Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients
Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients
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DOI：
10.1086/590211
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发表时间：
2008-08-15
影响因子：
6.4
通讯作者：
Walker, David H.
中科院分区：
文献类型：
--
作者：
de Sousa, Rita;Franca, Ana;Walker, David H.
背景。决定地中海斑疹热 (MSF) 严重程度的病理生理机制以及致命结果的宿主相关和微生物相关危险因素尚不完全清楚。方法。这项前瞻性研究使用单变量和多变量分析来确定 1994 年至 2006 年间在 13 家葡萄牙医院收治的 140 名康氏立克次体感染患者致命结果的危险因素，并记录了导致其感染的立克次体菌株的鉴定。结果。共有 71 名患者（51%）感染康氏立克次体 Malish 株，69 名患者（49%）感染以色列斑疹热（ISF）株。患者被送入重症监护病房 (40 [29%])、作为常规住院患者住院 (95[67%]) 或作为门诊患者管理 (5[4%])。 29 名成年人 (21%) 死亡。感染 ISF 菌株的患者死亡的可能性明显更大，而酗酒是一个危险因素。致命结果的病理生理学涉及瘀点皮疹、胃肠道症状、迟钝和/或意识模糊、脱水、呼吸急促、肝肿大、白细胞增多、凝血病、氮质血症、高胆红素血症以及肝酶和肌酸激酶水平升高的发生率显着增加。这些发现中的一些（但不是全部）在 ISF 菌株感染的患者中更常见。结论。尽管两组患者均出现死亡和相似的临床表现，但 ISF 菌株比 Malish 菌株毒性更强。多变量分析显示，急性肾衰竭和高胆红素血症与致命结果的相关性最强。
Background. The pathophysiologic mechanisms that determine the severity of Mediterranean spotted fever (MSF) and the host-related and microbe-related risk factors for a fatal outcome are incompletely understood.Methods. This prospective study used univariate and multivariate analyses to determine the risk factors for a fatal outcome for 140 patients with Rickettsia conorii infection admitted to 13 Portuguese hospitals during 1994-2006 with documented identification of the rickettsial strain causing their infection.Results. A total of 71 patients (51%) were infected with the Malish strain of Rickettsia conorii, and 69 (49%) were infected with the Israeli spotted fever (ISF) strain. Patients were admitted to the intensive care unit (40 [29%]), hospitalized as routine inpatients (95[67%]), or managed as outpatients (5[4%]). Death occurred in 29 adults (21%). A fatal outcome was significantly more likely for patients infected with the ISF strain, and alcoholism was a risk factor. The pathophysiology of a fatal outcome involved significantly greater incidence of petechial rash, gastrointestinal symptoms, obtundation and/or confusion, dehydration, tachypnea, hepatomegaly, leukocytosis, coagulopathy, azotemia, hyperbilirubinemia, and elevated levels of hepatic enzymes and creatine kinase. Some, but not all, of these findings were observed more often in ISF strain-infected patients.Conclusions. Although fatalities and similar clinical manifestations occurred among both groups of patients, the ISF strain was more virulent than the Malish strain. Multivariate analysis revealed that acute renal failure and hyperbilirubinemia were most strongly associated with a fatal outcome.