Active Ingredients: Doxycycline
The development of an IgG titre was more moderate, but it is reported that, in primary infections, individuals who have received antibiotic therapy initiated during the first week after disease onset showed strong IgM responses without pronounced increases in IgG.
The present findings demonstrate the importance of including an IgM assay to obtain a reliable serological assessment and better chance of early diagnosis.
We also isolated the rickettsial organism. In this case, the conditions were optimal, because the delay between the time of sample collection and inoculation onto shell vials was only a matter of hours.
Isolation therefore requires access to specialized laboratory facilities within a reasonable distance. For patients without rash or eschar, rickettsial diagnosis is not easy and cannot be definitively established on epidemiological, clinical, and standard laboratory criteria.
A diagnostic score to help the physician assess the diagnosis of SFR has been previously described for Mediterranean spotted fever, African tick bite fever, and lymphangitis-associated rickettsiosis, but not for other less established rickettsial diseases.
The diagnosis is established when laboratory findings and epidemiological, clinical, bacteriological, and serological criteria give a score equal to 25 or higher. In this case, using the same criteria, isolation of the bacterium and the serological findings provided a score well above 25.
The utility of the proposed criteria should be studied further for other species of rickettsial diseases. The standard treatment regimen for SFR consists of 200 mg doxycycline orally or intravenously, daily for 7—14 days depending on the clinical course.
Most patients will improve within the first 24 h after treatment begins, which has led to the proposal of shorter regimens, but treatment should at least be continued until the patient is afebrile for 24 h.
Obviously the patient was also infected with HSV-2. She had no previous history of recurrent episodes of severe headache, and the serological findings were suggestive of reactivated HSV-2 infection, which was probably asymptomatic in her case.
It is possible that the rickettsial infection reactivated her HSV-2 infection but the opposite is conceivable as well as simultaneous infection by both agents at the same time.
Similar co-infection with R. Early diagnosis of rickettsial infection is important, and though Sweden, like other European countries, is an endemic area for R.
Since rickettsial infections are eminently treatable, the availability of appropriate and timely diagnostics is essential to optimize the clinical outcome of those affected. References D. Raoult and V.
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