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PubMed2000

Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).

This report updates 1999 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (MMWR 1999;48[No. RR-4]: 1-29). These recommendations include five principal changes: a) the age for universal vaccination has been lowered to 50 years from 65 years; b) scheduling of large, organized vaccination campaigns after mid-October may be considered because the availability of vaccine in any location cannot be assured consistently in the early fall; c) 2000-2001 trivalent vaccine virus strains are A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Beijing/184/93-like strains; d) information on neuraminidase-inhibitor antiviral drugs has been added; and e) a list of other influenza-related infection control documents for special populations has been added. This report and other information on influenza can be accessed at the website for the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC at .

Adolescent↗

PubMed2003

[Epidemiologic features of Mediterranean spotted fever in Portugal].

Mediterranean spotted fever (MSF) is a tick-borne rickettsial disease. It is endemic in Portugal and Ricardo Jorge recognized it in 1930. Rhipicephalus sanguineus is the main vector and reservoir of the disease. In Portugal the etiologic agents are two strains of Rickettsia conorii complex: R. conorii Malish and "Israeli tick typhus". MSF is clinically characterized by a vasculitis process with the classical clinical triad of fever, rash, and lesion at the site of tick bite. Although the majority MSF cases are considered benign, last years some districts presented more severe cases than expected. The reported incidence of MSF in Portugal for 1989 to 2000 was 9.8/10(5) inhabitants, the highest incidence compared to other mediterranean countries. Alentejo was the region who presents the highest incidence with 31/10(5) inhabitants. Nevertheless, Bragança was the district which appears with greater number of cases, 62/10(5) inhabitants. The highest annual incidence rate reported was among children, peaking in those 1-4 years of age with 60.2/10(5) inhabitants. Observation of mortality rates have shown that Beja district have the highest mortality rates for MSF in Portugal, but in 1997 in this district, mortality have unexpected values with 7.6 deaths per 100,000 inhabitants have occurred. Although is an obligatory notifiable disease, high number of underreported cases are detected.

Adolescent↗

PubMed2004

Scrub typhus during pregnancy: a case report and review of the literature.

Scrub typhus is a rickettsial disease that is uncommon during pregnancy. We report a case of a 33-year-old woman, G1P0, 29 weeks pregnancy who presented to hospital with high fever, chill and headache for two weeks. Her diagnosis of scrub typhus was confirmed by serum immunofluorescent assay. She was successfully treated with chloramphenicol, but preterm delivery occurred. Her infant died from respiratory distress syndrome. No vertical transmission was demonstrated in this case. Scrub typhus should be listed in the differential diagnosis of acute febrile illness in pregnant women, who either live in, or return from, endemic areas. Chloramphenicol can be used safely during pregnancy if it is not circulating at the time of delivery.

Adult↗

PubMed2005

Short report: Abnormal liver function in scrub typhus.

Scrub typhus is one kind of rickettsial disease and may cause fever, cough, and skin rashes in infected humans. Regarding liver involvement, it was uncommon to be reported in previous medical literature from Western countries. This study observes the relationship between scrub typhus and liver function. From January 1998 to August 2003 in Kaohsiung Chang Gung Memorial Hospital in Taiwan, we observed 30 patients with scrub typhus, and 29 of them had liver function abnormality. In these patients, we found 89.3% with elevated aspartate aminotransferase (AST) levels, 91.7% with elevated alanine aminotransferase (ALT) levels, 84.2% with elevated alkaline phosphatase (ALP) levels, and 38.5% with elevated total bilirubin levels. In our study, there is a close relationship between scrub typhus and impaired liver function tests. Therefore, if patients are found with fever of unknown origin and abnormal liver function, we should take scrub typhus into consideration.

Female↗

PubMed1991

[Mediterranean boutonneuse fever disclosed by severe neurological involvement].

The authors report a case of mediterranean boutonneuse fever disclosed in a 6 year-old child presenting with severe neurological disorder, coma, hypotonia, sphincteral disorders, rash and eschar at the site of bite. Rise of antibodies detected by indirect immunofluorescence test (1/80----1/320) confirmed the diagnosis. Visualization of ischemic internal capsules at cerebral CT scan brought evidence of vascular lesions in rickettsial disease.

Boutonneuse Fever↗

PubMed1991

Rickettsial infection of the central nervous system: the role of prompt antimicrobial therapy.

Rickettsial diseases of man, which are prevalent in all the continents (except Antartica) continue to be a major health problem in tropical and temperate parts of the world. Rickettsioses must be considered in every traveller seeking medical attention soon after returning from endemic areas, since the disease can be associated with significant morbidity. When a definite diagnosis has been made by specific serological tests, prompt antimicrobial therapy is indicated. A tetracycline should be regarded as the drug of choice due to its high efficacy, low toxicity, superior in vitro activity and the possibility of relapse which can follow chloramphenicol therapy.

Anti-Bacterial Agents↗

PubMed1991

Rocky Mountain spotted fever.

Rocky Mountain spotted fever, the most prevalent rickettsial disease in the United States, is one of the most severe of all infectious diseases. It remains an important infectious disease because of its prevalence, the difficulty of clinical diagnosis, potentially fatal outcome, and lack of a widely available sensitive and specific diagnostic test during the acute stage of the illness.

Animals↗

PubMed1989

[An etiological study of acute hemorrhagic conjunctivitis in Beijing area in 1984].

Acute hemorrhagic conjunctivitis (AHC) has been widespread in China since 1971. An etiological survey of the sporadic outbreak in Beijing was done in 1984. Conjunctival swabs and sera were collected at the Eye Clinic of Peking Union Medical College Hospital and 10 strains of virus were isolated from 46 cases by culture on the HeLa cell line. 8 strains were identified as Enterovirus 70 by homologous antiserum J 670/71 obtained from the California State Laboratory of Viral and Rickettsial Diseases. 2 other strains defied neutralization by this antiserum and were eventually identified as Adenovirus type 3 and type 7. 30 paired sera were examined for neutralization antibodies to EV 70 (J 670/71). Among these, 23 (77%) showed fourfold or higher rise in titer. Furthermore, neutralization antibodies to EV70 (J 670/71) and the EV70 isolated from 7 patients with AHC by paired sera also showed a fourfold or higher rise in antibody titer, indicating that EV70 was the etiologic agent responsible for the 1984 outbreak in Beijing.

Adenoviruses, Human↗

PubMed1989

Human ehrlichiosis.

Ehrlichiosis is one of the latest tick-borne illnesses to be reported in humans. The authors describe two cases of this rickettsial disease that were apparently acquired in Missouri. They discuss diagnosis and treatment.

Animals↗

PubMed1987

Biochemistry of rickettsiae: recent advances.

The application of new biotechnology to the study of the biochemistry of rickettsiae was a prominent feature of the presentations at the 3rd International Symposium on Rickettsiae and Rickettsial Diseases, held in Smolenice near Bratislava in September 1984. This review is an attempt to summarize recent advances leading up to these presentations as well as the studies that have been reported in the two years since the meeting. Since rickettsiae are intracellular parasites, most reviews deal with the interaction of rickettsiae with host cells. It is useful, however, to focus also--as we have done--on the properties of rickettsiae that can be demonstrated in the absence of their hosts, although, undoubtedly, many of these properties reflect adaptation to an intracellular microenvironment.

Bacteriological Techniques↗

PubMed1986

A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia.

A seroepidemiological survey of 837 people and 383 febrile patients was performed in rural areas of Sabah. We determined that the rickettsial diseases scrub typhus and endemic typhus were uncommon causes of febrile illness, as was tick typhus, except in forest dwelling peoples. The rate of occurrence of SFGR specific antibody was 16.5% among 412 forest dwellers, indicating that tick typhus may be a frequent cause of illness in this population.

Adolescent↗

PubMed1988

Rickettsiosis in Japan.

The rickettsial diseases of man in Japan include Tsutsugamushi disease (scrub typhus), murine typhus, which occurs sporadically, and one of spotted fever group diseases, recognized as a new entity since 1984. Starting from 1976, there has been a remarkable resurgence in the number of reported cases of Tsutsugamushi disease in Japan after several years of virtual absence, and endemics are still continuing after reaching a prominent outbreak in 1984. Its yearly incidences from 1982 to 1986 were 538, 749, 971, 890 and 738, respectively. This resurgence is most likely related to an increase of vector mite colonies that carry Rickettsia tsutsugamushi. However, it cannot be explained as to how these foci of vector mites developed. The existence of spotted fever group disease had not been recognized until quite recently. This rickettsiosis was first identified in Tokushima and Kochi Prefectures in 1984. To date, the estimated total number of sero-positive cases is over 45 cases. The causative rickettsiae were isolated from the blood of 5 patients using cell culture methods and the identification of these rickettsiae is now being carried out.

Adolescent↗

PubMed1987

Metabolism and genetics of chlamydias and rickettsias.

Chlamydial and rickettsial diseases pose a hazard to man and to domesticated and wild animals. The virulence mechanisms which aid the establishment of these obligate intracellular parasites in the eukaryotic host are still not within our grasp. Recent knowledge of the biochemical stratagem, the metabolic capabilities and the genetic diversity of these microbes illustrate fundamental differences in ecology and evolutionary divergence. The preferred site of intracellular residence determines the strategy for uptake, for nutrient assimilation and also for evasion of the host's immunological defenses. The Chlamydia, Rickettsia, and Coxiella are the most extensively studied of the genera. Whereas the Ehrlichia and Cowdria are poorly understood, they are also the most intriguing of the Rickettsiae. A number of antigenically and genetically distinct species are identified for the genera Chlamydia, Rickettsia, and Ehrlichia, whereas the Coxiella and Cowdria may not represent such a wide diversity. Recent information on the genetic heterogeneity of the chromosomal and plasmid DNAs of the strains of Coxiella suggest the diversity is greater than was originally envisioned. New information regarding the antigenic structure of Cowdria and their cellular tropisms suggests that they are closely related to the Ehrlichia. In this review we compare the metabolic capabilities and the genetic diversity of these different intracellular bacteria.

Animals↗

PubMed1986

[Present status of rickettsiosis].

Actual knowledges of the biology of rickettsia, their pathogenicity and the diagnostic are briefly exposed. The description of sero-epidemic surveys in Bolivia, Botswana, Ethiopia, Greece and France shows that fifty years after the death of Charles Nicolle, rickettsial diseases are still a major health problem in numerous countries.

Animals↗

PubMed1987

[South African tick bite fever].

Two male patients developed South African tick bite fever after visits to South Africa. The clinical and laboratory findings in this condition, which is rarely seen in central Europe, are presented and its differential diagnosis to other rickettsial diseases is discussed.

Bites and Stings↗

PubMed1972

The need for routine rubella antibody testing of women.

Results of rubella antibody tests performed by the California State Viral and Rickettsial Disease Laboratory on blood specimens collected in 1968 and 1969 from school children and women of childbearing age showed a slightly lower prevalence of rubella antibody in California than reported from most other areas of the United States. Among women of childbearing age, rubella hemagglutination-inhibition (hi) antibody was found in 72 percent of those tested in California compared with 80 percent to 90 percent in other areas of the country. Rubella antibody testing services offered by the State Virus Laboratory included situations in which a pregnant woman was exposed to a suspected case of rubella. It was shown that very few of these exposures constitute a significant risk to the fetus as most of the women already possessed antibody to rubella from past infection and in many instances the exposures were not to actual cases of rubella. The results of this study emphasized the urgency of obtaining blood specimens from pregnant women as soon as possible after exposure to rubella or development of symptoms of rubella. The urgency and anxiety attending these situations can largely be obviated if routine rubella antibody testing of women is carried out prior to pregnancy or at the first prenatal visit.

Adolescent↗

PubMed1983

[Enzymatic parameters in boutonneuse fever. II. Behavior and significance of lactic dehydrogenase].

Serum levels of Lactic dehydrogenase (LDH) were determined at weekly intervals, in 52 patients with Boutonneuse Fever: 33 adults (23 uncomplicated and 10 complicated cases) and 19 children (no complication occurred in these patients). In the first week of illness, LDH was increased in 86 and 100% of adults (uncomplicated and complicated cases respectively) and in 89% of children. Mean values were 419 and 472 U/l for adults (uncomplicated and complicated) and 423 for children (normal values until 240 U/l). In total (adults plus children), in the first week, pathological findings were observed in 90% of patients. In the second week, LDH was increased in 53 and 100% for adults, and 66% for children. Mean values were 252 and 306 for adults, and 291 U/l for children. The significance of this increase is related to the pathophysiology of rickettsial diseases. Rickettsiae cause endothelial injury with platelet aggregation, activation of inflammation as well as coagulation mechanisms and subsequently damage of various organ systems at various degree (from silent to evident forms). From a general point of view LDH increase appears in part of platelet origin, at first stage of illness, in part from other organ systems involved in the vasculitic process.

Adolescent↗

PubMed1994

Q fever in Taiwan.

BACKGROUND: Although Q fever, a rickettsial disease caused by Coxiella burnetii, is supposed to occur sporadically worldwide, there is only one case report of this disease in Taiwan. We examined the antibody of Q fever to evaluate the status of Q fever in Taiwan. METHODS: In total, 579 paired serum specimens of suspected febrile patients sent by several hospitals and sanitary stations to this Institute in 1991 and 1992 were tested according to the technique of indirect fluorescent antibody (IFA). RESULTS: In total 48 serologically acute Q fever cases were found, mostly from Tainan, Pingtung and Kaohsiung. There was only one female, and the age of most patients was 40-50 years. The high season is in June and July. CONCLUSIONS: The antibody titer of all 48 positive cases reached 1:320 or higher on the 13th day after onset of the disease. IFA as a diagnostic tool to detect acute and convalescent serum antibody titer is discussed.

Adult↗