RESUMEN
Twenty-eight febrile Sri Lankan patients with undiagnosed fever for 7 days after hospital admission, who responded to empirical treatment with doxycycline, were retrospectively investigated using microimmunofluorescence assay to verify whether they had rickettsial infection. Eleven (39%) patients were confirmed as having spotted fever group rickettsioses and 10 (36%) as having Orientia tsutsugamushi. Seven were negative for all tests. This suggests that greater use of doxycycline appears justified for patients with undiagnosed fever in settings where rickettsial diseases are endemic or re-emerging with inadequate diagnostic facilities.
Asunto(s)
Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Fiebre de Origen Desconocido/microbiología , Infecciones por Rickettsia/complicaciones , Rickettsia/aislamiento & purificación , Adulto , Femenino , Fiebre de Origen Desconocido/tratamiento farmacológico , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Orientia tsutsugamushi/aislamiento & purificación , Infecciones por Rickettsia/diagnóstico , Infecciones por Rickettsia/tratamiento farmacológico , Tifus por Ácaros/diagnóstico , Sri Lanka , Adulto JovenRESUMEN
We report two patients who presented with a long-lasting febrile illness associated with pancytopenia. Both of them had evidence of hypercellular marrow with haemophagocytosis. They were confirmed as having rickettsial infections by serology and had a rapid haematological recovery with anti-rickettsial antibiotics. We highlight the importance of considering rickettsial infections in patients with such clinical presentations, especially in areas where these infections are endemic or re-emerging. Empirical use of anti-rickettsial antibiotics in such situations could be beneficial, when facilities to diagnose rickettsial diseases are not readily available.
