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CORRESPONDENCE
Year : 2015  |  Volume : 141  |  Issue : 2  |  Page : 242-244

Spotted fever rickettsiosis in Uttar Pradesh


1 Department of Microbiology, King George's Medical University, Lucknow 226 003, Uttar Pradesh, India
2 Department of Pediatrics, King George's Medical University, Lucknow 226 003, Uttar Pradesh, India

Date of Web Publication21-Apr-2015

Correspondence Address:
Mastan Singh
Department of Microbiology, King George's Medical University, Lucknow 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.155596

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How to cite this article:
Singh M, Agarwal J, Pati Tripathi CD, Kanta C. Spotted fever rickettsiosis in Uttar Pradesh. Indian J Med Res 2015;141:242-4

How to cite this URL:
Singh M, Agarwal J, Pati Tripathi CD, Kanta C. Spotted fever rickettsiosis in Uttar Pradesh. Indian J Med Res [serial online] 2015 [cited 2019 Jul 19];141:242-4. Available from: http://www.ijmr.org.in/text.asp?2015/141/2/242/155596

Sir,

Rickettsiosis consists of a spectrum of vector borne diseases caused by small Gram-negative obligate intracellular bacteria which includes epidemic typhus, scrub typhus and spotted fever. Rickettsial diseases have been reported from various parts of India namely Jammu and Kashmir, Uttarakhand, Maharashtra, Kerala, Tamil Nadu, Assam and West Bengal [1],[2],[3] . Cases described here were admitted in Paediatrics ward of King George's Medical University, Lucknow, Uttar Pradesh, India, in November 2013, and referred to the department of Microbiology for investigations. There were four confirmed cases belonging to ''spotted fever'' group which includes tick borne agents Rickettsia rickettsii, R. conorii and mite transmitted R. akari. All were from rural areas within 100 km of Lucknow (district- Hardoi, Raebareli, Sultanpur and Sitapur). Information related to demography, clinical presentation, vital parameters and routine haemogram done at the time of admission, is given in [Table 1]. Inoculation eschar was not noted in any of the patients. None reported pallor, cyanosis or icterus, and central nervous system examination was within normal limits. The institutional ethics committee approved the study.
Table 1. Clinical features and haemogram at the time of admission of patients


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Serology for typhoid (Typhidot, AB Diagnopath Manufacturing Pvt. Ltd, New Delhi, India ; Widal; in-house), malaria (antigen detection, Optimal, Bio-Rad Laboratories India Pvt. Ltd., Gurgaon, Haryana, India) and dengue (NS1 antigen, Microlisa, J. Mitra & Co. Pvt. Ltd., New Delhi, India) was negative and blood cultures were sterile even after seven days of aerobic incubation. Blood (4 ml) was drawn from each patient on days one and six of admission and serum was separated. Serum samples were tested for R. conorii IgG and IgM by ELISA (Vircell Microbiologists, Spain); antibody index (AI) was calculated as per the manufacturer's instructions. Further, serum samples were also tested for Weil Felix test (Tulip Diagnostics, Goa, India). All serological tests for rickettsiosis were done in paired samples (i.e. on days 1 and 6 of admission); results are presented in [Table 2].
Table 2. Results of rickettsial serology


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All patients were empirically treated with injection ceftriaxone and amikacin. Once serology reports were available on day two, patients were also given oral doxycycline 5 mg/kg/day in two divided doses for 5-7 days. There was rapid improvement in patient's condition and all became afebrile within 24-48 h and were discharged within next 7-9 days.

The disease spectrum of rickettsiosis is wide. In most patients it is mild; however, serious complications and fatalities have also been reported [4],[5] . Establishing the aetiological diagnosis is difficult during the acute stage of illness and the clinical features may be confused with atypical measles, dengue, malaria, sepsis, meningococcaemia, leptospirosis and vasculitis syndromes. These were ruled out clinically and by investigations in our patients. Definitive diagnosis usually requires heightened clinical suspicion and examination of paired serum samples for serological evidence [6] . Many cases of rickettsial infection are believed to go undiagnosed due to lack of diagnostic facilities [1],[2],[4],[5] .

Here, we reported four confirmed cases of spotted fever group infection; where clinical suspicion followed by examination of paired serum samples for serological evidence, confirmed the diagnosis and prompt treatment led to recovery in all patients.


   Acknowledgment Top


This work is done as part of an ongoing "Rickettsial Serosurveillance" Project with support from ICMR at the department of Microbiology, KGMU, Lucknow.

 
   References Top

1.
Mahajan SK. Rickettsial diseases. J Assoc Physicians India 2012; 60 : 37-44.   Back to cited text no. 1
    
2.
Shah V, Vaidya V, Bang V, Shah I. Spotted fever in a child in Mumbai, India. J Vector Borne Dis 2009; 46 : 310-2.   Back to cited text no. 2
    
3.
Chaudhry D, Garg A, Singh I, Tandon C, Saini R. Rickettsial diseases in Haryana: not an uncommon entity. J Assoc Physicians India 2009; 57 : 334-7.   Back to cited text no. 3
    
4.
Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 2005; 18 : 719-56.   Back to cited text no. 4
    
5.
Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis - United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 2006; 55 (RR-4) : 1-27.  Back to cited text no. 5
    
6.
Walker DH, Dumler JS, Marrie T. Rickettsial diseases. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison's principles of internal medicine, 18 th ed. New York: McGraw-Hill; 2012. p. 1407-17.  Back to cited text no. 6
    



 
 
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  [Table 1], [Table 2]



 

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