The liver in boutonneuse fever

Abstract

SUMMARY Hepatic lesions were studied for the first time in 13 cases of boutonneuse fever (Mediterranean exanthematous fever). The glutamic-oxalacetic transaminases were raised in eight patients, the glutamic-pyruvic transaminases showed an increase in 10 patients, alkaline phosphatases in seven of the 10 patients investigated, and conjugate bilirubin showed moderate increases in three patients. Five patients were studied histologically; this study showed lesions of a granulomatous type, similar to those described in Q fever, in three patients, fatty degeneration with marked alcoholism in another patient, and a normal liver in the last patient. Two of the three patients with granulomatous lesions showed a moderate increase in alkaline phosphatases. After this report boutonneuse fever must be included among the infectious conditions that can produce granulomas within the liver.

Indian Tick Typhus – An Uncommon Cause of Hepatitis: A Case Report

“…However, rash and eschar have rarely been found in India and they are less commonly observed in endemic areas with repeated infections [6][7][8]. A hepatic involvement, as was seen in present case, has been well documented in literature and it varies from asymptomatic transamnitis to acute liver failure [9][10][11][12]. Rickettsiae may infect the endothelial lining, the liver sinusoids, and the portal vasculature, but not hepatocytes and can lead to mild focal hepatitis and a periportal inflammation.…”

New trends in Mediterranean spotted fever

“…An increase of the hepatic enzymes is often noted and constitutes the most common manifestation of the well-documentated hepatopathy of MSF (7,10).…”

Hepatitis in Association with Rickettsialpox

“…Liver involvement has also been reported in infections caused by other members of the order Rickettsiales such as murine typhus (Silpapojakul et al 1996, Walker et al 1989, scrub typhus (Yang et al 1995, Hu et al 2005, human monocytic ehrlichiosis Bakken 1995, Nutt andRaufman 1999), and human granulocytic anaplasmosis Bakken 1995, Bakken et al 1994), as well as in Q fever (Coxiella burnetii is in the order Legionellales) (Maurin andRaoult 1999, Russell-Lodrigue et al 2005). Although no uniformity exists in histopathological appearance, granulomatous hepatitis (Guardia et al 1974(Guardia et al , 1981, hepatocellular necrosis Gear 1985, Walker et al 1986), fatty degeneration (Guardia et al 1974), portal inflammation (Jackson et al 1986, Guardia et al 1974, and portal vasculitis (Jackson et al 1986) are some of the changes described in patients with infection caused by the spotted fever group of rickettsioses. To our knowledge, the histology of the liver in a patient with rickettsialpox has not been reported.…”

“…Hepatitis is a well-documented complication of rickettsial diseases including Rocky Mountain spotted fever (Adams and Walker 1981, Ramphal et al 1978, Jackson et al 1986), Boutonneuse fever (Guardia et al 1974), South African tick bite fever (Walker and Gear 1985), North Asian tick typhus (Nelyubov 2002), and Queensland tick typhus (Sexton et al 1990(Sexton et al , 1991, among the spotted fever group of rickettsioses in which rickettsialpox is classified. Liver involvement has also been reported in infections caused by other members of the order Rickettsiales such as murine typhus (Silpapojakul et al 1996, Walker et al 1989, scrub typhus (Yang et al 1995, Hu et al 2005, human monocytic ehrlichiosis Bakken 1995, Nutt andRaufman 1999), and human granulocytic anaplasmosis Bakken 1995, Bakken et al 1994), as well as in Q fever (Coxiella burnetii is in the order Legionellales) (Maurin andRaoult 1999, Russell-Lodrigue et al 2005).…”