Follow-up of a Rickettsia felis encephalitis: Some new insights into clinical and imaging features. (March 2021)

• Record Type: Journal Article
• Authors: Zeng, Ziling; Wang, Chunjuan; Liu, Cuicui; Wang, Baojie; Meng, Xin; Chen, Yan; Guo, Shougang
• Is Part Of: International journal of infectious diseases. Volume 104(2021)
• Page Start: 300
• Page End: 302
• Publication Date: 2021-03
• Subjects: Rickettsia felis -- Encephalitis -- Brain biopsy -- Glioma -- Metagenomic next-generation sequencing; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.12.090
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: A misdiagnosed case of Rickettsia felis encephalitis was confirmed by cerebrospinal fluid mNGS. Neuroimaging showed a focal lesion in the right thalamus which was indistinguishable from a glioma. Perivascular inflammation in the lesion implied a vasophilic characteristic of the pathogen. Rickettsia felis encephalitis could clinically display as none-specific neurological symptoms. Abstract: Rickettsia felis ( R. felis ) infection is a cause of unspecified encephalitis. However, the incidence has been underestimated due to the intracellular features of the pathogen and insufficient understanding of its clinical picture. This study reported a case of R. felis infection in a 26-year-old female who only manifested with certain neurological symptoms. With a lack of specific systemic inflammatory symptoms, the diagnosis was initially misdiagnosed as a brain glioma. However, a brain tissue biopsy showed prominent perivascular inflammatory infiltrations, which indicated inflammatory disease. Spinal fluid metagenomic next-generation sequencing (mNGS) was taken after ruling out other common infectious and autoimmune diseases. The results suggested R. felis infection, which was also supported by Weil-Felix reaction in the serum. After the diagnosis was corrected as R. felis encephalitis, the patient was successfully treated with doxycycline and had a good prognosis at the 1-year follow-up.