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Volume 19, Number 2—February 2013

Dispatch

Human Infection with Rickettsia sibirica mongolitimonae, Spain, 2007–2011

José M. RamosComments to Author , Isabel Jado, Sergio Padilla, Mar Masiá, Pedro Anda, and Félix Gutiérrez
Author affiliations: Author affiliations: Hospital General Universitario de Elche, Alicante, Spain (J.M. Ramos, S. Padilla, M. Masiá, F. Gutiérrez); Centro Nacional de Microbiología Instituto de Salud Carlos III, Madrid, Spain (I. Jado, P. Anda); Universidad Miguel Hernández, Alicante (J.M. Ramos, M. Masiá, F. Gutiérrez).

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Table

Epidemiologic, clinical, and microbiologic characteristics associated with 6 case-patients infected with Rickettsia sibirica mongolitimonae, Spain, 2007–2011*

Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
Patient age, y/sex 67/F 32/M 33/M 42/F 40/F 75/F
Date of illness onset 2007 Jul 2009 Sep 2010 Apr 2011 Mar 2011 Apr 2011 Jul
Type of residence Rural Urban Urban Rural Rural Rural
At-risk activity Gardening Working at golf courses Walking in rural area Walking in rural area Excursion by horse Walking in rural area
Report of tick bite
No
No
No
No
Yes
No
Duration of fever, d 10 4 5 5 6 4
Temperature, °C 38.5 39.5 39.4 39.0 39.0 39.2
Headache Yes Yes Yes Yes Yes Yes
Myalgia Yes Yes Yes Yes Yes Yes
Location of eschar Scalp Thigh Leg Shoulder Neck Leg
Location of enlarged regional lymph nodes Retroauricular Inguinal Inguinal Supraclavicular Retroauricular None
Lymphangitis No Yes Yes No No Yes
Rash
Yes
Yes
No
No
Yes
Yes
Leukocytes, × 103 cells/μL 11.1 2.93 6.40 6.05 NA NA
Platelets, × 103/μL 540 126 198 217 NA NA
AST, IU 79 50 48 NA NA NA
ALT, IU 65 53 27 NA NA NA
C-reactive protein, mg/dL 101 44 46 15.4 NA NA
Lactate dehydrogenase, IU
642
567
NA
NA
NA
NA
Treatment Doxycycline Azithromycin Doxycycline Doxycycline Doxycycline Doxycycline
Complications
Hyponatremia, lethargy
NA
NA
NA
NA
NA
PCR results
Eschar Positive Positive Positive Positive Positive Positive
Lymph nodes NA Negative Negative NA NA NA
Whole blood
Negative
NA
NA
NA
NA
NA
IgM/IgG against R. sibirica mongolitimonae
Acute-phase sample 40/160 <20/<40 <20/<40 NA 40/160 <20/80
Convalescent-phase sample
NA
NA
<20/<40
<20/40
<20/80
<20/80
IgM/IgG against R. conorii
Acute-phase sample 40/160 <20/<40 <20/<40 NA 40/160 <20/40
Convalescent-phase sample NA NA <20/<40 <20/40 <20/80 <20/40

*NA, not available; AST, aspartate aminotransferase; ALT, alanine aminotransferase.
†Determined by using in-house microimmnunofluorescence assay.

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