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Rickettsia sibirica subsp. mongolitimonae infection and retinal vasculitis.

Caron J, Rolain JM, Mura F, Guillot B, Raoult D, Bessis D - Emerging Infect. Dis. (2008)

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Rickettsia sibirica subsp. mongolitimonae is an intracellular bacterium that belongs to the species R. sibirica... No tick bite was reported by the patient, although she had been walking a few days before in Camargue (southern France)... Serologic results for R. conorii, R. typhi, Brucella spp., Borrelia spp., and Coxiella burnetii were negative... She underwent a complete ophthalmic evaluation... Measurement of visual acuity and results of a slit-lamp examination were within normal limits, but a funduscopic examination showed a white retinal macular lesion that corresponded in a fluorescein angiograph to an area of retinal ischemia induced by vascular inflammation and subsequent occlusion (Figure)... Samples were sent to the World Health Organization Collaborative Center in Marseille for rickettsial reference and research... Immunoglobulin (Ig) G and IgM titers were estimated by using a microimmunofluorescence assay; results were negative... Nucleotide sequences of the PCR products were determined... All sequences shared 100% similarity with R. sibirica subsp. mongolotimonae when compared with those in the GenBank database... However, the vector of R. sibirica subsp. mongolitimonae has not been identified... Chloramphenicol is an alternative drug for pregnant women but it is not available in France... Macrolides (azithromycin, clarithromycin, and josamycin) are effective against rickettsial disease and can be used safely during pregnancy... No ocular complications were reported in the 11 previous cases of rickettsiosis caused by R. subsp. mongolitimonae... However, ocular lesions, including optic disk staining, white retinal lesions, retinal hemorrhages, multiple hypofluorescent choroidal dots, mild vitritis, and retinal vasculitis, have been described in patients with rickettsiosis caused by R. conorii, R. rickettsii, and R. typhi... Retinal vasculitis was reported in 45%–55% of the patients, but retinal artery occlusion secondary to vasculitis has been described in only 2 cases of infection with R. conorii and R. rickettsii without details of clinical symptoms.

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Fluorescein angiograph of the right eye of the patient showing retinal occlusive vasculitis with arteriolar leakage at late phase.
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Figure 1: Fluorescein angiograph of the right eye of the patient showing retinal occlusive vasculitis with arteriolar leakage at late phase.

Mentions: One day after admission, she reported loss of vision (scotoma) in her right eye. She underwent a complete ophthalmic evaluation. Measurement of visual acuity and results of a slit-lamp examination were within normal limits, but a funduscopic examination showed a white retinal macular lesion that corresponded in a fluorescein angiograph to an area of retinal ischemia induced by vascular inflammation and subsequent occlusion (Figure). The following day, a rash with a few maculopapular elements developed, which involved only the palms of the hands and soles of the feet. Mediterranean spotted fever was suspected. Cyclines and fluoroquinolones were contraindicated because of her pregnancy, and the patient had a history of maculopapular rash after taking josamycin. She was treated with azithromycin, 500 mg/day for 10 days, under close surveillance. After 2 days of treatment, she was afebrile and the rash completely resolved. No obstetric complications occurred and she gave birth to a healthy boy at term. Two years later, the right scotoma remained unchanged.


Rickettsia sibirica subsp. mongolitimonae infection and retinal vasculitis.

Caron J, Rolain JM, Mura F, Guillot B, Raoult D, Bessis D - Emerging Infect. Dis. (2008)

Fluorescein angiograph of the right eye of the patient showing retinal occlusive vasculitis with arteriolar leakage at late phase.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2570939&req=5

Figure 1: Fluorescein angiograph of the right eye of the patient showing retinal occlusive vasculitis with arteriolar leakage at late phase.
Mentions: One day after admission, she reported loss of vision (scotoma) in her right eye. She underwent a complete ophthalmic evaluation. Measurement of visual acuity and results of a slit-lamp examination were within normal limits, but a funduscopic examination showed a white retinal macular lesion that corresponded in a fluorescein angiograph to an area of retinal ischemia induced by vascular inflammation and subsequent occlusion (Figure). The following day, a rash with a few maculopapular elements developed, which involved only the palms of the hands and soles of the feet. Mediterranean spotted fever was suspected. Cyclines and fluoroquinolones were contraindicated because of her pregnancy, and the patient had a history of maculopapular rash after taking josamycin. She was treated with azithromycin, 500 mg/day for 10 days, under close surveillance. After 2 days of treatment, she was afebrile and the rash completely resolved. No obstetric complications occurred and she gave birth to a healthy boy at term. Two years later, the right scotoma remained unchanged.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Rickettsia sibirica subsp. mongolitimonae is an intracellular bacterium that belongs to the species R. sibirica... No tick bite was reported by the patient, although she had been walking a few days before in Camargue (southern France)... Serologic results for R. conorii, R. typhi, Brucella spp., Borrelia spp., and Coxiella burnetii were negative... She underwent a complete ophthalmic evaluation... Measurement of visual acuity and results of a slit-lamp examination were within normal limits, but a funduscopic examination showed a white retinal macular lesion that corresponded in a fluorescein angiograph to an area of retinal ischemia induced by vascular inflammation and subsequent occlusion (Figure)... Samples were sent to the World Health Organization Collaborative Center in Marseille for rickettsial reference and research... Immunoglobulin (Ig) G and IgM titers were estimated by using a microimmunofluorescence assay; results were negative... Nucleotide sequences of the PCR products were determined... All sequences shared 100% similarity with R. sibirica subsp. mongolotimonae when compared with those in the GenBank database... However, the vector of R. sibirica subsp. mongolitimonae has not been identified... Chloramphenicol is an alternative drug for pregnant women but it is not available in France... Macrolides (azithromycin, clarithromycin, and josamycin) are effective against rickettsial disease and can be used safely during pregnancy... No ocular complications were reported in the 11 previous cases of rickettsiosis caused by R. subsp. mongolitimonae... However, ocular lesions, including optic disk staining, white retinal lesions, retinal hemorrhages, multiple hypofluorescent choroidal dots, mild vitritis, and retinal vasculitis, have been described in patients with rickettsiosis caused by R. conorii, R. rickettsii, and R. typhi... Retinal vasculitis was reported in 45%–55% of the patients, but retinal artery occlusion secondary to vasculitis has been described in only 2 cases of infection with R. conorii and R. rickettsii without details of clinical symptoms.

Show MeSH
Related in: MedlinePlus