Autor(es):
Salva, I 
; Gouveia, C ; Sousa, R ; Brito, MJ
Data: 2011
Identificador Persistente: http://hdl.handle.net/10400.17/1034
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Pneumonia Rickettsial; Anticorpos; Criança; Caso Clínico; HDE INF PED
Descrição
Background: Rickettsia conorii is the most frequent species of RickettsiaI causing
disease in Portugal. In general the disease manifests itself by fever, exanthema,
headaches and the presence of an eschar. However atypical forms can be present and
physicians should be aware.
Aims: Analyse the atypical presentation of rickettsiosis.
Material and Methods: Children admitted at the CHLC Hospital from 2000 to 2010
with atypical presentation of rickettsiosis. Clinical diagnosis was confirmed by serology
and molecular techniques (PCR).
Results: Five cases of children with a median age of 2 years, 1 of which female, were admitted between June and August. The diagnoses were: myositis (1), synovitis (1),
cholecystitis (1), orchiepididymitis (1) and meningitis (1). Myositis developped with
functional disability, CPK 9600 U/L, lower limbs’ edema, hypoalbuminemia (1,6 g/dL)
and arterial hypertension. Synovitis developped with functional disability, synovial fluid increase and CRP 16,2 mg/dL. The child with cholecystitis had abdominal pain, intraabdominal fluid increase, leukopenia (1900/μL), thrombocytopenia (75000/μL) and CRP 15,3 mg/dL. Orchiepididymitis developped with testicle’s inflammatory signs, leukopenia (2900/μL), thrombocytopenia (90000/μL) and CRP 14,45 mg/dL. The patient with meningitis, who had pleocytosis (320 cells/μL), hyperproteinorrachia (284
mg/dL), hypoglicorrachia (36 mg/dL), presented only with fever and headaches. The
tache noire and the classical triad were present in 3/5 cases. The clinical course was
favourable in all cases. Antibodies against Rickettsia of spotted fever group were
detected in 3/5 cases. In one patient Rickettsia conorii Malish strain was identified by PCR and sequencing.
Conclusions: Rickettsial infection may present itself unusually. In a country of high prevalence, especially during summer months and in the presence of an inoculation
eschar, it is of the uttermost importance to study the atypical presentations for a possible rickettsial infection.
