Rickettsial meningitis: Fundoscopy as diagnostic tool.

Abstract

Mediterranean spotted fever (MSF), also known as boutonneuse fever, is caused by R. conorii. The onset of MSF is typically abrupt. Almost all patients have fever, headache, and a rash. Neurological complications are rarely described. AIM: We report a rare case of meningitis of rickettsial origin. Suspected and later confirmed on the basis of fundoscopy findings. METHODS: 31yr old female presented with fever, headache and altered sensorium of abrupt onset past one day. On examination she had signs of meningitis. Fundus examination revealed haemorrages and cotton wool spots. Cerebrospinal fluid examination revealed normal protein and sugar, with 2 lymphocytes and no polymorph nuclear cells on cytology. Weil- Felix test showed significantly raised titres to proteus antigen (ag) OX 19 (1:320) and proteus Ag OX 2 (1:640), suggestive of rickettsia of spotted fever group. Later confirmed with PCR based detection. Patient was started on Doxycycline and responded well. CONCLUSION: Meningitis of rickettsial origin require a high index of suspicion and Ocular involvement in rickettsioses is common, easily overlooked. Typical ocular manifestations are helpful in diagnosing a rickettsial disease, would increase the frequency with which rickettsial diseases are diagnosed. KEYWORDS: Rickettsia, Spotted fever, Weil-Felix test. INTRODUCTION: Rickettsia of the Spotted Fever Group (SFG), a class of arthropod-transmitted diseases, cause human disease and are heterogeneous group of small, obligate intracellular, gram negative coccobacilli and short bacilli. Regardless of species, infection with one of these Rickettsia leads to fever, headache, and intense myalgias, often in association with a rash or localized eschar. Rickettsial fevers with neurological involvement, in the form of encephalitis or meningitis as evident on cerebrospinal fluid examination are extremely uncommon.1,2 Ocular involvement in rickettsioses is common, but is easily overlooked. Retinal vascular lesions in patients with rickettsial disease may include focal or diffuse vascular sheathing, vascular leakage, intraretinal, white-centered, or subretinal hemorrhages, and retinal vascular occlusions.3-5 Typical ocular manifestations are helpful in diagnosing a rickettsial disease, and would help to have high index of suspicion.6 CASE REPORT: