Scientific letter
Rickettsia conorii: Unusual cause of diarrhoea
Rickettsia conorii: causa inusual de diarrea
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This was treated by a digestive disease outpatient clinic in September 2016 after she was referred from her primary care doctor due to suffering from diarrhoea for 15 days. Interesting epidemiological information included a tick bite 2 weeks earlier (she had dogs and lived in the countryside). The patient complained of severe asthenia, headache, myalgia and 4–5 semi-solid stools without blood, mucus or pus as a result of this tick bite. She had not travelled abroad. She had no fever upon physical examination at the clinic, but said she felt cold (she had a fever of 38.5<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> for the first 3 days after the onset of symptoms).</p><p id="par0010" class="elsevierStylePara elsevierViewall">A comprehensive stool culture was done with no relevant findings, and also an ileocolonoscopy was performed with no relevant gross findings, although biopsies showed mild non-specific inflammation. The following lab test results were obtained: negative transglutaminase antibodies, normal thyroid hormones and positive IgM test for <span class="elsevierStyleItalic">Rickettsia conorii</span> at titres of 1:160, plus high CRP and 13,000 leukocytes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As a result of these findings, the patient received an empirical cycle of doxycycline (100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h on the first day followed by 100<span class="elsevierStyleHsp" style=""></span>mg/day orally for a further 6 days) with clear improvement. She was asymptomatic after three days of treatment with normal number and consistency of bowel movements. Five months later, the patient is completely asymptomatic.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Rickettsiae</span> are gram-negative bacteria that behave as obligate intracellular parasites. The most common rickettsiosis in Spain, which is also most prevalent in the Mediterranean region (Spain, Italy, France and Israel), is Mediterranean spotted fever.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> There was a major resurgence of this zoonosis in these countries after approximately 1975. Rickettsioses can be transmitted through bites or stings, although they tend to infect hosts via vectors such as ticks or fleas. Human beings are accidental hosts.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of Mediterranean spotted fever, a large number of patients report previous contact with dogs. Its main vector is a tick (<span class="elsevierStyleItalic">Rhipicephalus sanguineus</span>) and its causative agent is <span class="elsevierStyleItalic">R. conorii</span>. Notably, most cases occur in the summer, coinciding with the tick season. Its incubation period can vary from 5 to 21 days, although this cannot usually be accurately determined since the tick's bite usually goes unnoticed. It was previously considered a rural disease, but is currently reported increasingly more often in urban areas.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Symptoms tend to have a sudden onset and generally include fever, headache, photophobia, myalgia and malaise. A papule with a necrotic centre and erythematous halo, known as a black spot or “tache noire”, tends to appear at the tick-bite site. This lesion is generally not painful. A maculopapular rash, with palmoplantar involvement, may appear. This is one of the most characteristic features. In some cases, vasculitic lesions, pericarditis, as well as kidney and gastrointestinal symptoms may occur.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Gastrointestinal symptoms (including most commonly diarrhoea, abdominal pain or vomiting) may occur in up to 30% of patients. Although hepatomegaly can also be seen in approximately 30% of cases, liver dysfunction tends to be subclinical.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The aforementioned black spot and especially a history of tick bite are the main features that result in early diagnosis of rickettsiosis. Once the rash appears, a differential diagnosis with other exanthematous diseases, such as toxicoderma, secondary syphilis or measles, must be performed. Serological diagnosis by immunofluorescence assay is fast. This method seems to be the best technique available as it has excellent sensitivity and specificity, demonstrating both specific IgM antibodies to a current infection and residual seropositivity. With this technique, titres of 1:80 or greater are considered significant.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Levels of acute-phase reactants tend to be high. The most common abnormal lab test results are leukopaenia (sometimes leukocytosis) and potential thrombocytopaenia. Hyponatraemia may also occur.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">If treated appropriately, rickettsiosis is generally a benign disease that can be cured. However, if treatment is delayed for more than one week, it may cause severe consequences and even death. <span class="elsevierStyleItalic">R. conorii</span> is highly sensitive to tetracyclines, especially doxycycline. Quinolones are also effective.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">To prevent the disease, measures such as checking your dog for ticks and parasites and disinfecting places frequented by infested animals is fundamental.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To conclude, it is important to remember that the patient's medical history is once again fundamental, since epidemiological information is often the only thing that can help us reach an early diagnosis. Given that this is a curable disease, adequate treatment must be started early in order to prevent potential complications. This disease is relatively prevalent in Spain, and can also be observed in urban areas today. Therefore, it must be considered in a differential diagnosis of diarrhoea.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Magaz Martínez M, Ramos A, Masegosa J, Abreu L. <span class="elsevierStyleItalic">Rickettsia conorii:</span> causa inusual de diarrea. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 1 | 10 |
| 2024 October | 18 | 5 | 23 |
| 2024 September | 27 | 1 | 28 |
| 2024 August | 28 | 3 | 31 |
| 2024 July | 22 | 3 | 25 |
| 2024 June | 17 | 0 | 17 |
| 2024 May | 17 | 6 | 23 |
| 2024 April | 21 | 1 | 22 |
| 2024 March | 35 | 5 | 40 |
| 2024 February | 44 | 6 | 50 |
| 2024 January | 52 | 9 | 61 |
| 2023 December | 44 | 6 | 50 |
| 2023 November | 32 | 4 | 36 |
| 2023 October | 56 | 17 | 73 |
| 2023 September | 36 | 1 | 37 |
| 2023 August | 43 | 0 | 43 |
| 2023 July | 37 | 1 | 38 |
| 2023 June | 44 | 2 | 46 |
| 2023 May | 74 | 1 | 75 |
| 2023 April | 64 | 1 | 65 |
| 2023 March | 61 | 1 | 62 |
| 2023 February | 49 | 4 | 53 |
| 2023 January | 54 | 8 | 62 |
| 2022 December | 28 | 3 | 31 |
| 2022 November | 33 | 7 | 40 |
| 2022 October | 25 | 3 | 28 |
| 2022 September | 28 | 6 | 34 |
| 2022 August | 34 | 8 | 42 |
| 2022 July | 21 | 5 | 26 |
| 2022 June | 29 | 7 | 36 |
| 2022 May | 25 | 7 | 32 |
| 2022 April | 30 | 7 | 37 |
| 2022 March | 30 | 9 | 39 |
| 2022 February | 37 | 6 | 43 |
| 2022 January | 41 | 5 | 46 |
| 2021 December | 26 | 5 | 31 |
| 2021 November | 20 | 9 | 29 |
| 2021 October | 31 | 10 | 41 |
| 2021 September | 21 | 14 | 35 |
| 2021 August | 19 | 6 | 25 |
| 2021 July | 10 | 7 | 17 |
| 2021 June | 11 | 9 | 20 |
| 2021 May | 22 | 13 | 35 |
| 2021 April | 32 | 13 | 45 |
| 2021 March | 11 | 7 | 18 |
| 2021 February | 15 | 13 | 28 |
| 2021 January | 16 | 7 | 23 |
| 2020 December | 11 | 8 | 19 |
| 2020 November | 10 | 14 | 24 |
| 2020 October | 4 | 4 | 8 |
| 2020 September | 9 | 8 | 17 |
| 2020 August | 11 | 6 | 17 |
| 2020 July | 4 | 6 | 10 |
| 2020 June | 7 | 11 | 18 |
| 2020 May | 10 | 3 | 13 |
| 2020 April | 7 | 5 | 12 |
| 2020 March | 11 | 9 | 20 |
| 2018 July | 0 | 0 | 0 |
| 2018 June | 1 | 0 | 1 |
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