Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2021.392
Autopsy and Case Reports
Autopsy Case Report

Rickettsia conorii infection with fatal complication

Sanjoli Chugh; Priyanka Kumari; Shriya Goel; Manisha Biswal; Inderpaul Singh Sehgal; Aravind Sekar

Downloads: 5
Views: 730

Abstract

Rickettsial diseases (RD) are a group of endotheliotropic infectious diseases caused by different species of genera Rickettsia. RD are not an uncommon disease and may be misdiagnosed during the evaluation of acute febrile illness due to a lack of reliable serological marker and diagnostic culture methods. Clinical manifestation of RD varies from febrile illness with rashes and myalgia to fatal complications such as shock and respiratory failure. We describe a case of a young male who presented initially with acute febrile illness, followed by shock and respiratory failure, and unfortunately succumbed to death. A post-mortem examination showed histological features of endotheliotropic infection, such as interstitial / perivascular edema in various organs and noncardiogenic pulmonary edema (suggesting increased vascular permeability) and evidence of vasculitis in the lung, liver, and intestines. Molecular studies performed from lung, liver, and kidney tissue confirm the diagnosis of spotted fever group rickettsial disease due to Rickettsia conorii.

Keywords

Autopsy, Fatal Outcome, Fever, Rickettsia Infections, Vasculitis

References

1 Sahni A, Fang R, Sahni SK, Walker DH. Pathogenesis of rickettsial diseases: pathogenic and immune mechanisms of an endotheliotropic infection. Annu Rev Pathol. 2019;14(1):127-52. http://dx.doi.org/10.1146/annurev-pathmechdis-012418-012800. PMid:30148688.

2 Biswal M, Krishnamoorthi S, Bisht K, et al. Rickettsial diseases: not uncommon causes of acute febrile illness in India. Trop Med Infect Dis. 2020;5(2):E59. http://dx.doi.org/10.3390/tropicalmed5020059. PMid:32326477.

3 van Eekeren LE, de Vries SG, Wagenaar JFP, Spijker R, Grobusch MP, Goorhuis A. Under-diagnosis of rickettsial disease in clinical practice: a systematic review. Travel Med Infect Dis. 2018;26:7-15. http://dx.doi.org/10.1016/j.tmaid.2018.02.006. PMid:29486240.

4 Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements ACA. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review. BMC Infect Dis. 2019;19(1):577. http://dx.doi.org/10.1186/s12879-019-4185-y. PMid:31272417.

5 Dumler JS, Walker DH. Rocky Mountain spotted fever: changing ecology and persisting virulence. N Engl J Med. 2005;353(6):551-3. http://dx.doi.org/10.1056/NEJMp058138. PMid:16093463.

6 Valbuena G, Walker DH. Changes in the adherens junctions of human endothelial cells infected with spotted fever group rickettsiae. Virchows Arch. 2005;446(4):379-82. http://dx.doi.org/10.1007/s00428-004-1165-3. PMid:15778845.

7 Woods ME, Olano JP. Host defenses to Rickettsia rickettsii infection contribute to increased microvascular permeability in human cerebral endothelial cells. J Clin Immunol. 2008;28(2):174-85. http://dx.doi.org/10.1007/s10875-007-9140-9. PMid:17957455.

8 Cascio A, Giordano S, Dones P, Venezia S, Iaria C, Ziino O. Haemophagocytic syndrome and rickettsial diseases. J Med Microbiol. 2011;60(Pt 4):537-42. http://dx.doi.org/10.1099/jmm.0.025833-0. PMid:21163825.
 


Submitted date:
04/21/2022

Accepted date:
07/05/2022

Publication date:
07/15/2022

62d15877a9539563e85b6363 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections