The Role of Mediterranean Spotted Fever in the Spectrum of Pediatric Fever with Rashes

When febrile illnesses develop a rash in children, parents are very concerned about a serious disease. Many rashes associated with fever are caused by infectious diseases. Rashes are generally nonspecific and play a supportive role in differential diagnosis, but for some diseases, the appearance of the rash is essential in making a diagnosis. Here is presented the case of a 4-year-old boy with high fever, headache, abdominal pain, vomiting, diarrhea, and a generalized maculo-papular rash including palms and soles. On physical examination were found a black eschar, cervical lymphadenopathy, and hepatosplenomegaly. Laboratory findings resulted in moderate leukocytosis and moderate involvement of the liver and renal function. Based on this finding, a diagnosis of Mediterranean Spotted Fever was performed. The child recovered after medication with azithromycin. Because there is no reliable test that can confirm MSF in its early stages, the diagnosis is commonly made on the basis of clinical findings, so a high index of suspicion should be maintained while evaluating a child with fever and rash.

External quality assessment of the detection of rickettsioses in China

Objective:To report a training course on the laboratory diagnoses of rickettsioses that 10 provincial/city CDCs participated in laboratory external quality assurance(EQA) based on the serological specific antibodies detection and rapid PCR amplifying targeted genes of rickettsiae. Methods:An EQA program to evaluate the following laboratory procedures was developed to detect rickettsiae:(1) immunofluorescent assay(IFA) to detect specific antibodies of A. phagocytophilum,R.heilongjiangensis and 0.tsutsugamshi respectively.(2) Two sets of nested PCR were used amplifying groEL genes for most members of the family Rickettsiaceae and amplifying 16SrRNA genes for the most members of family anaplasmae,respectively.A scoring scheme based on the distribution of the median antibody titer values of the serologic assays was designed and a ranking list of the scores of the PCR results based on the detected minimal copy numbers of reference DNA was created.Results:Among nine laboratories who reported the results on time,eight laboratories gave acceptable serologic results,the other one provided an unacceptable antibody titer(1:2 vs median 1:64) results for 0.tsutsugamshi.The limits of detection(LOD) for the PCR amplifying for five references DNA ranged from 1copy/μL to 10~6 copy/μL.Conclusions:We successfully trained and popularized modern diagnostic methods of rickettsiae in 10 provincial CDCs in China and first conducted the EQA projects and evaluated the results.