eMedicine Specialties > Dermatology > Bacterial Infections

Boutonneuse Fever: Follow-up

Author: Anna Zalewska, MD, PhD, Assistant Professor, Adjunct Professor, Department of Dermatology and Venereology, Medical University of Lodz, Poland
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jul 7, 2009

Follow-up

Further Inpatient Care

  • The fever decreases and the rash usually disappears after 2-4 days of first-line therapy.
  • Patients, being already in good health, are usually discharged after 7-8 days of treatment.
  • In one study presenting 142 patients hospitalized with boutonneuse fever, 5% of patients presented with malignant boutonneuse fever.
  • One-dose azithromycin can be used for prophylaxis of boutonneuse fever.

Deterrence/Prevention

  • No vaccine exists for boutonneuse fever.
  • Advise patients to pay attention to and not get in close contact with dogs, goats, and sheep when in endemic areas.

Complications

  • Complications with boutonneuse fever can occur mainly in patients who are immunocompromised or elderly and who present with the malignant form of boutonneuse fever. In Spain, complications are observed in about 22% of boutonneuse fever cases.
    • Renal failure - Mainly due to renal vasculitis, acute tubular necrosis, or perivascular interstitial glomerulonephritis
    • Respiratory failure
    • Gastrointestinal bleeding
    • Stroke
    • Deep venous thrombosis (DVT) - Observed in about 9% of patients during the late acute and early convalescent phase of boutonneuse fever
    • Arthromyalgia (16-76% of patients) and arthritis (rare)
    • Pulmonary complications (very rare)
    • Meningoencephalitic involvement - During the acute phase (lymphocytic coma, meningitis)
    • Myelitis - Early during convalescence, as acute-onset paraplegia involving the lumbosacral spinal cord (very rare)

Prognosis

  • The prognosis for boutonneuse fever is very good in mild cases.
  • The main concern is malignant boutonneuse fever cases occurring in patients who are immunocompromised and/or elderly.19

Patient Education

  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Boutonneuse fever cases are on the increase all over the world and should be considered in febrile patients returning from abroad, especially from endemic areas (eg, Mediterranean basin).
  • Antibodies develop late in the course of the disease and serologic confirmation can be useful only in the retrospective analysis.
  • Spotless fever and cases appearing in the winter also may be due to Rickettsia species infection; suspicion is required.
  • The clinical diagnosis is obvious when a history of travel to an endemic area and the triad of fever, rash, and tache noire exists.
  • History of a contact with a dog can be of considerable help.
  • Prompt diagnosis depends mainly on clinical suspicion.

Special Concerns

  • Regarding children with the malignant form of boutonneuse fever, tetracyclines should be considered (especially doxycycline). They are the most effective drugs for this disease (potentially life threatening). Recognize that a single short course (up to 1 wk) of doxycycline should not result in cosmetically significant staining of teeth. For patients with malignant boutonneuse fever, a narrow window of time exists during which effective antibiotic therapy in an extremely efficient way reduces the risk of any unfavorable outcome.
  • The course of boutonneuse fever may be malignant in people who are elderly and especially in those who are immunocompromised.
  • In pregnant women, erythromycin should be administered; however, it is not as effective as tetracyclines.
    • Josamycin, a new macrolide antibiotic, seems to be effective against malignant boutonneuse fever (when available). Consider this the drug of choice in malignant boutonneuse fever in pregnancy.20,21,22
    • Rifampin, though it belongs to Food and Drug Administration (FDA) category class C in pregnancy and tuberculosis, has also been used extensively and appears to be safe.
    • Recent studies indicate that oral clarithromycin and azithromycin could be regarded as an alternative treatment in children and in pregnant women.
 


More on Boutonneuse Fever

Overview: Boutonneuse Fever
Differential Diagnoses & Workup: Boutonneuse Fever
Treatment & Medication: Boutonneuse Fever
Follow-up: Boutonneuse Fever
References
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References

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Further Reading

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Keywords

boutonneuse fever, BF, Mediterranean spotted fever, MSF, Carducci fever, Carducci's fever, tick typhus, South African tick typhus, Indian tick typhus, tick bite fever, rickettsial disease, Rickettsia conorii, R conorii

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Contributor Information and Disclosures

Author

Anna Zalewska, MD, PhD, Assistant Professor, Adjunct Professor, Department of Dermatology and Venereology, Medical University of Lodz, Poland
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Robin Travers, MD, Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians
Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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