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Patients and Methods

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Patients and methods

Patients younger than 15 years old who were seen at the Oran Teaching Hospital in 2004–2005 with suspicion of rickettsioses were prospectively included in this study. Informed consent was obtained from all parents. For each child, the study involved obtaining an acute-phase serum sample within 2 weeks of the onset of the symptoms and, when possible, a convalescent-phase serum sample. IgG and IgM antibody titres were estimated by an immunofluorescence (IF) assay, using 10 rickettsial antigens [2].When cross-reactions were noted between several rickettsial antigens, Western blotting and cross-adsorption studies were used to complement the IF assay.

Results A total of 36 children were included in the study. Most of them (75%) were taken to healthcare providers before being seen at the Oran University Hospital. During a previous consultation they were prescribed a first-line antibiotics regimen, in particular amoxicillin (56%) or amoxicillin-clavulanate (22%); a few of them also received penicillin G, erythromycin, spiramycin or cotrimoxazole.A total of 24 cases were diagnosed as MSF. Most (16 children) of them were encountered in July (seven cases) and August (nine cases). The median age was 4.5 years old (15 days to 14 years old). A history of tick-bite was given in nine (37.5%) cases. Contact with dogs was reported in 20 (83.3%) cases.

Patients were seen at the hospital after a median of 6 days (range 3–10 days) of fever.All children but one had fever (Table 1). A rash was observed in all the children but one. It was maculopapular and included the palms and soles in 23 (92%) of the cases. One child had a petechial rash. An inoculation eschar was observed in 20 (83.3%) children. In the majority (16/20) of the cases it was localised in the cephalic region (retro-auricular, the lobule of the ear, scalp). For four other children, it was respectively localized on the trunk, on the buttocks, in the inguinal area, and between two toes. Eighteen patients (90%) presented with a single eschar, while two patients presented with two eschars. Two children presented with seizure and were considered as a severe form of MSF.

Leucopenia was found in eight cases (33.3%), leucocytosis in five (20%), thrombocytopenia in four cases (16.6%) and anaemia in 16 cases (66.6%).Intravenous chloramphenicol was used as a first-line drug in eight children who presented with vomiting. It was switched to oral josamycine (macrolid, five cases), doxycycline (two cases) or thiophenicol (one case). The 13 other children received josamycine as a first-line oral regimen.

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