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An Electroporation Method to Transform Rickettsia spp. with a Fluorescent Protein-Expressing Shuttle Vector in Tick Cell Lines
Published on: October 11, 2022
[Late diagnosis of fatal invasive rickettsial disease in the Intensive Care Unit]
Hassen Ben Ghezala1, Najla Feriani2
1Réanimation Médicale à la Faculté de Médecine de Tunis, Hôpital de Zaghouan, Avenue de l'Environnement, 1100 Zaghouan, Tunisie.
Abstract:
Mediterranean spotted fever is an infectious disease belonging to the rickettsial group due to an intracellular bacterium: Rickettsia Conorii. Pauci-symptomatic and benign forms are predominant. Severe forms are rare and increasingly reported in the recent literature with potentially life-threatening severe multi-systemic involvement. We here report a very rare case of a 52-year old patient admitted to an Intensive Care Unit with convulsions, septic shock and acute renal failure. On the second day, given the discovery of « inoculation chancre »-like lesions which needed to be treated, the diagnosis of severe rickettsial disease with severe multivisceral involvement was suspected and then confirmed by serology. Antibiotic treatment with doxycycline was then administered. However the patient developed acute tubular necrosis requiring extrarenal purification sessions. The patient rapidly developed fatal multivisceral failure. Rickettsiosis is associated with microcirculatory vasculitis thus leading to severe clinical manifestations. The mechanisms involved and the possible prognostic factors have been discussed in this study through a review of the literature.
Insights
Severe Mediterranean spotted fever caused by Rickettsia conorii is rare but can lead to fatal multivisceral failure. Early diagnosis and treatment are crucial for managing this severe infectious disease.
Area of Science:
- Infectious Diseases
- Bacteriology
- Intensive Care Medicine
Background:
- Mediterranean spotted fever is caused by Rickettsia conorii, an intracellular bacterium.
- While often benign, severe forms with multi-systemic involvement are increasingly reported.
- Rickettsiosis can lead to microcirculatory vasculitis, causing severe clinical manifestations.
Observation:
- A 52-year-old patient presented with severe symptoms including convulsions, septic shock, and acute renal failure.
- The presence of inoculation chancre-like lesions aided in suspecting a severe rickettsial infection.
- Despite doxycycline treatment, the patient developed acute tubular necrosis requiring dialysis.
Findings:
- The case highlights a rare, fatal outcome of severe Mediterranean spotted fever with multivisceral failure.
- Serology confirmed Rickettsia conorii infection.
- Acute tubular necrosis and multivisceral failure were critical complications.
Implications:
- This case underscores the potential for severe, life-threatening rickettsiosis.
- Understanding mechanisms and prognostic factors is vital for managing severe cases.
- Prompt recognition and treatment are essential, though outcomes can still be critical.
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