Hidden mortality attributable to rocky Mountain spotted fever : Immunohistochemical detection of fatal, serologically unconfirmed disease.
Rocky Mountain spotted fever (RMSF) is the most severe tickborne infection in the United States and is a nationally notifiable disease.
Since 1981, the annual case-fatality ratio for RMSF has been determined from laboratory-confirmed cases reported to the Centers for Disease Control and Prevention (CDC).
Herein, a description is given of patients with fatal, serologically unconfirmed RMSF for whom a diagnosis of RMSF was established by immunohistochemical (IHC) staining of tissues obtained at autopsy.
During 1996-1997, acute-phase serum and tissue samples from patients with fatal disease compatible with RMSF were tested at the CDC.
As determined by indirect immunofluorescence assay, no patient serum demonstrated IgG or IgM antibodies reactive with Rickettsia rickettsii at a diagnostic titer (i.e., >=64) ; however, IHC staining confirmed diagnosis of RMSF in all patients.
Polymerase chain reaction validated the IHC findings for 2 patients for whom appropriate samples were available for testing.
These findings suggest that dependence on serologic assays and limited use of IHC staining for confirmation of fatal RMSF results in underestimates of mortality and of case-fatality ratios for this disease.
Mots-clés Pascal : Rickettsia rickettsii, Rickettsieae, Rickettsiaceae, Rickettsiales, Bactérie, Homme, Fièvre pourprée, Rickettsiose, Rickettsialose, Bactériose, Infection, Epidémiologie, Mortalité, Prévalence, Diagnostic, Sérologie, Immunohistochimie, Symptomatologie, Etude cas, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Rickettsia rickettsii, Rickettsieae, Rickettsiaceae, Rickettsiales, Bacteria, Human, Rocky mountain spotted fever, Rickettsial infection, Rickettsialosis, Bacteriosis, Infection, Epidemiology, Mortality, Prevalence, Diagnosis, Serology, Immunohistochemistry, Symptomatology, Case study, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0309271
Code Inist : 002A05B11. Création : 16/11/1999.