The presence of eschars, but not greater severity, in Portuguese patients infected with Israeli spotted fever.
In Portugal, Mediterranean spotted fever (MSF) is caused by R. conorii Malish and Israeli spotted fever (ISF) strains. It has been suggested that the ISF strain isolated from patients with MSF causes different clinical manifestations compared to those caused by Malish strain, namely the absence of eschar and greater severity. The aim of this study was to analyze the presence or absence of eschar and of fatality in Portuguese patients infected with either Malish or ISF strain. Of 94 patients with a clinical diagnosis of MSF between 1994 to 2004, 47 were infected with Malish strain and 47 with ISF strain. Eschars were reported in 20 patients (49%) infected with Malish strain, and in 17 (39%) with ISF strain. The presence of eschar is not statistically associated to a greater extent with either R. conorii strain (P=0.346). A total of 22 patients died, 9 infected with Malish strain and 13 infected with ISF strain, and no statistically significant difference was found (P=0.330). This study showed that the concepts of absence of the eschar and greater severity in Israeli spotted fever infection should be revised.
Centro de Estudos de Vectores e Doenças Infecciosas , National Institute of Health Dr Ricardo Jorge, Av Liberdade 5, 2965-575 Aguas de Moura, Portugal. rita.sousa@insa.min-saude.pt
Rita
R
de Sousa
Nahed
N
Ismail
Sónia
S
Dória-Nóbrega
Pedro
P
Costa
Tiago
T
Abreu
Ana
A
França
Mário
M
Amaro
Paula
P
Proença
Paula
P
Brito
José
J
Poças
Teresa
T
Ramos
Graça
G
Cristina
Graça
G
Pombo
Liliana
L
Vitorino
Jorge
J
Torgal
Fátima
F
Bacellar
David
D
Walker
D000818:Animals; D001907:Boutonneuse Fever / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D011174:Portugal; D012189:Retrospective Studies; D020114:Rickettsia conorii / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012720:Severity of Illness Index; D013987:Ticks / Q000382:microbiology