title: Atypical fulminant Rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and adult respiratory distress syndrome.
abstract: Brazilian spotted fever, caused by Rickettsia rickettsii, has been increasingly reported in Brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with Adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against Rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.
authors: Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. psgcosta@fusoes.com.br
authors: Paulo Sérgio
authors: PS
authors: Gonçalves da Costa
authors: Marcos Emilio
authors: ME
authors: Brigatte
authors: Edmilton
authors: E
authors: Pereira de Almeida
authors: Lena Márcia
authors: LM
authors: de Carvalho Valle
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology*; D012282:Rickettsia Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D012284:Rickettsia rickettsii / Q000276:immunology / Q000302:isolation & purification*; D012698:Serologic Tests; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents