Spotted fever rickettsioses causing myocarditis and ARDS: a case from Sri Lanka

Abstract

BackgroundSpotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. ARDS and myocarditis are rare complications of Rickettsia conorii infections and only a few cases are reported to date.Case presentationA 53 years old manual worker presented with fever for 5 days and a skin rash. He was in circulatory failure on admission and developed severe hypoxaemia with gross changes in chest radiograph by next day requiring assisted ventilation. He had myocarditis causing left ventricular failure and acute respiratory distress syndrome. He was confirmed to have spotted fever rickettsial infection with rising titre of indirect immunofluorescence antibodies to Ricketssia conorii and made a complete recovery with appropriate antibiotic therapy and supportive care.ConclusionRickettsial infections can present with diverse manifestations. Even the patients with severe organ involvements such as myocarditis and ARDS can be completely cured if timely identified and treated.

Advances in the relationship between coronavirus infection and cardiovascular diseases

“…An increase in heart rate over a long period of time will lead to increased myocardial oxygen consumption and decreased cardiac output, which may cause ischemia or heart failure [156]. Many diseases with fever symptoms may be complicated by myocarditis, such as spotted fever rickettsioses infection [157], severe fever with thrombocytopenia syndrome [158], drug reaction with eosinophilia and systemic symptoms [159], dengue [160][161][162], complicated scrub typhus [163], herpes simplex virus infection [164], enteric fever [165].…”

An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil’s Disease

“…There is a very recent case report from Kandy, Sri Lanka, on myocarditis due to R. conorii infection [19]. He was successfully treated with intravenous chloramphenicol, hydrocortisone, and supportive therapy [19]. These cases reiterate that myocarditis is a rare but serious complication of rickettsial SFG, and it is treatable.…”

“…Nevertheless, we found a past report in a local journal on myocarditis due to rickettsioses from the Western Province of Sri Lanka, but the infecting organism (whether Orientia tsutsugamushi or SFG rickettsia) had not been clearly mentioned there [18]. There is a very recent case report from Kandy, Sri Lanka, on myocarditis due to R. conorii infection [19]. He was successfully treated with intravenous chloramphenicol, hydrocortisone, and supportive therapy [19].…”

Rickettsiosis: A Case Series on Different Clinical Presentation in Children

“…Symptoms occur mildly in 80% of cases. In presence of peculiar conditions (diabetes, glucose 6 phosphate dehydrogenase deficiency, cirrhosis…) the clinical course can be severe and also fatal (malignant MSF, 1-7 % of cases), because of complications like acute renal failure, thrombocytopenia, myocarditis, pneumonitis, gastric hemorrhage, shock, and even multiple organ failure [10,11]. Involvement of the central nervous system, which has been most frequently reported in adulthood, is extremely rare in children [11,12].…”