This study aimed to compare the epidemiology of Rickettsia felis infection and malaria in France, North Africa, and sub-Saharan Africa and to identify a common vector. Blood specimens from 3,122 febrile patients and from 500 nonfebrile persons were analyzed for R. felis and Plasmodium spp. We observed a significant linear trend (p<0.0001) of increasing risk for R. felis infection. The risks were lowest in France, Tunisia, and Algeria (1%), and highest in rural Senegal (15%). Co-infections with R. felis and Plasmodium spp. and occurrences of R. felis relapses or reinfections were identified. This study demonstrates a correlation between malaria and R. felis infection regarding geographic distribution, seasonality, asymptomatic infections, and a potential vector. R. felis infection should be suspected in these geographical areas where malaria is endemic. Doxycycline chemoprophylaxis against malaria in travelers to sub-Saharan Africa also protects against rickettsioses; thus, empirical treatment strategies for febrile illness for travelers and residents in sub-Saharan Africa may require reevaluation.

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The present report gives a unique panel of clinical aspects of MSF as well as new trends in this disease. Entomological, climatic, and molecular studies are needed to better understand both epidemiological and clinical aspects of MSF.

The installation of point-of-care laboratories in rural Africa can be a very effective tool for studying the epidemiology of many infectious diseases.

The presumptive cases of Mediterranean spotted fever have been identified in 1993 and since that time, its frequency has steadily increased. The prospective study, in summer 2004, was conducted in order to present the descriptive clinic and epidemiology, to identify more severe forms, the presence of the multiple eschars, and different rickettsial strains caused the disease in our region. In Oran, the cases were diagnosed clinically. In Marseille, serum specimens were tested by IFA using the panel of eight rickettsial antigen; Western blot and cross-adsorption studies were also performed in order to confirm the diagnosis. Ninety-three patients clinically diagnosed were recorded from July 3 to October 28, 2004. Eighty percent were male, the mean age was 44.3 years, 90% were exposed to dog and 32% reported tick bites. Clinical signs were as follow: presence of underlying disease (44%), sudden onset (78%), fever (100%), loss of weight (63%), conjunctivitis (43%), and a tache noire was noticed in 70%. Interestingly, two patients had two and three eschars, respectively. The rash was maculopapular (palm and sole) and purpuric in nine cases. Doxycycline was the most antibiotic (91%) with favourable outcome in 91% of the cases. Malignant form with death is reported for three patients (3.2%). Among the 93 patients, 104 serum from 65 patients were tested (serums of others patients were lost or ticket not found on tube. Sixty-three patients out of 65 had a positive serology by IFA with cross-reactive antibodies especially between R. conorii, R. felis and/or R. typhi. Two others negative serology were: one precocious serum and second from the patient, which presented symptoms of MSF and tested two serums, Western blot and cross-adsorption.

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