Boutonneuse fever is a fever

Fever

Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

 as a result of a Rickettsia

Rickettsia

Rickettsia is a genus of non-motile, Gram-negative, non-sporeforming, highly pleomorphic bacteria that can present as cocci , rods or thread-like . Being obligate intracellular parasites, the Rickettsia survival depends on entry, growth, and replication within the cytoplasm of eukaryotic host cells...

 infection caused by the bacterium Rickettsia conorii

Rickettsia conorii

Rickettsia conorii is a unicellular, gram-negative, obligate intracellular bacterium of the genus Rickettsia that causes human disease called Boutonneuse fever, Mediterranean spotted fever, Israeli tick typhus, Astrakhan spotted fever, Kenya tick typhus, Indian tick typhus, or other names that...

and transmitted by the dog tick Rhipicephalus sanguineus

Rhipicephalus sanguineus

The brown dog tick, Rhipicephalus sanguineus, is a species of tick which is found world-wide, but more commonly in warmer climates. This species is unusual among ticks in that its entire life cycle can be completed indoors.-Hosts:...

. Boutonneuse fever can be seen in many places around the world, although it is endemic in countries surrounding the Mediterranean Sea

Mediterranean Sea

The Mediterranean Sea is a sea connected to the Atlantic Ocean surrounded by the Mediterranean region and almost completely enclosed by land: on the north by Anatolia and Europe, on the south by North Africa, and on the east by the Levant...

. This disease was first described in Tunisia

Tunisia

Tunisia , officially the Tunisian RepublicThe long name of Tunisia in other languages used in the country is: , is the northernmost country in Africa. It is a Maghreb country and is bordered by Algeria to the west, Libya to the southeast, and the Mediterranean Sea to the north and east. Its area...

 in 1910 by Conor and Bruch and was named boutonneuse (French

French language

French is a Romance language spoken as a first language in France, the Romandy region in Switzerland, Wallonia and Brussels in Belgium, Monaco, the regions of Quebec and Acadia in Canada, and by various communities elsewhere. Second-language speakers of French are distributed throughout many parts...

 for "spotty") due to its papular skin rash characteristics.

Presentation

After an incubation period of around seven days, the disease manifests abruptly with chills, high fevers, muscular and articular pains, severe headache and photophobia

Photophobia

Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes, though the term...

. The location of the bite forms a black ulcerous crust (tache noire). Around the fourth day of the illness an exanthem

Exanthem

An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.It can be contrasted with an enanthem.-Types:...

 (widespread rash) appears, first macular and then maculopapular and sometimes petechial.

Diagnosis

The diagnosis is made with serologic methods, either the classic Weil-Felix test

Weil-Felix test

The Weil-Felix test is an agglutination test for the diagnosis of rickettsial infections. It was first described in 1916. By virtue of its long history and of its simplicity, it has been one of the most widely employed tests for rickettsia on a global scale, despite being superseded in many...

(agglutination

Agglutination (biology)

Agglutination is the clumping of particles. The word agglutination comes from the Latin agglutinare, meaning "to glue."This occurs in biology in three main examples:...

 of Proteus OX strains ), ELISA

ELISA

Enzyme-linked immunosorbent assay , is a popular format of a "wet-lab" type analytic biochemistry assay that uses one sub-type of heterogeneous, solid-phase enzyme immunoassay to detect the presence of a substance in a liquid sample."Wet lab" analytic biochemistry assays involves detection of an...

 or immunofluorescence

Immunofluorescence

Immunofluorescence is a technique used for light microscopy with a fluorescence microscope and is used primarily on biological samples. This technique uses the specificity of antibodies to their antigen to target fluorescent dyes to specific biomolecule targets within a cell, and therefore allows...

 assays in the bioptic material of the primary lesion.

Treatment

The illness can be treated with tetracycline

Tetracycline antibiotics

Tetracyclines are a group of broad-spectrum antibiotics whose general usefulness has been reduced with the onset of bacterial resistance. Despite this, they remain the treatment of choice for some specific indications....

s (doxycycline

Doxycycline

Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...

 is the preferred treatment), chloramphenicol

Chloramphenicol

Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

, macrolides or fluoroquinolones.

External links

• Mediterranean Spotted Fever Clinical Resources