How to diagnose mediterranean spotted fever in patients with fever and rash: a prospective study

• Autor(a) principal: Tribolet de Abreu, Tiago
• Data de Publicação: 2007
• Outros Autores: de Sousa, Rita, Pinto, Carla, Bacellar, Fátima
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1526
• topic: febre botonosa; febre escaro-nodular; Rickettsia conorii; Rickettsia israeli; diagnóstico; febre; exantema

Background: Mediterranean spotted fever (MSF) has a high incidence in Portugal, especially in the Alentejo region, where its mortality can reach 4.5%. Although diagnosis is clinical, the predictive value of the associated signs and symptoms is unknown.Objectives: To identify clinical and laboratory features, possible to obtain in the Emergency Room, that correlate with a diagnosis of MSF, in patients with fever and rash.Methods: A prospective study was conducted, between 1st January and 31st December 2002, that included all patients admitted with fever and rash. A clinical and laboratory evaluation was performed, along with serological screening for Rickettsiae, Borreliae, Ehrlichiae, Epstein Barr, HIV, Echo, Coxsackie, Salmonellae, Leptospirae, Treponema, Rheumatic fever, endocarditis and lupus. The correlation between the clinical and laboratory data and a definitive diagnosis of Rickettsiosis was studied using the Chi-square (or Fisher, when necessary) test. Logistic regression was used to study the predictive value of the variables with a statistically significant correlation.Results: 55 patients where admitted with fever and rash, in whom MSF was confirmed in 44. The mean age was 60.7 years and 46.7% were male. Only an admission diagnosis of MSF had a statistically significant correlation with that same definitive diagnosis (p=0.008).Conclusions: In this study, only an admission diagnosis of MSF had a statistically significant correlation with that same definitive diagnosis (odds ratio 10.7). The week of admission had a weak statistical significance (p=0.049, and odds ratio 4.0).