title: [Meningitis revealing Rickettsia typhi infection].
abstract: BACKGROUND
  Neurological manifestations are rarely observed in murine typhus. We present a case of meningitis caused by Rickettsia typhi.
  
  
  METHODS
  We report a case of Tunisian 57-year-old woman admitted for suspicion of meningitis. Clinical examination revealed fever at 39,5 degrees C and nuchal rigidity. There were no focal neurologic signs, cutaneous rash or eschar. Lumbar puncture showed clear cerebrospinal fluid containing normal glucose, 0,48 g/l protein and 30 WBC (78% lymphocyte). Gram-stained smear and culture were negative. Serology confirmed the diagnosis. The patient was initially treated by ampicillin 12 g daily but remained febrile. Retinal lesions were detected on ophthalmic examination, suggesting rickettsial infection. Clinical outcome was good after 7-day treatment with oral ciprofloxacin 1,5 g daily. The mean follow-up was six months.
  
  
  CONCLUSIONS
  Murine typhus is an endemic zoonosis. Neurological manifestations were uncommon. An ophthalmic examination is recommended if rickettsiosis was suspected.
authors.affiliation: Service de maladies infectieuses, CHU Fattouma-Bourguiba, 5019 Monastir, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Toumi
authors.forename: C
authors.initials: C
authors.lastname: Loussaief
authors.forename: S
authors.initials: S
authors.lastname: Ben Yahia
authors.forename: F
authors.initials: F
authors.lastname: Ben Romdhane
authors.forename: M
authors.initials: M
authors.lastname: Khairallah
authors.forename: M
authors.initials: M
authors.lastname: Chakroun
authors.forename: N
authors.initials: N
authors.lastname: Bouzouaïa
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008581:Meningitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D012282:Rickettsia Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D012286:Rickettsia typhi / Q000276:immunology / Q000472:pathogenicity; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin