Under-diagnosis of rickettsial disease in clinical practice: A systematic review

Travel Medicine and Infectious Disease
Louise E van EekerenAbraham Goorhuis

Abstract

Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars. We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to study design: 'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms. In 'complete approach' studies, ERD/NERD ratios were significantly lower, suggesting a considerable under-diagnosis of NERD in 'clinical judgement' studies. Based on these results, we estimate that the diagnosis of rickettsial disease was missed in 66.5% of patients with ST, and in 57.9% of patients with MSF. Study design influences the reported eschar rates in ST and MSF significantly. NERD is likely to be a vastly underdiagnosed entity, and clinicians should consider and test for the disease more often. ...Continue Reading

Citations

Dec 12, 2018·Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG·Marcellus Fischer
Dec 12, 2018·Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG·Marcellus Fischer
Oct 10, 2018·Infection and Immunity·Jeremy BechelliRong Fang
Jan 31, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Sophia G de VriesAbraham Goorhuis
Apr 25, 2020·Tropical Medicine and Infectious Disease·Manisha BiswalSunil Sethi
Mar 1, 2020·Indian Journal of Pediatrics·Ashwani K Sood, Amit Sachdeva
Apr 17, 2021·Travel Medicine and Infectious Disease·Cecilia CostaFederico Gobbi
May 14, 2021·PLoS Neglected Tropical Diseases·Jeanne SaljeNicholas Day

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