Boutonneuse fever
| Boutonneuse fever | |
|---|---|
| Other names: Mediterranean spotted fever, fièvre boutonneuse, Kenya tick typhus, Indian tick typhus, Marseilles fever, Astrakhan fever | |
 | |
| Typical eschar and spots on the leg in Boutonneuse fever[1] | |
 | |
| Specialty | Infectious disease |
| Symptoms | Fever, rash, flu-like symptoms[2] |
| Complications | Hearing loss, myocarditis, atrial fibrillation, retinopathy, retinal vasculitis[2] |
| Causes | Rickettsia conorii[2] |
| Diagnostic method | ELISA, Western blot (confirmatory test)[2] |
| Differential diagnosis | Varicella-zoster virus, rubella, rubeola, fifths disease, infectious mononucleosis, scarlet fever, toxic shock syndrome[2] |
| Treatment | Doxycycline[2] |
Boutonneuse fever, also called, Mediterranean spotted fever[3] among others, is a fever as a result of a rickettsial infection caused by the bacterium Rickettsia conorii and transmitted by the dog tick Rhipicephalus sanguineus.[2] [4]
Boutonneuse fever can be seen in many places around the world, although it is relatively common in countries surrounding the Mediterranean Sea. This disease was first described in Tunisia in 1910 by Conor and Bruch and was named boutonneuse (French for "spotty") due to its papular skin-rash characteristics.[1][5]
Signs and symptoms
After an incubation period around seven days, the disease manifests abruptly with chills, high fevers, muscular and articular pains, severe headache, and photophobia. The location of the bite forms a black, ulcerous crust (tache noire). After a few days of illness, a widespread rash appears, first macular and then maculopapular, and sometimes petechial.[2][6][7]
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Cutaneous lesion
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Typical appearance of Mediterranean spotted fever entrance site
Complications
In terms of the complications of Boutonneuse fever we find the following:[2]
- Hearing loss
- Myocarditis
- Atrial fibrillation
- Retinopathy
- Retinal vasculitis
- Cerebral infarct
- Meningoencephalitis
- Splenic rupture
Cause
The cause of Boutonneuse fever is due to Rickettsia conorii, which is a gram-negative, obligate intracellular bacteria. This bacteria is transmitted by the brown dog tick Rhipicephalus sanguineus[2]
Mechanism
In terms of the pathophysiology we find that once the tick bite occurs, R conorii spreads and causes endothelial injury, as well as, tissue necrosis. There is an alteration in the immune system- a decline in CD4 cells .The process or action of bringing about the COX-2 system and release of vasoactive prostaglandins contribute to regulation of inflammatory response and changes in vascular permeability.[8]
Diagnosis
The diagnosis is made with serologic methods, either the classic Weil–Felix test, (agglutination of Proteus OX strains), ELISA, or immunofluorescence assays in the bioptic material of the primary lesion. The Weil–Felix test demonstrated low sensitivity (33%) in diagnosing acute rickettsial infections and low specificity, with a positive titre of 1:320 seen in 54% of healthy volunteers and 62% of non-rickettsial fever patients. Therefore, the use of the WFT should be discouraged in the diagnosis of acute rickettsial infections.[2]
Differential diagnosis
In terms of the differential diagnosis for Boutonneuse fever we find the following:[2]
- Varicella-zoster virus
- Rubella
- Rubeola (measles)
- Fifths disease
- Infectious mononucleosis
- Scarlet fever
- Toxic shock syndrome
Treatment
The illness can be treated with tetracyclines (doxycycline is the preferred treatment), chloramphenicol, macrolides, or fluoroquinolones.[2][7]
Prognosis
In terms of the prognosis we find that as long as treatment is swift the prognosis is good, there is less than a five percent rate of fatality when this is the case[2]
Epidemiology
The first case in Algeria, was diagnosed in 1993, and the number of cases has increased in that country. In countries of Mediterranean basin, such as Italy and Portugal, the incidence has increased in the last 10 years.[10]
We find that in Romania the incidence of BF was as high as 4.2 per 100,000 people between 2000–2016 in southeastern Romania. [11]
A 2006 article by Sousa, et al, indicates that it seems the role of climate change in vector-borne diseases,resurgence of boutonneuse fever, may very well be attributable. Portugal, were the study numbers came from, found that Boutonneuse fever epidemiology is associated with low precipitation values (which have occurred more recently).[12]
See also
References
- ↑ 1.0 1.1 Rovery C, Brouqui P, Raoult D (2008). "Questions on Mediterranean Spotted Fever a Century after Its Discovery". Emerg Infect Dis. 14 (9): 1360–1367. doi:10.3201/eid1409.071133. PMC 2603122. PMID 18760001.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 MacConnachie, Kevin; Tishkowski, Kevin (2024). "Boutonneuse Fever". StatPearls. StatPearls Publishing. PMID 32809749. Archived from the original on 2024-07-25. Retrieved 2024-07-20.
- ↑ "Boutonneuse fever (Concept Id: C0006060) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Archived from the original on 24 July 2024. Retrieved 20 July 2024.
- ↑ Misdraji, Joseph (1 January 2010). "Chapter 10 - Liver and Bile Duct Infections". Diagnostic Pathology of Infectious Disease. W.B. Saunders. pp. 255–295. ISBN 978-1-4160-3429-2. Archived from the original on 21 October 2021. Retrieved 26 July 2024.
- ↑ Conor, A; A Bruch (1910). "Une fièvre éruptive observée en Tunisie". Bull Soc Pathol Exot Filial. 8: 492–496.
- ↑ Moraga, F. A.; Martinez-Roig, A.; Alonso, J. L.; Boronat, M.; Domingo, F. (February 1982). "Boutonneuse fever". Archives of Disease in Childhood. 57 (2): 149–151. doi:10.1136/adc.57.2.149. ISSN 1468-2044. PMC 1627538. PMID 7065712.
- ↑ 7.0 7.1 "DermNet® - Spotted fever group rickettsial disease". DermNet®. 26 October 2023. Archived from the original on 5 February 2024. Retrieved 27 July 2024.
- ↑ "Mediterranean Spotted Fever (Boutonneuse Fever): Background, Pathophysiology, Etiology". Medscape. 30 June 2023. Retrieved 24 July 2024.
- ↑ Cambrea, Simona Claudia; Badiu, Diana; Ionescu, Constantin; Penciu, Roxana; Pazara, Loredana; Mihai, Cristina Maria; Cambrea, Mara Andreea; Mihai, Larisia (9 November 2023). "Boutonneuse Fever in Southeastern Romania". Microorganisms. 11 (11): 2734. doi:10.3390/microorganisms11112734. ISSN 2076-2607. PMC 10673018. PMID 38004746.
- ↑ Rovery, Clarisse; Brouqui, Philippe; Raoult, Didier (September 2008). "Questions on Mediterranean Spotted Fever a Century after Its Discovery". Emerging Infectious Diseases. 14 (9): 1360–1367. doi:10.3201/eid1409.071133. PMC 2603122. PMID 18760001.
- ↑ "Analiza evoluției bolilor transmisibile aflate în supraveghere Raport pentru anul 2014". cnscbt. Archived from the original on 25 July 2024. Retrieved 24 July 2024.
- ↑ de Sousa, Rita; Luz, Teresa; Parreira, Paulo; Santos-Silva, Margarida; Bacellar, Fatima (October 2006). "Boutonneuse fever and climate variability". Annals of the New York Academy of Sciences. 1078 (1): 162–169. Bibcode:2006NYASA1078..162D. doi:10.1196/annals.1374.029. ISSN 0077-8923. PMID 17114701. Archived from the original on 2024-07-27. Retrieved 2024-07-25.
External links
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