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Fatal Rickettsia conorii subsp. israelensis infection, Israel.

Weinberger M, Keysary A, Sandbank J, Zaidenstein R, Itzhaki A, Strenger C, Leitner M, Paddock CD, Eremeeva ME - Emerging Infect. Dis. (2008)

Bottom Line: Underdiagnosis of fatal spotted fever may be attributed to nonspecific clinical features and insensitive acute-phase serologic studies.We describe the importance of molecular and immunohistochemical methods in establishing the postmortem diagnosis of locally acquired Israeli spotted fever due to Rickettsia conorii subsp. israelensis in a traveler returning to Israel from India.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. miriw@netvision.net.il

ABSTRACT
Underdiagnosis of fatal spotted fever may be attributed to nonspecific clinical features and insensitive acute-phase serologic studies. We describe the importance of molecular and immunohistochemical methods in establishing the postmortem diagnosis of locally acquired Israeli spotted fever due to Rickettsia conorii subsp. israelensis in a traveler returning to Israel from India.

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Related in: MedlinePlus

PCR product from the 17-kDa protein antigen gene obtained from DNA extracted from necropsied tissues of the patient. Primary PCR (A), nested PCR (B), and BfaI restriction enzyme pattern of the 17-kDa protein gene amplicon (C). Lane 1, reagent control; 2, skin; 3, liver; 4, lung; NTC, nontemplate control; SF, Rickettsia conorii DNA control; SM, size markers.
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Figure 2: PCR product from the 17-kDa protein antigen gene obtained from DNA extracted from necropsied tissues of the patient. Primary PCR (A), nested PCR (B), and BfaI restriction enzyme pattern of the 17-kDa protein gene amplicon (C). Lane 1, reagent control; 2, skin; 3, liver; 4, lung; NTC, nontemplate control; SF, Rickettsia conorii DNA control; SM, size markers.

Mentions: Results of nested PCR tests for spotted fever group rickettsiae (SFGR), performed at the Israeli National Reference Laboratory for Rickettsial Diseases on DNA samples prepared from serum collected on day 7 of illness (8), were negative. These tests were also applied to autopsy tissue samples (liver, muscle, skin, lung, kidney) and yielded a 214-bp amplicon from the 17-kDa protein gene of the SFGR (Figure 2). BfaI restriction profile of 17-kDa protein gene amplicons consisted of 2 fragments, 50 and 164 bp that were identical to that of R. conorii subsp. conorii and R. conorii subsp. israelensis (8). A 208-bp fragment of the conserved 17 kDa Rickettsia spp. antigen gene was amplified at CDC from a DNA specimen obtained from a serum sample collected during the autopsy, and indicated SFGR DNA in the patient’s bloodstream. An outer membrane protein A (ompA) gene fragment (70–602 nt) was amplified from the positive serum sample extracted at CDC and from skin, liver, and muscle samples extracted at the Israel Institute for Biological Research as described (9). Nucleotide sequences of each of the 4 ompA amplicons (GenBank accession no. EU122392) and R. conorii subsp. israelensis (U43797, http://www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nuccore&id=1174108) were identical.


Fatal Rickettsia conorii subsp. israelensis infection, Israel.

Weinberger M, Keysary A, Sandbank J, Zaidenstein R, Itzhaki A, Strenger C, Leitner M, Paddock CD, Eremeeva ME - Emerging Infect. Dis. (2008)

PCR product from the 17-kDa protein antigen gene obtained from DNA extracted from necropsied tissues of the patient. Primary PCR (A), nested PCR (B), and BfaI restriction enzyme pattern of the 17-kDa protein gene amplicon (C). Lane 1, reagent control; 2, skin; 3, liver; 4, lung; NTC, nontemplate control; SF, Rickettsia conorii DNA control; SM, size markers.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2600240&req=5

Figure 2: PCR product from the 17-kDa protein antigen gene obtained from DNA extracted from necropsied tissues of the patient. Primary PCR (A), nested PCR (B), and BfaI restriction enzyme pattern of the 17-kDa protein gene amplicon (C). Lane 1, reagent control; 2, skin; 3, liver; 4, lung; NTC, nontemplate control; SF, Rickettsia conorii DNA control; SM, size markers.
Mentions: Results of nested PCR tests for spotted fever group rickettsiae (SFGR), performed at the Israeli National Reference Laboratory for Rickettsial Diseases on DNA samples prepared from serum collected on day 7 of illness (8), were negative. These tests were also applied to autopsy tissue samples (liver, muscle, skin, lung, kidney) and yielded a 214-bp amplicon from the 17-kDa protein gene of the SFGR (Figure 2). BfaI restriction profile of 17-kDa protein gene amplicons consisted of 2 fragments, 50 and 164 bp that were identical to that of R. conorii subsp. conorii and R. conorii subsp. israelensis (8). A 208-bp fragment of the conserved 17 kDa Rickettsia spp. antigen gene was amplified at CDC from a DNA specimen obtained from a serum sample collected during the autopsy, and indicated SFGR DNA in the patient’s bloodstream. An outer membrane protein A (ompA) gene fragment (70–602 nt) was amplified from the positive serum sample extracted at CDC and from skin, liver, and muscle samples extracted at the Israel Institute for Biological Research as described (9). Nucleotide sequences of each of the 4 ompA amplicons (GenBank accession no. EU122392) and R. conorii subsp. israelensis (U43797, http://www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nuccore&id=1174108) were identical.

Bottom Line: Underdiagnosis of fatal spotted fever may be attributed to nonspecific clinical features and insensitive acute-phase serologic studies.We describe the importance of molecular and immunohistochemical methods in establishing the postmortem diagnosis of locally acquired Israeli spotted fever due to Rickettsia conorii subsp. israelensis in a traveler returning to Israel from India.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. miriw@netvision.net.il

ABSTRACT
Underdiagnosis of fatal spotted fever may be attributed to nonspecific clinical features and insensitive acute-phase serologic studies. We describe the importance of molecular and immunohistochemical methods in establishing the postmortem diagnosis of locally acquired Israeli spotted fever due to Rickettsia conorii subsp. israelensis in a traveler returning to Israel from India.

Show MeSH
Related in: MedlinePlus