title: Mediterranean spotted fever: case series of 24 years (1989-2012).
abstract: OBJECTIVE
  Mediterranean spotted fever (MSF) is the most prevalent zoonosis in Portugal. To characterize it's evolution between 1989 and 2012, the authors reviewed the cases diagnosed at their unit during this period.
  
  
  METHODS
  Review of clinical records of patients with MSF diagnosis, between 1989 and 2012.
  
  
  RESULTS
  Data from 250 patients was included, 54% male. Mean age at diagnosis was 58 years (11-92). Mean annual incidence was 10 cases, with clear summer predominance. Most patients, 78% lived in rural areas, 34% had contact with dogs and 10% noticed the tick bite. Most common symptoms were: fever (98%), myo-arthralgia (64%) and headache (48%). Maculopapular rash was noticed in 87%, affecting palms in 77% and soles in 69%. Inoculation eschar was found in 60%, mostly located on the trunk. Treatment included doxycycline in 86% and chloramphenicol in 12%, with a mean duration of 8 days. Most frequent blood test abnormalities were C-reactive protein, lactate dehydrogenase, aspartate aminotransferase and alanine transaminase elevations and thrombocytopenia. First serologic evaluation was positive in 37% (78/212), having seroconversion been documented in 85% (72/85). Most frequent complication was acute renal injury. ICU admission occurred in 5%. Average length of hospital stay was 11.2 days (1-106), with a mortality of 3.6%.
  
  
  CONCLUSIONS
  In our series, there was clear summer predominance of MSF, which had rural origin in 78%. Most common symptoms were fever, myo-arthralgia and headache. Maculopapular rash was noticed in 87% of cases and inoculation eschar in 60%. Most cases had favourable outcome, having 5% been admitted to ICU. Mortality was 3.6%.
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Crespo
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Seixas
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Marques
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Oliveira
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Saraiva
authors.initials: S
authors.lastname: da Cunha
authors.affiliation: Infectious Diseases Unit, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Meliço-Silvestre
keywords: Eschar; Mediterranean spotted fever; Rickettsia conorii; Tick-bite