RICKETTSIA CONORII INFECTION AND LIPID PROFILE CHANGES: A CASE REPORT
Evento: SPPC 2021
Poster Número: 044
Autores e Afiliações:
Olímpia Varela, Sara Sousa, José António Carvalho, Ana Fontes, Eliana Costa;
Serviço de Patologia Clínica, Centro Hospitalar de Trás-os-Montes e Alto Douro
Rickettsia is a member of the family Rickettsiaceae, which is described as intracellular and gram-negative bacilli, within α-proteobacteria. [1, 2]
Rickettsial infections are transmitted to human hosts mostly through arthropod bites and the most frequent vectors responsible for the transmission are ticks, which also act as reservoirs, lice, fleas or mites. 
Thrombocytopenia, leukopenia, an increase of C-reactive protein and elevated hepatic enzyme levels are the most common analytical changes described. 
Serological tests remain essential diagnostic tools, despite the fact that molecular diagnostic methods are more appropriate in the diagnosis of acute infection. 
The gold standard therapy is indeed represented by Doxycycline 100 mg per os twice daily x 7 days in adults. 
We related a clinical case of a Rickettsia infection with consequent changes in the lipid profile and a review of literature.
A 45-year-old man was admitted to the hospital for fever, chills and myalgia with 5 days of evolution, erythema associated with pruritus, malleolar edema, joint pain and a inoculation escharin in the right inguinal region. Amoxicillin/Clavulanic Acid was not effective for 3 days.
Laboratory tests showed leukopenia, thrombocytopenia, with associated liver cytolysis, increased aminotransferase (216 U/L), alanine aminotransferase (238 U/L), lactic dehydrogenase (701 U/L), C – reactive protein (24.8 mg/dL). The patient was hospitalized under Doxycycline therapy. 8 days after the beginning of the symptoms the lipid profile showed the following alterations: increased triglycerides (TG) (298 mg/dL) but considerable decrease in total cholesterol (66 mg/dL), HDL cholesterol (10 mg/dL) and LDL cholesterol (4mg/dL).
Blood cultures were negative. The zoonosis panel by Molecular Biology (which includes Anaplasm phagocytophilum, Ehrlichia chaffeensis, E. muris, Borrelia burgdorferi, B. miyamoti. B. hermsii, Coxiella burnetii, Babesia microti, B. divergens, Ricketssia spp. and Encephalitis Virus) was positive for Rickettsia spp. Serology test revealed IgG Mediterranean Spotted Fever with a titer of 1:64 and negative IgM (for admission).
After 3 days of hospitalization and with clinical improvement, the patient went straight home after his hospital discharge with indication to maintain Doxycycline (100 mg per os twice daily) for another 5 days.
In Southern Europe, Mediterranean Spotted Fever (MSF) is one of the most important diseases caused by Rickettsia conorii, whose classic triad of symptoms is fever, maculopapular rash and inoculation eschar , that’s was described in our case report.
Analytical changes and applied therapeutics were also compatible with literature.
With regard to lipids, its known that they are transported in plasma in the form of lipoproteins by two distinct mechanisms. The exogenous one, which comprises the absorption and transport of dietary fats (TG) to the liver (and to the tissues) and the endogenous, which encompasses the transport of very-low-density lipoprotein (VLDL) produced in the hepatocyte.  These changes in the lipid profile found in this case are justified insofar as, given the hepatic dysfunction, there is an accumulation of lipids produced upstream of the liver and a decrease in those produced by it and downstream.
The authors declare that there are no competing interests.