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Boutonneuse fever transmitted by conjunctival inoculation.
A Díez Ruíz1, A Ramos Jiménez, M A López Ruz
1Department of Internal Medicine, University of Granada, Spain.
Klinische Wochenschrift
|December 15, 1988
Summary
This study details three rare cases of boutonneuse fever caused by Rickettsia conorii entering the eyes. Prompt treatment with oral tetracycline led to recovery in all patients.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Microbiology
Background:
- Boutonneuse fever, a tick-borne illness caused by Rickettsia conorii, typically presents with fever, headache, rash, and a characteristic eschar (tache noire).
- Ocular involvement in Rickettsia infections is uncommon, with most cases resulting from direct tick bites on exposed skin.
Observation:
- Three patients (two adults, one child) developed symptoms consistent with boutonneuse fever after presumed conjunctival inoculation of R. conorii.
- Clinical presentation included high fever, headache, maculopapular exanthem, and conjunctivitis, notably without the presence of a tache noire.
- Serological confirmation revealed specific immunofluorescent antibodies and positive Weil-Felix reactions (Proteus OX-19, OX-2) after the second week of illness.
Findings:
- Conjunctival inoculation represents a rare but viable route of Rickettsia conorii transmission leading to boutonneuse fever.
- The absence of a tache noire in these cases highlights a potential variation in clinical presentation following ocular exposure.
- Early diagnosis and treatment with oral tetracycline were effective in resolving the infection.
Implications:
- This report expands the understanding of Rickettsia conorii transmission routes, emphasizing the risk of ocular inoculation.
- The findings suggest that conjunctivitis and fever without a tache noire should raise suspicion for boutonneuse fever in endemic areas.
- Further research into ocular manifestations and alternative transmission pathways of Rickettsia species is warranted.