Eosinophilic meningitis caused by rocky mountain spotted fever

Crennan, Joan M.; Scoy, Robert E. Van

doi:10.1016/0002-9343(86)90023-9

Cited by 21 publications

(8 citation statements)

References 3 publications

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“…These include allergic aspergillus sinusitis (37), streptococcal newborn infection (190), coxsackie viral meningitis (44), and lymphocytic choriomeningitis virus (152). Also associated with CSF eosinophilia is rickettsial disease and Rocky Mountain spotted fever (63). CSF eosinophilia has been described in a few cases of neurosyphilis and tuberculous meningitis but without a well-documented etiological role for these bacteria (152).…”

Section: Bacterial Viral and Allergic Diseasesmentioning

confidence: 99%

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

2009

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SUMMARY Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections.

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Section: Bacterial Viral and Allergic Diseasesmentioning

confidence: 99%

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

2009

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“…CSF findings in spotted fever group rickettsial disease are diverse: pleocytosis with predominant polymorphs (as in this case), predominance of eosinophils or predominance of lymphocytes. CSF may also be unremarkable [4,[7][8][9][10]. The predominant cell type in CSF may be related to the timing of CSF analysis; a report on tick-borne encephalitis showed an average of 570 cells with 60% polymorphs in the first three days of illness, and a predominance of mononuclear cells from the fifth day onwards [9].…”

Section: Discussionmentioning

confidence: 99%

Characterization of rickettsia rickettsii in a case of Fatal Brazilian spotted fever in the city of Rio de Janeiro, Brazil

Lamas¹,

Favacho²,

Rozental³

et al. 2008

Braz J Infect Dis

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A lethal case of Brazilian spotted fever (BSF) is presented. Clinical features were initially of gastrointestinal involvement and evolved with progression to septic shock, meningoencephalitis and death on the 6 th day of illness. Indirect immunofluorescence assay (IFA) for spotted fever group rickettsia (SFGR) was non-reactive. Diagnosis was confirmed by the polymerase chain reaction (PCR) and the nucleotide sequencing of a fragment of the ompA gene showed 100% homology to Rickettsia rickettsii. BSF has not been reported in the city of Rio de Janeiro in the last three decades, and the present description should alert the clinicians to its presence in urban Rio de Janeiro, and to the differential diagnosis with dengue fever, gastroenteritis, leptospirosis and bacterial septic shock, among others. Key-Words: Brazilian spotted fever, spotted fever group rickettsia, Rickettsia rickettsii, lethal case, Rio de Janeiro city, indirect immunofluorescence, polymerase chain reaction, central nervous system involvement.Brazilian spotted fever (BSF) is a systemic disease caused by Rickettsia rickettsii, a bacterium transmitted by the horse tick Amblyomma cajennense. It is endemic in the Southeast of Brazil (Rio de Janeiro, São Paulo, Minas Gerais and Espírito Santo states) and affects exposed children and adults [1][2][3][4]. Case presentation mimics several conditions which are endemic in the area, such as dengue fever, leptospirosis, gastroenteritis, meningococcal meningits and severe sepsis [1][2][3][4]. This paper reports a fatal case of BSF, occurring in July, in the metropolitan area of Rio de Janeiro, with prominent sepsis, rash and neurological and cerebrospinal fluid (CSF) findings. Case ReportA 48 year-old white male presented, six days prior to hospital admission, with acute onset of high-grade fever, myalgia, headache, nausea, vomiting and diarrhea. He was a heavy smoker, but past medical history was otherwise unremarkable. He sought medical attention and was treated symptomatically. Two days later his symptoms persisted and he developed jaundice: he was given sulfamethoxazole-trimethoprim and was sent home. The following day he sought the Emergency ward because of hematemesis and melena; he was oliguric. He was transferred to an infectious diseases reference hospital with the presumptive diagnosis of leptospirosis. He was a porter in the north area of Rio de Janeiro, and had frequent contact with rodents. He had been bitten by ticks in Campo Grande (west area of Rio Janeiro) two weeks previously, while visiting his brother, who was a horse cart driver. On arrival he was jaundiced, in deep coma with no neck stiffness, systolic blood pressure was 60 mmHg, heart rate =128 bpm, and a generalized purpuric rash was noted. He was intubated, mechanically ventilated, given rapid intravenous fluid, noradrenaline, ceftriaxone, oxacillin and chloramphenicol. Myoclonus was observed, and two hours after admission he presented a generalized tonic-clonic seizure. Initial investigation showed leukocytosis (18,200 cells/mm 3 , di...

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“…Other causes of eosinophilic meningitis include helminthic infection, 3 tuberculosis, 4 fungal infection, 5 rickettsiosis, 6 non-Hodgkin lymphoma, 7 carcinoma, 8 hypereosinophilic syndrome 9 and reaction to foreign bodies or drugs. 10 The diagnosis of Hodgkin lymphoma cytology requires the presence of large, atypical mononuclear Hodgkin cells or binucleate RS cells in the appropriate reactive background of small lymphocytes, monocytes, eosinophils and plasma cells.…”

Section: Discussionmentioning

confidence: 99%