One of our presentation on the Congress of GRanada 2004

1. SPOTTED FEVER IN A SOUTHERN
PORTUGUESE HOSPITAL 1998-2003
J. Rodriguez-Vera, N.F. Vieira, L. Arez, R. Tomé
Department of Internal Medicine. Sector I.
Hospital do Barlavento Algarvio. Portimão. Portugal. EU.

2. INTRODUCTION
Spotted fever:
Endemic rickettsiosis on the mediterran
area.
The most common rickettsiosis in
Portugal
Incidence: 10:100.000
Caused by Rickettsia ricketsii

3. OBJECTIVE
To know:
 Epidemiology
 Clinical characteristics
 Analytical characteristics
Of the patients admitted to our hospital with
the diagnosis of spotted fever

4. MATERIAL AND METHOD
Descriptive study
Inclusion criteria:
Patients admitted between Jan 1998-Ag 2003
with the GDH Spotted fever.
Exclusion criteria
None

5. MATERIAL AND METHOD (II)
Parameters asessed:
Demographical: age,gender, habitat, season
of the year
Clinical: form of presentation,
complications
Analytical: most common alterations.
Positivity of Weil-Felix
Pharmacological: Treatment followed
Management: Average stay, mortality

6. Results
30 patients fullfilled the inclusion criteria
7
6 6
5
4
2
1998 1999 2000 2001 2002 2003

7. Results (II)
6 6
4 Average
3 3 3
43 yrs
2 2
1
0-9 10 19 20-29 30-39 40-49 50-59 60-69 70-79 80-89

8. Results (III)
Female
30%
Male
70%
Ratio M:F 2:1

9. Results (IV)
9
8
7
6
5
4
3
2
1
0
Abr Mai Jun Jul Ago Set Out Nov
66% of cases between June and
August

10. Results (V)
Area of residence
Rural
33%
Urban
67%

11. Results (VI)
Other risk factors:
- Contact with dogs (30%);
- Tick bite (6,6%);
8 patients without identified risk
factors

12. F
ev
er
E
xa 30
nt
em
a
27
Ta
c he
no
i r
7
M
ya
lg
i as
13
V
om
iti
ng
Presenting symptoms
10
D
ia
rr
he
a
2
C
Results (VII)
ep
ha
le
a
7
F
at
ig
ue
A
10
rth
ra
lg
i as
2
E
de
m
as
1

13. Results (VIII)
Fever: Tache noir: Exantema:
- In all patients; - 23% - 90% of patients;
- >39ºC in 33% of - Exantema with
cases affectations of
- 1-21 days until palms and soles;
the admission
- Up to 10 days
after the begining
of fever;

14. Results (IX)
Complications
50%
43%
10%
3%
Hepatitis Thrombocyt. Pneumonia Renal failure

15. Leucopenia
16%
Leucocitosis
10%
> TGP
43%
Laboratory findings
> TGO
60%
< Platelets
53%
Results (X)
> PCR
40%
> Creatinine
10%

16. Results (XI)
Weil-Felix practiced in 90% of patients
Positive
41%
Negative
59%

17. Results (XII)
Doxyciclin: Ciprofloxacin:
-First choice -When intolerance to
-Not prescribed in 2 tetracyclines
patients for intolerance - Unsuccessful in 2
to tetracyclines. patients
-Suspended in 1 patient
for allergic reaction
Levofloxacin:
- 2nd choice in 1
case with allergy to
tetracyclines and
failure of
ciprofloxacin

18. Results (XIV)
Average Stay=5,9d Mortality=0
10
8
7
4
1
1-3d 4-6d 7-9d 10 - 12d > 12 d

19. Conclusions
1. Spotted fever is common in our region,
probably related to its broad country area
of influence .
2. All the patients had good outcome and
short average stay. We associate these
facts with the early initiation of the
antibiotic treatment.
3. Doxycicline remains the antibiotic of first
choice for spotted fever in our region