Fatal Rickettsia Japonica Infection Complicating Disseminated Intravascular Coagulation in Yichang, China

Abstract

Background Severe complications may cause a fatal or disabling outcome in patients with Rickettsia japonica infection but are poorly understood. Methods We identified 11 patients with only Rickettsia japonica infection with metagenomics next generation sequencing (mNGS) during April to November 2021 at Yichang Central People’s Hospital, China. Clinical data were obtained through review of medical records. Results Most patients realized that they had symptoms about one or two days after being bitten. Fever (91%), pulmonary effusion (91%), rash or erythema (100%), abnormal urine (100%), neutropenia (100%), lymphopenia (100%), and thrombocytopenia (100%) were the most common clinical signs. Six severely ill patients were admitted to the intensive care unit and five had mild symptoms. Systemic manifestations such as vomiting (83%), neurological manifestations (100%), and disseminated intravascular coagulation (100%) were more frequently observed in the severe cases, 33.3% of whom developed purpura fulminans requiring amputation or skin graft, and 16.6% died two days after admission. Some patients experienced sequelae. Conclusion Our study found that patients with critical Rickettsia japonica infection complicating disseminated intravascular coagulation had high risk of poor outcome.

Survey of Rickettsia species in hematophagous arthropods from endemic areas for Japanese spotted fever in China

“…Spotted fever is caused by the spotted fever group Rickettsia species, which are mainly vectored and transmitted by ticks. In China, Japanese spotted fever (JSF) caused by Rickettsia japonica is a common disease in eastern and central areas such as Zhejiang, Hubei, and Henan provinces ( Lu et al., 2018 ; Li et al., 2019 ; Li and Liu, 2021 ; Gao et al., 2022 ; Zhou et al., 2023 ). The main manifestations of JSF are fever, erythema, and eschar ( Noguchi et al., 2018 ).…”

“…The main manifestations of JSF are fever, erythema, and eschar ( Noguchi et al., 2018 ). Occasionally, JSF leads to inflammation of the central nervous system or even death ( Gao et al., 2022 ; Zhou et al., 2023 ). Rickettsia japonica is transmitted by hard ticks; it has been detected in multiple tick species such as Haemaphysalis longicornis , Haemaphysalis hystricis , Haemaphysalis flava , and Rhipicephalus microplus ( Zhao et al., 2021 ).…”

Diagnosing and reintegrating traceability of infectious diseases via metagenomic next-generation sequencing: Study of a severe case of Rickettsia japonica infection

“…Additionally, liver dysfunction, headache, and disseminated intravascular coagulation syndrome have been reported as associated symptoms [5] . In various provinces of China, including Anhui, Henan, Anhui, Hubei, and Zhejiang, cases of JSF have been documented [6] , [7] , [8] , [9] , [10] , with a higher number of reports in central and eastern China. This study provides details on a specific case of JSF caused by R. japonica in Shaanxi, northwest China, as well as supporting evidence for this infection from field epidemiological investigations.…”

Atypical Rickettsia japonica Infection Involving Critical Illness Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report

“…Therefore, various factors may lead to misdiagnosis, delay in starting treatment, and even lead to poor prognosis. 4,5 Here, we report a case of atypical JSF diagnosed by metagenomic next-generation sequencing (mNGS) 6 examination with severe complications.…”