Clinical and laboratory manifestations of tick-borne rickettsioses in the Novosibirsk Region

Aim. Determination of clinical and laboratory features of tick-borne rickettsioses, in particular caused by Rickettsia (R.) raoultii and R. sibirica, in adult residents of the Novosibirsk Region.

Materials and Methods. In the period from April to September 2016-2017 a total of 665 patients, who were examined on admission to the Novosibirsk Infectious Clinical Hospital No. 1 and had a history of tick attack, or crawling, or an episode of visiting the forest zone with the subsequent rise of body temperature to 37°С and above. Samples of blood, cerebrospinal fluid and skin scrapings from the tick’s bite site were taken from patients in the first 1-2 days after hospitalization and before the antibacterial therapy start. All patients underwent a comprehensive clinical and laboratory examination at the prehospital and hospital stages. The rickettsial DNA was detected by a nested PCR method followed by sequencing of the PCR fragments.

Results. The rickettsial DNA was found in clinical specimens of 37 patients (5.6% of all examined patients): in 14 patients — the DNA of R. sibirica, in 15 — R. raoultii, in one patient — Candidatus R. tarasevichiae, in 7 patients — the DNA of another rickettsia species and genovariants of the spotted fever group (SFG). The symptoms of R. raoultii disease were different from those of Siberian tick-borne typhus (STT). Only two of 15 patients (13.3%), in whose samples the DNA of R. raoultii was detected, had an eschar with regional lymphadenitis and rash, while in patients with STT — in 11 of 14 (75.8%). All patients with R. raoultii had asthenic syndrome, two-thirds — headache and febrile fever, and one-third — febrile fever up to 39°С. Arthralgia and myalgia characteristics of STT were rarely noted. The meningism phenomena were observed in 7 patients with R. raoultii and in 4 patients with R. sibirica, and in 5 patients the rickettsial DNA was found in cerebrospinal fluid — in 4 patients with the DNA of R. raoultii and in one — with that of R. sibirica. The duration of the febrile period under conditions of antibacterial therapy was 5 days on average.

Conclusion. Rickettsioses caused by R. raoultii do not have specific pathognomonic features, though sometimes such symptoms as fever, rash, lymphadenopathy, and eschar may suggest a presumptive diagnosis.

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