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地中海斑疹热中的冠状动脉受累情况。

Coronary involvement in Mediterranean spotted fever.

作者信息

Cascio Antonio, Maggio Maria Cristina, Cardella Francesca, Zangara Valeria, Accomando Salvatore, Costa Alessandro, Iaria Chiara, Mansueto Pasquale, Giordano Salvatore

机构信息

Dipartimento di Patologia Umana, Università di Messina, Messina, Italy.

出版信息

New Microbiol. 2011 Oct;34(4):421-4. Epub 2011 Oct 31.

Abstract

Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, a maculo-papular rash and a black eschar at the site of the tick bite. We describe the case of a 3-year-old boy with MSF who developed a transient right coronary artery ectasia. The patient was brought to the hospital after four days of fever and mild myalgia of the legs. The suspicion of MSF arose due to the presence of a maculo-papular skin rash and treatment with oral clarithromycin was started. After four days fever persisted and the differential diagnosis of Kawasaki syndrome was considered. Echocardiography showed a dilated right coronary artery with hyperreflective walls. Treatment with intravenous immunoglobulin was initiated while clarithromycin was continued. After one day the fever disappeared. An immunofluorescent antibody test performed after four weeks confirmed a R. conorii infection. A follow-up echocardiography was normal six weeks and six months later. We suggest that ectasia of the coronary arteries may be a manifestation of rickettsial vasculitis. Prospective studies are needed to understand the frequency and the possible consequences of this phenomenon in the course of MSF.

摘要

地中海斑疹热(MSF)是一种由康氏立克次体引起的蜱传急性发热性疾病,其特征为发热、斑丘疹和蜱叮咬部位出现黑色焦痂。我们描述了一例患地中海斑疹热的3岁男孩,该男孩出现了短暂性右冠状动脉扩张。患者在发热及腿部轻度肌痛4天后被送至医院。由于出现斑丘疹性皮疹,怀疑为地中海斑疹热,并开始口服克拉霉素治疗。4天后仍持续发热,考虑川崎病的鉴别诊断。超声心动图显示右冠状动脉扩张,血管壁回声增强。在继续使用克拉霉素的同时,开始静脉注射免疫球蛋白治疗。1天后发热消退。4周后进行的免疫荧光抗体检测证实为康氏立克次体感染。6周和6个月后的随访超声心动图检查结果正常。我们认为冠状动脉扩张可能是立克次体血管炎的一种表现。需要进行前瞻性研究以了解这种现象在地中海斑疹热病程中的发生率及可能后果。

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