Positive Weil-Felix Test Research Articles

Post-fever Retinitis With a Positive Weil-Felix Test: A Study From a Tertiary Center in South India.

Background Post-fever retinitis (PFR) is reported two to six weeks after fever and affects one or both eyes. Rickettsial fever is one of the most common causes of PFR. This study aimed to report the clinical features and treatment outcomes of PFR cases with a positive Weil-Felix test. Methodology In this study, we collected demographic data, fever details, eye symptoms, ocular examination findings, optical coherence tomography (OCT) and fundus fluorescein angiography findings, laboratory findings, and length of follow-up of consecutive PFR cases with a positive Weil-Felix test. All cases were treated with oral doxycycline and prednisolone. Final best-corrected visual acuity (BCVA) and ocular examination findings were recorded. Visual field examination and follow-up OCT results were noted if available. Results A total of nine patients (eight males) with a mean age of 39.1 years with fever before ocular symptoms and positive Weil-Felix test were included.Six patients had bilateral disease. The mean initial and final BCVA in the affected eyes was 1.16 and 0.35 logMAR units, respectively (p < 0001). All 15 eyes had typical white retinitis patches and retinal hemorrhages which resolved after treatment. OCT showed hyperreflectivity and inner retinal disorganization over retinitis patches. White subretinal lines were noted in three patients and retinal nerve fiber bundle defect with corresponding visual field defect was seen in one eye. Conclusions In this study, PFR due to rickettsia infections has been reported from our region for the first time. Hence, eye specialists in the region should be aware of this entity.

Cutaneous manifestations of Rickettsial fever in paediatric age group

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rickettsial fever is well known to have various cutaneous manifestations that can help in the probable clinical diagnosis especially in the context of non availability of resources and aid in prompt administration of treatment, hence reducing mortalitiy and morbidity. The main objective of this study was to estimate the prevalence of cutaneous manifestations in patients with a positive Weil-Felix and also to study the plethora of cutaneous manifestations seen in Rickettsial fever.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All the consenting patients admitted in in the Department of Paediatrics below 18 years and with a positive Weil-Felix test were thoroughly screened for cutaneous manifestations.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 114 patients screened, 29 children (21.05%) had cutaneous manifestations. The various cutaneous manifestations encountered in the study are erythematous rash, maculopapular rash, petechial rash and cutaneous necrosis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Though cutaneous manifestations was seen in only 21% of the patients with fever, when present it could help in suspecting rickettsial fever in a case of pyrexia of unknown origin.&lt;/p&gt;

Ocular manifestations of Rickettsia conorii in South India.

Purpose:Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients.Methods:In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes.Results:In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition.Conclusion:Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.

Evaluation of two diagnostic methods of scrub typhus with Bayes rule

Background: Scrub typhus or rickettsia, a zoonotic infection occurs due to the transmission of Gram-negative bacteria, Orientia tsutsugamushi and/or Tsutsugamushi sp. by the larval stage of the trombiculid mite, Leptotrombidium deliense. Infections at endothelial cells and phagocytes manifest clinically as vasculitis with an acute onset of fever, rashes, headache, myalgia, multiple organ dysfunction, eschar, respiratory morbidity, meningioencephalitis and sepsis syndrome on skin, whose severity varying with patients. Herein obtained data is used for evaluating the dependability of two determinative tests.Methods: The prospective survey with 80 rickettsia patients was carried during the last 6 months of 2016. Patients with the occurrence of fever for more than two days and a clinical suspicion of rickettsia infection were promoted for Weil-Felix as well as, ELISA tests.Results: The prevalence of rickettsia in the population of 80 patients was 17.5, and the sensitivity (the portion of the people with the rickettsia infection who will have positive Weil-Felix test results) value was 0.7143 and specificity (the people without the disease who will have negative Weil-Felix test results) value was 0.9697. Probability of Weil Felix test positive was 0.15, and probability of ELISA test positive was 0.175.Conclusions: The dependability of each test independently or a posteriori probability was 0.857. Both tests are dependable for correctness of outcomes being 0.857 or 85.7%, in combination; a high specificity value of Weil Felix test is a valuable test.

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications.

Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

Rickettsial retinitis-an Indian perspective.

BackgroundThough rickettsiosis is common in India, there is paucity of rickettsial retinitis (RR) reports from India. Moreover, rickettsial sub-types and their association with retinitis have not been studied. We are reporting a case series of presumed RR with their course of the disease, visual outcome, and association with rickettsial sub-type based on Weil-Felix test.FindingsThis is a retrospective study of 19 eyes of 10 patients presented to a single institution. Cases diagnosed with presumed RR were identified from our database from March 2006 to October 2014 and studied retrospectively for patient’s demography, clinical presentation, and treatment. Patients with history of fever, retinitis, and a positive Weil-Felix test and a negative chikungunya and dengue serology were diagnosed as presumed rickettsial uveitis. One patient was diagnosed to have epidemic typhus, and four were diagnosed to have Indian tick typhus. Nine patients had bilateral presentation. One patient had history of dog tick bite, and four patients had skin rashes. All the patients presented between 2 and 4 weeks after a fever.ConclusionsRetinitis on posterior pole with recent history of fever with or without skin rash and a positive Weil-Felix test may suggest a rickettsial etiology. Its ocular manifestation could be an immune response to recent systemic rickettsial infection. Indian tick typhus and epidemic typhus could be the common sub-types seen in our population. Although it has aggressive presentation, it has a good visual prognosis.

Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in North Eastern India: A Prospective Study.

Background:Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult.Aim:The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India.Subjects and Methods:We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil–Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed.Results:Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%). Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/μL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study.Conclusions:Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.

Clinico-laboratory profile and outcome of rickettsia in children: Hubli (Karnataka) experience

Abstract Aims To study the clinical and laboratory profile and outcome of rickettisial disease in children in the age group of 0–12 years. Methods Prospective hospital based study conducted at Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli from June 2011 to May 2012. Inclusion criteria All children in the age group of 0–12 years having fulfilled following criteria (i) Children with history of fever, rash, headache, myalgia, vomiting, oedema with (ii) Positive Weil–Felix test and/or (iii) Exposure/presence of tick/or mite/or louse on body. Exclusion criteria (i) Children who are positive for dengue serology (ii) Clinically suspected other viral infection (measles, enteroviral exanthems, dengue, infectious mononucleosis), protozoal (malaria), bacteria (meningococcemia, leptospirosis, scarlet fever) and collagen vascular (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions. A detailed clinical history, physical examination was carried out for all enrolled children. Complete haemogram, electrolytes and radiological examination was done whenever required. All children received doxycycline 2.2 mg/kg/dose every 12th hourly orally till 5–7 days or till 3 days following the afebrile period. Results Total number of children enrolled during the study was 36. Male:Female ratio was 1:1 (18:18). The mean age of presentation was 5.6 years (range 5 months–12 years). The most common clinical symptoms/signs were fever 36 (100%), rash 20 (55%), hepatomegaly 25 (69%), splenomegaly 18 (50%), pallor 18 (50%), pedal oedema 14 (38%) and ascities 6 (16%). Among the laboratory profile thrombocytopaenia was seen in 27% cases, hyponatremia in 71.4% cases. No mortality was present in this series. Conclusion Rickettisia is a re-emerging disease. The most clinical manifestation was very non-specific. High index of clinical suspicion is needed to make diagnosis.

A Case Report of Scrub Typhus-Associated Hemophagocytic Syndrome and a Review of Literature

A 34-year-old woman presented with septic shock, disseminated intravascular coagulation (DIC), and multiorgan dysfunction with a 1-week history of fever, abdominal pain in the right upper quadrant, and dull pain in the right flank. Physical and laboratory data showed cytopenia (thrombocytopenia and anemia), splenomegaly, hyperferritinemia, hypofibrinogenemia, and an elevated level of interleukin-2 receptor (soluble CD25). Bone marrow examinations disclosed hypercellular marrow with increased infiltration of histiocytes with hemophagocytosis. This diagnosis was confirmed by positive Weil-Felix test results (Proteus mirabilis OX-K titer, 1:80), the presence of IgG and IgM antibodies, and positive PCR results for Orientia tsutsugamushi. The patient developed a severe intracranial hemorrhage 3 days after admission and expired due to systemic inflammatory response syndrome with DIC and multiorgan failure on the 13th day of hospitalization. Scrub typhus with hemophagocytic syndrome can be complicated by DIC and multiorgan failure. Patients with scrub typhus usually have an excellent response to treatment; therefore, early diagnosis and prompt administration of antimicrobial therapy may prevent the development of serious complications.

First case of scrub typhus with meningoencephalitis from Kerala: An emerging infectious threat

Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil–Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well.

Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications

To study the clinical profile of and complications in children with scrub typhus. Prospective observational study. Tertiary care hospital. Children up to 12 years of age who had a fever for more than five days without an identifiable infection were included. All children who were suspected of having rickettsial infections were defined as having scrub typhus if they had a positive Weil-Felix test result (OX-K 1:80 or more) and one or more of the following clinical features (after exclusion of other diagnoses): rash, edema, hepatosplenomegaly, lymphadenopathy, an eschar, and a tick bite or tick exposure. Thirty-five children were diagnosed with scrub typhus between February 2010 and February 2011. The age of the patients ranged from 1.5 to 12 years. Edema, crackles/rhonchi, hepatomegaly and hypotension were encountered in 60%, 23%, 91% and 34% of patients, respectively. An eschar was observed in 11% of the cases. Complications included myocarditis with cardiogenic shock in 34% of the cases and acute kidney injury in 20% of the cases. Anicteric hepatitis and thrombocytopenia were observed in 31% and 61% of cases, respectively. One patient died. High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus.

Validity of the Weil-Felix test in the diagnosis of acute rickettsial infections in Sri Lanka

The diagnosis of rickettsial infections in developing countries is based on clinical features and a positive Weil-Felix test (WFT), as tests such as indirect immunofluorescent antibody (IFA) assays are not available for routine use. We estimated the sensitivity of the WFT in Sri Lanka using IFA testing as the gold standard. The WFT demonstrated low sensitivity (33%) in diagnosing acute rickettsial infections and low specificity, with a positive titre of 1:320 seen in 54% of healthy volunteers and 62% of non-rickettsial fever patients. Therefore, the use of the WFT should be discouraged in the diagnosis of acute rickettsial infections.

Study on 40 cases of rickettsia

Rickettsia is emerging in the subcontinent and clinically presents as non-specific febrile illness. At present there is no cheap & easily available diagnostic tool in our hand. Beside this, Weil-Felix test is becoming abandoned. So, high index of clinical suspicions is essential to diagnose rickettsia at early stage and to prevent mortality & morbidity. 40 cases were recorded among the admitted febrile patients in MMCH since 2003 to 2005. Cases were selected by clinical suspicions; exclusions of other common febrile illness & thereafter supported by lab. Investigations, specially by positive Weil-felix test. Cases were distributed through out the year but 19 (47.5%) cases were detected in March to May. 12 (30%) cases were found in August to October. The remaining 9 cases were detected in the rest 6 months. All (40) cases were presented with fever (100%), headache was present in 33 (82.5%) cases, rashes were present in 15 (37.5%) cases, isolated splenomegaly was found in 15 (37.5%) cases & hepatosplenomegaly in 12 (30%) cases, arthralgia in 13 (32.5%) cases, lymphadenopathy in 5 (12.5%) cases; 2 (5%) cases attended with unconsciousness & epistaxis in 1 (2.25%) case. Scrub typhus were 19 (47.5%), Indian tick typhus 16 (40%), 5 (12.5%) cases were with dual pathology and were associated with enteric fever. 15 (37.5%) cases were treated with tetracycline only. 20 (50%) cases with only doxyclycline & 5 (12.5%) cases with tetracycline and ceftriaxone as these cases were associated with enteric fever. All patients (100%) cured with treatment.

An Imported Case of Scrub Typhus

Letters to the EditorAn Imported Case of Scrub Typhus Zachariah Thomas, MD, DM Mohammed Yunus, MD Abdullah El-Subaie, and MD Kamal H. Al-AkhrasMBBS Zachariah Thomas Al-Nairiyah Hospital, Al-Nairiyah 31981, Saudi Arabia Search for more papers by this author , Mohammed Yunus Al-Nairiyah Hospital, Al-Nairiyah 31981, Saudi Arabia Search for more papers by this author , Abdullah El-Subaie Al-Nairiyah Hospital, Al-Nairiyah 31981, Saudi Arabia Search for more papers by this author , and Kamal H. Al-Akhras Al-Nairiyah Hospital, Al-Nairiyah 31981, Saudi Arabia Search for more papers by this author Published Online::25 Apr 2019https://doi.org/10.5144/0256-4947.1995.425SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We would like to report a case of scrub typhus in a patient who came to Saudi Arabia from India 10 days prior to the onset of his symptoms. Although this is presumed to be an imported case, the aim of this report is to remind physicians of this diagnostic possibility in patients who come from endemic areas of scrub typhus and who present with compatible clinical manifestations.A 30-year-old Indian male was admitted to Al-Nairiyah Hospital with a history of sore throat, high grade fever, headache and generalized maculopapular rash. He was mildly disoriented and complained of giddiness so much so that he could not even sit up. On examination, his temperature was 40°C. He had a maculopapular measles -like rash all over the body, mainly on the trunk. There were a few discrete tender cervical lymph nodes. The patient was confused and ataxic. There was no evidence of any eschar or mite bite mark. The rest of the examination was normal. Urinalysis showed a trace of albumin but was otherwise normal. Hb was 13.4 g/L, WBC was 7.4x10 g/L and platelet count was 117x10 g/L. Serological tests for brucella and typhoid were negative. Urine, throat and blood cultures yielded no bacterial growth. Ultrasound of the abdomen revealed no abnormalities. Chest x-ray, electrocardiogram and liver function tests were within normal limits.The patient was started on crystalline penicillin empirically as he was complaining of throat pain. He did not show any improvement even by the 5th day of hospitalization. At this stage, Weil-Felix test was performed and was positive for OX-K with a titer of 1:640 whereas OX-19 and OX-2 were negative.1 With the above clinical picture and a positive Weil-Felix test, a presumptive diagnosis of scrub typhus was made and the patient was treated with tetracycline and recovered completely. The diagnosis of scrub typhus was later confirmed by the Regional Laboratory, Dammam by indirect immunofluorescence test.2Scrub typhus is an acute febrile illness that is caused by Rickettsia tsutsugamushi. It is transmitted to humans by the bite of infected chiggers. Scrub typhus occurs in Southeast, Central and Eastern Asia, the Pacific Islands and Australia.Clinical symptoms of scrub typhus occur six to 18 days after the bite of an infected chigger and are comprised of fever, headache, myalgia and tender lymphadenopathy. The bite wound or eschar may be present in 46% of patients on examination. Other symptoms may include ocular pain, conjunctivitis, nonproductive cough and various neurologic manifestations such as apathy, delirium, tremors, slurred speech, nervousness or nuchal rigidity. The rash appears on the fifth day of illness and is usually maculopapular in nature and involves the trunk and extremities. The differential diagnosis includes typhoid fever, brucellosis, infectious mononucleosis, toxoplasmosis and dengue fever.3Tetracycline or chloramphenicol given for a period of up to two weeks are both effective in treating scrub typhus and preventing relapses; however, amelioration of symptoms may be more rapid with tetracycline. Limited studies suggest that ciprofloxacin and doxycycline may also be effective.3 Treatment shortens the illness considerably and reduces mortality and therefore early diagnosis and treatment of this condition are necessary.ARTICLE REFERENCES:1. Lennette EH, Schmidt NJ. Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections. 5th ed. New York, American Public Health Assoc, Inc, 1979. Google Scholar2. Brown GW, Shirai A, Rogers C, et al. "Diagnostic criteria for scrub typhus: probability values for immunofluorescent antibody and protein OX-K agglutinin titers" . Am J Trop Med Hyg. 1983; 32: 1101. Google Scholar3. Saah AJ. Rickettsia tsutsugamushi (scrub typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 3rd ed. Churchill Livingston Inc. 1990, 1480–2. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 15, Issue 4July 1995 Metrics History Published online25 April 2019 InformationCopyright © 1995, Annals of Saudi MedicinePDF download