Rickettsia: an unusual cause of sepsis in the emergency department

Mediterranean spotted fever (caused by Rickettsia conorii) is one of the tick-borne rickettsioses. It is prevalent in southern Europe, Africa and central Asia and may also be seen in travellers returning from these areas. It presents with various non-specific symptoms, including fever, maculopapular rash, headache, myalgia or diarrhoea and vomiting. A visible eschar at the site of the tick bite is characteristic but not present in all cases. There is no test that reliably confirms the disease in its early stages and diagnosis is often made on clinical grounds. Delay in diagnosis and in providing correct antibiotic treatment increases the mortality rate of this condition. Emergency clinicians should be aware of the possible diagnosis in travellers returning from endemic areas in order to start the correct treatment as early as possible and minimise subsequent complications and mortality.