Mouffok Nadjet, Parola Philippe, Lepidi Hubert, Raoult Didier
Service des Maladies Infectieuses, Centre Hospitalier Universitaire d'Oran, Algeria.
Int J Infect Dis. 2009 Mar;13(2):227-35. doi: 10.1016/j.ijid.2008.06.035. Epub 2008 Oct 19.
Mediterranean spotted fever (MSF) due to Rickettsia conorii is the most important tick-borne disease occurring in North Africa. However, there are only a few fragmentary reports on the epidemiology and clinical aspects of rickettsioses in North Africa, and cases are still rarely documented. We report herein a prospective study conducted in Oran, the second largest city in Algeria. This disease has not been properly described in Oran or in other Algerian cities.
A total of 167 cases of Mediterranean spotted fever were documented for the first time by the use of reference methods including immunofluorescence serology and Western blot and absorption studies, including isolation in culture by the shell-vial techniques, and molecular tools.
Although some aspects of MSF were found to be in accordance with the general epidemiology of the disease, uncommon aspects were found, including increased incidence and the presence of multiple inoculation eschars in 12% of patients. The role of climatic changes in alterations of host-seeking and feeding behaviors of the vectors, including the brown dog tick Rhipicephalus sanguineus, is discussed. Also, 49% of patients were hospitalized with a severe form. The global death rate was 3.6%, but it was 54.5% in patients hospitalized with major neurological manifestations and multiorgan involvement.
The present report gives a unique panel of clinical aspects of MSF as well as new trends in this disease. Entomological, climatic, and molecular studies are needed to better understand both epidemiological and clinical aspects of MSF.
由康氏立克次体引起的地中海斑疹热（MSF）是北非最重要的蜱传疾病。然而，关于北非立克次体病的流行病学和临床方面仅有一些零散报道，病例记录仍然很少。我们在此报告一项在阿尔及利亚第二大城市奥兰进行的前瞻性研究。这种疾病在奥兰或其他阿尔及利亚城市尚未得到恰当描述。
通过使用包括免疫荧光血清学、蛋白质印迹和吸收研究等参考方法，首次记录了总共167例地中海斑疹热病例，这些方法包括采用空斑技术进行培养分离以及分子工具。
尽管发现MSF的某些方面与该疾病的一般流行病学情况相符，但也发现了一些不常见的方面，包括发病率增加以及12%的患者出现多个接种性焦痂。讨论了气候变化在包括血红扇头蜱在内的病媒寻找宿主和取食行为改变中的作用。此外，49%的患者以重症形式住院。总体死亡率为3.6%，但在伴有主要神经表现和多器官受累的住院患者中死亡率为54.5%。
本报告给出了MSF独特的临床情况以及该疾病的新趋势。需要进行昆虫学、气候学和分子研究，以更好地了解MSF的流行病学和临床方面。
