend from mild towards severe MSF forms. MCP-1 level was elevated only in severe MSF. In all forms of MSF, in the convalescence period, sICAM-1, sVCAM-1 and МСР-1 concentration returned to reference levels whereas sE-selectin level persisted elevated. In the convalescence stage, sP- selectin concentration also showed an upward tendency, which in severe forms of MSF slightly exceeded the level in controls. sP-selectin levels correlated directly with platelet count, whereas sICAM-1 and sVCAM-1 levels showed a reverse correlation. sE-selectin, sICAM-1 and MCP-1 levels directly correlated with aminotransferase activity (ALT and/or AST). CONCLUSION: The soluble forms of CAMs reflect the endothelial inflammatory potential. There is evidence that endothelium activation is more potent in severe forms of MSF. Assessment of the endothelial response in the course of the disease is an important predictor of the outcome, the choice of therapeutic approach and disease prognosis.

scholarly journals A Rare Case of Mediterranean Spotted Fever and Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Raquel Sousa Almeida ◽  
Petra M. Pego ◽  
Maria João Pinto ◽  
João Matos Costa
Keyword(s):  
Rare Case ◽  
Spotted Fever ◽  
Rhipicephalus Sanguineus ◽  
Clinical Suspicion ◽  
Rickettsia Conorii ◽  
Mediterranean Spotted Fever ◽  
Neurological Manifestations ◽  
Limited Disease ◽  
Initiation Of Therapy ◽  
Dog Tick

Mediterranean spotted fever is a tick-borne zoonotic disease caused byRickettsia conorii. It is transmitted by the dog tickRhipicephalus sanguineus. It usually presents as a benign self-limited disease characterized by a skin rash, high fever, and, sometimes, a characteristic ulcer at the tick bite site calledtache noir. The course of this disease is usually benign, although severe manifestations have been previously described, mainly in adults. Neurological manifestations are very unusual. We present a case of Mediterranean spotted fever with encephalitis to highlight the importance of clinical suspicion, mainly in endemic areas, the potential severity of this disease, and the need of early initiation of therapy in order to prevent severe complications.

scholarly journals Rickettsia parkeri: a Rickettsial pathogen transmitted by ticks in endemic areas for spotted fever rickettsiosis in southern Uruguay

2012 ◽  
Vol 54 (3) ◽  
pp. 131-134 ◽  
Author(s):  
José M. Venzal ◽  
Agustín Estrada-Peña ◽  
Aránzazu Portillo ◽  
Atilio J. Mangold ◽  
Oscar Castro ◽  
...  
Keyword(s):  
Dna Sequences ◽  
Spotted Fever ◽  
Rhipicephalus Sanguineus ◽  
Rickettsia Conorii ◽  
Spotted Fever Group ◽  
Rickettsia Parkeri ◽  
Molecular Tests ◽  
Glta Gene ◽  
Dna Pools ◽  
Human Infections

At first Rickettsia conorii was implicated as the causative agent of spotted fever in Uruguay diagnosed by serological assays. Later Rickettsia parkeri was detected in human-biting Amblyomma triste ticks using molecular tests. The natural vector of R. conorii, Rhipicephalus sanguineus, has not been studied for the presence of rickettsial organisms in Uruguay. To address this question, 180 R. sanguineus from dogs and 245 A. triste from vegetation (flagging) collected in three endemic localities were screened for spotted fever group (SFG) rickettsiosis in southern Uruguay. Tick extracted DNA pools were subjected to PCR using primers which amplify a fragment of the rickettsial gltA gene. Positive tick DNA pools with these primers were subjected to a second PCR round with primers targeting a fragment of the ompA gene, which is only present in SFG rickettsiae. No rickettsial DNA was detected in R. sanguineus. However, DNA pools of A. triste were found to be positive for a rickettsial organism in two of the three localities, with prevalences of 11.8% to 37.5% positive pools. DNA sequences generated from these PCR-positive ticks corresponded to R. parkeri. These findings, joint with the aggressiveness shown by A. triste towards humans, support previous data on the involvement of A. triste as vector of human infections caused by R. parkeri in Uruguay.

scholarly journals New Spotted Fever Group Rickettsia Isolate, Identified by Sequence Analysis of Conserved Genomic Regions

Pathogens ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 11
Author(s):  
Dar Klein ◽  
Adi Beth-Din ◽  
Regev Cohen ◽  
Shirley Lazar ◽  
Itai Glinert ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Spotted Fever ◽  
Diagnostic Procedures ◽  
Clinical Samples ◽  
Severe Illness ◽  
Rickettsia Conorii ◽  
Spotted Fever Group ◽  
Rickettsia Species ◽  
Questing Ticks ◽  
Absolute Identity

The clinical features of spotted fever group (SFG) Rickettsia induced disease range from a mild to severe illness. The clinical complexity is even greater due to the fact that the disease can be caused by different species with varying degrees of virulence. Current knowledge asserts that the Israeli SFG (ISF) strain Rickettsia conorii israelensis is the only human pathogenic SFG member in Israel. Current diagnostic procedures distinguish between SFG and the typhus group rickettsiosis, assuming all SFG-positive clinical samples positive for ISF. Molecular studies on questing ticks over the past decade have uncovered the existence of other SFG strains besides ISF in Israel and the region. This study describes the first documented analysis of SFG-positive samples from Israeli patients with the goal of distinguishing between ISF and non-ISF SFG strains. We managed to identify a new Rickettsia isolate from three independent clinical samples in Israel which was shown to be an as-yet unknown SFG member, showing no absolute identity with any known Rickettsia species present in the NCBI database.

Genetic characterization of spotted fever group rickettsiae in questing ixodid ticks collected in Israel and environmental risk factors for their infection

Parasitology ◽  
2017 ◽  
Vol 144 (8) ◽  
pp. 1088-1101 ◽  
Author(s):  
JESSICA ROSE ◽  
YAARIT NACHUM-BIALA ◽  
KOSTA Y. MUMCUOGLU ◽  
MOH A. ALKHAMIS ◽  
ADI BEN-NUN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spotted Fever ◽  
Molecular Techniques ◽  
Ixodid Ticks ◽  
Geographical Information ◽  
Rickettsia Conorii ◽  
Spotted Fever Group ◽  
Gis Analysis ◽  
Spotted Fever Group Rickettsiae ◽  
Rickettsia Massiliae

SUMMARYThis study aimed to genetically characterize spotted fever group rickettsiae (SFGR) in questing ixodid ticks from Israel and to identify risk factors associated with SFGR-positive ticks using molecular techniques and geographic information systems (GIS) analysis. 1039 ticks from the genusRhipicephaluswere collected during 2014. 109/1039 (10·49%) carried SFGR-DNA of eitherRickettsia massiliae(95), ‘CandidatusRickettsia barbariae’ (8) orRickettsia conorii(6). Higher prevalence of SFGR was found inRhipicephalus turanicus(18·00%) compared withRhipicephalus sanguineussensu lato (3·22%).Rickettsia massiliaewas the most commonly detected species and the most widely disseminated throughout Israel (87·15% of allRickettsia-positive ticks). GIS analysis revealed that Central and Northern coastal regions are at high risk for SFGR. The presence of ticks was significantly associated with normalized difference vegetation index and temperature variation over the course of the year. The presence of rickettsiae was significantly associated with brown type soils, higher land surface temperature and higher precipitation. The latter parameters may contribute to infection of the tick with SFGR. Health care professionals should be aware of the possible exposure of local communities and travellers toR. massillae. Molecular and geographical information can help professionals to identify areas that are susceptible to SFGR-infected ticks.

scholarly journals An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
N. D. B. Ehelepola ◽  
G. D. N. R. Kumara ◽  
S. A. C. S. Sapurugala ◽  
W. M. N. P. Buddhadasa ◽  
Wasantha P. Dissanayake
Keyword(s):  
Spotted Fever ◽  
Supportive Therapy ◽  
Febrile Illness ◽  
Hemorrhagic Fever ◽  
Rickettsia Conorii ◽  
Spotted Fever Group ◽  
Serological Tests ◽  
Dark Urine ◽  
Weil’S Disease ◽  
Weil's Disease

A 65-year-old previously healthy male presented to us on the fourth day of a febrile illness with headache, arthralgia, myalgia, nausea, cough, chest pain, sore throat, and passing of watery stools and dark urine with a history of exposure to leptospirosis during a dengue outbreak. On examination, there was dehydration and hypovolemia, and an ultrasound scan revealed capillary leakage. His liver transaminases, serum creatine, blood urea, C-reactive protein, and neutrophil percentage were high, and thrombocytopenia was present. Moreover, myocarditis has been detected too. Supportive therapy with intravenous ceftriaxone was administered, considering possible Weil’s disease or dengue hemorrhagic fever with secondary bacterial infection. Serological tests, performed later, diagnosed him with a Rickettsia conorii infection and excluded dengue, leptospirosis, and hantavirus infections. Repeat 2D echocardiograms showed mild improvement of his cardiac failure after one month and a more improvement after eight months. Clinical features of the rickettsial spotted fever group (SFG) and leptospirosis overlap. Leptospirosis is common; thus, the risk of overlooking SFG and diagnosing leptospirosis is likely. Tests for differentiation are unavailable in Sri Lankan hospitals and in many other developing countries. Empirical doxycycline in suspected cases of SFG infections in areas where rickettsioses are prevalent can save lives as in this case.

scholarly journals The Rickettsial OmpB β-Peptide of Rickettsia conorii Is Sufficient To Facilitate Factor H-Mediated Serum Resistance

2012 ◽  
Vol 80 (8) ◽  
pp. 2735-2743 ◽  
Author(s):  
Sean P. Riley ◽  
Jennifer L. Patterson ◽  
Juan J. Martinez
Keyword(s):  
Human Serum ◽  
Spotted Fever ◽  
Factor H ◽  
Rickettsia Conorii ◽  
Serum Resistance ◽  
Mediterranean Spotted Fever ◽  
Spotted Fever Group ◽  
Serum Complement ◽  
Additional Function ◽  
Content Type

ABSTRACTPathogenic species of the spotted fever groupRickettsiaare subjected to repeated exposures to the host complement system through cyclic infections of mammalian and tick hosts. The serum complement machinery is a formidable obstacle for bacteria to overcome if they endeavor to endure this endozoonotic cycle. We have previously demonstrated that that the etiologic agent of Mediterranean spotted fever,Rickettsia conorii, is susceptible to complement-mediated killing only in the presence of specific monoclonal antibodies. We have also shown that in the absence of particular neutralizing antibody,R. conoriiis resistant to the effects of serum complement. We therefore hypothesized that the interactions between fluid-phase complement regulators and conserved rickettsial outer membrane-associated proteins are critical to mediate serum resistance. We demonstrate here thatR. conoriispecifically interacts with the soluble host complement inhibitor, factor H. Depletion of factor H from normal human serum rendersR. conoriimore susceptible to C3 and membrane attack complex deposition and to complement-mediated killing. We identified the autotransporter protein rickettsial OmpB (rOmpB) as a factor H ligand and further demonstrate that the rOmpB β-peptide is sufficient to mediate resistance to the bactericidal properties of human serum. Taken together, these data reveal an additional function for the highly conserved rickettsial surface cell antigen, rOmpB, and suggest that the ability to evade complement-mediated clearance from the hematogenous circulation is a novel virulence attribute for this class of pathogens.

scholarly journals Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan

2017 ◽  
Vol 11 (03) ◽  
pp. 242-246 ◽  
Author(s):  
Omar Nafi ◽  
Yasseen Tarawnah ◽  
Amjad Tarawnah
Keyword(s):  
Rural Areas ◽  
Spotted Fever ◽  
Specific Treatment ◽  
Rickettsia Conorii ◽  
Mediterranean Spotted Fever ◽  
Cure Rate ◽  
Serological Tests ◽  
Laboratory Findings ◽  
Route Of Transmission ◽  
High Index Of Suspicion

Introduction: The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan. Methodology: A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected. Results: In total, 35 male and 20 female patients (mean age: 6 years ± 3.6) were included. The incidence of MSF was 7.9 cases/100,000 inhabitants/year; MSF affected 89% of individuals in the summer, 74.5% of those living in a rural area with tent housing, and 100% of those who had contact with animals. All cases presented with fever, and 94.5% had a skin rash. Serological tests were positive in 87.2% of cases, and Rickettsia conorii (the Moroccan strain) was present in all positive cases. All cases had thrombocytopenia, but none had leukocytosis. Hyponatremia was present in 71% of cases, and 49%, 61.8%, and 72.7% had increased urea, alanine transaminase, and aspartate aminotransferase levels, respectively. Doxycycline was administered to all patients, with a cure rate of 96.4% and mortality rate of 3.6%. Conclusions: MSF caused by R. conorii (the Moroccan strain) is prevalent in Jordan, and contact with animals is the route of transmission. The patients’ responses to doxycycline were excellent. A high index of suspicion, early diagnosis, and specific treatment considerably decrease mortality. MSF should be considered as a possible cause of febrile disease in those with a rash and in those living in rural areas.

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