A case series of spotted fever rickettsiosis with neurological manifestations in Sri Lanka.

Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases (Impact Factor: 2.17). 04/2012; 16(7):e514-7. DOI: 10.1016/j.ijid.2012.02.016
Source: PubMed

ABSTRACT Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations.
The cases were studied prospectively from 2008 at the Teaching Hospital, Peradeniya. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis.
All had an IFA IgG titer ranging from 1/64 to 1/4096 and a positive IFA IgM titer against Rickettsia conorii antigen; in 10 (59%) cases the IgG titers were ≥ 1/256 (definitive cases). The median age of the patients was 62 years (range 26-82 years); 10 were male and seven female. The median duration of fever was 12 days (range 4-35 days). Neurological manifestations on admission were drowsiness or confusion in 14 (82%) and a semi-comatose state in three (18%). Rigidity of the limbs occurred in 14 (82%), bradykinesia and resting tremors in 12 (71%), which persisted after defervescence, neck stiffness in seven (42%), weakness of the limbs in five (29%), deafness in two (12%), and stupor in three (18%). Electroencephalograms in three (18%) showed generalized slow waves. Cerebrospinal fluid examination showed a cellular reaction, predominantly lymphocytes, in three cases. Two patients died (fatality rate 12%).
We have documented for the first time the neurological features of SFG rickettsioses in the Central Province, Sri Lanka. These were predominantly extrapyramidal features in patients of older age.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this review is to describe recent advances in our understanding of the pathogenesis, epidemiology, and clinical features of rickettsial diseases with emphasis placed on those relating to travel and tropical medicine. Rickettsioses are becoming increasingly recognized as causes of febrile illness in travelers and in those residing in the tropics. In South and Central America, infection with Rickettsia rickettsii continues to have severe consequences. Resurgence of Mediterranean spotted fever in Bulgaria highlights the threat of rickettsial infections when there is a lapse in vector and reservoir control. Similar to African tick-bite fever, Rickettsia parkeri is an emerging cause of eschar-associated infection in Brazil, Argentina, and Uruguay. Several reports of murine typhus requiring hospitalization demonstrate the risk of this infection to the traveler. The use of fluoroquinolones for milder spotted fevers may fall out of favor with evidence of deleterious effects in those treated with ciprofloxacin. With globalization and increased access to travel, clinical awareness of rickettsial diseases is of increasing importance. Although the growing number of rickettsial species may be daunting to the clinician, recognition of the patterns of rickettsial disease will ensure prompt and effective therapy.
    Current Opinion in Infectious Diseases 07/2013; · 5.03 Impact Factor
  • Asian Pacific Journal of Tropical Disease. 01/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mediterranean spotted fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a ‘tache noire’, serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman.
    International Journal of Infectious Diseases 09/2014; · 2.33 Impact Factor

Full-text (2 Sources)

Available from
Nov 14, 2014