Journal Article

Lymphangitis-Associated Rickettsiosis, a New Rickettsiosis Caused by <i>Rickettsia sibirica mongolotimonae:</i> Seven New Cases and Review of the Literature

Pierre-Edouard Fournier, Frédérique Gouriet, Philippe Brouqui, Frédéric Lucht and Didier Raoult

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 10, pages 1435-1444
Published in print May 2005 | ISSN: 1058-4838
Published online May 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/429625
Lymphangitis-Associated Rickettsiosis, a New Rickettsiosis Caused by Rickettsia sibirica mongolotimonae: Seven New Cases and Review of the Literature

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Background

Rickettsia sibirica mongolotimonae has been found in Hyalomma ticks in Inner Mongolia (in China) and Niger and in humans in France and South Africa. To date, only 3 cases of human infection have been reported.

Methods

Patients received a diagnosis of R. sibirica mongolotimonae infection on the basis of culture and/or PCR results plus serological test results.

Results

From January 2000 to June 2004, R. sibirica mongolotimonae infection was diagnosed in 7 patients. In 3 patients, the bacterium was cultivated from the inoculation eschar. The other 4 patients had cases that were diagnosed with use of PCR of samples obtained from the eschar (2 patients) or blood (2 patients), plus specific Western blot before (2 patients) and after (2 patients) cross-adsorption. The clinical presentation included fever (temperature, >38.5°C), a maculopapular rash, and ⩾1 inoculation eschar in 6 patients, enlarged regional lymph nodes in 4 patients, and lymphangitis in 3 patients. On the basis of the study of 9 cases, R. sibirica mongolotimonae infection differed from other tick-borne rickettsioses in the Mediterranean area in the following ways: it involved a specific incidence in the spring, the presence of 2 eschars in 2 (22%) of the patients, the presence of a draining lymph node in 5 (55%) of the patients, and lymphangitis expanding from the inoculation eschar to the draining node in 4 (44%) of the patients. The most recent patient in our series received a clinical diagnosis on the basis of such findings. All patients recovered without any sequelae.

Conclusions

We propose that this new rickettsiosis be named “lymphangitis-associated rickettsiosis.” Lymphangitis-associated rickettsiosis should be considered in the differential diagnosis of tick-borne rickettsioses in Europe, Africa, and Asia.

Journal Article.  5844 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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