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Volume 24, Number 5—May 2018
CME ACTIVITY - Synopsis

Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel

Regev CohenComments to Author , Frida Babushkin, Maurice Shapiro, Martina Uda, Yafit Atiya-Nasagi, Dar Klein, and Talya Finn
Author affiliations: The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel (R. Cohen); Laniado Hospital, Netanya, Israel (R. Cohen, F. Babushkin, M. Shapiro, M. Uda, T. Finn); The Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi, D. Klein)

Main Article

Table 2

Clinical characteristics of 5 case-patients with Israeli spotted fever, Sharon District, Israel*

Characteristic Case-patient 1 Case-patient 2 Case-patient 3 Case-patient 4 Case-patient 5
Age, y/sex
 75/F
 51/F
 38/ M
 48/M
 45/M
Concurrent condition
 Hypertension
 Mental retardation, diabetes mellitus
 None
 Alcoholism, HCV carrier, IVDU
 Nephrolithiasis, psoriasis
Signs/symptoms at hospitalization
Fever Yes Yes Yes Yes Yes
Rash Purpura fulminans Maculopapular, then purpura fulminans Maculopapular Maculopapular Maculopapular
Day of rash from disease onset 6 6 4 4 3
Hypotension Yes Yes No No No
Multiorgan failure Yes Yes No No No
Eschar No No No No No
Headache No Unknown Yes No No
Confusion No No No No No
Myalgia
 Yes
 Unknown
 Yes
 No
 No
Epidemiologic factor
Animal exposure Dog Unknown Dog None Dog
Tick exposure
 No
 No
 No
 No
 No
Serologic result, day/result
First sample 9/nonreactive 6/IgM titer >100, IgG titer borderline† 6/nonreactive 6/nonreactive 5/nonreactive
Second sample
 19/IgM titer nonreactive, IgG titer 1:800†
 NR
 NR
 NR
 19/IgM titer >1:100, IgG titer 1:1,600†
PCR result, whole blood/doxycycline treatment day NR +/3 NR NR –/5
PCR result, skin biopsy specimen/doxycycline treatment day
 +/4
 +/3
 +/4
 +/3
 –/3
Doxycycline treatment
Day of illness 6 5 5 5 4
Day of hospitalization
 0
 2
 0
 1
 0
Length of hospitalization, d
 14
 20
 7
 4
 8
Outcome Died Died Survived Survived Survived

*HCV, hepatitis C virus; IVDU, intravenous drug use; NR, not relevant/not obtained; +, positive; –, negative.
†Results from the Israeli reference laboratory for rickettsial diseases.

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Page created: April 17, 2018
Page updated: April 17, 2018
Page reviewed: April 17, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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