title: Fulminant Japanese spotted fever definitively diagnosed by the polymerase chain reaction method.
abstract: A 72-year-old man was admitted to the emergency ward in our hospital on July 20, 2001, because of consciousness disturbance, fever, generalized skin eruption, and severe general weakness beginning 7 days previously. Physical examination on admission revealed marked systemic cyanosis, erythema, and purpura. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiorgan failure (platelet count, 0.9 x 10(4)/micro l; fibrin degradation product, 110 micro g/ml; C-reactive protein, 22.6 mg/dl). Soluble interleukin 2-receptor (sIL-2R) was markedly increased to 14 710 U/ml. Blood gas analysis demonstrated severe metabolic acidosis. He was diagnosed with multiorgan failure due to DIC. Administration of heparin and sodium bicarbonate was started immediately, but respiratory failure was exacerbated and systemic spasm caused by encephalitis was noted. Although he was supported by an artificial ventilator, deterioration of metabolic acidosis occurred, and the blood pressure decreased to less than 60 mm Hg. He died 5.5 h after admission. The serological test showed no positive antibody titers against Orientia tsutsugamushi, Rickettsia japonica, or Rickettsia typhi. However, a specific DNA band derived from R. japonica was detected by the polymerase chain reaction (PCR) method using a primer from a blood clot. Therefore, he was definitively diagnosed as having Japanese spotted fever. The PCR method may be markedly useful for establishing a definitive diagnosis of Japanese spotted fever during the critical stage.
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, 1-6-6 Shimokamo, Sumoto, Hyogo 656-0013, Japan. kodama@awaji-hosp.sumoto.hyogo.jp
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kodama
authors.forename: Takanori
authors.initials: T
authors.lastname: Senba
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Chikahira
authors.forename: Takashi
authors.initials: T
authors.lastname: Katayama
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Furuya
authors.forename: Hiromi
authors.initials: H
authors.lastname: Fujita
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D004269:DNA, Bacterial / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000209:etiology; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods*; D015375:Receptors, Interleukin-2 / Q000032:analysis; D012282:Rickettsia Infections / Q000175:diagnosis*
chemical_list: D004269:DNA, Bacterial; D015375:Receptors, Interleukin-2