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Volume 19, Number 10—October 2013


Rickettsia slovaca Infection in Humans, Portugal

Rita de SousaComments to Author , Branca Isabel Pereira, Claúdia Nazareth, Susana Cabral, Conceição Ventura, Pedro Crespo, Nuno Marques, and Saraiva da Cunha
Author affiliations: National Institute of Health Dr. Ricardo Jorge, Águas de Moura, Portugal (R. de Sousa); University Hospitals of Coimbra, Coimbra, Portugal (B.I. Pereira, C. Nazareth, S. Cabral, C. Ventura, P. Crespo, N. Marques, S. da Cunha)

Main Article


Epidemiologic, clinical and microbiologic characteristics of 3 patients infected with Rickettsia slovaca, Portugal

Characteristic Patient 1 Patient 2 Patient 3
Age, y/sex 50/F 53/F 30/F
Date of illness onset 2010 Oct 2012 Apr 2012 May
Type of residence Rural Rural Rural
At-risk activity Field worker Field worker, contact with domestic animals Contact with dogs
Reported tick bite
Clinical characteristics
Incubation time, d*† 4 7 NA
Fever Yes, 37.8°C No No
Eschar on scalp Yes Yes Yes
Rash No Yes, maculopapular No
Painful cervical/occipital lymphadenopathy Yes No Yes
Facial edema Yes Yes No
Headache Yes No No
Localized alopecia
Laboratory diagnostics
Antibodies against R. slovaca by IFA‡
Sample 1, titer IgM/IgG Negative 32/64 32/64
Sample 2, titer IgM/IgG 32/128 1,024/1,024 ND
Culture from eschar Positive ND Contaminated
PCR from eschar Positive Positive Positive

*All patients were treated with doxycycline. NA, not available; ND, not done; IFA, immunofluorescence assay.
†From tick bite to symptom onset.
‡Positive cutoff values, IgM = 32; IgG = 128.

Main Article