Mediterranean spotted fever (MSF) due to Rickettsia conorii is the most important tick-borne disease occurring in North Africa. The authors report a prospective study conducted in Oran, the second largest city in Algeria. With a total of 167 documented cases, they give a unique panel of clinical aspects of MSF as well as new trends in this disease. Although some aspects of MSF were found to be in accordance with the general epidemiology of the disease, uncommon aspects were found, including increased incidence and the presence of multiple inoculation eschars in 12% of patients. The role of climatic changes in alterations of host-seeking and feeding behaviours of the vectors, including the brown dog tick Rhipicephalus sanguineus, is discussed. Also, 49% of patients were hospitalized with a severe form. The global death rate was 3.6%, but it was 54.5% in patients hospitalized with major neurological manifestations and multiorgan involvement.
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ECDC Comment (2009-05-19)
In recent years, tick-borne rickettsioses have emerged in the field of Travel medicine. This paper highlights 2 aspects of importance. First, MSF might be severe and even fatal. Furthermore, the role of climatic changes in alterations of host-seeking and feeding behaviors of vectors is an ongoing debate of public importance. For travelers, it should be remember that the best method to avoid tick bites comprises two components: a topical DEET (N,N-Diethyl-m-toluamide) repellent applied to exposed skin and treatment of clothing with permethrin.