Abstract

Background

We wish to increase awareness by U.S. physicians of the clinical manifestations and diagnosis of Mediterranean spotted fever (MSF), and to determine the incidence of MSF among travelers returning to the United States from endemic areas.

Methods

We report a case of a 56-year-old female physician from New Orleans who returned from a 3-week safari trip to Zimbabwe and Zambia with clinical findings of MSF. The diagnosis was confirmed with a greater than fourfold rise in titer of IgM and IgG antibody to Rickettsia conorii on acute and convalescent sera (16 days apart) using indirect immuno-fluorescence technique. In addition, we conducted a MEDLINE computer search of published MSF cases in U.S. travelers returning to the United States and obtained the United States data over the past 20 years from the Centers for Disease Control and Prevention (CDC).

Results

Less than 50 imported cases of MSF have been reported and confirmed by the CDC. Only seven cases have been published in the literature and none in the last 7 years.

Conclusions

Despite the increasing incidence of MSF in Europe, Asia and Africa, and the high number of U.S. citizens traveling to these endemic areas, only a few imported cases of MSF in travelers have been reported in the United States. Physicians in the United States are not familiar with the clinical findings and diagnosis of MSF; therefore this disease is underrecognized in the majority of cases.

References

1
Conor
JD
Bruch
M.
Une fievre éruptive observée en Tunisie
.
Bull Soc Pathol Exo Filiales
 
1910
;
8
:
139
142
.
2
Segura
F
Font
B.
Resurgence of Mediterranean spotted fever in Spain [Letter]
.
Lancet
 
1982
;
2
:
280
.
3
Raeber
PA
Winteler
S
Paget
J.
Fever in the returned traveller: remember rickettsial diseases [Letter]
.
Lancet
 
1994
;
344
:
331
.
4
Treadwell
TL
Phillips
SD
Jablonski
WJ.
Mediterranean spotted fever in children returning from France
.
Am J Dis Child
 
1990
;
144
:
1037
1038
.
5
Harris
RL
Kaplan
SL
Bradshaw
MW
Williams
TW
Jr.
Boutonneuse fever in American travelers
.
J Infect Dis
 
1986
;
153
:
126
128
.
6
Barrett-Connor
E
Ginsberg
MM.
Imported South African tick typhus
.
West J Med
 
1983
;
138
:
264
266
.
7
Anderson
JF
Magnarelli
LA
Burgdorfer
W
, et al.
Importation into the United States from Africa of Rhipicephalus simus on a Boutonneuse fever patient
.
Am J Trop Med Hyg
 
1981
;
30
:
897
899
.
8
Font-Creus
B
Bella-Cueto
F
Espejo-Arenas
E
, et al.
Mediterranean spotted feve:a cooperative study of 227 cases
.
Rev Infect Dis
 
1985
;
7
:
635
642
.
9
Kelly
PJ
Beati
L
Matthewman
LA
, et al.
A new pathogenic-spotted fever group rickettsia from Africa
.
J Trop Med Hyg
 
1994
;
97
:
129
137
.
10
Brouqui
P
Harle
JR
Delmont
J
, et al.
African tick-bite fever. An imported spotless rickettsiosis
.
Arch Intern Med
 
1997
;
157
:
119
124
.
11
Marrero
M
Raoult
D.
Centrifugation-shell vial technique for rapid detection of Mediterranean spotted fever rickettsia in blood culture
.
Am J Trop Med Hyg
 
1989
;
40
:
197
199
.
12
Raoult
D
De Micco
C
Gallais
H
Toga
M.
Laboratory diagnosis of Mediterranean spotted fever by immunofluorescent demonstration of Rickettsia conorii in cutaneous lesions
.
J Infect Dis
 
1984
;
150
:
145
148
.
13
Roux
V
Fournier
PE
Raoult
D.
Differentiation of spotted fever group rickettsiae by sequencing and analysis of restriction fragment length polymorphism of PCR-amplified DNA of the gene encoding the protein rOmpA
.
J Clin Microbiol
 
1996
;
34
:
2058
2065
.
14
Bella-Cueto
F
Font-Creus
B
Segura-Porta
F
, et al.
Comparative, randomized trial of one-day doxycycline versus 10-day tetracycline therapy for Mediterranean spotted fever
.
J Infect Dis
 
1987
;
155
:
1056
1058
.
15
Ruiz Beltran
R
Herrero Herrero
JI.
Evaluation of ciprofloxacin and doxycycline in the treatment of Mediterranean spotted fever
.
Eur J Clin Microbiol Infect Dis
 
1992
;
11
:
427
431
.
16
Ruiz Beltran
R
Herrero Herrero
JI.
Deleterious effect of trimethoprim/sulfamethoxazole in Mediterranean spotted fever [Letter, Comment]
.
Antimicrob Agents Chemother
 
1992
;
36
:
1342
1343
.
This paper was presented at the 5th International Conference of Travel Medicine in Geneva, Switzerland, 25 March 1997.