Arrived with weakness and fever - and was diagnosed with Mediterranean spotted fever

4-year-old N. recently arrived at the Wolfson Medical Center suffering from a fever, general weakness, and a rash. The symptoms could have fit a common viral illness in children, but the characteristics of the rash and the results of blood tests led the doctors to suspect Mediterranean spotted fever, a disease that can become complicated without timely treatment.

The suspicion was not obvious: N.'s parents did not notice a tick or a bite, and the girl had not been hiking in nature before she fell ill. During the investigation, it turned out that she had been in contact with the family dog, which could have carried ticks. Mediterranean spotted fever is caused by bacteria from the Rickettsia family and is transmitted to humans through dog ticks. Contrary to what is commonly thought, exposure does not only occur following direct contact with a dog. Ticks can also be found in places where dogs have been, and therefore one can be bitten without noticing it.

"This is exactly the type of case where the disease at its onset can resemble any normal viral illness, which makes diagnosis difficult," explains Dr. Diana Tasher, director of the pediatric department at Wolfson and an expert in pediatric infectious diseases.

According to her, simple and effective antibiotic treatment can prevent the deterioration of the disease, and therefore it is important to raise the suspicion at an early stage. The disease usually manifests with a high fever, headaches, weakness, and muscle aches. Later, a rash may appear, which sometimes also involves the palms and soles of the feet. In some cases, a black scab appears at the site of the bite, but it is not always possible to identify a clear external sign.

Dr. Tasher explains that the diagnosis is made using a dedicated blood test: the diagnosis is based on a specific test for the disease pathogen. There may also be non-specific clues in initial blood tests, such as low white blood cell and platelet counts and a disturbance in liver enzymes. It is important to start antibiotic treatment when the suspicion arises, without waiting for laboratory confirmation.

N. received appropriate antibiotic treatment, her condition improved, and she was discharged home.

"We were very surprised by the diagnosis. Today she is recovering and we want to be past this already. As a parent, I think it is important to raise awareness of the disease both among parents and among medical staff," says her father.

Dr. Tasher emphasizes that there is no reason to panic at every appearance of a fever or rash, and that only a very small fraction of tick bites leads to the disease. However, a persistent fever accompanied by significant weakness, a rash, or a deterioration in the child's condition requires a medical examination. In such cases, it is important to tell the doctor also about contact with dogs or about staying in an open area, even if there is no known bite. To reduce the risk, it is recommended to ensure treatment against ticks on dogs and in places where they lie, and to check the body thoroughly after a trip in open areas. If a tick is found, it should be removed carefully using tweezers and without crushing it. Although exposure to ticks is more common in the summer, it can occur throughout the year.