Switaj Karolina, Chmielewski Tomasz, Borkowski Piotr, Tylewska-Wierzbanowska Stanislawa, Olszynska-Krowicka Maria
Medical University of Warsaw, Department of Zoonotic and Tropical Diseases, Regional Infectious Diseases Hospital, Warsaw.
Przegl Epidemiol. 2012;66(2):347-50.
We report the case of rickettsial eschar-associated spotted fever, most probable due to Rickettsia raoultii, an emerging pathogen, which was previously described in patients with tick-borne lymphadenopathy (TIBOLA), also called Dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL). The pathogenicity of R. raoultii is not well established. The survey of ticks from Poland (Ixodes ricinus and Dermacentor reticulatus) revealed that R. raoultii occur in all regions of Poland and predominate over other rickettsiae of spotted fever group--R. slovaca and R. helvetica. A 17-year-old otherwise healthy girl was admitted to Department of Zoonotic and Tropical Diseases because of fever, eschar and rash. Multiple disseminated small lesions were present on the skin of her head, trunk and limbs, also palms and soles, and mucosa of her lips. The majority of them had necrotic center slightly elevated with redness around, single ones had vesicular appearance. The lymph nodes on the right side of her neck were enlarged. Laboratory investigations revealed: leukopenia (with 22% of bands in differential), thromocytopenia, slightly elevated C-Reactive Protein, as well as procalcytonin. The quick improvement was observed with a treatment with ceftriaxone and doxycycline. Two weeks after the onset of disease, IgG serum antibodies titer of 128 reacting with R. rickettsii antigen only was detected. IFA tests with six SFG rickettsial species demonstrated the strongest reaction with R. raoultii group antigens in a titer of 64. The case we report, resembling boutonneuse fever, with leukopenia, thrombocytopenia and septic parameters indicates possible higher virulence of R. raoultii than it was previously observed.
我们报告了一例与立克次体焦痂相关的斑疹热病例，极有可能由新型病原体拉乌尔立克次体（Rickettsia raoultii）引起，该病原体先前在蜱传淋巴结病（TIBOLA，也称为革蜱传播的坏死性红斑和淋巴结病，即DEBONEL）患者中被描述过。拉乌尔立克次体的致病性尚未完全明确。对来自波兰的蜱虫（蓖麻硬蜱和网纹革蜱）的调查显示，拉乌尔立克次体在波兰所有地区均有出现，且在斑点热群的其他立克次体——斯洛伐克立克次体（R. slovaca）和瑞士立克次体（R. helvetica）中占主导地位。一名17岁身体健康的女孩因发热、焦痂和皮疹入住人畜共患病与热带病科。她的头部、躯干、四肢皮肤，包括手掌和脚底以及唇部黏膜出现了多个散在的小病变。其中大多数病变有坏死中心，略隆起，周围发红，单个病变有水泡样外观。她右侧颈部的淋巴结肿大。实验室检查结果显示：白细胞减少（分类中杆状核细胞占22%）、血小板减少、C反应蛋白略有升高以及降钙素原升高。使用头孢曲松和多西环素治疗后病情迅速好转。发病两周后，仅检测到与立氏立克次体（R. rickettsii）抗原反应的IgG血清抗体滴度为128。对六种斑点热群立克次体进行的间接荧光抗体试验（IFA）显示，与拉乌尔立克次体群抗原反应最强，滴度为64。我们报告的该病例类似南欧斑疹热，伴有白细胞减少、血小板减少和脓毒症参数，表明拉乌尔立克次体的毒力可能比之前观察到的更高。
