CLINICAL CASE OF SEVERE ASTRAKHAN SPOTTED FEVER

Abstract

Astrakhan spotted fever is an acute natural focal vector-transmitted disease of the tick-borne rickettsioses group. The Astrakhan region is highly endemic for ASF. In recent years, the incidence of ASF in the Russian Federation has declined. However, severe forms of the disease, including complicated, have recently become more common, and lethal outcomes have begun to be recorded. This article presents a clinical case of complicated Astrakhan spotted fever in a female patient arrived from the Astrakhan region. The patient had fallen ill suddenly with a fever reaching febrile levels, symptoms of intoxication syndrome, severe myalgia, and arthralgia. The patient treated independently and did not seek medical help. Due to deteriorating condition, she was hospitalized by ambulance at Infectious Clinical Hospital No. 2 of the Moscow City Health Department in the intensive care unit in severe condition on the seventh day of illness with a referral diagnosis of generalized bacterial infection. Septic shock? Based on clinical and epidemiological data, laboratory and instrumental studies, severe ASF was suspected. Complications included infectious toxic shock and bilateral interstitial pneumonia of unknown etiology. Differential diagnosis included generalized bacterial infection, leptospirosis, hemorrhagic fever with renal syndrome, and neuroinfection. The diagnosis of ASF was confirmed by PCR: Rickettsia conorii ssp. caspia DNA was detected at a concentration of 106 copies/ml. In the intensive care unit, comprehensive care was administered, including infusion and transfusion support with correction of volume and electrolyte imbalances, broad-spectrum antibiotic combination therapy augmented with doxycycline 200 mg/day, administration of inotropic agents, and respiratory support. Extracorporeal detoxification methods were used, including continuous venovenous hemodiafiltration with selective endotoxin sorption (PLS-sorption), fresh frozen plasma, and platelet transfusions. On the 26th day of hospitalization, the patient was discharged in satisfactory condition under the supervision of an infectious disease specialist at her place of residence. Given the growth of domestic tourism in the Russian Federation, the risk of importing tick-borne rickettsioses to non-endemic regions remains high. This necessitates a cautious approach by general practitioners and infectious disease specialists to natural focal infections, particularly ASF.