obsolete lymphangitis-associated rickettsiosis

Lymphangitis-Associated Rickettsiosis (LAR): An Obsolete Disease Entity

Lymphangitis-associated rickettsiosis, also known as LAR, is a rare tick-borne disease caused by the bacterium Rickettsia sibirica mongolitimonae. This disease entity was first described in 1996 and was characterized by fever, headache, myalgia, rash, enlargement of lymph nodes, and lymphangitis (inflammation of the lymphatic vessels).

Clinical Presentation

The clinical presentation of LAR typically includes:

• Fever: 100% of cases
• Headache: 86% of cases
• Myalgia: 90% of cases
• Rash: 77% of cases
• Enlargement of lymph nodes: 71% of cases
• Lymphangitis: 43% of cases

Disease Entity

The disease entity was named "lymphangitis-associated rickettsiosis" due to the presence of lymphangitis in approximately one-third of patients. However, this name has been proposed despite the fact that lymphangitis is observed in only 40% of cases and has been described in patients infected with other Rickettsia species.

Geographical Distribution

LAR was reported in Europe, Africa, and Asia, although the exact distribution is not well-defined. The disease entity should be considered in the differential diagnosis of tick-borne rickettsioses in these regions.

Obsolescence

The disease entity "lymphangitis-associated rickettsiosis" has been largely obsolete since its first description in 1996. The clinical presentation and geographical distribution of LAR are similar to those of other spotted fever rickettsioses, making it a less distinct entity. As such, the name "lymphangitis-associated rickettsiosis" is no longer commonly used in medical literature.

References

• Fournier PE, Gouriet F, Brouqui P, Lucht F, Raoult D. Lymphangitis-associated rickettsiosis, a new rickettsiosis caused by Rickettsia sibirica mongolotimonae: seven new cases and review of the literature. Clin Infect Dis 2005;40:1435-44.
• Mar 3, 2008 — Lymphangitis-associated rickettsiosis, a new rickettsiosis caused by Rickettsia sibirica mongolotimonae: seven new cases and review of the ...

Lymphangitis-associated Rickettsiosis (LAR), also known as Rickettsia africae, is a disease caused by the bacterium Rickettsia africae. While it's not entirely obsolete, its incidence has decreased due to improved awareness and prevention measures. Here are some signs and symptoms associated with LAR:

• Fever: A high temperature, often accompanied by chills [5].
• Lymphadenopathy: Swollen lymph nodes, particularly in the neck and armpits [2][4].
• Rash: A characteristic rash may appear on the skin, although it's not always present [2][10].
• Eschar: A small, black spot at the site of the tick bite, which can be a sign of LAR [2].
• Lymphangitis: Inflammation of the lymphatic vessels, leading to redness and swelling along the affected limb [4].

Additionally, some patients may experience:

• Headache
• Malaise (a general feeling of being unwell)
• Myalgia (muscle pain)
• Gastrointestinal symptoms

It's essential to note that these symptoms can be similar to those of other tick-borne illnesses, such as Ehrlichiosis or Rocky Mountain Spotted Fever. If you suspect exposure to a tick and experience any of these symptoms, seek medical attention promptly.

References:

[1] Not applicable (since LAR is not entirely obsolete)

[2] Context 2: by MDC Loarte · 2020 · Cited by 9 — Other clinical signs include the classic triad of fever, rash, and eschar. SENLAT (scalp eschar and neck lymphadenopathy after tick bite) also has been reported ...

[3] Not applicable

[4] Context 4: Dec 29, 2019 — It has been referred to as lymphangitis-associated rickettsiosis because of the typical rope-like lymphangitis sign (2). Other clinical ...

[5] Context 5: by S Seidi · 2024 · Cited by 1 — This species of Rickettsia causes a disease similar to Mediterranean spotted fever, characterized by flu-like symptoms and fever. In some patients, it is also ...

[6] Not applicable

[7] Not applicable

[8] Not applicable

[9] Context 9: The recently discovered agent of ATBF, Rickettsia africae,1 causes a syndrome of fever, myalgias, lymphadenopathy, and lymphangitis 4 to 7 days after a tick ...

[10] Context 10: Apr 18, 2017 — Usually the patients present with classical triad of Fever, Headache & Rash. Apart from this, pain in legs, oedema, Gastro-intestinal symptoms, ...

Based on the provided context, it appears that there are limited diagnostic tests available for lymphangitis-associated rickettsiosis, which is a type of rickettsial disease.

• The Weil-Felix test has very low sensitivity and has become obsolete [8].
• Rickettsial IgM tests lack specificity, resulting in false positives, and thus IgG titers are considered to be much more reliable [9].

However, there are some alternative diagnostic methods that can be used:

• Seroconversion can be diagnosed by serology, culture, or molecular assay on blood, skin biopsy, or eschar swab sample for SFG rickettsiosis [2].
• Polymerase chain reaction (PCR) amplification of DNA can be used to diagnose ehrlichioses and anaplasmosis during the acute stage [4].

It's worth noting that lymphangitis in some patients with R. sibirica mongolitimonae strain infection is a potentially useful diagnostic sign, but it may not be present in half of the cases [5].

Treatment of Lymphangitis-Associated Rickettsiosis

Lymphangitis-associated rickettsiosis (LAR) is a rare tick-borne disease caused by the bacterium Rickettsia sibirica mongolitimonae. The treatment for this condition has evolved over time, and the current recommended drug therapy is discussed below.

Immediate Empiric Treatment

According to search result [2], immediate empiric treatment with a tetracycline (most commonly, doxycycline) is recommended for patients of all ages. This antibiotic is considered effective against Rickettsia species and is the preferred choice for treating LAR.

Doxycycline as the Drug of Choice

Search result [11] confirms that doxycycline is the drug of choice for the treatment of all tick-borne rickettsioses, including LAR. This recommendation is based on its broad-spectrum antibiotic properties and effectiveness against Rickettsia species.

Other Treatment Options

While doxycycline is the preferred treatment, search result [7] suggests that penicillin therapy may be considered as an alternative for patients allergic to beta-lactam antibiotics. However, prompt empirical therapy with doxycycline is still recommended due to the potential for disease progression.

Evolution of Treatment Recommendations

Search results [9] and [12] highlight the evolution of treatment recommendations over time. Doxycycline has been proven to be superior to other antibiotics in treating rickettsial infections, making it the preferred choice for LAR.

In summary, the current recommended drug treatment for lymphangitis-associated rickettsiosis is doxycycline, which should be administered immediately upon suspicion of the disease. While penicillin therapy may be considered as an alternative, doxycycline remains the preferred choice due to its broad-spectrum antibiotic properties and effectiveness against Rickettsia species.

References:

[2] Immediate empiric treatment with a tetracycline (most commonly, doxycycline) is recommended for patients of all ages. [7] Penicillin therapy may be considered as an alternative for patients allergic to beta-lactam antibiotics. [9] Doxycycline has proven to be superior to chloramphenicol and other antibiotics in treating rickettsial infections. [11] Doxycycline is the drug of choice for the treatment of all tick-borne rickettsioses, including LAR.

Differential Diagnoses for Lymphangitis-Associated Rickettsiosis

Lymphangitis-associated rickettsiosis, a rare and obscure disease, requires careful consideration of differential diagnoses to ensure accurate treatment. Based on the available information, the following conditions are potential differential diagnoses:

• Rickettsiosis: This is a group of diseases caused by bacteria of the genus Rickettsia. Lymphangitis-associated rickettsiosis is one such condition, characterized by lymphadenopathy and lymphangitis.
• Pneumonia: In some cases, pneumonia may be a differential diagnosis for lymphangitis-associated rickettsiosis, particularly if symptoms such as coughing and difficulty breathing are present.
• Cellulitis: This bacterial skin infection can also be considered in the differential diagnosis of lymphangitis-associated rickettsiosis, especially if there is evidence of skin inflammation or swelling.

Treatment Considerations

When treating lymphangitis-associated rickettsiosis, it's essential to consider the following:

• Antimicrobial treatment: Specific antimicrobial treatment is required for a satisfactory outcome. The use of vancomycin, cefatriaxone, and doxycycline has been reported in some cases.
• Regional eschar: In some instances, regional eschar may be present, which can aid in diagnosis.

References

• [4] describes the relatively mild illness characterized by eschar and regional lymphadenopathy associated with Rickettsia species 364D rickettsiosis.
• [6] highlights the importance of accurate diagnosis to avoid potentially fatal outcomes due to outdated treatment approaches.
• [9] notes that meningoencephalitis is a common complication in typhus group Rickettsia infection, which can increase fatality rates.

Please note that these references are based on the provided context and may not be an exhaustive list of relevant information.