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Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients.

2008Journal article Open access
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dc.contributor.authorSousa, R
dc.contributor.authorFrança, A
dc.contributor.authorNóbrega, SD
dc.contributor.authorBelo, A
dc.contributor.authorAmaro, M
dc.contributor.authorAbreu, T
dc.contributor.authorPoças, J
dc.contributor.authorProença, P
dc.contributor.authorVaz, J
dc.contributor.authorTorgal, J
dc.contributor.authorBacellar, F
dc.contributor.authorIsmail, N
dc.contributor.authorWalker, D
dc.date.accessioned2010-03-04T15:42:49Z
dc.date.available2010-03-04T15:42:49Z
dc.date.issued2008
dc.description.abstractBACKGROUND: The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood. METHODS: This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection. RESULTS: A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients. CONCLUSIONS: Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.pt
dc.identifier.citationJ Infect Dis. 2008 Aug 15;198(4):576-85pt
dc.identifier.issn0022-1899
dc.identifier.urihttp://hdl.handle.net/10400.10/45
dc.language.isoengpt
dc.publisherUniversity of Chicago Presspt
dc.subjectFebre botonosapt
dc.subjectInsuficiência renal agudapt
dc.subjectEpidemiologiapt
dc.subjectEstudos prospectivospt
dc.subjectDoenças infecciosaspt
dc.subjectInfecções bacterianaspt
dc.titleHost- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients.pt
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceChicagopt
oaire.citation.endPage585pt
oaire.citation.startPage576pt
oaire.citation.titleJournal of Infectious Diseasespt
rcaap.rightsopenAccesspt
rcaap.typearticlept

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