title: Diversity of life-threatening complications due to Mediterranean spotted fever in returning travelers.
abstract: BACKGROUND
  Mediterranean spotted fever (MSF) is a tick-borne infection caused by Rickettsia conorii conorii mainly endemic in the Mediterranean Basin. Although usually considered as a benign disease, severe forms of MSF have been sporadically reported.
  
  
  METHODS
  We report on three patients who developed severe MSF complications after a stay in Morocco. Literature was reviewed to assess the frequency and pattern of MSF complications in the largest reported case series in endemic countries.
  
  
  RESULTS
  Each of our three patients diagnosed with MSF presented with a different complicated course: one with meningoencephalitis, one with lung embolism and one with septic shock and multi organ failure. In published series, rate of complications (defined as severe organ involvement) ranged from 1% to 20%. However, study designs and settings were highly variable and did not allow for relevant comparisons. Meningoencephalitis and shock with multi organ failure were the most frequently observed complications. Mortality of severe course was up to 20% in some series.
  
  
  CONCLUSIONS
  Severe organ involvement is not infrequent in patients with Mediterranean spotted fever and fatal outcome is regularly reported. Because presentations of complicated course may be extremely diverse, a high index of suspicion is required in febrile patients with potential exposure, in particular if skin rash and/or eschar are found. Early appropriate antibiotherapy is crucial to improve outcome.
authors.affiliation: Department of Internal Medicine, University Hospital Saint-Pierre, Brussels, Belgium. rdemeest@ulb.ac.be
authors.forename: Rémy
authors.initials: R
authors.lastname: Demeester
authors.forename: Marc
authors.initials: M
authors.lastname: Claus
authors.forename: Marc
authors.initials: M
authors.lastname: Hildebrand
authors.forename: Erika
authors.initials: E
authors.lastname: Vlieghe
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bottieau
mesh_terms: D001530:Belgium / Q000453:epidemiology; D001907:Boutonneuse Fever / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000382:microbiology; D008875:Middle Aged; D009018:Morocco; D009102:Multiple Organ Failure / Q000382:microbiology; D011655:Pulmonary Embolism / Q000382:microbiology; D012772:Shock, Septic / Q000382:microbiology; D014195:Travel