title: Rickettsial infection caused by accidental conjunctival inoculation.
abstract: The most common transmission route of tick-borne Rickettsia is through tick bite; nevertheless, other transmission routes should also be considered. We report a case of rickettsial infection in a 15-year-old boy caused by accidental contamination of the conjunctiva through the infected fluid of a crushed engorged tick removed from a dog. Right eye pain, conjunctival hyperaemia with mucopurulent exudate, chemosis and eyelid oedema were the first signs and symptoms. Two days later, the boy developed fever, myalgia, headache, abdominal pain and was vomiting; physical examination showed multiple cervical adenopathies but no rash. He was treated with doxycycline (200 mg/day) for 7 days with progressive resolution of clinical signs. Rickettsial infection was confirmed by immunofluorescence assay with serological seroconversion in two consecutive samples. Rickettsia conorii or Rickettsia massiliae were the possible causal agents since they are the Rickettsia spp found in the Rhipicephalus sanguineus dog tick in Portugal.
authors.affiliation: Department of Pediatric, Hospital Dona Estefania, Lisboa, Portugal.
authors.forename: Joao
authors.initials: J
authors.lastname: Brissos
authors.affiliation: Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr Ricardo Jorge, Setúbal, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: de Sousa
authors.affiliation: Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr Ricardo Jorge, Setúbal, Portugal.
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Santos
authors.affiliation: Department of Pediatric, Hospital Dona Estefania, Lisboa, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Gouveia
mesh_terms: D000059:Accidents; D000293:Adolescent; D000822:Animal Husbandry; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001907:Boutonneuse Fever / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D003228:Conjunctiva / Q000382:microbiology*; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D004285:Dogs; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011174:Portugal; D048508:Rhipicephalus sanguineus / Q000382:microbiology*; D012281:Rickettsia; D020114:Rickettsia conorii
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline