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Mediterranean Spotted Fever in Travelers from the United States
1Department of Infectious Diseases, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana.
Abstract:
Background: We wish to increase awareness by U.S. physicians of the clinical manifestations and diagnosis of Mediterranean spotted fever (MSF), and to determine the incidence of MSF among travelers returning to the United States from endemic areas. Methods: We report a case of a 56-year-old female physician from New Orleans who returned from a 3-week safari trip to Zimbabwe and Zambia with clinical findings of MSF. The diagnosis was confirmed with a greater than fourfold rise in titer of IgM and IgG antibody to Rickettsia conorii on acute and convalescent sera (16 days apart) using indirect immunofluorescence technique. In addition, we conducted a MEDLINE computer search of published MSF cases in U.S. travelers returning to the United States and obtained the United States data over the past 20 years from the Centers for Disease Control and Prevention (CDC). Results: Less than 50 imported cases of MSF have been reported and confirmed by the CDC. Only seven cases have been published in the literature and none in the last 7 years. Conclusions: Despite the increasing incidence of MSF in Europe, Asia and Africa, and the high number of U.S. citizens traveling to these endemic areas, only a few imported cases of MSF in travelers have been reported in the United States. Physicians in the United States are not familiar with the clinical findings and diagnosis of MSF; therefore this disease is underrecognized in the majority of cases.
Insights
Mediterranean spotted fever (MSF) is underrecognized in the U.S. due to physician unfamiliarity. Few imported cases are reported despite increased travel to endemic regions, highlighting a need for greater awareness.
Area of Science:
- Infectious Diseases
- Travel Medicine
- Epidemiology
Background:
- Mediterranean spotted fever (MSF) is a tick-borne illness caused by Rickettsia conorii.
- MSF is endemic in parts of Europe, Asia, and Africa.
- Increasing numbers of U.S. citizens travel to MSF-endemic areas.
Purpose of the Study:
- To raise awareness among U.S. physicians regarding the clinical manifestations and diagnosis of MSF.
- To determine the incidence of MSF in travelers returning to the U.S. from endemic regions.
Main Methods:
- Case report of a U.S. physician diagnosed with MSF after travel to Zimbabwe and Zambia.
- Diagnostic confirmation using indirect immunofluorescence assay for Rickettsia conorii antibodies.
- MEDLINE search for published MSF cases in U.S. travelers and data retrieval from the CDC over 20 years.
Main Results:
- Fewer than 50 imported MSF cases have been reported and confirmed by the CDC.
- Only seven MSF cases in U.S. travelers have been published, with none in the last seven years.
- Despite rising global incidence, MSF remains underreported in the United States.
Conclusions:
- MSF is underrecognized by U.S. physicians due to a lack of familiarity with its clinical presentation and diagnostic methods.
- The low number of reported cases suggests significant underdiagnosis in returning travelers.
- Enhanced physician education is crucial for improving MSF recognition and reporting in the U.S.