Mediterranean (Marseilles) fever

Description:

The Marseilles fever — an acute rickettsial disease which is characterized by the high-quality course, existence of primary affect and widespread makulo-papular rash.

Symptoms of the Mediterranean (Marseilles) fever:

The incubation interval rather short (3 — 7 days), disease is subdivided into an initial stage (before emergence of rash), the period of a heat and the period of recovery. Characteristic of the Marseilles fever is existence of primary affect prior to the beginning of a disease. At most of patients the acute beginning with bystry temperature increase to high figures 38 — 400 is noted, further fever of constant type (remittiruyushchy is more rare) remains within 3 — 10 days. In addition to fervescence patients complain of the fever, a severe headache, the general weakness expressed to a mialgiya and arthralgias, sleeplessness. There can be vomiting. At survey of the patient the hyperemia and some puffiness of the person, an injection of vessels of scleras and mucous membranes of a pharynx is noted. Primary affect is observed almost at all patients. To an onset of the illness it represents the site of an inflammation of skin with a diameter about 10 mm in which center the necrotic center with a diameter about 3 mm covered with a dark crust which disappears only to 5 — to the 7th day of normal temperature is localized; the opened small sore gradually is epithelized within 8 — 12 days then there is a pigmented spot. Localization of primary affect the most various, usually on the sites of skin closed by clothes. Patients do not note subjective feelings in the field of primary affect. A part of patients (about 30%) has a regional lymphadenitis in the form of small increase and morbidity of lymph nodes. Sometimes existence of lymphadenitis helps to find primary affect which sometimes happens very small.
The most important clinical display of the Marseilles fever is the dieback which is observed at all patients. Elements of rash appear on 2 — the 4th day of a disease at first on a breast and a stomach, then during the closest 48 h extends to a neck, a face, extremities, almost elements of rash are found in all patients on palms and soles. Rash is plentiful, especially on extremities, consists of spots and papules, a part of elements is exposed to hemorrhagic transformation, at many patients on site of papules vesicles are formed. Standing rash the most plentiful, elements of rash is brighter and larger, than on other sites of skin. Rash remains within 8-10 days, leaving behind a xanthopathy. Pigmentation remains sometimes up to 2-3 months.
From bodies of blood circulation bradycardia and small decrease in the ABP, a respiratory organs without essential pathology is noted, at a part of patients increase in a liver (40-50%) and spleens (about 30%) comes to light. At a blood analysis the moderate leukocytosis and small increase in SOE is possible.
Complications are observed very seldom in the form of pneumonia, thrombophlebitises, as a rule, at elderly people.
Diagnosis and differential diagnosis. Diagnosis of typical cases of the Marseilles fever does not cause great difficulties. First of all consider epidemiological premises (stay in the endemic area, a season, contact with dogs, stings of a tick and so forth). For diagnosis the triad has the greatest value:
1) existence of primary affect ("a black spot");
2) regional lymphadenitis;
3) early emergence of plentiful polymorphic rash on all body, including palms and soles.
Moderate expressiveness of the general intoxication, lack of the typhus status is considered. It is necessary to differentiate from other rickettsioses. Laboratory confirmation of the diagnosis is based on serological tests (RSK with a specific antigen, in parallel put reaction and with other rickettsial antigens, use also RNGA, but more preferable indirect reaction of an immunofluorescence is).

Reasons of the Mediterranean (Marseilles) fever:

The activator — Rickettsia conori was open in 1932 and is called in honor of Conor who for the first time described the Marseilles fever in 1910. Has properties, the general and for other rickettsiae. As well as the causative agent of fever of the Rocky Mountains, can parasitize both in cytoplasm, and in kernels of cells of the owner. The causative agent of the southern African tick-borne fever and Kenyan tick-borne fever (R. pijperii) on the cultural and antigenic properties does not differ from the causative agent of the Marseilles fever. As well as other rickettsiae, the causative agent of the Marseilles fever gram-negative, does not grow on mediums, breeds in culture of fabrics, on the developing chicken embryo and at infection of laboratory animals (in mesothelium cells). Patogenen for Guinea pigs, monkeys, rabbits, gophers, white mice and white rats. In the antigenic relation it is close to activators of group of tick-borne spotty fevers.
Epidemiology. The Marseilles fever belongs to a zoonosis with a natural ochagovost. The main source and the keeper of rickettsiae is the dog tick of Rhipicephalus sanguineus in whose organism they remain up to 1,5 years, transovarial transmission of infection is characteristic. Other mites can be carriers of an infection also (Rhipicephalus simus, R. everbsi, Rh. appendiculatus), but the dog tick has major importance. Dogs, hares, jackals can be carriers of rickettsiae. Seasonality of the Marseilles fever (from May to October) is also caused by feature of biology of a dog tick, during this period their number significantly increases, and activity increases. The dog tick rather seldom attacks the person therefore incidence has sporadic character and is observed generally among owners of dogs. Infection of the person is possible and at rubbing in in leather of the crushed infected ticks. Transmission of infection from the person to the person does not happen. The Marseilles fever meets in basins of the Mediterranean, Black and Caspian seas. In our country the Marseilles fever met rather seldom and only during the period from May to September.
Pathogeny. The activator gets through skin at a sting of the infected tick (seldom at rubbing in of the crushed infected ticks into skin or mucous membranes of a nose, a conjunctiva). On site implementations primary affect ("a black spot") which is found soon after a sting of a tick and in 5 — 7 days prior to emergence of symptoms of a disease forms. Primary affect represents the site of an inflammation of skin in the beginning, in the central part it there is a site of a necrosis with a diameter of 2 — 3 mm, the extent of primary affect gradually increases and reaches full development by the beginning of the feverish period. In lymphatic ways of a rickettsia get to blood, are localized in an endothelium of capillaries and venules. Process reminds the changes which are observed at an epidemic sapropyra, however the quantity of granulomas (small knots) are less and necrotic changes are less expressed. The postponed disease leaves durable immunity. Recurrent diseases are not observed by the Marseilles fever.

Treatment of the Mediterranean (Marseilles) fever:

As well as at other rickettsioses, the most effective etiotropic drug is tetracycline. It is appointed inside on 0,3 — 0,4 g 4 times a day within 4 — 5 days. At intolerance of antibiotics of tetracycline group it is possible to use levomycetinum (chloramphenicol) which is appointed on 0,5 — 0,75 g by 4 times a day within 4 — 5 days.