CLINICAL FEATURES AND TREATMENT OF MEDITERRANEAN SPOTTED FEVER IN CHILDREN: A PRACTICAL UPDATE FOR THE CLINICIAN

Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. It is characterized by the symptomatologic triad of fever, exanthema and «tache noire» – the typical eschar at the site of the tick bite. Oral or parenteral administration of tetracyclines or chloramphenicol represent the standard treatment; however, both these drugs may cause significant adverse effects in children. Recent studies indicate that oral clarithromycin and azithromycin may represent an acceptable alternative for the treatment of children with MSF. There are no data to indicate that antimicrobial prophylaxis is beneficial for tick-bitten patients to prevent MSF. However, in the presence of a lesion ascribed to «tache noire», antibiotic treatment should be started even in the absence of fever or exanthema.