Table 4

Spotted Fever Group Rickettsioses in Israel, 2010–2019

Regev Cohen

, 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

Laboratory features of 42 patients with spotted fever group rickettsiosis according to rickettsial species, during hospitalization days 1–3, Israel, 2010–2019*

Feature†	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
Acute kidney injury (creatinine >1.3 mg/dL), no. (%)	20/32 (62.5)	0/2	1/4 (25)	1/3 (33)	22/41 (54)	NS‡
Creatinine, mg/dL, mean (range)	1.8 (0.13–6.25)	0.83 (0.7–0.9)	0.96 (0.6–1.3)	1.6 (1.17–2.4)	1.6 (0.1–6.25)	NS§
Hepatocellular injury pattern
AST or ALT >2 ULN, no. (%)	24/33 (73)	2/2 (100)	0/4 (100)	2/3 (67)	28/42 (67)	0.02‡
AST, IU/L, mean (range)	855 (42–8,895)	249 (270–228)	27 (23–31)	83 (60–107)	728 (23–8,895)	NS§
ALT, IU/L, mean (range)	334 (12–2,881)	94 (109–80)	26 (25–29)	88 (40–164)	22/41 (54)	NS§
Cholestatic injury pattern
Alkaline phosphatase  or GGT >2 ULN, no. (%)	16/32 (48)	2/2 (100)	1/4 (25)	2/3 (67)	21/41 (51)	NS‡
Alkaline phosphatase, IU/L,  mean (range)	196 (32–1,056)	109 (67–152)	64 (63–65)	265 (60–416)	190 (32–1,056)	NS§
GGT, IU/L, mean (range)	156 (15–1,026)	150 (129–171)	73 (21–125)	507	154 (15–1,026)	NS§
Jaundice, bilirubin >1.3 mg/dL, no. (%)	14/33 (42)	1/2 (50)	0/3	0/3	15/41 (36)	NS‡
Bilirubin, mg/dL, mean (range)	1.77 (0.29–10)	2.6 (1.3–4)	0.4 (0.3–0.5)	0.93 (0.6–1.3)	1.46 (0.29–10)	NS§
C-reactive protein >5 mg/L, no. (%)	30/30 (100)	1/1 (100)	4/4 (100)	3/3 (100)	38/38 (100)	NS‡
C-reactive protein, mg/L, (range)	207 (17–460)	102	35 (17–61)	223 (131–273)	187 (17–410)	0.034§
Rhabdomyolysis, creatine kinase >ULN, no. (%)	17/30 (52)	1/2 (50)	0/2	0/3	18/37 (49)	NS‡
Creatine kinase, IU/L (range)	1,345  (81–8,900)	271  (128–414)	92  (71–113)	79  (57–102)	1,119  (57–8,900)	NS§
Complete blood count
Leukocytosis, >10,000  leukocytes/μL, no. (%)	15/33 (45)	0/2	0/4	1/3 (33)	16/42 (38)	NS‡
Leukopenia, <4,000  leukocytes/μL, no. (%)	6/33 (18)	1/2 (50)	0/4	1/3 (33)	8/42 (19)	NS‡
Leukocytes, × 10³/μL, mean (range)	14.2 (2.5–43.3)	4.5 (2.6, 6.4)	4.5 (4–5.2)	10.2 (3.9–17.1)	13.1 (2.5–43.3)	NS§
Lymphocytopenia, ALC <1,500/μL,  no. (%)	30/33 (91)	2/2 (100)	4/4 (100)	3/3 (100)	36/42 (93)	NS‡
ALC, × 10³/μL, mean (range)	0.9 (0.2–6.9)	0.35 (0.3–0.4)	1.26 (1.2–1.3)	1.1 (0.6–2.3)	0.9 (0.2–6.9)	NS§
Thrombocytopenia, platelets <150K  cells/μL, no. (%)	29/32 (88)	2/2 (100)	0/4	3/3 (100)	34/41 (83)	0.001‡
Platelets, × 10³/μL, mean (range)	84  (15–271)	36  (26–46)	238  (164–316)	64  (37–101)	82  (15–271)	0.001§
Coagulopathy, INR >1.2, no. (%)	16/33 (48)	1/2 (50)	0/2	0/3	17/40 (42)	NS‡
INR, mean (range)	1.38  (0.9–3)	1.5  (1.1–1.9)	0.96  (0.93–1)	1.09  (1.04–1.16)	1.36 (0.9–3)	NS§
Molecular diagnosis source, no. (%)
Skin biopsy sample/eschar	19 (58)	1 (50)	4 (100)	3 (100)	27 (64)
Blood	16 (48)	2 (100)	0	1 (33)	19 (45)
CSF	1 (3)	0	0	0	1 (2)
Other organs	2 (6)¶	0	0	0	2 (5)
Serologic diagnosis, no. (%) samples	32 (97)	2 (100)	1 (25)	1 (33)	36 (86)
Positive	5 (16)	0	0	0	5 (14)
Borderline	2 (6)	0	0	1 (33)	3 (8)
Negative	25 (78)	2 (100)	1 (25)	0	28 (78)

*ALC, absolute lymphocyte count; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CSF, cerebrospinal fluid; GGT, gamma glutamyl transpeptidase; INR, international normalized ratio; NS, not significant; ULN, within upper limit of normal range. †Highest or lowest levels reached within the time frame are reported. ‡By Pearson χ² test. §By 1-way analysis of variance, conducted on day-of-admission data. ¶One from liver biopsy sample and 1 from enlarged lymph node.

Main Article

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Page updated: July 18, 2021

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