Advertisement

Mediterranean spotted fever in the elderly: a prospective cohort study

  • Elena EspejoEmail author
  • Marta Andrés
  • Maria-Consol Garcia
  • Anna Fajardo
  • Marta Mauri
  • Josefa Pérez
  • Feliu Bella
Original Article
  • 24 Downloads

Abstract

The objective of this study is to evaluate the characteristics and outcome of elderly patients with Mediterranean spotted fever (MSF). This study was a prospective observational cohort study of all adult cases with confirmed MSF treated in a teaching hospital (1984–2015) to compare the characteristics of elderly patients (> 65 years) with younger adults. We identified 263 adult patients with MSF, and 53 (20.2%) were elderly. Severe MSF was more frequent in the elderly (26.4% vs. 10.5%; p = 0.002). Gastrointestinal symptoms, impaired consciousness, lung infiltrate, oedema, acute hearing loss, raised alanine transaminase, hyponatremia, and thrombocytopenia occurred more frequently in elderly patients, and arthromyalgia occurred less frequently. Most patients were treated with a single-day doxycycline regimen (two oral doses of 200 mg for 1 day). All patients recovered uneventfully. Fever disappeared 2.55 ± 1.16 days after treatment initiation in elderly patients, and the remaining symptoms disappeared after 3.65 ± 1.42 days. These figures were similar to non-elderly patients. Severe MSF was more frequent in elderly patients. Some clinical manifestations occurred with different frequencies in the elderly compared with younger patients. Single-day doxycycline therapy is an effective and well-tolerated treatment for MSF in elderly patients.

Keywords

Mediterranean spotted fever Rickettsia conorii Elderly Doxycycline Tick-borne diseases Severity 

Notes

Acknowledgements

The authors thank the staff of the Internal Medicine Service at Hospital de Terrassa, for their cooperation.

Author’s contribution

EE and FB were involved in the study design.

EE, MA, MCG, MM, and AF were involved in data acquisition. All authors were involved in data analysis and interpretation.

EE and FB drafted the manuscript.

MA, MCG, JP, MM, and AF revised the manuscript critically for important intellectual content. All authors approved the final version to be submitted.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board. This study complied with the principles of the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was waived because no intervention was involved, and no identifying patient information was included.

References

  1. 1.
    Rovery C, Raoult D (2008) Mediterranean spotted fever. Infect Dis Clin N Am 22:515–530CrossRefGoogle Scholar
  2. 2.
    Font-Creus B, Bella-Cueto F, Espejo-Arenas E, Vidal-Sanahuja R, Muñoz-Espín T, Nolla-Salas M, Casagran-Borrell A, Mercade-Cuesta J, Segura-Porta F (1985) Mediterranean spotted fever: a cooperative study of 227 cases. Rev Infect Dis 7:635–642CrossRefGoogle Scholar
  3. 3.
    Anton E, Font B, Muñoz T, Sanfeliu I, Segura F (2003) Clinical and laboratory characteristics of 144 patients with Mediterranean spotted fever. Eur J Clin Microbiol Infect Dis 22:126–128Google Scholar
  4. 4.
    Herrador Z, Fernandez-Martinez A, Gomez-Barroso D, León I, Vieira C, Muro A, Benito A (2017) Mediterraneran spotted fever in Spain, 1997-2014: epidemiological situation based on hospitalization records. PLoS One 12(3):e0174745.  https://doi.org/10.1371/journal.pone.0174745 CrossRefGoogle Scholar
  5. 5.
    Espejo E, Andrés M, Pérez J, Prat J, Guerrero C, Muñoz MT, Alegre MD, Lite J, Bella F (2016) Prevalence of antibodies to Rickettsia conorii in human beings and dogs from Catalonia: a 20-year perspective. Epidemiol Infect 144:1889–1894CrossRefGoogle Scholar
  6. 6.
    Raoult D, Gallais H, Ottomani A, Resch JP, Tichadou D, De Micco P, Casanova P (1983) Malignant form of Mediterranean boutonneuse fever. Six cases. Presse Med 12:2375–2378Google Scholar
  7. 7.
    Raoult D, Zuchelli P, Weiller PJ, Charrel C, San Marco JL, Gallais H, Casanova P (1986) Incidence, clinical observations and risk factors in the severe form of Mediterranean spotted fever among patients admitted to hospital in Marseilles 1983-1984. J Infect 12:111–116CrossRefGoogle Scholar
  8. 8.
    Font-Creus B, Espejo-Arenas E, Muñoz-Espín T, Uriz-Urzainqui S, Bella-Cueto F, Segura-Porta F (1991) Mediterranean boutonneuse fever. Study of 246 cases. Med Clin (Barc) 96:121–125Google Scholar
  9. 9.
    Parola P, Paddock CD, Socolovschi C, Labruna MB, Mediannikov O, Kernif T, Abdad MY, Stenos J, Bitam I, Fournier PE, Raoult D (2013) Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 26:657–702CrossRefGoogle Scholar
  10. 10.
    Brouqui P, Bacellar F, Baranton G, Birtles RJ, Bjoërsdorff A, Blanco JR, Caruso G, Cinco M, Fournier PE, Francavilla E, Jensenius M, Kazar J, Laferl H, Lakos A, Lotric Furlan S, Maurin M, Oteo JA, Parola P, Perez-Eid C, Peter O, Postic D, Raoult D, Tellez A, Tselentis Y, Wilske B (2004) Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect 10:1108–1132CrossRefGoogle Scholar
  11. 11.
    Espejo E, Andrés M, Garcia MC, Fajardo A, Pérez J, Bella F (2018) Prospective cohort study of single-day doxycycline therapy for Mediterranean spotted fever. Antimicrob Agents Chemother 62(11). pii: e00978-18).  https://doi.org/10.1128/AAC.00978-18
  12. 12.
    Bella-Cueto F, Font-Creus B, Segura-Porta F, Espejo-Arenas E, López-Parés P, Muñoz-Espín T (1987) Comparative, randomized trial of one-day doxycycline versus 10-day tetracycline therapy for Mediterranean spotted fever. J Infect Dis 155:1056–1058CrossRefGoogle Scholar
  13. 13.
    Bella F, Font B, Uriz S, Muñoz T, Espejo E, Travería J, Serrano JA, Segura F (1990) Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever. Antimicrob Agents Chemother 34:937–938CrossRefGoogle Scholar
  14. 14.
    Bella F, Espejo E, Uriz S, Serrano JA, Alegre MD, Tort J (1991) Randomized trial of 5-day rifampin versus 1-day doxycycline for Mediterranean spotted fever. J Infect Dis 164:433–434CrossRefGoogle Scholar
  15. 15.
    Bella F, Espejo E, Uriz S, García JL, Martínez A, Mauri M (1997) Roxithromycin versus doxycycline for Mediterranean spotted fever (MSF). Clin Microbiol Infect 3(Suppl 1):340Google Scholar
  16. 16.
    Schneider EL (1999) Ageing in the third millenium. Science 283:796–797CrossRefGoogle Scholar
  17. 17.
    Bloom DE, Chatterji S, Kowal P, Lloyd-Sherlock P, Mckee M, Rechel B, Rosenberg L, Smith JP (2015) Macroeconomic implications of population ageing and selected policy responses. Lancet 385:649–657CrossRefGoogle Scholar
  18. 18.
    Yoshikawa TT (2000) Epidemiology and unique aspects of aging and infectious diseases. Clin Infect Dis 30:931–933CrossRefGoogle Scholar
  19. 19.
    Botelho-Nevers E, Rovery C, Richet H, Raoult D (2011) Analysis of risk factors for malignant Mediterranean spotted fever indicates that fluoroquinolone treatment has a deleterious effect. J Antimicrob Chemother 66:1821–1830CrossRefGoogle Scholar
  20. 20.
    Drancourt M, Raoult D, Harlé JR, Chaudet H, Janbon F, Charrel C, Gallais H (1990) Biological variations in 412 patients with Mediterranean spotted fever. Ann N Y Acad Sci 590:39–50CrossRefGoogle Scholar
  21. 21.
    Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M (2017) Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensamble. Lancet 389:1323–1335CrossRefGoogle Scholar
  22. 22.
    Fuentes E, Fuentes M, Alarcón M, Palomo I (2017) Immune system dysfunction in the elderly. An Acad Bras Cienc 89:285–299CrossRefGoogle Scholar
  23. 23.
    Weyand CM, Goronzy JJ (2016) Aging of the immune system. Mechanisms and therapeutic targets. Ann Am Thorac Soc 13(Suppl 5):S422–S428CrossRefGoogle Scholar
  24. 24.
    Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Ïnfect Dis 31:578–585CrossRefGoogle Scholar
  25. 25.
    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43CrossRefGoogle Scholar
  26. 26.
    Doherty TJ (2003) Invited review: aging and sarcopenia. J Appl Physiol 95:1717–1727CrossRefGoogle Scholar
  27. 27.
    Filippatos TD, Makri A, Elisaf MS, Liamis G (2017) Hyponetremia in the elderly: challenges and solutions. Clin Interv Aging 12:1957–1965CrossRefGoogle Scholar
  28. 28.
    Botelho-Nevers E, Socolovschi C, Raoult D, Parola P (2012) Treatment of Ricketssia spp. infections: a review. Expert Rev Anti-Infect Ther 10:1425–1437CrossRefGoogle Scholar
  29. 29.
    Raoult D (1989) Antibiotic susceptibility of Rickettsia and treatment of rickettsioses. Eur J Epidemiol 5:432–435CrossRefGoogle Scholar
  30. 30.
    Raoult D, Roux V (1997) Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev 10:694–719CrossRefGoogle Scholar
  31. 31.
    Portillo A, Santibáñez S, García-Álvarez L, Palomar AM, Oteo JA (2015) Rickettsioses in Europe. Microbes Infect 17:834–838CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Infectious Diseases Unit, Internal Medicine ServiceHospital de Terrassa (Consorci Sanitari de Terrassa)TerrassaSpain
  2. 2.Internal Medicine ServiceHospital de Terrassa (Consorci Sanitari de Terrassa)TerrassaSpain
  3. 3.Microbiology LaboratoryCatlabViladecavallsSpain

Personalised recommendations