Marseilles fever: causes, symptoms, diagnosis, treatment

Marseilles febris (Marseilles febris, ixodorickettsiosis, Marseilles rickettsiosis, Papular fever, Carducci-Olmer disease, tick-borne fever, Mediterranean, etc.) - acute zoonotic rickettsiosis with a transmissible mechanism of transmission of the pathogen, characterized by benign course, the presence of primary affect and widespread maculopapular rash.

ICD-10 code

A77.1. Spotted fever caused by Rickettsia conorii.

Epidemiology of Marseilles fever

The main vector is the dog mite Rhipicephalussanguineus, in the organism of which they persist up to 1.5 years; transovarial transmission of the pathogen is characteristic. Other ticks (Rhipicephalus simus, Rh. Everbsi Rh. Appendiculatus) can also be transported . Exciter's reservoir - many kinds of domestic and wild animals (for example, dogs, jackals, hedgehogs, rodents). Seasonality of Marseilles fever (May-October) is also due to the peculiarity of the biology of canine tick (during this period their number increases and activity increases). A human agent is transmitted when the tick is sucked, but infection is possible when crushed and rubbed into the skin of infected ticks. Dog mite relatively rarely attacks a person, so the incidence is sporadic. Marseilles fever is diagnosed mainly among dog owners. The cases of the Marseilles fever are recorded in the countries of the Mediterranean, on the Black Sea coast, in India. Astrakhan rickettsial fever is common in the Astrakhan region (ARL is a variant of the Marseillian fever), considered as an independent nosological form for a number of epidemiological, ecological and clinical criteria. There were no cases of transmission of the pathogen from person to person. Postinfectious immunity is stable.

[1], [2], [3], [4], [5], [6], [7]

What causes Marseilles fever?

Marseilles fever is caused by the rod-shaped gram-negative bacterium Rickettsia conorii. The intracellular intracellular parasite: multiplies in tissue culture (in the yolk sac of a chicken embryo) and in infection of laboratory animals (in mesothelium cells). Pathogen for guinea pigs, monkeys, rabbits, ground squirrels, white mice and white rats. By antigenic properties it is close to other pathogens of a group of tick-borne spotted fevers. Can parasitize in the cytoplasm and nuclei of host cells. In patients, the pathogen is detected in the blood in the early days of the febrile period, in the primary affect and in the skin's roseol. In the environment it is unstable.

Pathogenesis of Marseilles fever

Marseilles fever begins in connection with the development of rickettsiaemia and toxemia. The causative agent penetrates through the skin or mucous membranes of the nose and conjunctiva. A primary affect ("black spot") is formed at the site of implantation, which is detected soon after a tick bite (for 5-7 days, until the symptoms of Marseillian fever come into play). Through the lymphatic system, rickettsia first enter the regional lymph nodes (cause lymphadenitis), and then into the blood (affect the endothelium of the capillaries and venules). In this case, there are changes similar to those detected in epidemic typhus, but the amount of granules (nodules) is less and necrotic changes are less pronounced.

Symptoms of Marseillian fever

Marseilles fever has an incubation period that lasts from 3 to 7 days.

There are four periods of Marseilles fever:

• incubation:
• initial (before the appearance of the rash);
• the height;
• recovery.

The peculiarity of Marseilles fever is the presence of primary affect, which is revealed in the majority of patients before the onset of the disease. Primary affect first represents a focus of skin inflammation with a dark-crusted area of necrosis 2-3 mm in diameter in the center. The dimensions of the primary affect gradually increase to 5-10 mm at the onset of the febrile period. The crust disappears only on the 5th-7th day after the normal temperature is established. The opened small ulcer gradually epithelizes (within 8-12 days). After which remains a pigmented spot. Localization of primary affect is diverse (usually on skin areas covered by clothing); can be 2-3 foci. Subjective sensations in the area of primary affect patients do not complain. Approximately one third of them have regional lymphadenitis with a slight increase and soreness of the lymph nodes. The onset of the disease is acute, with a rapid increase in temperature to 38-40 ° C. Fever of a constant type (less often remitting) persists for 3-10 days and is accompanied by chills, severe headache, general weakness, pronounced myalgia, as well as arthralgia and insomnia. Vomiting is possible. When examined, there is flushing and some puffiness of the face, injection of vessels of sclera and mucous membranes of throat.

To inflame the disease is characterized by the appearance of exanthema (on the 2-4th day of its course), detected in all patients. The rash appears first on the chest and abdomen, then spreads over the neck, face, limbs; almost in all patients it is found on the palms and soles. Rashes abundant (especially on the limbs), consist of spots and papules, some of the elements undergo hemorrhagic transformation. Many patients have vesicles in place of papules. On the feet the rash is most abundant; its elements are brighter and larger than in other areas of the skin. Eruptions disappear after 8-10 days, leaving behind pigmentation of the skin, which persists sometimes up to 2-3 months.

There is a bradycardia, a slight decrease in blood pressure. A significant pathology of the respiratory system does not develop. The abdomen is soft or (in some patients it is moderately inflated, with palpation painless.) In 50% of patients in a feverish period, stool retention and very rarely a loose stool are found, some patients have an enlarged liver and, more rarely, a spleen, daily diuresis and proteinuria in the first week.) During the period of convalescence, the general condition improves and all symptoms fade.

Complications of Marseilles fever

The picture of blood is of little character. Complications of Marseillian fever occur rarely. Possible development of pneumonia, thrombophlebitis (usually the streets of the elderly).

[8], [9], [10], [11], [12]

Diagnosis of Marseilles fever

Diagnosis of Marseillian fever should take into account the epidemiological background (stay in endemic area, season, contact with dogs, tick bites, etc.). In the clinical picture the most important is the triad of symptoms:

• primary affect ("black spot");
• regional lymphadenitis;
• early appearance of abundant polymorphous rashes throughout the body, including palms and soles.

Consider the moderate severity of general intoxication and the absence of typhoid status.

[13], [14], [15]

Specific and nonspecific laboratory diagnostics of Marseilles fever

Laboratory confirmation of the diagnosis is based on serological reactions: the reaction of binding complement with a specific antigen (in parallel, the reaction with other rickettsial antigens), RIGA. Preference is given to the recommended WHO RNIF (minimum reliable titer - serum dilution 1: 40-1: 64). High titers of specific antibodies in RNIF are detected on the 4-9th day of the disease and at the diagnostic level - at least 45 days.

Differential diagnosis of Marseilles fever

Differential diagnosis of Marseilles fever is conducted with close on clinical manifestations of infectious diseases: rat, rash, typhoid fever, paratyphoid. Secondary syphilis, toxic-allergic drug dermatitis, as well as other exanthemic infectious pathologies.

[16], [17], [18], [19], [20], [21],

Indications for hospitalization

Indications for hospitalization are fever, marked intoxication, tick bite, rash.

Treatment of Marseilles fever

Diet and diet

The regime is bedding. Diet - table number 13.

[22], [23],

Medicamentous treatment of Marseilles fever

As with other rickettsiosis, tetracycline is most effective (prescribe inside 0.3-0.4 g four times a day for 4-5 days). Doxycycline is also used (0.2 g in the first day and 0.1 g in the subsequent - up to 3 days after the temperature stabilization). When intolerance to tetracycline antibiotics is prescribed chloramphenicol (0.5-0.75 g four times a day for 4-5 days).

Pathogenetic treatment of Marseilles fever is aimed at eliminating intoxication and hemorrhagic manifestations. Depending on the severity of the disease, detoxification is performed with the help of drugs for oral administration [tsitraglukosolan, rehydron (dextrose + potassium chloride + sodium chloride + sodium citrate)] or for intravenous administration, taking into account age, body weight, condition of the circulatory and urinary system, in volume from 200-400 ml to 1.5-2 l [sodium chloride solution is complex (potassium chloride + calcium chloride + sodium chloride), trisol (sodium hydrogen carbonate + sodium chloride + potassium chloride), disol (sodium acetate + sodium chloride), acesol (sodium acetate + sodium chloride + to Leah chloride)]. When expressed hemorrhagic syndrome (for example, abundant hemorrhagic rash, bleeding gums, nosebleeds) and the presence of thrombocytopenia, ascorutin (ascorbic acid + rutoside), calcium gluconate, menadione sodium bisulphite, ascorbic acid, calcium chloride, gelatin, aminocaproic acid are prescribed.

Clinical examination

The patients are discharged 8-12 days after the temperature is normalized.

[24], [25], [26],

How is Marseilles fever prevented?

Specific prophylaxis of Marseilles fever is not developed.

In epidemic outbreaks, the possible habitats of ticks are treated with insecticides (for example, dogs, canine booths), catching stray dogs.

What prognosis does the Marseilles fever have?

Marseilles fever has a favorable prognosis. Lethal outcomes are rare.