Scientific letter
Rickettsia typhi. A new causative agent of round pneumonia in adults
Rickettsia typhi. Un nuevo agente etiológico de neumonía redonda en adultos
Virginia Velasco-Tiradoa,
, Michele Hernández-Cabrerab,c, Elena Pisos-Álamoc, José-Luis Pérez-Arellanob,c
Corresponding author
a Service of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
b Department of Infectious Diseases and Tropical Medicine, University Insular Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
c Department of Medical and Surgical Science, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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A new causative agent of round pneumonia in adults" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "428" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Virginia Velasco-Tirado, Michele Hernández-Cabrera, Elena Pisos-Álamo, José-Luis Pérez-Arellano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Virginia" "apellidos" => "Velasco-Tirado" "email" => array:1 [ 0 => "virvela@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Michele" "apellidos" => "Hernández-Cabrera" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Elena" "apellidos" => "Pisos-Álamo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José-Luis" "apellidos" => "Pérez-Arellano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Service of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Infectious Diseases and Tropical Medicine, University Insular Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Medical and Surgical Science, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Rickettsia typhi</span>. Un nuevo agente etiológico de neumonía redonda en adultos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2171 "Ancho" => 1642 "Tamanyo" => 212778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Thoracic CT showed a nodule of 2<span class="elsevierStyleHsp" style=""></span>cm in upper right lobe with adjacent pneumonitis. (B) Thoracic CT fourteen days after onset revealed resolution of nodular image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Round pneumonia is an inflammatory illness of the lung parenchyma (usually of infectious origin) presented as spherical or oval-shaped consolidation in chest radiography (CR). This well-known clinical-radiological syndrome is generally thought to be a disease of children, being reported rarely in adults<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. We report two patients with murine typhus (<span class="elsevierStyleItalic">Rickettsia typhi</span>) with a clinical-radiological picture of round pneumonia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patient 1: A 58-year-old male who owned cats was admitted to the hospital because of fever, chills, oppressive headache and diffuse abdominal pain in the last four days. Physical exam only revealed moderate tenderness to abdominal palpation. Laboratory tests revealed liver enzymes mildly elevated and thrombocypenia. CR and thoracic computed tomography (CT) showed a nodule of 2<span class="elsevierStyleHsp" style=""></span>cm in upper right lobe with adjacent pneumonitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). A broncoscopy was performed but cytological and microbiologic analyses were negative, as well as transbronchial biopsy. Doxycycline was administrated, with remission of fever within 48<span class="elsevierStyleHsp" style=""></span>hours and clinical improvement. Serologic tests for <span class="elsevierStyleItalic">R. typhi</span> were positive (Ig<span class="elsevierStyleHsp" style=""></span>M 1/40960 and Ig G 1/320). Thoracic CT obtained fourteen days after onset revealed resolution of nodular image (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Patient 2: A 20-year-old male in contact with a dog presented with a 6-day history of fever up to 39.5<span class="elsevierStyleHsp" style=""></span>°C, dry cough, arthralgias, myalgias, headache, sweating and vomiting. He showed a macular rash on the trunk and upper limbs without itching. Results of tests revealed aspartate transaminase slightly elevated, mild thrombocypenia, proteinuria and microhematuria. CR displayed a nodular lesion in middle lobe. Doxycycline was prescribed and patient's condition improved within 72<span class="elsevierStyleHsp" style=""></span>hours, disappearing fever and the remainder of symptoms. Serologic analysis for <span class="elsevierStyleItalic">R. typhi</span> was positive (Ig<span class="elsevierStyleHsp" style=""></span>M 1/10.240 and Ig G 1/5120). A CR obtained 14 days after diagnosis was normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Round pneumonia is more common in children under 5 years being the lower lobes more commonly affected region. The prevalence in this age group and pulmonary localization is due to anatomical features<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. In children, the main agents of round pneumonia are the same as those involved in other radiological forms of pneumonia. In adults, the number of cases is lower and probably their pathogenic mechanisms are differents. In addition, the microorganisms involved are less known and possibly geographical differences exist. Anton and colleagues have described the important role of Coxiella burnetii infection<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and to a lesser extent other atypical pathogens (Legionella pneumophila)<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> as causative agents of round pneumonia in Spain. This statement has also been observed in other European countries where Q fever is common<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In recent years, our group has described in the Canaries the existence of a significant number of cases of murine typhus<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. This disease is manifested by high fever, severe headache, musculoskeletal pain, and occasionally rash. Although the classic form of transmission of R. typhi is the bite of fleas, inhalation of contaminated faeces also appears to play an important role. Respiratory involvement is relatively common in this disease<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. However, radiographic changes occur only around 6% (interstitial pneumonitis, pleuro-pericarditis with pulmonary thromboembolism and alveolar infiltrates with or without pleural effusion)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. After a comprehensive review we have only found one case of round pneumonia caused by R. typhi<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that the description of these cases has a dual interest. On the one hand, we should perform a serological survey, which could prevent unnecessary invasive procedures, in any patient with fever and nodular images in areas where R. typhi infection is high. On the other hand, we should include doxycycline in the empirical treatment of round pneumonia in adults, pending microbiological results and depending on the geographic area.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2171 "Ancho" => 1642 "Tamanyo" => 212778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Thoracic CT showed a nodule of 2<span class="elsevierStyleHsp" style=""></span>cm in upper right lobe with adjacent pneumonitis. (B) Thoracic CT fourteen days after onset revealed resolution of nodular image.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Round pneumonia: Image findings in a large series of children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.W. Kim" 1 => "L.F. 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| 2019 November | 27 | 6 | 33 |
| 2019 October | 30 | 9 | 39 |
| 2019 September | 34 | 6 | 40 |
| 2019 August | 24 | 4 | 28 |
| 2019 July | 32 | 13 | 45 |
| 2019 June | 94 | 13 | 107 |
| 2019 May | 199 | 25 | 224 |
| 2019 April | 95 | 18 | 113 |
| 2019 March | 15 | 5 | 20 |
| 2019 February | 17 | 7 | 24 |
| 2019 January | 8 | 9 | 17 |
| 2018 December | 12 | 16 | 28 |
| 2018 November | 18 | 9 | 27 |
| 2018 October | 31 | 5 | 36 |
| 2018 September | 11 | 6 | 17 |
| 2018 August | 11 | 3 | 14 |
| 2018 July | 9 | 4 | 13 |
| 2018 June | 7 | 1 | 8 |
| 2018 May | 23 | 2 | 25 |
| 2018 April | 21 | 1 | 22 |
| 2018 March | 12 | 0 | 12 |
| 2018 February | 13 | 0 | 13 |
| 2018 January | 20 | 1 | 21 |
| 2017 December | 42 | 0 | 42 |
| 2017 November | 15 | 4 | 19 |
| 2017 October | 27 | 1 | 28 |
| 2017 September | 11 | 3 | 14 |
| 2017 August | 24 | 7 | 31 |
| 2017 July | 19 | 2 | 21 |
| 2017 June | 26 | 4 | 30 |
| 2017 May | 81 | 1 | 82 |
| 2017 April | 47 | 0 | 47 |
| 2017 March | 51 | 30 | 81 |
| 2017 February | 91 | 3 | 94 |
| 2017 January | 30 | 1 | 31 |
| 2016 December | 35 | 9 | 44 |
| 2016 November | 34 | 6 | 40 |
| 2016 October | 56 | 2 | 58 |
| 2016 September | 66 | 9 | 75 |
| 2016 August | 42 | 3 | 45 |
| 2016 July | 34 | 3 | 37 |
| 2016 June | 29 | 4 | 33 |
| 2016 May | 37 | 10 | 47 |
| 2016 April | 31 | 16 | 47 |
| 2016 March | 25 | 1 | 26 |
| 2016 February | 33 | 8 | 41 |
| 2016 January | 46 | 15 | 61 |
| 2015 December | 49 | 7 | 56 |
| 2015 November | 31 | 0 | 31 |
| 2015 October | 53 | 5 | 58 |
| 2015 September | 26 | 6 | 32 |
| 2015 August | 73 | 3 | 76 |
| 2015 July | 78 | 4 | 82 |
| 2015 June | 42 | 1 | 43 |
| 2015 May | 59 | 5 | 64 |
| 2015 April | 67 | 8 | 75 |
| 2015 March | 71 | 6 | 77 |
| 2015 February | 38 | 1 | 39 |
| 2015 January | 56 | 6 | 62 |
| 2014 December | 84 | 9 | 93 |
| 2014 November | 43 | 3 | 46 |
| 2014 October | 40 | 6 | 46 |
| 2014 September | 41 | 2 | 43 |
| 2014 August | 30 | 4 | 34 |
| 2014 July | 43 | 5 | 48 |
| 2014 June | 46 | 5 | 51 |
| 2014 May | 34 | 5 | 39 |
| 2014 April | 28 | 3 | 31 |
| 2014 March | 55 | 11 | 66 |
| 2014 February | 63 | 10 | 73 |
| 2014 January | 66 | 8 | 74 |
| 2013 December | 67 | 9 | 76 |
| 2013 November | 60 | 6 | 66 |
| 2013 October | 59 | 10 | 69 |
| 2013 September | 62 | 22 | 84 |
| 2013 August | 69 | 5 | 74 |
| 2013 July | 49 | 9 | 58 |
| 2013 June | 27 | 1 | 28 |
| 2013 May | 30 | 8 | 38 |
| 2013 April | 23 | 11 | 34 |
| 2013 March | 28 | 7 | 35 |
| 2013 February | 13 | 7 | 20 |
| 2013 January | 12 | 3 | 15 |
| 2012 December | 4 | 1 | 5 |
| 2012 November | 4 | 6 | 10 |
| 2012 October | 6 | 6 | 12 |
| 2012 September | 4 | 5 | 9 |
| 2012 July | 456 | 0 | 456 |
Show all
