Candidatus Rickettsia tarasevichiae Infection in Eastern Central China: A Case Series

Ann Intern Med. 2016 May 17;164(10):641-8. doi: 10.7326/M15-2572. Epub 2016 Mar 29.

Abstract

Background: Human infection with Candidatus Rickettsia tarasevichiae (CRT) was first reported in northeastern China in 2012.

Objective: To describe the clinical spectrum and laboratory findings of patients infected with CRT in eastern central China.

Design: Case series.

Setting: A sentinel hospital for severe fever with thrombocytopenia syndrome (SFTS) in eastern central China in 2014.

Participants: Hospitalized patients with SFTS-like illness.

Measurements: Molecular and serologic tests were performed to diagnose CRT infection. Data about clinical manifestations and laboratory findings were retrieved from medical records.

Results: 56 of 733 assessed patients had CRT based on polymerase chain reaction and sequencing. All patients presented with nonspecific manifestations, including fever (96%), malaise (88%), myalgia (57%), cough (25%), and dizziness (14%). Only 2 patients had rash. Further, 16% had eschar, 29% had lymphadenopathy, 100% had gastrointestinal symptoms, 34% had neurologic symptoms, 43% had hemorrhagic manifestations, and 23% had signs of plasma leakage. Thrombocytopenia was observed in 70%, leukopenia in 59%; lymphopenia in 45%; and elevated levels of lactate dehydrogenase in 82%, aspartate aminotransferase in 70%, alanine aminotransferase in 54%, and creatinine kinase in 46%. Co-infection with SFTS virus was documented in 66% patients, and 8 of the 56 patients died.

Limitations: Patients with CRT were not treated for infection because they were retrospectively identified. This was not a population-based study, and the results cannot be generalized to all patients with CRT.

Conclusion: Candidatus R tarasevichiae infection should be considered in the differential diagnosis of febrile patients with SFTS-like illness in endemic areas.

Primary funding source: National Natural Science Foundation of China.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bunyaviridae Infections / diagnosis
  • Bunyaviridae Infections / epidemiology
  • China / epidemiology
  • Comorbidity
  • Cross Infection / diagnosis*
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Diagnosis, Differential
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Fluorescent Antibody Technique, Indirect
  • Humans
  • Male
  • Middle Aged
  • Phlebovirus
  • Phylogeny
  • Polymerase Chain Reaction
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • Rickettsia / isolation & purification*
  • Rickettsia Infections / diagnosis*
  • Rickettsia Infections / epidemiology
  • Rickettsia Infections / microbiology