Encefalite por Rickettsia sem exantema: a propósito de um caso clínico

Abstract

Objective:: To report a rare case of Rickettsia encephalitis without exanthema. Case report:A 44-year-old male patient, a rural worker, presented daily fever, myalgia and asthenia progressing with left eye amaurosis, ataxia, mental fluctuation, paraparesis of the lower limbs, and divergent strabismus on the left. He was treated empirically with Ceftriaxone and dixiclin for Brucellosis, Rickettsia and Lyme. Positive laboratory test for Rickettsia rickettsii. Discussion: Macular Fever is an acute febrile infectious disease caused by Rickettsia rickettsii. It is acquired by the bite of the infected tick, of the genus Amblyomma. It presents a variable clinical course. The onset of symptoms is usually abrupt and nonspecific. Neurological manifestations are present in about 40% of the cases. The indirect immunofluorescence reaction is the gold standard for diagnosis. The drugs most effective for the treatment are: doxycycline and chloramphenicol. In Brazil, mortality rates are around 20-30%. Comments:Clinical suspicion and early initiation of targeted antibiotic therapy are critical to prevent more severe manifestations and to allow therapeutic success.

Keywords

• Spotted fever
• Rickettsia rickettsii.
• Rickettsiosis.
• Luís Pedro de Assis¹
• Paulo Ricardo de Lima¹.1-Universidade Federal de Goiás
• Goiânia -GO-Brasil.ResumoObjetivo:Relatar caso raro de encefalite por Rickettsiasem exantema. Relato do Caso:Paciente sexo masculino de 44 anos
• trabalhador rural
• apresentou quadro de febre diária
• mialgia e astenia progredindo com amaurose de olho esquerdo
• ataxia
• flutuação mental
• paraparesia de membros inferiores e estrabismo divergente à esquerda. Concerniu-se em tratamento empírico com ceftriaxone e dixiclina para Brucelose
• Rickettsia e Lyme. Exame laboratorial positivou para Rickettsia rickettsii. Discussão: A febre maculosa é uma doença infecciosa febril aguda
• causada pela Rickettsia rickettsii. É adquirida pela picada do carrapato infectado
• do gênero Amblyomma. Apresenta um curso clínico variável. O início dos sintomas costuma ser abrupto e inespecíficos. Manifestações neurológicas estão presentes em cerca de 40% dos casos. A reação de imunofluorescência indireta é o padrão-ouro para o diagnóstico. Os fármacos de melhor eficácia para o tratamento são: doxiciclina e o cloranfenicol. No Brasil
• as taxas de mortalidade giram em torno de 20 a 30%. Considerações finais: A suspeição clínica e início precoce de antibioticoterapia dirigida são fundamentais para prevenir manifestações mais severas e permitir o sucesso terapêutico.Palavras-chave:Febre maculosa. Rickettsia rickettsii.Rickettsioses. Zoonoses.AbstractObjective:: To report a rare case of Rickettsia encephalitis without exanthema. Case report:A 44-year-old male patient
• a rural worker
• presented daily fever
• myalgia and asthenia progressing with left eye amaurosis
• mental fluctuation
• paraparesis of the lower limbs
• and divergent strabismus on the left. He was treated empirically with Ceftriaxone and dixiclin for Brucellosis
• Rickettsia and Lyme. Positive laboratory test for Rickettsia rickettsii. Discussion: Macular Fever is an acute febrile infectious disease caused by Rickettsia rickettsii. It is acquired by the bite of the infected tick
• of the genus Amblyomma. It presents a variable clinical course. The onset of symptoms is usually abrupt and nonspecific. Neurological manifestations are present in about 40% of the cases. The indirect immunofluorescence reaction is the gold standard for diagnosis. The drugs most effective for the treatment are: doxycycline and chloramphenicol. In Brazil
• mortality rates are around 20-30%. Comments:Clinical suspicion and early initiation of targeted antibiotic therapy are critical to prevent more severe manifestations and to allow therapeutic success.Keyword:Spotted fever. Rickettsia rickettsii. Rickettsiosis.
• Zoonosis