Oztoprak Nefise, Celebi Güven, Aydemir Hande, Pişkin Nihal, Bektaş Sibel, Koca Rafet, Kuloğlu Figen
Zonguldak Karaelmas Universitesi Tip Fakültesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Zonguldak.
Mikrobiyol Bul. 2008 Oct;42(4):701-6.
Mediterranean spotted fever (MSF) is one of the tick-borne rickettsial infections caused by Rickettsia conorii. It is transmitted to humans by brown dog ticks (Rhipicephalus sanguineus). In this case report, a 16-years-old male patient who was diagnosed as MSF after an exposure to dog-tick in Bartin province (located at middle Black Sea region of Turkey) has been presented. His history revealed that, five days before admission to the hospital (on June, 2007) he had cleaned dog-ticks from his dog, and after 12 hours he found a stucked tick on his leg and he took it out right away with a tweezer. High fever, headache and generalized maculopapular rash including soles and palms and a black-colored lesion at the tick bite site developed three days later. In clinical examination, there was a black escar circled with a red-purple colored halo in front of the right tibia at the site of the tick bite showing high similarity to "tache noire" which was specific to MSF. Indirect immunofluorescence assay (IFA) for Rickettsia yielded negative result in the serum sample collected on admission day, however, it was found positive at 1/512 titer in the serum sample collected 10 days after admission. The patient has recovered completely without any complication after 10 days of doxycycline therapy. The aim of this presentation is to point out that MSF should be considered for the differential diagnosis of a patient with a history of tick bite, fever, maculopapular rash, headache, myalgia, arthralgia and especially with black escar during summer months in our country where the incidence of tick-borne infections has been increasing since recent years.
地中海斑疹热（MSF）是由康氏立克次体引起的蜱传立克次体感染之一。它通过棕狗蜱（血红扇头蜱）传播给人类。在本病例报告中，介绍了一名16岁男性患者，他在土耳其黑海中部地区的巴尔廷省接触狗蜱后被诊断为地中海斑疹热。他的病史显示，2007年6月入院前五天，他为自己的狗清理了狗蜱，12小时后他发现一只蜱虫粘在自己腿上，他立即用镊子将其取出。三天后出现高热、头痛和包括手掌和脚底在内的全身性斑丘疹，蜱叮咬部位出现黑色病变。临床检查发现，蜱叮咬部位右胫骨前方有一个黑色焦痂，周围有红紫色晕圈，与地中海斑疹热特有的“黑色斑点”高度相似。入院当天采集的血清样本中，立克次体间接免疫荧光试验（IFA）结果为阴性，但入院10天后采集的血清样本中发现滴度为1/512的阳性结果。患者在接受多西环素治疗10天后完全康复，无任何并发症。本病例报告的目的是指出，在我国蜱传感染发病率近年来不断上升的情况下，对于有蜱叮咬史、发热、斑丘疹、头痛、肌痛、关节痛，尤其是有黑色焦痂的患者，在夏季应考虑将地中海斑疹热作为鉴别诊断。
