Mediterranean Spotted Fever in Southeastern Romania

Abstract

Although cases of Mediterranean spotted fever (MSF) have been reported for decades in southeastern Romania, there are few published data. We retrospectively studied 339 patients, diagnosed with MSF at the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” between 2000 and 2011, in order to raise awareness about MSF in certain regions of Romania. According to the Raoult diagnostic criteria 171 (50.4%) had a score >25 points. Mean age was 52.5 years. One hundred and fifty-five (90.6%) patients were from Bucharest and the surrounding region. Almost all patients presented with fever (99.4%) and rash (98.2%), and 57.9% had evidence of a tick bite. There were no recorded deaths. Serologic diagnosis was made by indirect immunofluorescence assay. Of the 171 patients, serology results for R. conorii were available in 147. One hundred and twenty-three (83.7%) of them had a titer IgG ≥1 : 160 or a fourfold increase in titer in paired samples. MSF is endemic in southeastern Romania and should be considered in patients with fever and rash even in the absence of recognized tick exposure. Since the disease is prevalent in areas highly frequented by tourists, travel-associated MSF should be suspected in patients with characteristic symptoms returning from the endemic area.

Severe clinical forms of Mediterranean spotted fever: A case series from an endemic area in Bulgaria

“…The mean age of 54.9 years is similar to other reports 4,8,20 . Males were the predominant gender in our study.…”

“…Most of our patients had contacts with dogs and 50% of them mentioned tick bites which were predispositions for developing a tick-borne disease. Similar epidemiological data were identified by Pitigoi et al 4 , Romdhane et al 23 and Kuloglu et al 24 . The clinical symptoms and signs were similar to ones presented in other studies 4,8,13,15,20,[23][24][25][26] .…”

“…Similar epidemiological data were identified by Pitigoi et al 4 , Romdhane et al 23 and Kuloglu et al 24 . The clinical symptoms and signs were similar to ones presented in other studies 4,8,13,15,20,[23][24][25][26] . The leading clinical features in severe forms were high fever with severe headache, hepatomegaly/splenomegaly and the combination of older age and underlying diseases.…”

“…In 1923, the typical cutaneous lesion at the place of tick bite (tache noire) was drawn by Pieri in Marseilles 3 . The disease is endemic for Mediterranean region and northern Africa, although cases are reported in the central and eastern Europe, India, and southern Africa 1,4 . Most of the Balkan countries (Bulgaria, Croatia, Greece, Romania, Serbia, Turkey) have reported the infection or serological data for the circulation [4][5][6][7][8][9][10] .…”

“…The disease is endemic for Mediterranean region and northern Africa, although cases are reported in the central and eastern Europe, India, and southern Africa 1,4 . Most of the Balkan countries (Bulgaria, Croatia, Greece, Romania, Serbia, Turkey) have reported the infection or serological data for the circulation [4][5][6][7][8][9][10] . In Bulgaria, the infection was identified for the first time in 1948 by Vapzarov 11 .…”