Boutonneuse fever

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Boutonneuse fever (Mediterranean spotted fever)

Boutonneuse fever is an infection caused by the bacteria Rickettsia conorii and spread by the dog tick, Rhipicephalus sanguineus. It mainly occurs around the Mediterranean but can be found in other places.

Origin of the name: It was first described in Tunisia in 1910. “Boutonneuse” means “spotty” in French, named for the skin rash seen in many patients.

What happens: After about a seven-day incubation, people often suddenly develop chills, high fever, muscle and joint pain, severe headache, and sensitivity to light. The bite site can form a black crust called an eschar (tache noire). By roughly day four, a widespread rash appears, starting as small red spots and then becoming a maculopapular rash, sometimes with tiny red spots (petechiae).

How it’s diagnosed: Doctors use blood tests and tests on the skin lesion. The older Weil–Felix test is not very reliable, so newer tests like ELISA or immunofluorescence are preferred.

How it’s treated: The usual treatment is antibiotics, with doxycycline as the preferred option. Other antibiotics such as chloramphenicol, macrolides, or fluoroquinolones can also be used.