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IDCases 2019 21;15:e00528. Epub 2019 Mar 21.

Department of Infectious Diseases, Fattouma Bourguiba Hospital, Monastir, Tunisia.

Mediterranean spotted fever is a generally benign disease but with the potential of serious manifestations. We report a case of Mediterranean spotted fever in a 56-year-old woman, with pet dog exposure, who presented with a septic shock pattern. Based on clinical symptoms, history, and laboratory results, the diagnosis of Mediterranean spotted fever was suspected and the outcome was favorable with doxycycline treatment. Read More

Eur J Clin Microbiol Infect Dis 2019 Apr 11. Epub 2019 Apr 11.

Infectious Diseases Unit, Internal Medicine Service, Hospital de Terrassa (Consorci Sanitari de Terrassa), Ctra. Torrebonica s/n, 08227, Terrassa, Spain.

The objective of this study is to evaluate the characteristics and outcome of elderly patients with Mediterranean spotted fever (MSF). This study was a prospective observational cohort study of all adult cases with confirmed MSF treated in a teaching hospital (1984-2015) to compare the characteristics of elderly patients (> 65 years) with younger adults. We identified 263 adult patients with MSF, and 53 (20. Read More

Genes (Basel) 2019 Mar 8;10(3). Epub 2019 Mar 8.

Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA.

Mediterranean spotted fever develops from an infection with , an obligate intracellular, Gram-negative, endotheliotropic, and tick-transmitted bacterial pathogen, and is an acute, febrile illness that can progress to life-threatening complications if not diagnosed and treated early with effective antibiotics. Despite significant morbidity and mortality, little is known about changes in gene expression that determine the host responses during in vivo infection. We have investigated the transcriptional landscape of host lungs as a prominently affected organ system in an established murine model of infection by RNA-sequencing. Read More

Ticks Tick Borne Dis 2019 04 13;10(3):606-613. Epub 2019 Feb 13.

EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France. Electronic address:

Although livestock farming (sheep, goats, pigs, and cattle) is an important economic activity in Corsica, a French Mediterranean island, knowledge about the tick fauna and microorganisms carried by them remains scarce. This study aimed to investigate the presence and perform molecular characterization of Anaplasmataceae, Rickettsia spp., and Borrelia burgdorferi sensu lato (sl) in tick species collected in Corsica. Read More

J Fr Ophtalmol 2019 Feb 22;42(2):e47-e50. Epub 2019 Jan 22.

Service d'ophtalmologie, hôpital Militaire d'Instruction Mohamed V, 10010 Rabat, Maroc.

An Pediatr (Barc) 2019 Jan 17. Epub 2019 Jan 17.

Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.

BMC Infect Dis 2018 Dec 29;18(1):705. Epub 2018 Dec 29.

Department of General Medicine, General Hospital (Teaching), Kandy, Sri Lanka.

Background: Spotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. ARDS and myocarditis are rare complications of Rickettsia conorii infections and only a few cases are reported to date. Read More

Mikrobiyol Bul 2018 Oct;52(4):431-438

Ministry of Health, General Directorate of Public Health, Microbiology Reference Laboratory, Ankara, Turkey.

Rickettsia species are gram-negative intracellular, small pleomorphic coccobacilli in the Rickettsiaceae family. This genus is serologically and genotypically divided into four groups as spotted fever group, typhus group, Rickettsia belli and Rickettsia canadensis. Rickettsia conorii (R. Read More

J Dtsch Dermatol Ges 2018 Dec;16(12):1459-1476

While epidemic typhus caused by Rickettsia prowazekii posed a significant threat in Europe before and throughout World War II due to its high mortality, the condition fortunately no longer plays a significant role. Nevertheless, rickettsioses, such as African tick bite fever, have been increasingly diagnosed in travelers returning from sub-Saharan Africa. Caused by Rickettsia africae, African tick bite fever presents with characteristic cutaneous findings such as eschar (tache noir) and a rash. Read More

Med Princ Pract 2018 Dec 3. Epub 2018 Dec 3.

Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, and Clinic of Infectious Diseases, St. George University Hospital, Plovdiv, Bulgaria.

Objective: To report a rare case of maculopapular rash on the scalp in a patient with Mediterranean spotted fever (MSF).

Clinical Presentation And Intervention: A 58-year-old woman with breast cancer and chemotherapy-induced alopecia contracted MSF. Her clinical features were typical, except for a maculopapular rash covering the scalp. Read More

Indian J Ophthalmol 2018 Dec;66(12):1840-1844

Resident, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Salem, Tamil Nadu, India.

Purpose: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced-scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced-Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever-serologically proven Indian tick typhus (Rickettsia conorii)-has been reported. We report for the first time ocular manifestations of serologically proven R. Read More

Travel Med Infect Dis 2018 Nov - Dec;26:51-57. Epub 2018 Nov 9.

Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France. Electronic address:

Background: In Algeria, Mediterranean spotted fever (MSF), caused by Rickettsia conorii conorii and transmitted by Rhipicephalus sanguineus, is endemic. However, the documentation of cases is rare due to a lack of laboratory facilities. Our aim was to screen for rickettsioses in patients with fever, rash and a possible inoculation eschar. Read More

Ticks Tick Borne Dis 2019 01 3;10(1):43-50. Epub 2018 Sep 3.

Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.

The Mediterranean spotted fever (MSF) rickettsiosis is the predominant rickettsial disease among the spotted fever group (SFG) rickettsiae in the Mediterranean countries and North Africa. Its causative agent is Rickettsia conorii, although, SFG rickettsiosis - cases due to Rickettsia monacensis, Rickettsia massiliae and Rickettsia aeschlimannii were also described. A retrospective study based on hospital discharge records with a diagnosis of SFG rickettsiosis was carried out to describe the spatial pattern, the trend of the disease, and the epidemiological characteristics of persons hospitalized in the period 2001-2015. Read More

Antimicrob Agents Chemother 2018 Nov 24;62(11). Epub 2018 Oct 24.

Infectious Diseases Unit, Internal Medicine Service, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa, Spain.

The objective of this study is to evaluate the results of single-day doxycycline therapy for Mediterranean spotted fever (MSF). This is a prospective cohort study of cases with confirmed MSF treated with the single-day doxycycline regimen in a teaching hospital from 1990 to 2015. Patients received two oral doses of 200 mg of doxycycline for 1 day. Read More

Dtsch Med Wochenschr 2018 08 30;143(15):1116-1119. Epub 2018 Jul 30.

IV. Medizinische Klinik und Poliklinik der LMU, München.

History: A healthy 41 year old man was bitten by a tick while on safari in the Kruger National Park in South Africa. He developed severe fever and malaise 5 days later. A characteristic red skin sore with a dark centre and surrounding erythema (eschar, tache noir) developed at the site of the tick bite. Read More

Ann Dermatol Venereol 2018 Aug - Sep;145(8-9):516-520. Epub 2018 Jul 10.

Département de dermatologie, CHU St-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.

Introduction: Haemophagocytic syndrome (HS) is a rare disease with a severe prognosis that is defined by clinical, laboratory and histopathological criteria. Infections represent the classical cause of HS. HS secondary to Mediterranean spotted fever (MSF) is rare with only a few cases being reported in the literature. Read More

Acta Med Port 2018 Apr 30;31(4):196-200. Epub 2018 Apr 30.

Pediatric Department. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real, Portugal.

Introduction: Mediterranean spotted fever is an infectious disease included in the human rickettsiosis group, with its main distribution in the Mediterranean and South European countries. It is an endemic disease in Portugal, with dogs acting as the main domestic reservoir. Children are a particularly vulnerable group due to their close contact with household animals and by frequently playing outdoors. Read More

J Med Case Rep 2018 May 26;12(1):145. Epub 2018 May 26.

Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

Background: Purpura fulminans is an acute life-threatening disorder characterized by intravascular thrombosis and hemorrhagic infarction of the skin complicated with disseminated intravascular coagulation. It is commonly seen in acute infections following meningococcal and streptococcal infections. Few cases of purpura fulminans following rickettsial infections have been described in the literature. Read More

BMJ Case Rep 2018 May 18;2018. Epub 2018 May 18.

Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.

We review two cases of ocular manifestations of infection in children. A girl who presented unilateral visual loss with focal retinitis and macular oedema and a boy with unilateral central scotoma and bilateral anterior uveitis. Progressive functional and anatomic recovery was observed after oral antibiotics and steroids were initiated. Read More

Arch Pediatr 2018 05 11;25(4):302. Epub 2018 Apr 11.

Unité d'infectiologie et dermatologie, centre hospitalier de Fréjus-Saint-Raphaël, 240, avenue Saint-Lambert, 83600 Fréjus, France. Electronic address:

Travel Med Infect Dis 2018 Nov - Dec;26:7-15. Epub 2018 Mar 2.

Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands. Electronic address:

Background: Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars.

Methods: We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to study design: 'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms. Read More

Travel Med Infect Dis 2018 Nov - Dec;26:16-24. Epub 2018 Feb 17.

Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta.

Background: Mediterranean Spotted Fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii which is endemic in Malta, an island in the South Mediterranean that is a popular tourist destination. Diagnosis is frequently based on clinical manifestations as laboratory results are often limited to a retrospective diagnosis. We describe the clinical presentation, diagnosis and treatment of children <16 years who presented with MSF from 2011 to 2016. Read More

Med Princ Pract 2018 3;27(1):92-94. Epub 2018 Jan 3.

Objective: To describe a rare case of acute Q fever with tache noire.

Clinical Presentation And Intervention: A 51-year-old man experienced acute Q fever showing tache noire, generally considered a pathognomonic sign of Mediterranean spotted fever (MSF) and MSF-like illness, but not a clinical feature of Q fever. The patient was treated with doxycycline 100 mg every 12 h. Read More

Med Clin (Barc) 2018 Aug 22;151(3):130. Epub 2017 Nov 22.

Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.

Ann Dermatol Venereol 2018 Feb 21;145(2):95-99. Epub 2017 Nov 21.

Service des maladies infectieuses, université de Sfax, CHU Hédi Chaker, 3029 Sfax, Tunisie.

Background: Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. Read More

Parasitol Res 2017 Nov 7;116(11):3249-3251. Epub 2017 Oct 7.

Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937, Munich, Germany.

Ticks are important vectors for Rickettsia spp. of the spotted fever group all around the world. Rickettsia conorii is the etiological agent of boutonneuse fever in the Mediterranean region and Africa. Read More

Vector Borne Zoonotic Dis 2017 10 23;17(10):698-708. Epub 2017 Aug 23.

6 Virology Unit, Department of Medical Microbiology, Faculty of Medicine, Hacettepe University , Ankara, Turkey .

Introduction: Birds are involved in the epidemiology of several vector-borne viruses, as amplification hosts for viruses, dissemination vehicles for the vectors, and sources of emerging strains in cross-species transmission. Turkey provides diverse habitats for a variety of wild birds and is located along major bird migration routes. This study was undertaken to provide a cross-sectional screening of avian specimens for a spectrum of vector-borne viruses. Read More

PLoS One 2017 14;12(8):e0183181. Epub 2017 Aug 14.

Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America.

Rickettsial infections continue to cause serious morbidity and mortality in severe human cases around the world. Host cell adhesion and invasion is an essential requisite for intracellular growth, replication, and subsequent dissemination of pathogenic rickettsiae. Heparan sulfate proteoglycans [HSPGs] facilitate the interactions between fibroblast growth factor(s) and their tyrosine kinase receptors resulting in receptor dimerization/activation and have been implicated in bacterial adhesion to target host cells. Read More

Front Microbiol 2017 20;8:1363. Epub 2017 Jul 20.

Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes, UM63, Centre National De La Recherche Scientifique 7278, IRD 198, Institut National De La Santé Et De La Recherche Médicale U1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille UniversitéMarseille, France.

Arthropod-borne species are obligate intracellular bacteria which are pathogenic for humans. Within this genus, and cause frequent and potentially severe infections, whereas and cause rare and milder infections. All four species belong to spotted fever group (SFG) rickettsiae. Read More

Pan Afr Med J 2017 20;26:80. Epub 2017 Feb 20.

Service de Neurlogie, Hopital Militaire Moulay Ismail, Meknès, Maroc.

Mediterranean spotted fever (MSF) is a rickettsiosis of the spotted fever group caused by rickettsia conorii. This zoonosis is benign but it can be complicated by severe neurological impairment (hence its severity). We report the case of a 49-year old patient hospitalized in the Department of Dermatology for rickettsiosis, who suffered from right massive hemiplegia of brutal onset. Read More

J Fr Ophtalmol 2017 May 4;40(5):444-446. Epub 2017 May 4.

Service d'ophtalmologie, CHU Habib Bourguiba, avenue El Ferdaous, 3029 Sfax, Tunisie.

Ticks Tick Borne Dis 2017 06 12;8(4):610-614. Epub 2017 Apr 12.

SaBio. Instituto de Investigación en Recursos Cinegéticos, IREC (CSIC, UCLM, JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain; Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA. Electronic address:

Rickettsiae (family Rickettsiaceae, order Rickettsiales) are obligate intracellular bacteria transmitted by arthropod vectors. Several Rickettsia species causing vector-borne rickettsioses belong to the spotted fever group (SFG). Traditionally, Rickettsia conorii has been considered as the main etiologic agent of Mediterranean spotted fever. Read More

Gastroenterol Hepatol 2018 03 17;41(3):165-166. Epub 2017 Apr 17.

Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.

Int J Infect Dis 2017 Aug 10;61:7-12. Epub 2017 Apr 10.

Dipartimento di Scienze per la Promozione Della Salute e Materno-Infantile, Università di Palermo, Italy. Electronic address:

Mediterranean spotted fever (MSF) is endemic in Italy, where Rickettsia conorii subsp. conorii was thought to be the only pathogenic rickettsia and Rhipicephalus sanguineus the vector and main reservoir. R. Read More

J Infect Dev Ctries 2017 Mar 31;11(3):242-246. Epub 2017 Mar 31.

Faculty of Medicine, Mutah University, Karak, Jordan.

Introduction: The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan.

Methodology: A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected. Read More

PLoS One 2017 29;12(3):e0174745. Epub 2017 Mar 29.

National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.

Introduction: Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii. In Spain, deficiencies in the official reporting result in misreporting of this disease. This study aims to describe the clinical and temporal-spatial characteristics of MSF hospitalizations between 1997 and 2014. Read More

JMM Case Rep 2016 Aug 30;3(4):e005039. Epub 2016 Aug 30.

Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.

Introduction: Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by . Most cases follow a benign course, with a case fatality rate of 3-7 % among hospitalized patients. Complications are described mainly in adult patients and include hepatic, renal, neurological and cardiac impairment. Read More

Pan Afr Med J 2016 6;25:211. Epub 2016 Dec 6.

Chirurgie Générale à la Faculté de Médecine de Tunis, Hôpital de Zaghouan, Avenue de l'Environnement, 1100 Zaghouan, Tunisie.

Mediterranean spotted fever is an infectious disease belonging to the rickettsial group due to an intracellular bacterium: Rickettsia Conorii. Pauci-symptomatic and benign forms are predominant. Severe forms are rare and increasingly reported in the recent literature with potentially life-threatening severe multi-systemic involvement. Read More

Cureus 2017 Jan 12;9(1):e974. Epub 2017 Jan 12.

Department of Medicine, Overlook Medical Center.

We report a case of a 43-year-old Israeli male who presented with an intermittent fever associated with a gradual appearance of diffusely scattered erythematous non-pruritic maculopapular lesions, generalized body malaise, muscle aches, and distal extremity weakness. He works in the Israeli military and has been exposed to dogs that are used to search for people in tunnels and claimed that he had removed ticks from the dogs. In the hospital, he presented with fever, a diffuse maculopapular rash, and an isolated round black eschar. Read More

Case Rep Infect Dis 2016 7;2016:2421540. Epub 2016 Dec 7.

3rd Department of Internal Medicine, Hospital Distrital de Santarém, Santarém, Portugal.

Mediterranean spotted fever is a tick-borne zoonotic disease caused by . It is transmitted by the dog tick . 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 . Read More

Med Clin (Barc) 2017 10 27;149(8):e39. Epub 2016 Dec 27.

Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.

J Neurol Sci 2016 Dec 14;371:60-61. Epub 2016 Oct 14.

Department of Neurology, "IASO General" Hospital, Athens, Greece; 251 Hellenic Airforce Hospital, Athens, Greece.

Sci Rep 2016 11 11;6:36728. Epub 2016 Nov 11.

Department of Pathology, The University of Texas Medical Branch, Galveston, TX, 77555, USA.

Small regulatory RNAs comprise critically important modulators of gene expression in bacteria, yet very little is known about their prevalence and functions in Rickettsia species. R. conorii, the causative agent of Mediterranean spotted fever, is a tick-borne pathogen that primarily infects microvascular endothelium in humans. Read More

Travel Med Infect Dis 2016 Sep - Oct;14(5):436-443. Epub 2016 Jul 9.

Medica, Medizinische Laboratorien Dr. F. Kaeppeli, Wolfbachstrasse 17, CH-8024 Zurich, Switzerland. Electronic address:

Aim: To review the current state of knowledge concerning rickettsiae and rickettsioses in Croatia and to discuss their implications for travellers.

Methods: The PubMed database was searched from 1991 to 2015 by combining the words "rickettsia," "rickettsiosis", "travellers" and "Croatia".

Results: Since 1969, Croatia appears to be free of epidemic typhus (ET) caused by Rickettsia prowazekii and the last case of Brill-Zinsser disease was recorded in 2008. Read More

Int J Dermatol 2017 Mar 1;56(3):252-259. Epub 2016 Oct 1.

Division of Clinical Dermatology, Mayo Clinic, Rochester, MN, USA.

Climate change refers to variation in the climate of a specific region or globally over time. A change has been reported in the epidemiology of tick- and mosquito-borne diseases in recent decades. Investigators have postulated that this effect may be associated with climate change. Read More

Arch Pediatr 2016 Oct 15;23(10):1076-1079. Epub 2016 Sep 15.

Hedi Chaker hospital, pediatric department, Sfax, Tunisia; Faculty of medicine, Sfax, Tunisia.

Since the Arab Spring, a resurgence of zoonotic diseases such as rickettsiosis, endemic in the Mediterranean basin, has been observed. It preferentially infects microvascular endothelial cells of mammalian hosts inducing vasculitis with endothelial injury. Rickettsioses are considered benign infectious diseases. Read More

Jpn J Infect Dis 2016 ;69(4):352

Animal Health Department, University of Extremadura.

Jpn J Infect Dis 2016 ;69(4):352-4

Department of Microbiology, Hospital General La Mancha Centro.

Front Cell Infect Microbiol 2016 29;6:80. Epub 2016 Jul 29.

Vector Borne Disease Laboratories, Department of Pathobiological Sciences, LSU School of Veterinary Medicine Baton Rouge, LA, USA.

Spotted fever group (SFG) rickettsiae are recognized as important agents of human tick-borne diseases worldwide, such as Mediterranean spotted fever (Rickettsia conorii) and Rocky Mountain spotted fever (Rickettsia rickettsii). Recent studies in several animal models have provided evidence of non-endothelial parasitism by pathogenic SFG Rickettsia species, suggesting that the interaction of rickettsiae with cells other than the endothelium may play an important role in pathogenesis of rickettsial diseases. These studies raise the hypothesis that the role of macrophages in rickettsial pathogenesis may have been underappreciated. Read More

Indian J Med Microbiol 2016 Jul-Sep;34(3):293-8

Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India.

Background: Rickettsial infections are re-emerging. In India, they are now being reported from several areas where they were previously unknown.

Objectives: The objective of this study was to describe the epidemiology, clinical profile and outcome of serologically-confirmed scrub typhus and spotted fever among children in a tertiary care hospital in Bengaluru. Read More