Volume 28, Number 5—May 2022
Research Letter
Rare Case of Rickettsiosis Caused by Rickettsia monacensis, Portugal, 2021
Rita de Sousa
, Marta Leal dos Santos, Claudina Cruz, Vasco Almeida, Ana Raquel Garrote, Freddy Ramirez, Diana Seixas, Maria J. Manata, and Fernando Maltez
, Marta Leal dos Santos, Claudina Cruz, Vasco Almeida, Ana Raquel Garrote, Freddy Ramirez, Diana Seixas, Maria J. Manata, and Fernando Maltez
Table
Clinical features and laboratory diagnosis of patients with Rickettsia monacensis infection, 2003–2021
| Feature |
Patient 1, La Rioja, Spain (1) |
Patient 2, Basque, Spain (1) |
Patient 3, Sardinia, Italy (2) |
Patient 4, South Korea (3) |
Patient 5, South Korea (4) |
Patient 6, Portugal (this study) |
|---|---|---|---|---|---|---|
| Epidemiologic | ||||||
| Age, y/ sex | 84/M | 59/F | 28/M | 73/M | 75/F | 67/M |
| Date of onset | Jun 2003 | Sep 2003 | Apr 2011 | 2006 | Oct 2019 | Feb 2021 |
| Tick bite history |
NK |
Yes |
NK |
NK |
NK |
Yes |
| Clinical | ||||||
| Fever, ºC (ºF) | Yes, 39.5º (103.1º) | Yes, 38º (100.4º) | Yes, 38.2º (100.8º) | Yes, 40º (104.0º) | Yes, 38.4º (101.1º) | Yes, 39.9º (103.8º) |
| Eschar (location) | No | No | Yes (calf) | Yes (back) | Yes (scalp) | Yes (back) |
| Rash | Yes | Yes | No | Yes | Yes | Yes |
| Type | Maculopapular | Erythematous | Maculopapular | Maculopapular | Erythematous | |
| Including palm and soles | Yes | Yes | ||||
| Headache | Yes | Yes | Yes | Yes | NK | Yes |
| Lymphadenopathy |
NK |
NK |
NK |
Yes |
Yes |
NK |
| Laboratory test results | ||||||
| SFGR IFA titer | ||||||
| Sample 1 | <40 IgG | 2,560 IgG | 128 IgG | 320 (IgM + IgG) | <16 IgM/32 IgG, negative | Negative |
| Sample 2 | 1,280 IgG (26 wk later) | 1,280 IgG | NA | NA | 16 IgM/128 IgG (2 mo) | 32 IgM /128 IgG (2 wk) |
| Culture, blood/biopsy | Positive | Negative | NA | Positive | NA | NA |
| PCR detection, blood and/or skin biopsy |
Positive |
Positive |
Positive |
NK |
Positive |
Positive |
| Co-infections with other pathogens |
NK |
NK |
NK |
NK |
Orientia tsutsugamushi |
NK |
| Treatment | ||||||
| Hospitalization | NA | NA | Yes | Yes | Yes | Yes |
| Antimicrobial drug | Doxycycline 100 mg every 12 h for 10 d |
Doxycycline 100 mg every 12 h for 10 d |
Doxycycline 100 mg every 12 h for 7 d |
Azithromycin 500 mg, 1 dose |
Doxycycline 200 mg/d |
Doxycycline 200 mg/d |
References
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