Rickettsial meningitis

BMJ Case Rep. 2014 Mar 10:2014:bcr2013203283. doi: 10.1136/bcr-2013-203283.

Abstract

Rickettsial infections are common in southern Europe and the most frequent and lethal type is Mediterranean spotted fever, caused by Rickettsia conorii. The disease is usually characterised by the classical triad of fever, eschar and rash, and is generally a mild disease in children. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in an 18-year-old man, presenting during summer with fever and persistent headache. The cerebrospinal fluid analysis revealed increased cellularity (107 cells/μL), hypoglycorrhachia (50% of glycaemia) and hyperproteinorrhachia (284 mg/dL). Rickettsial infection was confirmed by serology and the patient was treated with doxycycline, with a favourable outcome. The patient's pet squirrel and/or associated vectors might be involved in the transmission of Rickettsia spp. This case underlines the importance of a high clinical suspicion and the benefits of early empirical treatment when facing compatible epidemiological contexts.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Bacterial / immunology*
  • Boutonneuse Fever / diagnosis*
  • Boutonneuse Fever / drug therapy
  • Boutonneuse Fever / immunology
  • Doxycycline / therapeutic use
  • Humans
  • Male
  • Meningitis, Bacterial / diagnosis*
  • Meningitis, Bacterial / drug therapy
  • Meningitis, Bacterial / immunology
  • Pets / microbiology
  • Rickettsia conorii / immunology*
  • Sciuridae

Substances

  • Anti-Bacterial Agents
  • Antibodies, Bacterial
  • Doxycycline