Host and microbial risk factors and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients
| Autor: | Rita de Sousa, Adelaide Belo, Fátima Bacellar, Tiago Abreu, Paula Proença, David H. Walker, Nahed Ismail, José Vaz, Ana França, Sónia Dória Nóbrega, Mário Amaro, Jorge Torgal, José Poças |
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| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Comorbidity Boutonneuse Fever Article Risk Factors Internal medicine medicine Humans Immunology and Allergy Prospective Studies Leukocytosis Risk factor Portugal biology business.industry Incidence (epidemiology) Rickettsia Infections Petechial rash Acute Kidney Injury medicine.disease biology.organism_classification Spotted fever Boutonneuse fever Rickettsia conorii Infectious Diseases Rickettsiosis Multivariate Analysis Immunology medicine.symptom business |
| Popis: | Background. The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. Methods. This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients withRickettsiaconorii infection admitted to 13 Portuguese hospitals during 1994 –2006 with documented identification of the rickettsial strain causing their infection. Results. A total of 71 patients (51%) were infected with the Malish strain ofRickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain–infected patients. Conclusions. Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome. Mediterranean spotted fever (MSF), Israeli spotted fever (ISF), Indian tick typhus, and Astrakhan spotted fever are caused by distinct strains of Rickettsia conorii. These strains exhibit minor antigenic and genotypic differences and have been hypothesized to cause distinctive clinical signs, as well as disease of differing severity [1, 2]. In Portugal, MSF is caused by R. conorii Malish and ISF strains [3]. The incidence of MSF was 8.4 infections |
| Databáze: | OpenAIRE |
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