Serological and molecular epidemiological investigation of Mediterranean spotted fever in Yunnan Province, China.

OBJECTIVES: Given the limited research and its potential hazards, the study aimed to determine the prevalence of Mediterranean spotted fever (MSF) caused by Rickettsia conorii (R. conorii), a tick-borne disease, in Yunnan Province, China. METHODS: Through stratified sampling across five distinct regions in Yunnan, 5358 blood samples were obtained from the general healthy population. Enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IFA), and Polymerase chain reaction (PCR) were employed for analysis. RESULTS: IFA identified 27 (0.50%) subjects with immunoglobulin G (IgG) positivity; none were positive for immunoglobulin M (IgM) via ELISA. PCR detected one individual with R. conorii outer membrane protein A (ompA). Significant seroprevalence variation was observed, particularly in Southern Yunnan (P = 0.032), with R. conorii subsp. conorii confirmed in the PCR-positive sample. CONCLUSIONS: This research reveals a correlation between MSF prevalence, geography, and climate in Yunnan. The paucity of prior studies underscores MSF's potential diagnostic challenges in the region. Comprehensive understanding of the pathogen's distribution is pivotal for intervention. Given the study's scope and Yunnan's unique setting, additional research is advocated.

Natural Mediterranean Spotted Fever Foci, Qingdao, China.

We sequenced DNA from spleens of rodents captured in rural areas of Qingdao, East China, during 2013-2015. We found 1 Apodemus agrarius mouse infected with Rickettsia conorii, indicating a natural Mediterranean spotted fever foci exists in East China and that the range of R. conorii could be expanding.

An update on spotted fever group serology in Kerman Province, Iran.

Rickettsia conorii is the causative agent of Mediterranean spotted fever (MSF) and reports of its geographical distribution are spreading every day. Recently, some cases of the MSF have been reported from Iran. However, little information is available about the MSF epidemiology in Iran. The aim of the current study was to investigate anti-R. conorii IgG seroprevalence among farmers living in the rural regions of Kerman province (in southeastern Iran). In this study, 281 blood samples were collected from farmers in Zarand and Jiroft counties and tested for detection of anti-R. conorii IgG antibodies using the ELISA method. Among the 281 samples, 14 farmers (4.98%, CI 95%; 2.45-7.55%) had anti-R. conorii IgG antibodies. Seroprevalence of MSF in Zarand and Jiroft counties were 4.58% and 5.33%, respectively. The serological evidence of this study indicates the seroprevalence of R. conorii in rural areas of the Kerman province of Iran. So, it is recommended that the Iranian health care system pay attention to the MSF.

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data.

OBJECTIVE: Mediterranean spotted fever (MSF) is a tick-borne rickettsial infection endemic to the Mediterranean coastline countries. As a result of growing tourism, imported cases have been registered in many nonendemic countries and regions. We present clinical laboratory parameters and histopathological data on renal impairment in patients with MSF. The study meets our goal of identifying kidney involvement and detecting renal damage in people with MSF. SUBJECTS AND METHODS: Three hundred fifty patients with MSF with a diagnosis confirmed by immunofluorescence analysis were tested for serum urea, creatinine, and albumin. Fifty-five patients with malignant form of MSF were divided into 2 groups: 19 fatalities and 36 survivors. The percentage of patients with acute renal failure (ARF) was compared in both groups. RESULTS: Subjects with elevated urea and creatinine levels increased from 5.21 to 3.47% in mild to 48.78 and 29.26% in severe MSF, respectively. Loss of serum albumin also increased from mild to severe MSF. Renal impairment comprised 60% of the cohort of 55 patients with malignant MSF: 89.4% in the group of deaths and almost twice less in the survivors. ARF developed in 84.2% of fatal cases and was >2 times less in survivors. Postmortem light microscopy of renal samples of 9 fatal cases revealed perivascular mononuclear inflammatory infiltrates, vasculitis with fibrinoid necrosis, acute tubular necrosis, interstitial edema, hemorrhage, and thrombosis. CONCLUSION: Renal pathology associated with MSF rickettsial infection consists of systemic small vessel vasculitis and vascular injury, leading to ARF in the most severe cases.

Mediterranean spotted fever in child and adult patients: investigation from an endemic region in Bulgaria.

OBJECTIVES: Mediterranean spotted fever (MSF) is a tick-borne endemic disease caused by Rickettsia conorii conorii and transmitted to humans by the brown dog tick Rhipicephalus sanguineus. It is characterized by fever, maculopapular rash and a tick bite skin lesion "tache noire". The disease affects all age groups and usually has mild to moderate course. It has long been considered a benign infection. However, very severe "malignant" forms with fatal outcome strongly influenced by the patients' age were also observed. We aimed to reveal the features of MSF in children by comparing them with some of the disease patterns in adults. METHODS: Our prospective study data are based on the monitoring of all inpatients of the Clinic of Infectious Diseases in Plovdiv City and environs, the largest MSF endemic region in Bulgaria. The total number of patients admitted and treated for MSF over a study period of 10 years is 549, the incidence reaching 9.44/100,000. MSF is confirmed by antibody response to a specific antigen measured by indirect immunofluorescence assay (IFA). IgG ≥ 128 and/or IgM > 64 were considered to be indicative of acute infection. RESULTS: Eighty-five (15.48%) patients were children up to 14 years of age and 464 (84.52%) were aged 15-85 years. The skin lesion "tache noire" was present in 73.68% of children, and in 76.93% of the older age groups; symptoms as anorexia, nausea, vomiting, abdominal pain, and diarrhoea were more frequent in children, till general weakness and malaise was prevalent in adults. Children accounted approximately for 70% of the disease mild forms. No lethality was registered in this age group. Even though there were isolated cases of severe and malignant forms, children did not undergo the fatal complications seen in adults. CONCLUSION: Knowledge of the peculiarities of MSF in children will contribute to children's health protection, timely diagnose and disease prevention.

Quantitative Proteomics of the Endothelial Secretome Identifies RC0497 as Diagnostic of Acute Rickettsial Spotted Fever Infections.

Mediterranean spotted fever is a reemerging acute tick-borne infection produced by the α-proteobacterium, Rickettsia conorii. Rickettsia conorii infects vascular endothelial cells producing disseminated plasma leakage, manifesting as nonspecific fever, headache, and maculopapular rash. Because there are no available tests of early infection, Mediterranean spotted fever is often undiagnosed and untreated, resulting in significant mortality. To address this critical need, we have applied a quantitative proteomics pipeline for analyzing the secretome of primary human umbilical vein endothelial cells. Of the 104 proteins whose abundance changed significantly in the R. conorii-infected human umbilical vein endothelial cells' secretome, 46 proteins were up-regulated: 45 were host secreted proteins (including cytokines), and 1 was a rickettsial protein, the putative N-acetylmuramoyl-l-alanine amidase RC0497. Proteins with sequence highly homologous to RC0497 were found to be shared by many species of the spotted fever group rickettsiae, but not typhus group rickettsiae. Quantitative targeted proteomics studies of plasma from a mouse model of sublethal and lethal R. conorii identified RC0497 in the blood, and its circulating levels were proportionally associated with infection outcome. Finally, the presence of RC0497 in the serum samples from a cohort of humans presenting with acute rickettsioses was confirmed. The detection of RC0497 has the potential to be a sensitive and specific marker for acute rickettsial spotted rickettsioses.

Early Findings of Rickettsioses in Morocco.

BACKGROUND & OBJECTIVES: Rickettsioses are zoonoses transmitted to humans by arthropods. They are due to strict intracellular bacteria belonging to the family Rickettsiaceae. Our purpose is to present the clinical and paraclinical characteristics of 14 new cases diagnosed in Al-Hoceima region, Morocco; indeed, the patients associated a diagnosis of Mediterranean Spotted Fever (MSF). RESULTS: The average age of patients was 55 years. The patients were hospitalized for infectious syndrome, renal deficiency, pneumonia, and suspected meningitis. All cases had a general papular rash with palmo-plantar involvement, 12 out of 14 patients showed an escarotic spot, while neurological disorders were observed in 2 patients. Ophthalmic involvement was represented by retinal vasculitis in a single patient. Thrombocytopenia and cytolysis were constant in all patients. Renal deficiency was found in 3 cases and 2 cases had interstitial syndrome. The serology was positive in only one patient. All cases had been treated with doxycycline 200mg/day for 7 days with a good improvement of the clinical and biological symptoms. INTERPRETATION & CONCLUSION: The frequency of MSF in Morocco is not completely elucidated. A good knowledge of the clinical form allows an early diagnosis in order to institute an effective treatment.

Spatial and temporal trends of Mediterranean spotted fever in Spain, 2005-2015.

BACKGROUND: Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii and transmitted by Rhipicephalus sanguineus sensu lato. The aim of this study is to understand the epidemiology and trends regarding the disease in Spain, based on notifications to the Spanish National Epidemiology Surveillance Network (RENAVE) and the National Hospital Discharge Database (CMBD) between 2005 and 2015. METHODS: We carried out a retrospective cross-sectional study of the cases and the outbreaks reported to the RENAVE and of those found in the CMBD between January 1st, 2005 and December 31st, 2015. We studied the characteristics of the cases and analyzed their spatio-temporal distribution. RESULTS: 1603 cases notified to the RENAVE and 1789 cases registered in the CMBD were analyzed. The most affected group were men between 45 and 64. There were 8 MSF outbreaks during the study period. RENAVE registered lower rates until 2012, when it was decided that MSF in Spain would become a notifiable disease. Across the temporal series we saw that there was seasonality with an increase in cases in summer, and an overall upward trend according to the RENAVE data and descending according to the CMBD. The geographic distribution was heterogeneous throughout the territory, with maximum rates in La Rioja at 1.87 cases and 2.01 cases per 100,000 inhabitants according to the RENAVE and the CMBD, respectively. CONCLUSIONS: It is of great importance to continue monitoring the disease since it appears to be endemic throughout Spain. There is a need for a common strategy on monitoring and reporting, which would facilitate a more accurate picture on the MSF epidemiological scenario. Entomological information will be of added value.

Seroprevalences of Rickettsia conorii, Ehrlichia canis and Coxiella burnetii in Dogs from Montenegro.

PURPOSE: The incidence of vector-borne zoonoses has been increasing in Europe as a result of global climate change, and rickettsioses are a significant etiologic entity among these infections. The objective of this study was to investigate the seroprevalences of Rickettsia conorii, Ehrlichia canis and Coxiella burnetii in dogs in Montenegro. METHODS: The seroepidemiological study covered 259 dogs, of which 155 were owned dogs suspected of infection with agents of rickettsial aetiology from the continental (Podgorica) or five coastal municipalities of Montenegro (Budva, Herceg Novi, Kotor, Ulcinj and Bar), and 104 dogs were from a public shelter in Podgorica. The presence of specific IgG antibodies against R. conorii was analysed using a commercial indirect enzyme-linked immunosorbent assay (ELISA) test, and the presence of antibodies against E. canis and C. burnetii was analysed using commercial indirect immunofluorescence tests (IFAT). RESULTS: Seroprevalences of 73.36, 19.3 and 1.16% were determined for R. conorii, E. canis and C. burnetii, respectively. R. conorii was significantly more prevalent (χ2 = 14.53; p < 0.001) in owned dogs (81.93%) than in dogs from the public shelter (60.6%), while E. canis was more prevalent (χ2 = 12.31; p < 0.001) in dogs from the public shelter (29.81%) than in owned dogs (12.26%). Coinfection with two pathogens was determined in 40 (15.44%) dogs, and the prevalence of R. conorii/E. canis (χ2 = 4.23; p < 0.05) was greater in dogs from the public shelter (20.19%) than in owned dogs (10.97%). CONCLUSION: The prevailing evidence from this study shows that dogs from Montenegro are exposed to pathogens of veterinary and public health importance. This calls for the One Health approach to sensitise the public on the risks of zoonoses from dogs and to formulate policies and strategies to mitigate their spread and safeguard public health.

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province, South Africa.

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii, the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities ("dip tanks") were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9-30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002-1.06). Twenty-one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58-45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49-43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001-0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non-significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.

Mediterranean spotted fever rickettsiosis in Italy, 2001-2015: Spatio-temporal distribution based on hospitalization records.

The Mediterranean spotted fever (MSF) rickettsiosis is the predominant rickettsial disease among the spotted fever group (SFG) rickettsiae in the Mediterranean countries and North Africa. Its causative agent is Rickettsia conorii, although, SFG rickettsiosis - cases due to Rickettsia monacensis, Rickettsia massiliae and Rickettsia aeschlimannii were also described. A retrospective study based on hospital discharge records with a diagnosis of SFG rickettsiosis was carried out to describe the spatial pattern, the trend of the disease, and the epidemiological characteristics of persons hospitalized in the period 2001-2015. Standardized hospitalization ratios were calculated at municipal level using the European population. Smoothed maps were produced using a localised smoothing Poisson model. The mean annual standardized hospitalization rate was 1.36/100,000 person years (95%CI: 1.34; 1.39). Rates showed strong summer seasonality and tended to decrease over time. During the study period, 28.89% of municipalities had smoothed standardized hospitalization ratios greater than 1 and 14.01% above 20. Higher standardized hospitalization ratios were found in areas along the Tyrrhenian coast, especially in the south of Calabria and in the islands of Sardinia and Sicily, where the disease is of public health relevance.

Tick- and flea-borne rickettsioses in Tizi-Ouzou, Algeria: Implications for travel medicine.

BACKGROUND: In Algeria, Mediterranean spotted fever (MSF), caused by Rickettsia conorii conorii and transmitted by Rhipicephalus sanguineus, is endemic. However, the documentation of cases is rare due to a lack of laboratory facilities. Our aim was to screen for rickettsioses in patients with fever, rash and a possible inoculation eschar. MATERIALS AND METHODS: Between 2013 and 2015, patients with a fever and a rash presenting at hospitals in the Tizi-Ouzou region were prospectively included in our study. Sera were screened using Indirect Immunofluorescence Assay (IFA) and qPCR was performed on swab samples from eschars. RESULTS: One hundred and sixty-six patients were included. For 57 patients, MSF due to R. conorii conorii was diagnosed by serology and qPCR on a swab eschar sample. Three patients were diagnosed with murine typhus, a flea borne rickettsiosis. In addition, two patients had a positive serology in IgM for R. felis. For nine patients, serology for rickettsiosis was positive, but the specific rickettsia involved could not be determined. Nine patients had a severe disease with neurological involvement or multi-organ failure. CONCLUSION: Clinicians should routinely screen for rickettsioses in patients and travellers presenting with a rash upon return from Algeria. Doxycycline treatment must be given promptly because the prognosis can be severe.

Mediterranean Spotted Fever in Children: Study of a Portuguese Endemic Region.

INTRODUCTION: Mediterranean spotted fever is an infectious disease included in the human rickettsiosis group, with its main distribution in the Mediterranean and South European countries. It is an endemic disease in Portugal, with dogs acting as the main domestic reservoir. Children are a particularly vulnerable group due to their close contact with household animals and by frequently playing outdoors. In this study, we aim to describe the local epidemiology and characterize the clinical features and treatment options in a Portuguese endemic region. MATERIALS AND METHODS: We performed a prospective descriptive study of the Mediterranean spotted fever cases admitted to the paediatrics emergency department of a of a group II hospital, between January 1st 2013 and December 31st 2015. All patients were examined by a physician, who was later asked to fill out a detailed questionnaire regarding clinical presentation, diagnostic attitudes and treatment of their patients. Parents were later interviewed and questioned about post-discharge disease evolution. RESULTS: We registered 32 cases (93.9% reported between July and October). After fever, the most frequent reported symptoms were myalgia (37.5%), abdominal pain (25%) and headache (25%). Exanthema was present in 84.4% of cases by the third day of fever:maculonodular (53.1%), papular (37.5%) and macular (9.4%). Eschars were found in 59% of patients, with regional lymphadenopathypresent in 46.9% of cases. Azithromycin (84.4%) and doxycycline (15.5%) were the selected treatments in our population, with no cases of therapeutic failure or side-effects reported. CONCLUSION: The incidence of Mediterranean spotted fever is higher in our population in comparison with the rest of the country. Fever, myalgia, abdominal pain and headache were the most common presenting symptoms, while exanthema was the predominant cutaneous finding. Azithromycin was the preferred treatment and it proved to be successful and safe in all cases.

Introdução: A febre escaro-nodular é uma doença infeciosa aguda incluída no grupo das rickettsioses humanas, que atinge sobretudo os países da bacia do Mediterrâneo e sul da Europa. É uma doença endémica em Portugal com o cão como principal reservatório doméstico. As crianças são um grupo particularmente vulnerável devido ao contato próximo com animais domésticos e a brincarem em campos e jardins. O principal objetivo deste estudo foi perceber e estudar a epidemiologia local, bem como caracterizar a clinica e a resposta terapêutica da nossa população. Material e Métodos: Foi realizado um estudo prospetivo descritivo de todas as crianças com febre escaro-nodular admitidas no serviço de urgência de um hospital grupo II, entre janeiro de 2013 e dezembro de 2015. Todos os doentes foram avaliados por médico, que respondeu a um questionário referente as manifestações clínicas apresentadas e atitudes de diagnóstico e terapêuticas instituídas. Os pais foram posteriormente contatados, por telefone, e questionados sobre a evolução da doença. Resultados: Foram registados 32 casos (93,9% de julho a outubro). Além da febre, as queixas mais frequentes foram mialgias (37,5%), dor abdominal e cefaleias (25%). O exantema estava presente no terceiro dia de febre em 84,4%: maculopapulonodular (53,1%); papular (37,5%) e macular (9,4%). Foi identificada escara em 59% e adenopatia satélite em 46,9%. Azitromicina (84,4%) ou doxiciclina (15,5%) foram os antibióticos de escolha, com sucesso em qualquer dos casos. Não foram relatadas complicações. Conclusão: A incidência de febre escaro-nodular na nossa população é alta, quando comparada com a incidência no restante país. Febre, mialgias e cefaleias foram os principais sintomas e sinais registados enquanto a presença de exantema foi o achado dermatológico predominante. Azitromicina, antibiótico de escolha na maioria dos casos, mostrou ser eficaz.

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan.

INTRODUCTION: The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan. METHODOLOGY: A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected. RESULTS: In total, 35 male and 20 female patients (mean age: 6 years ± 3.6) were included. The incidence of MSF was 7.9 cases/100,000 inhabitants/year; MSF affected 89% of individuals in the summer, 74.5% of those living in a rural area with tent housing, and 100% of those who had contact with animals. All cases presented with fever, and 94.5% had a skin rash. Serological tests were positive in 87.2% of cases, and Rickettsia conorii (the Moroccan strain) was present in all positive cases. All cases had thrombocytopenia, but none had leukocytosis. Hyponatremia was present in 71% of cases, and 49%, 61.8%, and 72.7% had increased urea, alanine transaminase, and aspartate aminotransferase levels, respectively. Doxycycline was administered to all patients, with a cure rate of 96.4% and mortality rate of 3.6%. CONCLUSIONS: MSF caused by R. conorii (the Moroccan strain) is prevalent in Jordan, and contact with animals is the route of transmission. The patients' responses to doxycycline were excellent. A high index of suspicion, early diagnosis, and specific treatment considerably decrease mortality. MSF should be considered as a possible cause of febrile disease in those with a rash and in those living in rural areas.

Israeli Spotted Fever in Sicily. Description of two cases and minireview.

Mediterranean spotted fever (MSF) is endemic in Italy, where Rickettsia conorii subsp. conorii was thought to be the only pathogenic rickettsia and Rhipicephalus sanguineus the vector and main reservoir. R. conorii subsp. israelensis, which belongs to the R. conorii complex, is the agent of Israeli spotted fever (ISF); apart from Israel, it has also been found in Italy (Sicily and Sardinia) and in different regions of Portugal. We describe here two severe cases of ISF which occurred in otherwise healthy Italian adults. Their characteristics are analyzed and discussed in the light of other 91 cases found through a systematic review of international literature.

Mediterranean spotted fever in Spain, 1997-2014: Epidemiological situation based on hospitalization records.

INTRODUCTION: Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii. In Spain, deficiencies in the official reporting result in misreporting of this disease. This study aims to describe the clinical and temporal-spatial characteristics of MSF hospitalizations between 1997 and 2014. MATERIALS AND METHODS: We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD). All CMBD's hospital discharges with ICD-9 CM code 082.1 were analyzed. Hospitalization rates were calculated and clinical characteristics were described. Spatial distribution of cases and their temporal behavior were also assessed. RESULTS: A total of 4,735 hospitalizations with MSF diagnosis were recorded during the study period, out of which 62.2% were male, mean age of 48. Diabetes mellitus, alcohol dependence syndrome, and chronic liver disease occurred in 10.8%, 2.4% and 2.8% hospitalizations, respectively. The median annual hospitalization rate showed a decreasing trend from a maximum of 12.9 in 1997 to a minimum rate of 3.1 in 2014. Most admissions occurred during the summer, showing a significant annual seasonal behavior. Important regional differences were found. DISCUSSION: Although MSF hospitalization rates have decreased considerably, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and surveillance.

Rickettsiosis tras la picadura de una garrapata: una clínica sutil en muchas ocasiones, debemos estar atentos / Rickettsiosis after tick bite: A subtle clinic picture on many occasions, we must be vigilant

Las rickettsiosis constituyen un grupo de enfermedades transmitidas por la picadura de garrapatas, clasificándose en 2 grandes grupos: fiebres manchadas y fiebres tifíticas. Además, recientemente se ha descrito una nueva entidad conocida como linfadenopatía por picadura de garrapata. Presentamos una serie retrospectiva de casos pediátricos diagnosticados de rickettsiosis durante los años 2013-2014. Se incluyeron un total de 8 pacientes, 2 de ellos diagnosticados de fiebre botonosa mediterránea y 6 de linfadenopatía por picadura de garrapata, identificándose en 3 de ellos Rickettsia slovaca, Rickettsia sibirica mongolitimonae y Rickettsia massiliae. Se describen la etiología, las características clínicas y el tratamiento realizado en cada uno de ellos. El interés de estos casos radica en que aunque mayoritariamente presentan un curso benigno, la elevada sospecha diagnóstica y el inicio precoz del tratamiento parecen ser beneficiosos en su evolución

Rickettsia diseases are a group of tick-borne transmitted diseases, classified into 2 large groups: spotted fevers and typhus fevers. In addition, a new condition has been described recently, known as tick-borne lymphadenopathy. A retrospective series is presented of paediatric cases of rickettsia diseases diagnosed in 2013 and 2014. A total of 8 patients were included, of which 2 of them were diagnosed as Mediterranean spotted fever, and 6 as tick-borne lymphadenopathy. Rickettsia slovaca, Rickettsia sibirica mongolitimonae, and Rickettsia massiliae were identified in 3 of them. Aetiology, clinical features and treatment carried out in each of them are described. The interest of these cases is that, although most have a benign course, the high diagnostic suspicion and early treatment seem to be beneficial for its outcome