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BioMed Research International
Volume 2013, Article ID 395806, 4 pages
Clinical Study

Mediterranean Spotted Fever in Southeastern Romania

1National Institute of Infectious Diseases “Prof. Dr. Matei Bals”, 021105 Bucharest, Romania
2Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
3National Institute of Research and Development for Microbiology and Immunology (Cantacuzino), 050096 Bucharest, Romania

Received 3 April 2013; Accepted 14 July 2013

Academic Editor: Klaus P. Hunfeld

Copyright © 2013 Daniela Pitigoi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Although cases of Mediterranean spotted fever (MSF) have been reported for decades in southeastern Romania, there are few published data. We retrospectively studied 339 patients, diagnosed with MSF at the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” between 2000 and 2011, in order to raise awareness about MSF in certain regions of Romania. According to the Raoult diagnostic criteria 171 (50.4%) had a score >25 points. Mean age was 52.5 years. One hundred and fifty-five (90.6%) patients were from Bucharest and the surrounding region. Almost all patients presented with fever (99.4%) and rash (98.2%), and 57.9% had evidence of a tick bite. There were no recorded deaths. Serologic diagnosis was made by indirect immunofluorescence assay. Of the 171 patients, serology results for R. conorii were available in 147. One hundred and twenty-three (83.7%) of them had a titer IgG ≥1 : 160 or a fourfold increase in titer in paired samples. MSF is endemic in southeastern Romania and should be considered in patients with fever and rash even in the absence of recognized tick exposure. Since the disease is prevalent in areas highly frequented by tourists, travel-associated MSF should be suspected in patients with characteristic symptoms returning from the endemic area.