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<Provider Id="sundheddkcms"> <Item Id="{66465939-1391-4FF7-A58C-561743694493}" Name="rickettsioser" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{0CAC8C92-CAAA-46E9-9ED8-C34BB57E4B91}" SortOrder="2500" PublishDate="2010-08-23T10:08:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <h4>Epidemisk plettyfus</h4> <ul> <li>Prodromal fase med hovedpine, derefter kulderystelser og feber</li> <li>Udtalt hovedpine, udmattelse, persisterende høj feber</li> <li>Makulært udslæt, som optræder på 4.-7. dag på trunkus og i aksiller, siden spredes det til resten af kroppen undtaget ansigt, håndflader og fodsåler</li> <li>Diagnosen bekræftes ved positiv PCR undersøgelse eller forekomst af specifikke antistoffer</li> </ul> <h4>Endemisk plettyfus</h4> <ul> <li>Gradvis start, feber og udslæt varer kortere (6-13 dage)</li> <li>Symptomerne er mindre udtalte end ved epidemisk tyfus</li> <li>Udslæt er makulopapulært, koncentreret på trunkus og blegner hurtigt</li> <li>Diagnosen bekræftes ved positiv PCR undersøgelse eller forekomst af specifikke antistoffer</li> </ul> <h4>Rocky Mountain Spotted Fever</h4> <ul> <li>Eksponering for flåtbid i endemisk område</li> <li>Influenzalignende prodromalperiode efterfulgt af kulderystelser, feber, udtalt hovedpine, muskelsmerter, rastløshed og udmattelse; sjældnere delirium og koma</li> <li>Rødt makulært udslæt mellem 2. og 6. dag med feber, først ved håndled og ankler, siden mere centralt, kan blive petekkialt</li> <li>Diagnosen bekræftes ved positiv PCR undersøgelse eller forekomst af specifikke antistoffer</li> </ul> <h4>African Tick Bite Fever</h4> <ul> <li>Overføres af flåter fra kvæg; ofte i forbindelse med safariturisme i Afrika</li> <li>Flåterne er mest aktive fra november til april</li> <li>Influenzalignende billede; en sort sårskorpe med rød halo (eschar) og makulopapuløst udslæt er almindelig (hos ca. 50 %). Der ses også regional lymfeglandelsvulst</li> <li>Almindeligvis mildt forløb og god prognose</li> <li>Diagnosen kan stilles klinisk ud fra relevant eksposition og klinisk præsentation. Diagnosen kan bekræftes ved positiv PCR undersøgelse på skrab eller biopsi fra hudlæsion</li> </ul> <h4>Scrub typhus</h4> <ul> <li>Eksponering for mider i endemisk område i Sydøstasien, vestlige stillehavsområde (inklusiv Korea) og Australien</li> <li>Sort eschar ved bidsted med regional og generaliseret lymfeglandelsvulst</li> <li>Konjunktivitis og kortvarende makulært udslæt</li> <li>Hyppigt pneumonitis, encefalitis og hjertesvigt</li> <li>Diagnosen bekræftes ved forekomst af specifikke antistoffer</li> </ul> <h4>Generelt om diagnostik</h4> <ul> <li>Statens Serum Institut tilbyder <a href="https://www.ssi.dk/produkter-og-ydelser/diagnostik/diagnostiskhaandbog/r/354">serologisk diagnostik</a> ved hjælp af en specifik immunfluorescensbaseret serologisk metode, som kan skelne mellem de to hovedgrupper af <em>Rickettsia</em> (Spotted Fever Group og Typhus Group). Herudover giver den mulighed for at skelne mellem akut og tidligere infektion ved påvisning af både IgM- og IgG-antistoffer</li> <li>Der kan også foretages diagnostik ved hjælp af <a href="https://www.ssi.dk/produkter-og-ydelser/diagnostik/diagnostiskhaandbog/r/079">PCR</a><a href="http://www.ssi.dk/Aktuelt/Nyhedsbreve/EPI-NYT/2016/Uge%2025%20-%202016.aspx" title="Rickettsia-diagnostik i Danmark 2008-2015. EPI-NYT. Uge 25-2016. " data-url="http://www.ssi.dk/Aktuelt/Nyhedsbreve/EPI-NYT/2016/Uge%2025%20-%202016.aspx" data-value="Rickettsia-diagnostik i Danmark 2008-2015. EPI-NYT. Uge 25-2016. " data-type="other-reference"><sup>1</sup></a>. Prøven til PCR (blodprøve eller biopsi fra fx eschar) bør tages tidligt i forløbet og før relevant antibiotikabehandling. Ikke alle patienter med rickettsiose har <em>Rickettsia</em>-bakterier i blodet, og et negativt resultat kan derfor ikke udelukke infektion med <em>Rickettsia</em>. Metoden undersøger for <em>Rickettsia</em> fra Spotted Fever Group og Typhus Group. Ved positivt svar vil artsidentifikation foretages ved DNA sekventering</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Klinisk billede for rickettsioser er varierende, men inkluderer en prodromalfase efterfulgt af feber, udslæt og almensymptomer</li> </ul> <h4>Epidemisk plettyfus</h4> <ul> <li>Inkubationstid på 10-14 dage</li> <li>Prodromal sygdomsfølelse, hoste, hovedpine, rygsmerter, ledsmerter og brystsmerter</li> <li>En periode med akut indsættende kulderystelser, høj feber og udmattelse følger efter prodromalperioden <ul> <li>Hovedpinen er udtalt og feberen langvarig</li> </ul> </li> <li>Symptomerne er influenzalignende og kan progrediere til delirium</li> <li>Ved spontan bedring ses fald i temperaturen efter ca. 14 dage</li> </ul> <h4>Endemisk plettyfus</h4> <ul> <li>Ligner tilbagevendende epidemisk tyfus, da sygdomsbilledet er præget af en langsom startfase og feber og udslæt af kortere varighed (1-2 uger)</li> <li>Symptomerne er mindre udtalte end ved epidemisk plettyfus</li> <li>Udslættet er makulopapulært, koncentreret til trunkus og afbleger hurtigt</li> <li>Adskilles fra Rocky Mountain Spotted Fever på baggrund af årstid og geografi; endemisk plettyfus forekommer senere på året og både i byer og på landet; Rocky Mountain Spotted Fever forekommer kun på landet</li> </ul> <h4>Rocky Mountain Spotted Fever</h4> <ul> <li>3-10 dage efter flåtbid ses symptomer som feber, kulderystelser, hovedpine, kvalme, opkast, myalgier, rastløshed og irritabilitet</li> <li>Hoste og pneumonitis kan ses</li> <li>Delirium, epileptiske anfald og koma kan forekomme</li> </ul> <h4>Scrub typhus</h4> <ul> <li>Inkubationstiden er 1-3 uger</li> <li>Sygdomsfølelse, kulderystelser, udtalt hovedpine og rygsmerter udvikles</li> <li>Feberen stiger gradvist og et makulært udslæt dukker op, først på trunkus efter en uge med feber, kan være forbigående eller vare en uge</li> </ul> <h4>Andre typer plettyfus</h4> <ul> <li>Navngives ofte efter geografisk forekomst</li> <li>Vektorerne efterlader oftest en sort prik ved stedet for biddet</li> <li>Endotelskade vil give perivaskulært ødem og dermal nekrose</li> <li>Regional lymfeglandelsvulst, disseminerede læsioner, fokale leverforandringer og encefalitis kan ses</li> </ul> <h3>Kliniske fund</h3> <h4>Epidemisk plettyfus</h4> <ul> <li>Konjunktivitis, ansigtsrødme, stetoskopiske tegn på lungeaffektion, splenomegali</li> <li>Udslættet har makulære elementer og kan blive konfluerende <ul> <li>Det optræder først i aksiller, sidenhen på trunkus, spredes så over ekstremiteterne, men sjældent til ansigt, håndflader eller fodsåler</li> <li>Udslættet kan hos meget syge patienter blive hæmoragisk, og hypotension vil være udtalt</li> </ul> </li> <li>Der kan forekomme nyresvigt, cerebral påvirkning og delirium</li> </ul> <h4>Endemisk plettyfus</h4> <ul> <li>De kliniske fund ved endemisk plettyfus er som ved epidemisk plettyfus, men oftest mindre udtalte</li> </ul> <h4>Rocky Mountain Spotted Fever</h4> <ul> <li>Ansigtsrødme, injicerede konjunktiva</li> <li>Udslættet fremtræder som pletter, der progredierer til makulopapoløse affektioner og petekkier <ul> <li>Udslættet optræder mellem dag 2 og 6 efter, feberen er begyndt</li> <li>Det kommer først ved håndled og ankler, siden spredes det centralt til arme, ben og trunkus</li> <li>Håndflader og fodsåler involveres</li> <li>Omtrent 10 % mangler udslæt</li> </ul> </li> <li>Andre fund er hepatomegali, splenomegali, ikterus, myokarditis og uræmi</li> </ul> <h4>Scrub typhus</h4> <ul> <li>Ved bidstedet ses papel, som udvikles til flad, sort eschar</li> <li>Regionale lymfeknuder er forstørret og ømme, og der kan være generaliseret lymfeglandelssvulst</li> <li>I anden eller tredje uge vil pneumonitis, myokarditis, hjertesvigt, encefalitis, akutte mavesmerter, hepatitis eller akut nyresvigt kunne udvikles</li> </ul> <p><img src="57C5A1130213459F8920499811EDD822-240-229" style="height: 229px; width: 240px;" alt="Foto af scrub-typhus" height="229" width="240"><sup>Foto venligst udlånt af <a href="https://dermnetnz.org/">DermNet</a>. </sup></p> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Udredningen vil i alt overvejende grad finde sted på sygehus</li> </ul> <h3>Andre undersøgelser hos specialist eller undersøgelse på sygehus</h3> <ul> <li>Epidemisk plettyfus <ul> <li>Leukocyttallet er variabelt, proteinuri og hæmaturi forekommer ofte</li> <li>Antistoffer vil kunne påvises i serum efter 5-12 dage </li> </ul> </li> <li>Endemisk plettyfus <ul> <li>Serologi</li> </ul> </li> <li>Rocky Mountain Spotted Fever <ul> <li>Leukocytose, trombocytopeni, hyponatriæmi, proteinuri og hæmaturi er almindelig</li> <li>På grund af endotelskade ses aktivering af trombocytter og tegn på koagulationspåvirkning med fibrinolyse</li> <li>I den akutte kan fase kan <em>R. rickettsiae</em> påvises ved PCR i hudbiopsier</li> <li>Serologi</li> </ul> </li> <li>Øvrige plettyfussygdomme <ul> <li>Serologi og/eller PCR, som beskrevet ovenfor</li> </ul> </li> </ul> <h4>Andre undersøgelser</h4> <ul> <li>Epidemisk plettyfus <ul> <li>Røntgen af thorax kan vise tegn på interstitiel pneumoni</li> </ul> </li> <li>Rocky Mountain Spotted Fever <ul> <li>Cerebrospinalvæsken kan vise pleocytose</li> </ul> </li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Ved epidemisk plettyfus skal en række andre årsager til febril sygdom overvejes</li> <li>Ved endemisk plettyfus kan man overveje <a href="~/link.aspx?_id=119A486E7B53479F8AC32D6F69452AEB&_z=z">mæslinger</a>, <a href="~/link.aspx?_id=C46237BAA27E4EA9968302DD4861E4EF&_z=z">rubella</a>, roseola, nyt udbrud af epidemisk plettyfus, samt Rocky Mountain Spotted Fever</li> <li>Rocky Mountain Spotted Fever kan ligne <a href="~/link.aspx?_id=119A486E7B53479F8AC32D6F69452AEB&_z=z">mæslinger</a>, <a href="~/link.aspx?_id=47CDC70A044345D3823E2A8B9BD42AB3&_z=z">tyfus</a>, ehrlichiose eller meningokokæmi</li> <li>Ved scrub typhus er <a href="~/link.aspx?_id=B2867B7E34034FA8A838A8B3C3B44D07&_z=z">leptospirose</a>, <a href="~/link.aspx?_id=47CDC70A044345D3823E2A8B9BD42AB3&_z=z">tyfus</a>, <a href="~/link.aspx?_id=E9AF1BBD81C44D8899F417DCCF2125AA&_z=z">dengue feber</a>, <a href="~/link.aspx?_id=CA7CC64FC95D489ABC9CC05F08E1FA29&_z=z">malaria</a> og andre rickettsieinfektioner relevante differentialdiagnoser</li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Sanere infektionen</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Førstevalg til behandling af rickettsioser er [DliActiveSubstance;5273;doxycyclin]</li> <li>Betalaktam-antibiotika har ingen effekt overfor rickettsier</li> <li>I<em> </em>in vitro studier har både <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/185000">makrolider</a> og <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/194000">fluorquinoloner</a> god aktivitet overfor rickettsier. Der foreligger også kliniske studier, der understøtter anvendelsen af makrolider, hvor doxycyclin ikke kan anvendes<a href="%20" title="Anton E, Muñoz T, Travería FJ, Navarro G, Font B, Sanfeliu I, Segura F, Randomized Trial of Clarithromycin for Mediterranean Spotted Fever. Antimicrobial Agents and Chemotherapy 2016;60: 1642-1645" data-url="reference-link" data-value-piped="Anton E, Muñoz T, Travería FJ, Navarro G, Font B, Sanfeliu I, Segura F|Randomized Trial of Clarithromycin for Mediterranean Spotted Fever|Antimicrobial Agents and Chemotherapy|2016|60|1642-1645" data-value="Anton E, Muñoz T, Travería FJ, Navarro G, Font B, Sanfeliu I, Segura F, Randomized Trial of Clarithromycin for Mediterranean Spotted Fever. Antimicrobial Agents and Chemotherapy 2016;60: 1642-1645" data-type="journal-reference"><sup>2</sup></a> </li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Håndtering vil i alt overvejende grad finde sted på sygehus</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Se forebyggende behandling. Rejsende rådgives om beskyttende foranstaltninger til at undgå insektbid</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Alle de beskrevne tilstande kan behandles med [DliActiveSubstance;5273;doxycyclin] 100 mg x 2 i et varierende antal dage afhængig af symptomernes varighed; nogle tilstande kan også med held behandles med blot en enkelt dosis doxycyclin; behandling til 2-3 døgns feberfrihed vil være det almindeligste; et alternativ til doxycyclin kan være et <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/185000">makrolid</a></li> <li>African Tick Bite Fever behandles med doxycyclin 100 mg x 2 i 5-7 dage<a href=" " data-type="journal-reference" data-value="Frean J, Grayson W, South African Tick Bite Fever: An Overview. Dermatopathology (Basel) 2019;6: 70-76" data-value-piped="Frean J, Grayson W|South African Tick Bite Fever: An Overview.|Dermatopathology (Basel)|2019|6|70-76|31700846" data-url="reference-link" data-pubmedid="31700846" title="Frean J, Grayson W, South African Tick Bite Fever: An Overview. Dermatopathology (Basel) 2019;6: 70-76"><sup>#</sup></a> </li> </ul> <ul> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Kontrol af vektor <ul> <li>Grundig undersøgelse af kroppen ved potentiel eksponering og fjernelse af eventuel vektor</li> </ul> </li> <li>Epidemisk plettyfus kan forebygges med lusekontrol</li> <li>Endemisk plettyfus - kontrol af rotter og lopper</li> <li>Typhus Group - beskyttende tøj, kemikalier og mekanisk fjernelse af flåter</li> <li>Scrub typhus forebygges med midemidler eller eventuel systemisk profylakse med [DliActiveSubstance;5273;doxycyclin] (200 mg/uge)</li> <li>Ved overnatning i telt i Afrika anbefales myggemidler og beskyttende tøj for at beskytte mod flåtbid</li> <li>Vaccine er ikke aktuelt</li> </ul> <h2>Henvisning</h2> <ul> <li>Henvises til hospital ved mistanke om de beskrevne tilstande</li> </ul> <h2>Opfølgning</h2> <ul> <li>Ikke indikation for opfølgning efter overstået sygdom</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Epidemisk plettyfus har oftest et mildt forløb hos børn under 10 år</li> </ul> <h3>Komplikationer</h3> <ul> <li>Epidemisk plettyfus kan kompliceres af <a href="~/link.aspx?_id=C0137DD2232646F6AD549B643A06B77F&_z=z">pneumoni</a>, vaskulitis med obstruktion af større kar, gangræn, cirkulationssvigt, myokarditis og uræmi</li> <li>Ved endemisk plettyfus er pneumoni og gangræn sjælden</li> <li>Komplikationer ved Rocky Mountain Spotted Fever er pneumonitis med lunge- og <a href="~/link.aspx?_id=3EA9AFEB17F04EE2876045A9FB53DBDC&_z=z">hjertesvigt</a> (ofte årsag til død), epileptiske anfald, encefalopati, perifer neuropati, paraparese, tarm- og blæreinkontinens, cerebellar og vestibulær dysfunktion, hørenedsættelse og pareser</li> </ul> <h3>Prognose</h3> <ul> <li>Epidemisk plettyfus har en mortalitet på ca. 10 % hos patienter i tyverne og trediverne</li> <li>Endemisk plettyfus er kun dødelig hos ældre</li> <li>Ved Rock Mountain Spotted Fever er mortaliteten hos ubehandlede 70 % hos ældre, men under 20 % hos børn</li> <li>African Tick Bite Fever giver mild sygdom med god prognose</li> <li>Ved Scrub typhus kan feberen forsvinde efter 2 uger, men mortaliteten kan alligevel være 10-30 % ubehandlet, god prognose ved behandling</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Rickettsioser er en gruppe zoonoser forårsaget af nært beslægtede arter af <em>Rickettsia</em>-bakterier</li> <li><em>Rickettsia </em>er en obligat intracellulær bakterie, der kan inddeles i to undergrupper: Typhus Group og Spotted Fever Group, som hver dækker over en række arter</li> <li>Sygdommene overføres ved kontakt med lus, lopper eller flåter<a href="%20" title="Parola P, Paddock CD, Socolovschi C, Labruna MB et al, Update on Tick-Borne Rickettsioses around the World: a Geographic Approach. Clinical Microbiology Reviews 2013;26: 657-702" data-url="reference-link" data-value-piped="Parola P, Paddock CD, Socolovschi C, Labruna MB et al|Update on Tick-Borne Rickettsioses around the World: a Geographic Approach|Clinical Microbiology Reviews |2013|26|657-702" data-value="Parola P, Paddock CD, Socolovschi C, Labruna MB et al, Update on Tick-Borne Rickettsioses around the World: a Geographic Approach. Clinical Microbiology Reviews 2013;26: 657-702" data-type="journal-reference"><sup>3</sup></a></li> </ul> <h4>Inddeling</h4> <ul> <li> Typhus Group <ul> <li>Endemisk plettyfus skyldes <em>Rickettsia typhi</em>; lopper er vektorer<a href=" " data-type="journal-reference" data-value="Caravedo Martinez MA, Ramírez-Hernández A, Blanton LS, Manifestations and Management of Flea-Borne Rickettsioses. Res Rep Trop Med 2021;12: 1-14" data-value-piped="Caravedo Martinez MA, Ramírez-Hernández A, Blanton LS|Manifestations and Management of Flea-Borne Rickettsioses.|Res Rep Trop Med|2021|12|1-14|33574726" data-url="reference-link" data-pubmedid="33574726" title="Caravedo Martinez MA, Ramírez-Hernández A, Blanton LS, Manifestations and Management of Flea-Borne Rickettsioses. Res Rep Trop Med 2021;12: 1-14"><sup>4</sup></a></li> <li>Epidemisk plettyfus også kaldet klassisk plettyfus skyldes <em>R. prowazekii</em>, kropslus er vektorer</li> </ul> </li> <li> Spotted Fever Group (flåter er vektorer)<a href="%20" title="Parola P, Paddock CD, Socolovschi C, Labruna MB et al, Update on Tick-Borne Rickettsioses around the World: a Geographic Approach. Clinical Microbiology Reviews 2013;26: 657-702" data-url="reference-link" data-value-piped="Parola P, Paddock CD, Socolovschi C, Labruna MB et al|Update on Tick-Borne Rickettsioses around the World: a Geographic Approach|Clinical Microbiology Reviews |2013|26|657-702" data-value="Parola P, Paddock CD, Socolovschi C, Labruna MB et al, Update on Tick-Borne Rickettsioses around the World: a Geographic Approach. Clinical Microbiology Reviews 2013;26: 657-702" data-type="journal-reference"><sup>3</sup></a><br> <ul> <li>Rocky Mountain Spotted Fever, som skyldes <em>R. rickettsii</em> </li> <li>Mediterranean Spotted Fever, som skyldes <em>R. conorii</em> </li> <li>African Tick Bite Fever, som skyldes <em>R. africae</em> </li> <li>Sibirisk plettyfus, som skyldes <em>R. siberica</em> </li> <li>Australsk plettyfus, som skyldes <em>R. australis</em> </li> <li>Orientalsk pletfeber som skyldes <em>R. japonica</em></li> </ul> </li> <li> Scrub typhus har mider som vektorer; sygdommen er principielt ikke en rickettsiose, men skyldes en beslægtet bakterie <em>Orientia tsutsugamushi</em></li> </ul> <h3>Forekomst</h3> <ul> <li>Man kan pådrage sig rickettsiose overalt i verden ved vektorbåren infektion</li> <li>Tilfælde af rickettsiose påvist i Danmark er for det meste erhvervet i Afrika<a href=" " data-type="journal-reference" data-value="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA, Rickettsioses in Denmark: A retrospective survey of clinical features and travel history. Ticks Tick Borne Dis 2018;9: 573-579" data-value-piped="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA|Rickettsioses in Denmark: A retrospective survey of clinical features and travel history.|Ticks Tick Borne Dis|2018|9|573-579|29415864" data-url="reference-link" data-pubmedid="29415864" title="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA, Rickettsioses in Denmark: A retrospective survey of clinical features and travel history. Ticks Tick Borne Dis 2018;9: 573-579"><sup>5</sup></a>. I et svensk studie med hjemvendte, der havde fået feber efter rejse til områder med malariaforekomst, fandt man rickettsiose hos 4 %. I et tilsvarende norsk studie fandt man, at 5 % havde en symptomgivende rickettsioseinfektion ved rejse til Afrika syd for Sahara. Blandt rejsende på storvildtjagt var 25 % inficerede</li> <li>Forskellige arter af bakterien findes endemisk i Danmark. Smitte er derfor mulig i Danmark ved bid af skovflåt, men rickettsioser erhvervet i Danmark formodes at være mildt forløbende<a href=" " data-type="journal-reference" data-value="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA, Rickettsioses in Denmark: A retrospective survey of clinical features and travel history. Ticks Tick Borne Dis 2018;9: 573-579" data-value-piped="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA|Rickettsioses in Denmark: A retrospective survey of clinical features and travel history.|Ticks Tick Borne Dis|2018|9|573-579|29415864" data-url="reference-link" data-pubmedid="29415864" title="Ocias LF, Jensen BB, Villumsen S, Lebech AM, Skarphedinsson S, Dessau RB, Krogfelt KA, Rickettsioses in Denmark: A retrospective survey of clinical features and travel history. Ticks Tick Borne Dis 2018;9: 573-579"><sup>5</sup></a> </li> </ul> <h4>Geografisk udbredelse</h4> <ul> <li> Typhus Group <ul> <li>Endemisk plettyfus forekommer i hele verden </li> <li>Epidemisk plettyfus forekommer i mindre udviklede områder i blandt andet Sydamerika, Afrika, Asien og Nordafrika</li> </ul> </li> <li> Spotted Fever Group <ul> <li>Rocky Mountain Spotted Fever forekommer på den vestlige halvkugle (omkring 2000 tilfælde pr. år i USA) </li> <li>Mediterranean Spotted Fever forekommer i middelhavslandene, Afrika, Indien og Sydvestasien </li> <li>African Tick Bite Fever forekommer i Afrika syd for Sahara </li> <li>Sibirisk plettyfus forekommer i Sibirien, Mongoliet, Nordkina og Australien </li> <li>Australsk plettyfus forekommer i Australien </li> <li>Orientalsk pletfeber forekommer i Japan</li> </ul> </li> <li> Scrub typhus forekommer i Asien, Nordaustralien og på Stillehavsøer</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Bortset fra epidemisk plettyfus er alle rickettsioser zoonoser, som overføres til mennesker fra andre pattedyr med lus, lopper og flåter </li> <li>Epidemisk plettyfus kan også overføres fra menneske til menneske</li> </ul> <h4>Patogenese</h4> <ul> <li>Hos mennesker vokser rickettsier hovedsagligt i endotelceller i små blodkar <ul> <li>Dette medfører vaskulitis, cellenekrose, trombose i årer, hududslæt og organdysfunktion</li> </ul> </li> </ul> <h3>ICPC-2</h3> <div>[ICPC]</div> <h3>ICD-10/SKS-koder</h3> <div>[ICD10]</div> <h2>Patientinformation</h2> <h3>Link til patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=E3CBE4DA0E3648D9ADA4DEBDB5A72A15&_z=z">Rickettsioser</a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og regionale pakkeforløb [ICPC]</li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h4>Diagnose</h4> <ul> <li>Det klinisk billede for rickettsioser er varierende afhængig af hvilken art man er inficeret med <ul> <li>Sygdomsbilledet inkluderer en prodromalfase efterfulgt af feber, udslæt og almensymptomer</li> <li>Varierer i alvolighed fra overvejende milde til svære endog livstruende forløb</li> </ul> </li> <li>Differentialdiagnose ved rejserelateret feber og udslæt</li> <li>Diagnosen bekræftes ved positiv PCR-undersøgelse i prøve fra hudlæsion eller i blod, eller ved forekomst af specifikke antistoffer i blod</li> </ul> <h4>Behandling</h4> <ul> <li>Første valg til behandling af rickettsioser er doxycyclin</li> <li>African Tick Bite Fever behandles i 5-7 dage med doxycyclin 100 mg x 2</li> </ul> <h4>Henvisning</h4> <ul> <li>Ved mistanke om rickettsiose henvises til infektionsmedicinsk afdeling</li> </ul> <h3>Seneste væsentlige ændringer</h3> <ul> <li>Behandlingsvarighed for African Tick Bite Fever er præciseret</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">1793</TextField> <TextField Name="PageTitle">Rickettsioser</TextField> <TextField Name="NavigationTitle">Rickettsioser</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2025-08-19T13:31:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{023FD322-AE57-4908-9D87-54B711C48AA5}</LinkField> <LinkField linktype="internal">{ED7CEC94-3F7A-4FB5-BBB0-A3681BCFC481}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <TextField Name="ICD10">A79, A79.9</TextField> <TextField Name="ICPC2">A78</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Rickettsioser er en gruppe zoonoser forårsaget af nært beslægtede arter af Rickettsia-bakterier. 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]]></Media> 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