United Press International - Monday, 18 September 2000
Ed Susman, UPI Science News

The earliest signs of infection with human immunodeficiency virus sometimes looks like Mediterranean or Rocky Mountain spotter fever, a bacterial disease, said Dr. Ferran Segura Porta, chief of infective diseases at the Hospital of Sabadell, near Barcelona.

And if the bacterial infection is misdiagnosed, patients and physicians lose an early opportunity to attack HIV infection at a critical stage, added Dr. Antonio Guerrero Espejo, chief of microbiology services at Complejo Hospitalario, La Coruna, Spain.

"We can not forget the diagnosis of HIV infection when patients develop fever and rash similar to the Mediterranean spotted fever eruption," Segura cautioned. "This is a warning about the possible diagnostic confusion that may occur between the clinical presentation of primary HIV infection and other diseases endemic to certain geographical zones."

In a report to the Interscience Conference on Antimicrobial Agents and Chemotherapy, an infectious disease meeting of the American Society for Microbiology in Toronto, Segura identified four patients who were treated for Mediterranean spotted fever -- a disease common to the Barcelona area, particularly during summer -- but apparently were really suffering from the early stages of HIV infection.

Segura noted that in the United States similar misdiagnoses have been made, confusing early HIV infection with Rocky Mountain spotted fever, also caused by a species of Rickettsia bacteria.

"Acute HIV infection is symptomatic in up to 40 percent of cases," explained Dr. Esperanza Anton of Sabadell hospital, lead author of the Barcelona study.

The infection can often be characterized by fever and skin eruptions -- very similar to Mediterranean spotted fever.

In the four Spanish cases, patients were administered antibiotics, the symptoms subsided and the patients were discharged. Laboratory blood tests performed after the they left the hospital failed to show infection.

One of the cases, a 42-year-old man, was treated for spotted fever and released; seven years later he returned to the hospital with infections typical of AIDS. His immune system had been almost totally destroyed by the disease.

In another patient, a 44-year-old woman was diagnosed a month later when she developed AIDS-related brain disease.

The others were diagnosed with HIV infection two and five years later in an advanced stage of HIV disease.

"Diagnosis of primary HIV infection is very important," Anton said, "since it constitutes an indication to start treatment at a time when the immune system of the patient is still intact. Longer duration of symptoms without treatment has been associated with more rapid progression of AIDS."

Guerrero said he was aware of similar misdiagnoses that occurred at a hospital in Madrid where he previously worked.
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