S. Ben Yahia

Diagnostic value of ocular examination in Mediterranean spotted fever.

Mediterranean spotted fever (MSF), also named boutonneuse fever or tick-borne rickettsiosis, is endemic in Mediterranean countries [1] The aetiologic agent for this infection is Rickettsia conorii, a strictly intracellular alpha-proteobacterium. The pathophysiologic hallmark of R. conorii infection is the invasion of vascular endothelial cells by the organism, causing endothelial injury and tissue necrosis. Ocular involvement in rickettsioses has not been frequently reported and most published studies were single case reports. Data from recent prospective studies show that patients with acute MSF frequently exhibit ocular posterior segment changes that are commonly asymptomatic and self-limited [2,3]. These include retinitis, retinal vascular lesions, optic nerve changes, and numerous other findings. The aim of the present study was to better ascertain the frequency of retinitis and the role of fundus examination in the clinical diagnosis of MSF.

Epidemiological, clinical and laboratory features of murine typhus in central Tunisia.

OBJECTIVEnMurine typhus is an endemic zoonosis. It is difficult to diagnose because of its non-specific clinical manifestations. Our objective was to describe the epidemiological, clinical, laboratory, and treatment features of murine typhus.nnnMETHODSnWe conducted a retrospective study of 73 adult patients hospitalized for murine typhus from 2006 to 2011. The diagnosis was confirmed by a single titer of IgM≥128 or by seroconversion to typhus group antigen identified by indirect fluorescent assay.nnnRESULTSnThe mean age of patients was 33.1 years (range, 13-68 years). Thirty-eight patients (52%) lived in rural or suburban areas; neither fleabites nor exposure to rats were reported. The most common clinical symptoms were: fever, headache, and myalgia. A maculopapular and non-confluent rash was observed in 47 patients (64.4%). No inoculation eschar was observed in any patient. Eight patients presented with interstitial pneumonia and two with lymphocytic meningitis. The diagnosis was confirmed by indirect fluorescence assay in every case. A single titer of IgM ≥ 128 was found in 62 (84.9%) cases. The other 11 cases were diagnosed by seroconversion. All patients were given antibiotics. Tetracyclines were prescribed in 57 cases (78%). The two patients presenting with meningitis were treated with fluoroquinolone. The outcome was favorable for all patients and no relapse was observed.nnnCONCLUSIONnThe features of murine typhus are non-specific. The definitive diagnosis is based on serologic testing by indirect fluorescent assay. Cyclins were the most prescribed antibiotics.