Boutonneuse fever

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Synonyms and keywords: Kenya tick typhus; Marseilles fever; Mediterranean spotted fever; Rickettsia conorii; fièvre boutonneuse; Boutonneuese fever

Overview

Boutonneuse fever is a fever as a result of a Rickettsial infection caused by the bacterium Rickettsia conorii and transmitted by the dog tick Riphicephalus sanguineus. Boutonneuse fever is endemic in many countries surrounding the Mediterranean Sea. It has an incubation period of 7 days. Symptoms include fever, joint pain, chills, headache, and photophobia. On physical examination a black crust (tache noire) in the place of the tick bite may be seen. Diagnosis is made with serologic methods, either the classic Weil Felix test (agglutination of Proteus OX strains ), either ELISA or immunofluorescence assays. The mainstay of therapy for Boutonneuse fever is antimicrobial therapy.

Diagnosis

Symptoms

• Chills
• Fever
• Myalgias
• Joint pains
• Headache
• Photophobia

Physical Examination

Skin

• A black crust (tache noire) forms in the place of the tick bite.
• Around the 4th day of the illness an exanthem appears, first macular and then maculopapular and sometimes petechial.

Laboratory Findings

The diagnosis is made with serologic methods, either the classic Weil Felix test (agglutination of Proteus OX strains ), either ELISA or immunofluorescence assays.

Treatment

Antimicrobial Regimen

• Boutonneuese fever

• 1. Adult

• Preferred regimen (1): Doxycycline 200 mg PO bid for 1 day
• Preferred regimen (2): Doxycycline 200 mg or 100 mg PO bid for 2-5 days
• Alternative regimen (1): Josamycin 1g q8h for 7 days
• Alternative regimen (2):Ciprofloxacin

• 2. Children

• Preferred regimen (Children <100 lbs): Doxycycline 2.2 mg/kg PO bid
• Preferred regimen (Children >100lbs): Doxycycline 200 mg PO bid in one day and 200 mg bid/qid or 100 mg bid for 2-5 days
• Alternative regimen (Children <8 years) (1): Josamycin 2.2mg/kg q12h for 5 days
• Alternative regimen (Children <8 years) (2): Clarithromycin 15 mg/ kg in bid for 7 days AND Azithromycin 10 mg/kg/day qd for 3 days

Related Chapters

• Rocky Mountain spotted fever

References

Template:WikiDoc Sources