Coronary involvement in Mediterranean spotted fever

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.     

Comparative electrophoresis of spotted fever group rickettsial proteins.

Electrophoretic analyses were performed to establish the polypeptide profiles of the following tick-borne typhus rickettsiae of the spotted fever group: $\text{Rickettsia rickettsii}$ (Sheila Smith, Bitter Root, Iowa and R strains), $\text{R. sibirica}$, $\text{R. conorii}$, $\text{R. parkeri}$, $\text{R. australis}$ and $\text{R. akari}$. Organisms were propagated in chick embryo fibroblast cells in roller bottles and purified by density centrifugation. After polyacrylamide gel electrophoresis, comparative electrophoretic profiles were examined by densitometric scanning. Of the more than 20 separate polypeptides detected, six of the most prominent were found in all rickettsiae examined except $\text{R. akari}$. No carbohydrate-containing moieties were detected in electrophoretic gels.     

Seroepidemiology of spotted fever group rickettsiae in small field rodents in Japan.

To clarify the geographic distribution of spotted fever group (SFG) rickettsiae in Japan, small field rodents captured in endemic and nonendemic areas were screened for anti-SFG rickettsia antibodies by the immunofluorescence test. Among total 716 specimens tested, 73-75% of rodents were antibody-positive against Rickettsia japonica and/or Rickettsia montana, showing different degree of antibody-positive proportions among each species of the rodents. Interestingly, these profiles were not different in the rodents from each endemic and nonendemic areas, indicating that the SFG rickettsiae are prevailing in the wider areas where patients have not been found yet.     

Immunoblot cross-reactions among Rickettsia, Proteus spp. and Legionella spp. in patients with Mediterranean spotted fever

Abstract Sera from patients suffering from Mediterranean spotted fever (i.e. an infection due to Rickettsia conorii ) were studied by immunoblot to investigate cross-reactivity. A prevalence of IgM antibodies to Proteus OX 19, Proteus 0X 2, to the Rickettsia typhus group, to Legionella pneumophila serovars 4 and 5, to L. bozemanii Wiga and to L. micdadei Tatlock was found. Western blot confirmed that the antibodies were directed against the lipopolysaccharide as demonstrated by proteinase K digestion of the antigens. Cross-adsorptions showed that there is a common cross-reacting epitope among L. bozemanii Wiga, R. typhi and Proteus OX 19 but cross-reacting antibodies to L. micdadei and OX 2 were distinct and independent. This IgM cross-reaction could lead to a misdiagnosis.     

Evidence for infection caused by spotted fever group Rickettsia in Kyushu, Japan

Of 50 cases that gave negative immunofluorescence reaction with Rickettsia tsutsugamushi among patients with suspected tsutsugamushi disease encountered in Miyazaki Prefecture during the last four years, three showed a significant rise in the antibody titer to Rickettsia montana, a species of spotted fever group. This paper reports evidence for the occurrence of the rickettsial infection of the spotted fever group in Kyushu, Japan.     

Gelatin particle agglutination test for early serodiagnosis of Japanese spotted fever.

A gelatin particle agglutination (PA) test for Japanese spotted fever has been developed. Gelatin particles were sensitized with a sonicated causative rickettsia and used as antigens. The antibodies by PA test were detected as early as days 4-7 after the onset, whereas those by indirect immunoperoxidase (IP) test were detected after days 8-11. In addition, PA titers were higher than IP titers before days 20-23. The agglutinins detected by PA test were proven to be IgM because they were all sensitive to dithiothreitol. PA test was, however, less specific than IP test, giving a little nonspecific reaction to the sera from patients with scrub typhus and from individuals unrelated to those two rickettsioses. Nevertheless, PA test, which is simple, rapid, and easy to interpret the results, is useful for the early serodiagnosis of Japanese spotted fever.     

Detection of spotted fever group Rickettsia in Haemaphysalis longicornis from Hebei Province, China

DNA samples from 737 tick pools, representing 6,850 Haemaphysalis longicornis and 51 Dermacentor nuttalli collected from Hebei Province, China, were analyzed by polymerase chain reaction (PCR) for the presence of spotted fever group Rickettsia. Fifty (6.9%) of 724 H. longicornis in the tick pool were positive, but no positive samples were found in 13 D. nuttalli. Sequence analysis of the partial outer membrane protein A (ompA) genes from the 10 positive samples showed 97.4-99.8% identity, but were different from the homologous sequence of Rickettsia previously deposited in GenBank. Phylogenetic analysis of ompA genes indicated that the Rickettsia detected in this study belonged to a novel haplotype, and formed a clade distinct from Rickettsia heilongjiangii, Rickettsia sibirica, and Rickettsia hulinii in China. The new strain, named Candidatus Rickettsia hebeiii, appears to represent a distinct lineage and could constitute a new species with a minimum prevalence of about 0.7% in H. longicornis from Hebei Province, China.