Clinically-diagnosed Mediterranean Spotted Fever in Malta

Area of Science:

• Pediatrics
• Infectious Diseases
• Dermatology

Background:

• Mediterranean Spotted Fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii.
• Malta, a Mediterranean tourist destination, has endemic MSF.
• Clinical diagnosis is often primary due to delayed laboratory results.

Purpose of the Study:

• To describe the clinical presentation, diagnosis, and treatment of children under 16 with MSF in Malta.
• To highlight the importance of clinical suspicion in diagnosing MSF in pediatric travelers.

Main Methods:

• Retrospective case note review of children hospitalized with suspected MSF (fever and eschar) between 2011 and 2016.
• Analysis of demographics, clinical findings, laboratory results, management, and outcomes.

Main Results:

• Six pediatric cases of MSF were diagnosed.
• All cases involved tick exposure, with most occurring in summer.
• Non-specific laboratory findings included inflammatory markers, altered lymphocyte counts, and hyponatremia.
• Serological and molecular methods confirmed diagnosis.
• Rapid clinical improvement was observed with clarithromycin or doxycycline.

Conclusions:

• MSF should be considered in the differential diagnosis for febrile illnesses with rash and eschar in children traveling to Malta.
• Clinical diagnosis remains crucial for timely MSF management in children, even with advanced diagnostics.