ABSTRACT
HISTORY: A healthy 41 year old man was bitten by a tick while on safari in the Kruger National Park in South Africa. He developed severe fever and malaise 5 days later. A characteristic red skin sore with a dark centre and surrounding erythema (eschar, tache noir) developed at the site of the tick bite. The travel history and clinical picture were strongly suggestive of a tick borne fever. DIAGNOSTIC PROCEDURES: The diagnosis of tick bite fever caused by rickettsia (spotted fever group) was proven serologically. The clinical course of the disease was complicated by myocarditis, indicated by an elevated troponin I and later confirmed by cardio-MRI. The complicated clinical course and the singular eschar suggested Rickettsia conorii as the etiological agent. CLINICAL COURSE: The rickettsial infection was treated with doxycycline, which led to a rapid improvement of the patient's clinical status. However, recovery from this imported infection was delayed due to myocarditis. CONCLUSION: Rickettsioses should be included in the differential diagnosis in travellers returning from Africa. The clinical course is usually mild but can be complicated by involvement of major organs even in formerly healthy young people.
Subject(s)
Boutonneuse Fever/diagnosis , Developing Countries , Rickettsia conorii , Tick-Borne Diseases/diagnosis , Travel-Related Illness , Adult , Diagnosis, Differential , Humans , Male , South AfricaABSTRACT
Overweight and obesity are widespread in the German population, affecting not only adults but also a significant number of children and adolescents. The risk to develop chronic kidney disease is markedly increased in overweight or adipose children, adolescents and adults.Overweight and obesity induced risk factors have a direct impact on the development of chronic renal disease (obesity-associated focal segmental glomerulosclerosis). They accelerate the progression of coexistent nephropathies (diabetic or hypertensive nephropathy, primary glomerulonephritides) and are independent risk factors for the development of acute kidney injury in critically ill patients.Obesity induced nephropathies are basically preventible. Marked weight reduction, normoglycemia and control of hypertension may contribute to an improved glomerular filtration rate and/or reduced proteinuria in early stages of renal damage.The prevalence of kidney diseases in Germany is 13â% and estimated 80â000 patients need renal replacement therapy. In order to avoid a further rapid increase in numbers, preventive measures should be enforced more rigorously.It is necessary to raise the awareness of the negative consequences of obesity in the general public, to motivate the public to adopt a healthier lifestyle and to install nephrological surveillance to contain the obesity "epidemic".
