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Isaac Johnson
Isaac Johnson

Boutonneuse Fever _TOP_



Boutonneuse fever (also called, Mediterranean spotted fever, fièvre boutonneuse, Kenya tick typhus, Indian tick typhus, Marseilles fever, or Astrakhan fever) is a fever as a result of a rickettsial infection caused by the bacterium Rickettsia conorii and transmitted by the dog tick Rhipicephalus sanguineus. Boutonneuse fever can be seen in many places around the world, although it is endemic in countries surrounding the Mediterranean Sea. This disease was first described in Tunisia in 1910 by Conor and Bruch and was named boutonneuse (French for "spotty") due to its papular skin-rash characteristics.[1][2]




boutonneuse fever


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After an incubation period around seven days, the disease manifests abruptly with chills, high fevers, muscular and articular pains, severe headache, and photophobia. The location of the bite forms a black, ulcerous crust (tache noire). Around the fourth day of the illness, a widespread rash appears, first macular and then maculopapular, and sometimes petechial.[citation needed]


  • processing.... Drugs & Diseases > Infectious Diseases Mediterranean Spotted Fever (Boutonneuse Fever) Updated: Sep 15, 2021 Author: D Matthew Shoemaker, DO, FIDSA; Chief Editor: Michael Stuart Bronze, MD more...

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Antibiotics Show All Media Gallery References Overview Background Mediterranean spotted fever (MSF), also known as boutonneuse fever (BF), is caused by Rickettsia conorii subspecies conorii (R conorii). R conorii is an organism that is endemic in the Mediterranean region. It was first described in Tunisia in 1910; Tunisia was a French protectorate at the time MSF was first described clinically. The illness derives its name from the French word boutonneux which translates as spotty or pimpled.


MSF is uncommon in the United States. About 50 imported cases of MSF have been reported and confirmed by the US Centers for Disease Control and Prevention (CDC). [9] A rickettsial illness similar to MSF with an eschar is found in the southeastern United States. The causative organism is Rickettsia parkeri and the vector is the Gulf Coast tick (Amblyomma maculatum). Rocky Mountain spotted fever (RMSF) is also found in the United States. Rocky Mountain spotted fever is caused by Rickettsia rickettsii, for which the ixodid tick is the vector. RMSF is typically more severe than MSF. RMSF does not cause an eschar.


In Germany, Norway, and the Netherlands, sporadic cases of so-called imported MSF (eg, disease acquired via infected dogs or as a holiday souvenir) are described. MSF and other rickettsial infections are reported from Korea. [16] In the United Kingdom, spotted fever group rickettsial species were detected in 9.7% of Ixodes ricinus ticks and 27% of Dermacentor reticularis ticks. [17]


Boutonneuse fever is a disease caused by the rickettsia genus and is of the spotted fever group classification. This disease classically causes fever, rash, and flu-like symptoms. It is most commonly found in the Mediterranean region of Europe. It follows a similar, yet more benign clinical course compared to that of Rocky Mountain spotted fever. Treatment is largely the same for all rickettsial infections, which includes the first-line treatment of doxycycline. Interprofessional communication and teamwork are paramount to diagnose and treat this unique disease successfully.


Objectives:Identify the etiology of Boutonneuse fever.Review significant history and physical exam findings encountered during the evaluation of patients with Boutonneuse fever.Outline the management options available for Boutonneuse fever.Discuss interprofessional team strategies for improving care coordination and communication to advance treatment strategies for Boutonneuse fever and improve outcomes.Access free multiple choice questions on this topic.


Boutonneuse fever typically has an incubation period of 5 to7 days following the tick bite. The tick bite is usually painless and may not be noticed if it occurs in an inconspicuous location. The diagnosis is commonly made based on a history of travel to an endemic location and clinical findings: fever, exanthem (rash), and the tache noire (black eschar). This disease that follows classically causes flu-like symptoms. It typically follows a similar, yet more benign clinical course compared to that of Rocky Mountain spotted fever but can occasionally cause more advanced signs and symptoms such as hepatomegaly, jaundice, meningitis, other neurologic complications, orchitis, retinopathy, gastrointestinal bleeding, and pneumonia.


Boutonneuse fever was first described in the literature in 1910 in Tunis. Numerous reports followed from the Mediterranean basin, and at present time, southern Europe is considered the main endemic region. Over time, new subspecies of Rickettsia conorii, such as Rickettsia conorii israelensis, have been discovered in various regions. These regions include sub-Saharan Africa, India, Greece, and areas around the Black Sea such as Turkey, Bulgaria, and Ukraine. These subspecies differ to an extent on a molecular-genetic level, yet all result in a similar clinical syndrome. Most cases occur in the summer months, thought to be due to increased tick prevalence and increased tick activity in the summer months. It is prevalent equally in all ages and genders.


The incubation period lasts around 6 days, followed by the rapid development of symptoms. Classic symptoms for BF include a fever, rash, flu-like symptoms, and eschar at the bite site. This eschar, known uniquely as "tache noire," is another classically associated finding of this disease. All of these symptoms are present to varying degrees, with fever (96% to 100%) and rash (87-96%) being the most common symptoms reported. This rash is classically spread to the palms and soles and is most commonly maculopapular, and less common vesicular (6% to 10%).


MSF typically follows a less severe course compared to Rocky Mountain spotted fever (RMSF). The disease course is typically mild and self-limiting. The case-fatality rate (CFR) of BF is less than 5% versus RMSF at 55 to 10%. It does appear that certain subspecies of Rickettsia conorii are more severe, with a CFR of the R. conorii israelensis in one study approaching 29% compared to 9% for the Malish strain.[7][8]


Patients will present with symptoms beginning after an average incubation period 6 to 10 days following the tick bite. Symptoms include fever, flu-like symptoms, and rash. Lymphadenopathy is rare. "Tache noire" is the term for the eschar that classicly develops with this disease. Uncommonly, multiple eschars are present. Rash typically spreads 2 to 4 days after onset of fever. It is a maculopapular rash that spreads from the palms and soles and spares the face.


Less common is the presence of a vesicular-like rash. In endemic regions, high clinical suspicion must be maintained for patients presenting with undifferentiated rash, fever, or flu-like symptoms. Travel history may also be a key component in making this diagnosis.[9]


A broad differential diagnosis exists for BF. Febrile illness presenting with an associated rash is a concern for several viral exanthems and bacterial syndromes including, but not limited to: varicella-zoster virus, rubella, rubeola, fifths disease, infectious mononucleosis, scarlet fever, toxic shock syndrome, and various other rickettsial infections. Also included in the differential are connective tissue disorders, such as lupus and dermatomyositis. Diseases presenting with fever and eschar, including cutaneous anthrax, and oriental infections are included. Other non-rickettsial protozoal infections, such as malaria, should also be considered.[13]


Figure 3. Geographic distribution of the Gulf Coast tick showing presumed and confirmed human cases of American boutonneuse fever (ABF). Solid circles are confirmed cases; darker shading represents established/primary distribution of the tick (Drawing courtesy Dr. Kristine T. Edwards, Mississippi State University).


Finley, R. W., J. Goddard, D. Raoult, M. E. Eremeeva, R. D. Cox, C. D. Paddock. 2006. Rickettsia parkeri: a case of tick-borne, eschar-associated spotted fever in Mississippi. International Conference on Emerging Infectious Diseases, Abstract No. 188.


Fournier, P. E., V. Roux, D. Raoult. 1998. Phylogenetic analysis of spotted fever group rickettsiae by study of the outer surface protein rOmpA. Int. J. Syst. Bacteriol.48 Pt 3: 839-849. 041b061a72


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