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Volume 30, Number 7—July 2024
Research

Newly Recognized Spotted Fever Group Rickettsia as Cause of Severe Rocky Mountain Spotted Fever–Like Illness, Northern California, USA

Will S. ProbertComments to Author , Monica P. Haw, Aran C. Nichol, Carol A. Glaser, Sarah Y. Park, Laura E. Campbell, Kavita K. Trivedi, Hannah Romo, Megan E.M. Saunders, Anne M. Kjemtrup, Kerry A. Padgett, and Jill K. Hacker
Author affiliations: California Department of Public Health, Richmond, California, USA (W.S. Probert, M.P. Haw, C.A. Glaser, H. Romo, M.E.M Saunders, K.A. Padgett, J.K. Hacker); Kaiser Permanente, Oakland, California, USA (A.C. Nichol); Karius, Redwood City, California, USA (S.Y. Park); Alameda County Public Health Department, San Leandro, California, USA (L.E. Campbell, K.K. Trivedi); California Department of Public Health, Sacramento, California, USA (A.M. Kjemtrup)

Main Article

Table 1

Clinical and laboratory features of Rickettsia sp. CA6269 infections in study of newly recognized SFG Rickettsia as cause of severe RMSF-like illness, northern California, USA*

Feature Case-patient 1 Case-patient 2
Clinical
Fever at hospital admission Present, 103°F (39.4°C) Present, 101.8°F (38.8°C)
Inoculation eschar Absent Absent
Rash Absent Present, maculopapular including palms
Myalgia Present Present
Headache Present Present
Nausea Present Present
Vomiting Present Present
Diarrhea Present Absent
Abdominal pain Present Absent
Acute kidney injury Present Absent
Photophobia Present Present
Altered mental status Present Present
Acute respiratory failure Present Present
Cutaneous necrosis and gangrene Present Absent
Coma Present Present
Days in intensive care unit 11 4
Days hospitalized
 22
 13
Laboratory†
Serum sodium Low (124 mEq/L) Low (133 mEq/L)
Serum lactate dehydrogenase High (421 U/L) High (1,280 U/L)
Serum creatinine High (1.44 mg/dL) Unremarkable (1.0 mg/dL)
Serum bilirubin, total High (2.3 mg/dL) Unremarkable (0.6 mg/dL)
Aspartate transaminase High (483 U/L) High (268 U/L)
Alanine transaminase High (323 U/L) High (125 U/L)
CBC platelets Low (45K/uL) Low (80K/uL)
CBC leukocyte count Unremarkable (4.5K/uL) High (12.9K/uL)
CBC neutrophil percentage Unremarkable (64%) High (84%)
CSF glucose NA Unremarkable (69 mg/uL)
CSF protein NA High (147 mg/dL)
CSF leukocyte count NA High (9/uL)
SFG Rickettsia IgG titer (acute) Unremarkable <1:128 Elevated (1:4,096)
SFG Rickettsia IgG titer (convalescent) Elevated (>1:256) Elevated (1:16,384)

*CBC, complete blood count; CSF, cerebral spinal fluid; NA, not applicable; RMSF, Rocky Mountain spotted fever; SFG, spotted fever group. †Samples for the blood metabolic panel, CBC, and CSF analyses (case-patient 2 only) were collected on the day of hospital admission for case-patient 1 and 3 days after hospital admission for case-patient 2.

Main Article

Page created: May 17, 2024
Page updated: June 22, 2024
Page reviewed: June 22, 2024
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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