Spotted fever rickettsioses causing myocarditis and ARDS: a case from Sri Lanka

• Published in: BMC infectious diseases Vol. 18; no. 1; p. 705
• Main Authors: Herath, H M L Y, Jayasundara, J M H D, Senadhira, S D N, Kularatne, S A M, Kularatne, W K S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.12.2018; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Adult respiratory distress syndrome; Antibiotics; Antibodies; Arachnids; ARDS; Blood pressure; Boutonneuse Fever - complications; Boutonneuse Fever - diagnosis; Boutonneuse Fever - pathology; Care and treatment; Case Report; Case studies; Complications; Complications and side effects; Development and progression; Fever; Fever - complications; Fever - diagnosis; Fever - microbiology; Fever - pathology; Heart; Heart diseases; Hospitals; Humans; Illnesses; Immunofluorescence; Infections; Infectious diseases; Male; Mechanical ventilation; Middle Aged; Mortality; Myocarditis; Myocarditis - diagnosis; Myocarditis - microbiology; Myocarditis - pathology; Patients; Radiographs; Radiography, Thoracic; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - microbiology; Respiratory Distress Syndrome, Adult - pathology; Rickettsia conorii; Rickettsia conorii - isolation & purification; Rickettsial diseases; Skin; Spotted fever; Sri Lanka; Tropical diseases; Ventilation; Ventricle; Sri Lanka; Acute respiratory distress syndrome; Myocarditis; Spotted fever; Rickettsia conorii; ARDS
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-018-3631-6

Spotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. ARDS and myocarditis are rare complications of Rickettsia conorii infections and only a few cases are reported to date. A 53 years old manual worker presented with fever for 5 days and a skin rash. He was in circulatory failure on admission and developed severe hypoxaemia with gross changes in chest radiograph by next day requiring assisted ventilation. He had myocarditis causing left ventricular failure and acute respiratory distress syndrome. He was confirmed to have spotted fever rickettsial infection with rising titre of indirect immunofluorescence antibodies to Ricketssia conorii and made a complete recovery with appropriate antibiotic therapy and supportive care. Rickettsial infections can present with diverse manifestations. Even the patients with severe organ involvements such as myocarditis and ARDS can be completely cured if timely identified and treated.