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Volume 27, Number 8—August 2021
Research

Spotted Fever Group Rickettsioses in Israel, 2010–2019

Regev CohenComments to Author , Talya Finn, Frida Babushkin, Yael Paran, Ronen Ben Ami, Alaa Atamna, Sharon Reisfeld, Gabriel Weber, Neta Petersiel, Hiba Zayyad, Eyal Leshem, Miriam Weinberger, Yasmin Maor, Nicola Makhoul, Lior Nesher, Galia Zaide, Dar Klein, Adi Beth-Din, and Yafit Atiya-Nasagi
Author affiliations: Laniado Hospital, Netanya, Israel (R. Cohen, T. Finn, F. Babushkin); Technion–Israel Institute of Technology, Haifa, Israel (R. Cohen, T. Finn, S. Reisfeld, G. Weber); Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel (Y. Paran, R. Ben Ami); Tel Aviv University, Tel Aviv (Y. Paran, R. Ben Ami, A. Atamna, E. Leshem, M. Weinberger, Y. Maor); Rabin Medical Centre, Petah-Tikva, Israel (A. Atamna); Hillel Yaffe Medical Centre, Hadera, Israel (S. Reisfeld); Carmel Medical Centre, Haifa (G. Weber); Rambam Medical Centre, Haifa (N. Petersiel); Padeh Poriya Medical Centre, Tiberias, Israel (H. Zayyad); Bar Ilan University, Safed, Israel (H. Zayyad, N. Makhoul); S; heba Medical Centre, Ramat Gan, Israel (E. Leshem); Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel (M. Weinberger); Edith Wolfson Medical Centre, Holon, Israel (Y. Maor); Galilee Medical Centre, Nahariya, Israel (N. Makhoul); Soroka Medical Centre, Beer Sheba, Israel (L. Nesher); Ben-Gurion University of the Negev, Beer Sheba (L. Nesher); Israel Institute for Biological Research, Ness Ziona, Israel (G. Zaide, D. Klein, A. Beth-Din, Y. Atiya-Nasagi)

Main Article

Table 3

Clinical features of patients with spotted fever group rickettsiosis, according to rickettsial species, Israel, 2010–2019*

Patient data
 R. conorii Israeli tick typhus strain
 R. conorii Malish strain
 R. africae
 New Rickettsia variant
 Total
 p value
No. cases
 33
 2
 4
 3
 42
Fever 32 (97) 2 (100) 4 (100) 3 (100) 41 (98) NS
Fever to admission interval, d, mean (± SD, range)
 4.5 
(± 2.1, 0–8)
 6.5 
(± 3.5, 4–9)
 3.5 
(± 2.4, 1–6)
 13.6 
(± 13.3, 5–29)
 5.2 
(± 4.3, 0–29)
 0.002†
Systemic rash 33 (100) 1 (50) 0 3 (100) 37 (88) <0.0001‡
Rash type
Macular only 4 (12) 0 0 0 4 (10)
Maculopapular 19 (58) 1 (100) 0 2 (67) 22 (53)
Macular and petechial 5 (15) 0 0 1 (33) 6 (15)
Petechial only 2 (6) 0 0 0 2 (5)
Purpura fulminans 3 (9) 0 0 0 3 (7)
Palm and sole involvement
Yes 27 (82) 1 (100) 0 2 (67) 30 (73) <0.0001‡
No 4 (12) 0 4 (100) 1 (33) 9 (22)
Unknown
 2 (6)
 0
 0
 0
 2 (5)
Fever to rash interval, d, mean (± SD, range)§
 3.2 
(± 2.2, 0–8)
 −1¶
 NR
 15 
(± 16.9, 3−27)#
 3.7 
(± 4.6, 0–27)
Eschar 4 (12) 1 (50) 4 (100) 1 (33) 10 (24) 0.011‡
>1 eschar 1 case (3 lesions) None None None None
Location
Lower limb 3 1 4 0 8
Upper limb 1 0 0 0 1
Neck
0
 0
 0
 1
 1
Other signs/symptoms
Lymphadenitis 2 (6) 1 (50) 1 (25) 1 (33) 5 (12) NS
Lymphangitis 0 0 0 0 0 NS
Myalgia 13 (39) 2 (100) 1 (25) 2 (67) 18 (43) NS
Arthralgia 5 (15) 0 0 1 (33) 6 (14) NS
Cough 7 (21) 1 (50) 0 1 (33) 9 (21) NS
Diarrhea 7 (21) 2 (100) 0 1 (33) 10 (24) NS
Rigors 12 (36) 2 (100) 1 (25) 0 15 (36) NS
Headache 14 (42) 2 (100) 1 (25) 1 (33) 18 (43) NS
Photophobia 1 (3) 0 0 0 1 (2) NS
Confusion 10 (30) 0 0 2 (67) 12 (28) NS
Meningoencephalitis 8 (24) 0 0 0 8 (19) NS
Fever of unknown origin 5 (15) 0 0 1 (33) 6 (14) NS
ARDS 10 (30) 1 (50) 0 2 (67) 13 (31) NS
DIC 10 (30) 1(50) 0 0 11 (26) NS
Shock
 13 (39)
 2 (100)
 0
 1 (33)
 16 (38)
 NS
Hospitalization 33 (100) 2 (100) 3 (75) 3 (100) 41 (98) NS
LOS, d, mean (± SD, range) 8.9 
(± 10.4, 1–47) 12 
(± 2.8, 10–14) 2.2 
(± 2, 0–4) 57.6 
(± 91, 5–163) 11.9 
(± 25.6, 0–163) 0.01†
Intensive care admission 17 (52) 2 (100) 0 1 (33) 20 (48) NS
Mechanical ventilation 13 (39) 2 (100) 0 1 (33) 16 (38) NS
Death from rickettsiosis 10 (30) 0 0 0 10 (24) NS**

*Values are no. (%) unless otherwise indicated. ARDS, acute respiratory distress syndrome; DIC, disseminated intravascular coagulation; LOS, length of stay; NS, not significant. †Between the new Rickettsia group and other spotted fever groups, using 1-way analysis of variance. ‡Between R. africae and the other 3 Rickettsia spotted fever groups, using Pearson χ2 tests. §Data available for 36 patients: 1 had no fever (Israeli spotted fever), 1 had no rash (R. conorii Malish strain), and 4 had unknown date of rash appearance (3 Israeli spotted fever strain and 1 the new species). ¶One R. conorii Malish patient had no rash and the other had rash before fever. #For 1 patient, the date of rash appearance was not documented. **p = 0.058 for R. conorii Israeli tick typhus strain compared with the other Rickettsia groups, using Pearson χ2 test.

Main Article

Page created: June 09, 2021
Page updated: July 18, 2021
Page reviewed: July 18, 2021
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