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We reviewed 58 patients, 27 with murine typhus (MT) and 31 with Israeli Mediterranean spotted fever (IMSF), hospitalized at the Sheba Medical Center 1979-1988. Five patients with MT and five with IMSF had evidence of renal impairment. One patient with MT underwent a renal biopsy, and two patients with IMSF died and had autopsy examinations with histology of the kidney. The principal histopathological lesion found in those most severe cases of rickettsiosis-induced renal failure was multifocal perivascular interstitial nephritis. In contrast with previous reports, involvement of the kidneys in rickettsial infection seems to be relatively common. Early diagnosis and treatment with hydration and specific antimicrobial agents is mandatory to prevent morbidity.
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