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Unusual Abdominal Involvement in Rickettsial Diseases-Reply

David H. Walker, MD; William D. Bradford, MD
JAMA. 1983;249(13):1710. doi:10.1001/jama.1983.03330370023019.
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In Reply.—  Dr Mansueto and co-work-ers describe two unusual and in teresting patients with BF and intra-abdominal lesions. Although gastrointestinal (GI) symptoms are frequent in RMSF (63% of 131 patients described by Kaplowitz et al having nausea, vomiting, or diarrhea before treatment),1 our knowledge of intra-abdominal pathological lesions in RMSF is limited to usually mild hepatic involvement in fatal cases.2 It is possible that GI symptoms are caused by rickettsial infection in the blood vessels of the intestine, peritoneum, or other abdominal viscera; on the other hand, nausea and vomiting might be caused by rickettsial encephalitis, probably the most important component of severe RMSF.The parallel rise of RMSF in the United States and BF in Italy is important knowledge. Ecologic changes, including those affecting tick populations in the United States and the Mediterranean basin, must be elucidated. Physicians must be aware that infection with R conorii may


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