Diagnosis
One of the tick borne spotted fevers starts, with a black ulcer (tache noir for you Francophiles) and proceeds to fevers, chills, headache, myalgias and a rash.
Epidemiologic Risks
Bit by the dog tick in the Mediterranean (so keep your Mediterranean covered): Spain, France, Israel.
Microbiology
R. conorii. Diagnose with serology.
Empiric Therapy
Tetracycline / doxycycline (preferred) OR chloramphenicol. Quinolones maybe effective, but stick with a tetracycline.
Pearls
These are endothelial infections, so it is an infectious vasculitis, hence the systemic and nonfocal findings. Intravascular clot, and the resultant complications, are not uncommon.
Rants
Last Update: 05/14/18.