Clinical study of Japanese spotted fever and its aggravating factors
| Autor: | Yoshimi Chikahira, Tetsuhiko Nomura, Hayato Yamauchi, Takanori Senba, Kazuya Kodama |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Adolescent Multiple Organ Failure Fulminant Minocycline Eschar Gastroenterology Meningoencephalitis Internal medicine Prevalence Coagulopathy Humans Medicine Pharmacology (medical) Rickettsia Child Cytokine Steroid Aged Key words Japanese spotted fever Disseminated intravascular coagulation Respiratory Distress Syndrome Newborn Fibrin degradation product biology business.industry Infant Newborn Receptors Interleukin-2 Rickettsia Infections Soluble interleukin 2 receptor Disseminated Intravascular Coagulation Middle Aged medicine.disease Anti-Bacterial Agents Infectious Diseases Acute Disease Immunology biology.protein Japanese spotted fever Female Original Article Creatine kinase medicine.symptom business medicine.drug |
| Zdroj: | Journal of Infection and Chemotherapy |
| ISSN: | 1341-321X |
| DOI: | 10.1007/s10156-002-0223-5 |
| Popis: | Twenty-eight patients with Japanese spotted fever were clinically investigated. The diagnosis was determined by confirming an increase of specific antibody. All patients were treated with minocycline, and all recovered, excluding one patient with a fulminant course. Fever and exanthema were observed in all patients, and an eschar was pointed out in 20 (71%) patients. The platelet count was 10 x 10(4)/microl or lower in 8 (28%) patients. The fibrin degradation product (FDP)-level was abnormally high, 10 microg/ml or more, in 16 (57%) patients. The creatine kinase (CK) value was high in 14 of 22 patients, suggesting the presence of myositis. The leukocyte count, FDP, C-reactive protein, and soluble interleukin 2 receptor (sIL2-R) levels were significantly higher in severe cases. In the group without concomitant steroid therapy, mean times of 54.7 h and 101.4 h were required to reduce the temperature to 38 degrees C and 37 degrees C or lower, respectively, after the initiation of tetracycline treatment. There were 6 severe cases: 1 with disseminated intravascular coagulation, 2 with multiorgan failure, 1 with acute respiratory distress syndrome, and 2 with meningoencephalitis. These severe cases formed a group that required 6 or more days to initiate therapy after the onset (P < 0.005 vs non-severe group), showing that delay in diagnosis and therapy is the major cause of aggravation. In the 2 patients complicated by multiorgan failure, the sIL2-R level, produced by activated lymphocytes, was 10,000 U/ml or higher, suggesting that an sIL2-R level of more than 10,000 U/ml can be used as a marker of poor prognosis. It may be better that moderate to severe cases are treated with minocycline plus short-term steroid therapy. |
| Databáze: | OpenAIRE |
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