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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 4

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.

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