Abstract
Mediterranean spotted fever is a tick-borne zoonotic disease caused by Rickettsia conorii. It is transmitted by the dog tick Rhipicephalus sanguineus. It usually presents as a benign self-limited disease characterized by a skin rash, high fever, and, sometimes, a characteristic ulcer at the tick bite site called tache noir. The course of this disease is usually benign, although severe manifestations have been previously described, mainly in adults. Neurological manifestations are very unusual. We present a case of Mediterranean spotted fever with encephalitis to highlight the importance of clinical suspicion, mainly in endemic areas, the potential severity of this disease, and the need of early initiation of therapy in order to prevent severe complications.
Highlights
Mediterranean spotted fever (MSF) is an emerging zoonosis caused by Rickettsia conorii, a member of the spotted fever group of rickettsiae [1]
Chronic alcoholism, immunocompromised status, glucose6-phosphate dehydrogenase deficiency, prior prescription of inappropriate antimicrobial therapy, delay in treatment, and diabetes are risk factors for more severe presentations which can lead to a fatal outcome [2, 7]
Assuming the possible cross-reactions with other emerging Rickettsia of the spotted fever group, the use of standard serological tests for diagnosis is a limitation in our observation
Summary
Mediterranean spotted fever (MSF) is an emerging zoonosis caused by Rickettsia conorii, a member of the spotted fever group of rickettsiae [1]. Rhipicephalus sanguineus (dog tick) is the only recognized tick vector of rickettsiae identified in Portugal. Most of the cases occur during summer, during the period from July to September [2]. MSF is usually a benign and self-limited disease, characterized by skin rash, high fever, and a characteristic ulcer at the tick bite site called tache noir. Severe presentations are unusual but have been increasingly reported [3, 4]. Diagnosis is based on epidemiological, clinical, and laboratory criteria. Doxycycline (200 mg/day during 7–14 days, depending on the clinical course) is the drug of choice for the treatment of MSF [6]
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