Questions on Mediterranean spotted fever a century after its discovery

Area of Science:

• Infectious Diseases
• Epidemiology
• Tick-borne Illnesses

Background:

• Mediterranean spotted fever (MSF) was historically considered a mild illness.
• It is a rickettsial disease transmitted by the brown dog tick.
• Severe cases and deaths were rarely reported until the 1980s.

Purpose of the Study:

• To highlight recent epidemiological shifts in MSF.
• To discuss the evolving clinical presentation and severity of MSF.
• To examine the classification and vectors of Rickettsia conorii conorii.

Main Methods:

• Review of epidemiological data over the last decade.
• Analysis of molecular classification of Rickettsia species.
• Clinical case review for emerging features.

Main Results:

• MSF shows emergence and reemergence in multiple countries.
• Rickettsia conorii conorii is now classified as a subspecies.
• New clinical signs, like multiple eschars, have been observed.
• MSF has surpassed RMSF in severity, with mortality rates up to 32% in some regions.

Conclusions:

• MSF epidemiology is changing, with increased severity and new clinical manifestations.
• The role of Rhipicephalus sanguineus as the sole vector and reservoir requires further investigation.