Fatal rickettsial meningitis in Hong Kong: a need for rapid laboratory diagnosis

A 22-year-old Chinese male, investigated elsewhere for fever and myalgia, was transferred to our hospital drowsy, unresponsive to commands and with a petechial rash. Partially treated meningococcal meningitis was suspected and high-dose antibiotics were immediately started. Rising Weil-Felix titres occurred too late for anti-rickettsial therapy to prevent a fatal outcome. Subsequent specific serology showed rising titres against Rickettsia conori. The desirability of more rapid and reliable methods of laboratory diagnosis of rickettsial infection is evident.