Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients

Rita De Sousa, Ana França, Sónia Dória Nòbrega, Adelaide Belo, Mario Amaro, Tiago Abreu, José Poças, Paula Proença, José Vaz, Jorge Torgal, Fátima Bacellar, Nahed Ismail, David Walker

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background. The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. Methods. This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection. Results. A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients. Conclusions. Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.

Original languageEnglish (US)
Pages (from-to)576-585
Number of pages10
JournalJournal of Infectious Diseases
Volume198
Issue number4
DOIs
StatePublished - Aug 15 2008

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Rickettsia Infections
Rickettsia conorii
Fatal Outcome
Fever
Hyperbilirubinemia
Multivariate Analysis
Boutonneuse Fever
Azotemia
Tachypnea
Confusion
Hepatomegaly
Leukocytosis
Creatine Kinase
Exanthema
Dehydration
Acute Kidney Injury
Alcoholism
Intensive Care Units
Inpatients
Outpatients

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Immunology

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Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. / De Sousa, Rita; França, Ana; Nòbrega, Sónia Dória; Belo, Adelaide; Amaro, Mario; Abreu, Tiago; Poças, José; Proença, Paula; Vaz, José; Torgal, Jorge; Bacellar, Fátima; Ismail, Nahed; Walker, David.

In: Journal of Infectious Diseases, Vol. 198, No. 4, 15.08.2008, p. 576-585.

Research output: Contribution to journalArticle

De Sousa, R, França, A, Nòbrega, SD, Belo, A, Amaro, M, Abreu, T, Poças, J, Proença, P, Vaz, J, Torgal, J, Bacellar, F, Ismail, N & Walker, D 2008, 'Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients', Journal of Infectious Diseases, vol. 198, no. 4, pp. 576-585. https://doi.org/10.1086/590211
De Sousa, Rita ; França, Ana ; Nòbrega, Sónia Dória ; Belo, Adelaide ; Amaro, Mario ; Abreu, Tiago ; Poças, José ; Proença, Paula ; Vaz, José ; Torgal, Jorge ; Bacellar, Fátima ; Ismail, Nahed ; Walker, David. / Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. In: Journal of Infectious Diseases. 2008 ; Vol. 198, No. 4. pp. 576-585.
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AU - França, Ana

AU - Nòbrega, Sónia Dória

AU - Belo, Adelaide

AU - Amaro, Mario

AU - Abreu, Tiago

AU - Poças, José

AU - Proença, Paula

AU - Vaz, José

AU - Torgal, Jorge

AU - Bacellar, Fátima

AU - Ismail, Nahed

AU - Walker, David

PY - 2008/8/15

Y1 - 2008/8/15

N2 - Background. The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. Methods. This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection. Results. A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients. Conclusions. Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.

AB - Background. The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. Methods. This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection. Results. A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients. Conclusions. Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.

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