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

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

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.

PMID:
27019406
DOI:
10.7326/M15-2572
[Indexed for MEDLINE]

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