Prospective evaluation of rickettsioses in the Trakya region of Turkey, 2008

Abstract number: R2217

Kuloglu F., Yulugkural Z., Dogan-Celik A., Akata F.

Objectives: Prospective surveillance, serologic and molecular diagnosis of rickettsioses in the Trakya Region of Turkey has been conducted by Trakya University and Université de la Mediterranée, Marseille, France since 2003. For three years, we have started to use molecular methods for the diagnosis of spotted fever group(SFG) rickettsioses in the Trakya University Hospital, a tertiary-care hospital in Edirne, Turkey.

Materials and Methods: From May to September 2008, 28 patients with Mediterranean spotted fever (MSF) were admitted to the Trakya University Hospital. SFG rickettsioses were diagnosed clinically. Before treatment, punch biopsy from skin lesions (eschar or maculopapular rash) was performed. Serum specimens were tested by microimmunofluorescence assay MIF) using a commercially available antigen (R. conorii IFA IgG; Focus Technologies, USA). DNA was extracted from skin biopsies using the High Pure PCR Template Preparation Kit (Roche Diagnostics, Germany). Standard PCR was performed with primers suitable for hybridisation within the conserved region of genes coding for outer membrane protein A (ompA) and citrate synthase (gltA).

Results: The average age of 28 patients (12 male and 16 female) was 57±17. All the patients had high fever and maculopapular rash (including the palms or soles of the feet). Twenty three patients (82%) had eschar. Twenty patients (71.4%) had clinical scores 25. One patient presented with meningoencephalitis. Twenty one patients (75%)had significant antibody titers against Spotted Fever Group Rickettsiae. Twenty three patients (82%)accepted skin biopsy. PCR experiments were positive in 18(78%) out of 23 biopsy samples.

A 28 years old man with possible tick contact presented with high fever, headache, nausea and a few macular rash on his arms without eschar; leukopenia, thrombocytopenia, elevated ALT, AST, LDH, CPK levels, low level of CRP were determined. RT-PCR test for Crimean-Congo haemorrhagic fever virus RNA was negative but antibody titers against Spotted Fever Group Rickettsiae increased more than four folds.

Conclusion: Trakya Region is an endemic area for rickettsioses with a population of one million. Since 2001, 124 patients were diagnosed as SFG rickettsioses. Differential diagnosis of tick-born diseases is important in Turkey, as Crimean-Congo haemorrhagic fever is also reported since 2003.

This study was supported by TÜB[Idot]TAK SBAG-K-78 (104S290).