title: Fatal Mediterranean spotted fever in Greece.
abstract: Forty-five days after the first confirmed and fatal Crimean-Congo haemorrhagic fever (CCHF) case in Greece in 2008, a female patient with similar signs and symptoms (high fever, thrombocytopaenia) and resident of the same area, was admitted to the University General Hospital of Alexandroupolis. Before admission, she had visited a local hospital where a cephalosporin was prescribed. A rash manifested over subsequent days, which was misdiagnosed as an allergy to the drug. Upon admission to the University Hospital, she was given further antibiotics, including doxycycline; a few hours later, ribavirin was added because CCHF was suspected. After the patient's death, rickettsiosis caused by Rickettsia conorii conorii (Meditteranean spotted fever; MSF) was diagnosed. Extremely high values of interleukin (IL)-1ra, IL-6, interferon-gamma-inducible protein-10, monocyte chemoattractant protein-1 and an absence of tumour necrosis factor-alpha were observed. MSF is a potentially severe and even fatal disease resembling viral haemorrhagic fevers that has to be included in the differential diagnosis of febrile syndromes combined with thrombocytopaenia, even when a tick bite is not reported, and an eschar is absent. Physicians have to be aware of MSF in patients with severe disease who are returning from the Mediterranean area.
authors: First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, WHO Collaborating Centre for Reference and Research on Arboviruses and Hemorrhagic Fever Viruses, Thessaloniki. annap@med.auth.gr
authors: A
authors: A
authors: Papa
authors: V
authors: V
authors: Dalla
authors: A
authors: A
authors: Petala
authors: H C
authors: HC
authors: Maltezou
authors: E
authors: E
authors: Maltezos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001907:Boutonneuse Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D002511:Cephalosporins / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood; D004318:Doxycycline / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006115:Greece; D006801:Humans; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use; D020114:Rickettsia conorii / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D002511:Cephalosporins; D016207:Cytokines; D012254:Ribavirin; D004318:Doxycycline