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Epidemiological and clinical features regarding Rickettsia conorii infection in Romania

Abstract number: P1541

Hristea A., Serban R., Savastre M., Badescu D., Apostol M., Streinu Cercel A., Rafila A., Arama V., Moroti R.

Objectives: presenting the epidemiological and clinical aspects of Rickettsia conorii infection in Romania between 2000 and 2008

Methods: Epidemiological descriptive study of Mediterranean spotted fever (MSF) cases reported in Romania during 2000–2008 presenting the clinical features of cases admitted to INBI "Prof Dr Matei Bals". The inclusion criteria were the presence of at least three of the following: fever, maculopapular rash, eschar, history of tick bite/contact plus positive serology (indirect immunofluorescence reaction). The sources of the data are the centralised reports from the National Center for Surveillance and Control of Communicable Diseases Bucharest, case enquiries and charts of the patients admitted between 2000 and 2008.

Results: The incidence for the whole country varied from 0.4/100,000 (2006) to 2/100,000 (2001). All the cases reported during 2000–2008 were from the southern part of Romania. The counties with the highest incidence were Constanta (44.2/100,000 in 2001), Tulcea (39/100,000 in 2002), and Bucharest (3.15/100,000 in 2002). The patients were mainly from urban areas (85.5%) the infection being related to recreational activities. Most patients (83%) acquired the infection between June and September. We have also collected clinical data from 270 patients admitted to the National Institute of Infectious Diseases "Matei Bals" of which 56.7% were women and 43.3% men, with a mean age of 47 years. The painless tick bite was often-unnoticed (46.6% of patients). The clinical features consisted of: fever 96.6%, rash 97.4%, eschar 46.8%, myalgia 42.6%, arthralgia 15.9%, headache 39.3%, neurologic manifestations 2.9%. Laboratory tests revealed: ALT > N in 103/244 (42.2%), of which >2N in 29/244 (11.9%); WBC >10,000/mm3 68/269 (25.3%), PLT <150,000/mm3 116/269 (43.2%), fibrinogen >400 mg/dl in 140/194 (72.2%). There were two fatal cases during this period but none among the patients admitted to our institute.

Conclusion: The sporadic nature of cases demonstrates the endemicity of the disease in Romania. Present ecological and climatic changes lead to the widening of previous endemic areas, thus contributing to an increasing number of infections especially the subclinical ones. The geographic distribution of MSF widened to areas that are not on the shores of the Black Sea. MSF should be considered in the differential diagnosis of any traveler returning with fever, history of tick bite, rash, and/or eschar (tache noire) from endemic areas.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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