Teške kliničke forme mediteranske pegave groznice: serija slučajeva iz endemskog područja Bugarske
Sažetak
Apstrakt
Uvod/Cilj. Mediteranska pegava groznica (MPG) pripada rikeciozama (grupа pegave groznice) – izaziva je Rickettsia (R.) conorii conorii, a prenosi se na ljude ujedom krpelja pasa Rhipicephalus sanguineus. Cilj ove studije bio je da se opišu kliničke i laboratorijske karakteristike bolesnika sa teškom formom MPG koji su bili hospitalizovani u univerzitetskoj bolnici u endemskom području Bugarske. Metode. Retrospektivna studija sprovedena je u Univerzitetskoj bolnici Stara Zagora (južnoistočna Bugarska) u periodu od aprila 2015. godine do avgusta 2016. godine. Tokom analiziranog perioda 58 bolesnika imalo je kliničke i laboratorijske znake MPG. Za potvrdu etiološke dijagnoze primenjeni su serološki testovi. Za MPG specifična imunoglobulinska (IG) antitela za IgM i IgG pronađena su u serumu imunoenzimskim indirektnim esejom (ELISA IgG/IgM, Vircell, Španija). R. conorii ELISA IgG senzitivnost bila je 85%, specifičnost 100%, a R. conorii ELISA IgM senzitivnost bila je 94%, specifičnost 95%. Statistička analiza urađena je u programu MS Excel 2007 i SPSS verzija 19.0. Rezultati. Osamnaest bolesnika imalo je težak oblik MPG. Muškarci (78%) su bili brojniji u odnosu na žene (22%). Srednja vrednost starosti kod 18 analiziranih bolesnika bila je 55 godina (14–78 godina). Kod 10 bolesnika pojavili su se poremećaji funkcije jetre, a kod četiri, neurološki simptomi. U laboratorijskim analizama trombocitipenija se javila kod 15 bolesnika, a srednja vrednost trombocita u celoj grupi iznosila je 108,6 ± 53,8 × 10 9/L. Jetreni enzimi bili su povišeni, a srednja vrednost aspartat aminotransferaze (AST) iznosila je 161,4 ± 90,1 IU/L, a alanin aminotransferaze (ALT) 163,9 ± 81,5 IU/L. Srednja vrednost reaktanata akutne faze kao sto je C-reaktivni protein (CRP) iznosila je 140,3 mg/L (9–230 mg/L). Kod nekih bolenika javio se poremećaj bubrežne funkcije. Srednja vrednost kreatinina u posmatranoj grupi iznosila je 134,7 µmol/L (78–313 µmol/L), a ureje iznosila je 9,6 mmol/L (4,2–27,4). Zaključak. Bugarska je endemsko područje za bolesti nastale zbog ujeda krpelja. Slučajevi MPG se analiziraju na godišnjem nivou. Teški oblici MPG nisu retki. Tipične kliničke i laboratorijske markere za procenu težine bolesti treba aktivno pratiti. Rana dijagnoza i odgovarajuće lečenje ključni su za izbegavanje komplikacija i oporavak bolesnika.
Reference
REFERENCES
Raoult D. Introduction to Rickettsioses, Ehrlichioses, and Anaplasmosis. In: Bennett JE, Dolin R, Blaser MJ, editors. Man-dell, Douglas, and Bennett's Principles and practice of infec-tious diseases. 8th ed. Philadelphia (USA): Elsevier Saunders; 2015. p. 2194‒7.
Conor A, Bruch A. Une fièvre éruptive observée en Tu¬nisie. Bull Soc Pathol Exot Filial 1910; 8: 492–6.
Walker DH, Occhino C, Tringali GR, Di Rosa S, Mansueto S. Pa-thogenesis of rickettsial eschars: The tache noire of bouton-neuse fever. Hum Pathol 1988; 19(12): 1449–54.
Pitigoi D, Olaru I, Badescu D, Rafila A, Arama V, Hristea A. Mediterranean spotted fever in southeastern Romania. Biomed Res Int 2013; 2013: 395806.
Baltadzhiev IG, Popivanova NI. Some epidemiological fea¬tures of the Mediterranean spotted fever re-emerging in Bulgaria. Folia Med (Plovdiv) 2012; 54(1): 36–43.
Punda-Polić V, Luksić B, Capkun V. Epidemiological fea¬tures of Mediterranean spotted fever, murine typhus, and Q fever in Split-Dalmatia County (Croatia), 1982-2002. Epidemiol Infect 2008; 136(7): 972–9.
Papa A, Dalla V, Petala A, Maltezou HC, Maltezos E. Fatal Me-diterranean spotted fever in Greece. Clinical microbi¬ology and infection 2010; 16(6): 589–92.
Kuloglu F, Rolain JM, Akata F, Eroglu C, Celik AD, Parola P. Mediterranean spotted fever in the Trakya region of Turkey. Ticks Tick-Borne Dis 2012; 3(5–6): 298–304.
Samardzic S, Marinkovic T, Marinkovic D, Djuricic B, Ris¬tanovic E, Simovic T, et al. Prevalence of antibodies to Rickettsiae in dif-ferent regions of Serbia. Vector Borne Zoonotic Dis 2008; 8(2): 219–24.
Brouqui P, Parola P, Fournier PE, Raoult D. Spotted fever rickettsioses in Southern and Eastern Europe. FEMS Im-munol Med Microbiol 2007; 49(1): 2–12.
Vapzarov I. A small epidemic of Mediterranean spotted fe¬ver in Plovdiv region. Bulgaria. Health Care 1948; 1: 21–9. (Bulgarian)
Serbezov V, Komitova R, Voynova V. Mediterranean spot¬ted fev-er. In: Serbezov V, Kantardjiev T, Krushkov I, edi¬tors. Human tick-borne diseases in Bulgaria. Sofia, BG: East-West; 2003. p. 78–92. (Bulgarian)
Baltadzhiev IG, Popivanova NI, Stoilova YM, Kevorkian AK. Medi-terranean spotted fever: Classification by disease course and criteria for determining the disease severity. Folia Med (Plov-div) 2012; 54(4): 53–61.
Baltadzhiev I. Clinical, epidemiological and pathogenetic as-pects of Mediterranean spotted fever [thesis]. Plovdiv: Faculty of Medicine, University of Plovdiv; 2012. (Bulgar¬ian)
Pishmisheva M, Stoycheva M, Vatev N, Semerdjieva M. Medi-terranean spotted fever in children in the Pazardjik region, South Bulgaria. Pediatr Infect Dis J 2014; 33(5): 542–4.
Baltadzhiev I, Popivanova N, Zaprianov Z. Malignant forms of Mediterranean spotted fever: Risk factors for fatal out¬comes. Braz J Infect Dis 2016; 20(5): 511–2.
Raoult D, Tissot Dupont H, Caraco P, Brouqui P, Drancourt M, et al. Mediterranean spotted fever in Marseille: Descrip¬tive epi-demiology and the influence of climatic factors. Eur J Epide-miol 1992; 8(2): 192–7.
Raoult D, Weiller PJ, Chagnon A, Chaudet H, Gallais H, Casanova P. Mediterranean spotted fever: Clinical, labora¬tory and epidemiological features of 199 cases. Am J Trop Med Hyg 1986; 35(4): 845–50.
Raoult D, Zuchelli P, Weiller P, Charrel C, San Marco J, Gal¬lais H, et al. Incidence, clinical observations and risk fac¬tors in the severe form of Mediterranean spotted fever among patients admitted to the hospital in Marseilles 1983-1984. J Infect 1986; 12(2): 111–6.
Germanakis A, Psaroulaki A, Gikas A, Tselentis Y. Mediterra-nean spotted fever in Crete, Greece: Clinical and therapeutic data of 15 consecutive patients. Ann N Y Acad Sci 2006; 1078: 263–9.
Botelho-Nevers E, Raoult D. Host, pathogen and treatment-related prognostic factors in rickettsioses. Eur J Clin Mi-crobiol Infect Dis 2011; 30(10): 1139–50.
Portillo A, Santibanez S, Garcia-Alvarez L, Palomar AM, Oteo JA. Rickettsioses in Europe. Microb Infect 2015; 17(11–12): 834–8.
Romdhane FB, Loussaief C, Toumi A, Yahia SB, Khaiyrallah M, Bouzouaia N, et al. Mediterranean spotted fever: A re¬port of 200 cases in Tunisia. Clin Microbiol Infect 2009; 15(Suppl 2): 209–10.
Kuloglu F, Akata F, Tansel O, Gurcan S, Sakru N, Otkun M, et al. Serologically confirmed cases of Mediterranean spot¬ted fever in the Trakya region of Turkey. Turk J Parasitol 2004; 28(3): 167–70.
Yilmaz E, Akalin H, Mistik R, Heper Y, Engin A, Kilicaslan E, et al. Mediterranean spotted fever: Retrospective evalua¬tion of 16 cases. Trakya Univ Tip Fak Derg 2010; 27(2): 167–71.
Colomba C, Saporito L, Polara VF, Rubino R, Titone L. Medi-terranean spotted fever: Clinical and laboratory char¬acteristics of 415 Sicilian children. BMC Infect Dis 2006; 6: 60.
Aliaga L, Sanchez-Blazquez P, Rodriguez-Granger J, Sam¬pedro A, Orozco M, Pastor J. Mediterranean spotted fever with encephalitis. J Med Microbiol 2009; 58(4): 521–5.
Tzavella K, Chatzizisis Y, Vakali A, Mandraveli K, Zioutas D, Alexiou-Daniel S. Severe case of Mediterranean spotted fever in Greece with predominantly neurological features. J Med Microbiol 2006; 55(Pt 3): 341–3.