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Boutonneuse Fever - Causes, Symptoms, Diagnosis, Treatment, and Prevention

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A dog tick bite may cause an illness called boutonneuse fever. Read the article to know more about the causes, diagnosis, and treatment.

Written byDr. Gayathri P

Medically reviewed byDr. Shubadeep Debabrata Sinha

Published At December 28, 2022
Reviewed AtOctober 3, 2024

What Is a Boutonneuse Fever?

Boutonneuse fever is an illness caused by bacterial infection, mainly the Rickettsia conorii species. It was first reported in Tunisia, North Africa, in 1910. Humans may acquire this disease from a dog tick bite, which leads to rashes and black spots at the site of the bite. Hence, Boutonneuse fever is classified under spotted fevers.

Is Boutonneuse Fever Common?

The disease is prevalent in the Mediterranean region of Europe; therefore also named Mediterranean spotted fever. It is also reported in other parts of the world like Greece, India, sub-Saharan Africa, etc. However, the prevalence of Boutonneuse fever is less in the United States but may be found in travelers from the central endemic regions. The Boutonneuse fever occurs more commonly in the summer month, as there is increased tick activity during the summer season. It equally affects men and women.

The following factors may increase the risk of individuals developing severe symptoms:

  • Increased age.

  • Chronic alcoholism.

  • Poor immune system.

  • Glucose- 6-phosphate dehydrogenase deficiency.

  • Inappropriate antibiotic treatment.

How Is Boutonneuse Fever Caused?

The main culprit that causes Boutonneuse fever is Rickettsia conorii. It is an intracellular bacteria that is transmitted to humans via the brown dog tick, namely the Rhipicephalus sanguineus. The bacteria then enter the blood to cause several symptoms.

What Are the Signs and Symptoms?

The dog tick bite is usually not noticed, and it is painless. It takes five to seven days (incubation period) for the symptoms to appear.

The following symptoms develop after seven days of a dog tick bite:

  • Fever (96 %).

  • Rash (87 to 96 %) - Flat rashes with raised bumps may be observed over the palms and soles; the interesting fact is that the face is usually spared from rashes. Once a fever occurs, it takes two to four days for the rashes to develop.

  • Flu-like symptoms.

  • Eschar or black spots appear at the site of the dog tick bite.

  • Lymphadenopathy may rarely occur.

How Does the Doctor Diagnose Boutonneuse Fever?

The healthcare specialist uses the following method to diagnose Boutonneuse Fever:

1) Physical Examination - The doctor might enquire about any recent travel to endemic areas and check for classic signs like fever, black spots, and rashes.

2) Laboratory Investigation - It does not aid in the accurate diagnosis of Boutonneuse fever as the physical examination, and other confirmatory tests do. However, the following are significant laboratory findings:

  • Leukopenia (decreased white blood cells).

  • Thrombocytopenia (low platelet count).

  • Hyponatremia (low sodium level).

  • Elevated lactate dehydrogenase (LDH) levels.

The other findings that indicate the severe form of the disease are:

  • Purple-colored patches on the skin (epidermal purpura).

  • Deteriorating liver function.

3) Serologic Testing - It is done to detect the presence of antibodies against specific microorganisms that caused the disease. The test does not produce significant results during the initial stages of Boutonneuse fever but aids in detecting antibodies (IgM and IgG) after 10 to 14 days of initial symptoms. The main drawback of serological testing is that it does not help in differentiating the subspecies of the causative bacteria. The commonly used serological test is as follows:

  • Enzyme-linked immunosorbent assay (ELISA).

  • Western blot immunoassay.

4) Polymerase Chain Reaction (PCR) - The healthcare specialist collects samples like saliva, blood, or mucus to detect the presence of disease-causing microorganisms, either bacteria or viruses. It is a quick, easy, and affordable test capable of finding out the disease during the initial stages; when there is less amount of pathogen in the system.

The disease that possesses similar characteristics to Boutonneuse fever are as follows:

  • Rocky Mountain spotted fever is similar to Boutonneuse fever in etiology but may cause severe signs like liver enlargement, jaundice, retinopathy, pneumonia, etc. Therefore, it requires treatment at the earliest.

  • Viral exanthema refers to skin rashes that develop due to viral infection.

  • Scarlet fever is an infectious disorder. Children are the most affected, and the classic symptoms include fever, sore throat, and pink-red rashes.

  • Infectious mononucleosis is an infectious viral disease. Fever, sore throat, fatigue, and skin rash are typical symptoms.

What Are the Complications?

Not all affected with Boutonneuse fever may face the below-listed complications; it may occur among individuals with associated risk factors.

A few complications include:

  • Retinopathy is an eye disorder that occurs due to damage to the retinal blood vessels and causes vision impairment.

  • Meningoencephalitis - A neurological condition characterized by the inflammation of the brain and its coverings (meninges).

  • Myocarditis is an infectious disease that involves the inflammation of the myocardium (heart muscle).

  • Sensorineural hearing loss.

How Is Boutonneuse Fever Treated?

The healthcare specialist mainly focuses on treating Boutonneuse fever at its initial stage to reduce complications.

The drugs that are used in managing are:

  • Doxycycline - The drug of choice for treating Boutonneuse fever is Doxycycline. Initially, it was not used among pregnant women and children as it was thought to cause defects in the developing fetus inside the womb. However, recent studies show that Doxycycline is safe to be used in children and pregnant women for a short duration, especially in treating Boutonneuse fever. Nevertheless, it is essential to inform your healthcare specialist if you have had allergic reactions or impaired liver function with prior use of Doxycycline, as your doctor may suggest an alternate drug.

  • Azithromycin - When the symptoms are mild, the doctor may suggest Azithromycin, especially in pregnant women and younger children. It is usually recommended for seven to ten days.

  • Chloramphenicol - To reduce severe symptoms, Chloramphenicol is used.

  • Fluoroquinolone - Fluoroquinolone is contraindicated in individuals with Boutonneuse fever due to adverse outcomes.

Can Boutonneuse Fever Be Prevented?

The specific measures to be followed to prevent Boutonneuse fever are:

  • Avoid close contact with tick-carrying animals.

  • Take precautionary measures while traveling to endemic areas.

  • Self-check is necessary to identify any tick bite.

  • Frequently use tick repellants such as DEET.

Conclusion:

Boutonneuse fever is an endemic disease and causes rashes and flu-like symptoms. However, education and awareness among the population living in endemic regions or individuals who travel to those places are crucial in preventing such diseases. It is not a fatal disease but may cause severe symptoms in specific individuals (elderly or immunocompromised). Therefore, seek medical advice if you have recently traveled to endemic regions and have symptoms like fever and rashes.

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Frequently Asked Questions

Tick fever can cause various symptoms, and pain can be one of them. The severity and type of pain experienced can vary among individuals and depend on factors such as the specific tick-borne infection, the stage of the infection, and the individual's response to the infection. It is important to note that while pain can be a symptom of tick fever, it is not always present or may vary in intensity among individuals
Tick-borne diseases, including tick bite fever, can vary depending on the specific infection, individual factors, and timely treatment. While some tick-borne diseases can cause mild symptoms that resolve independently, others can be more serious and require medical intervention. These complications may include organ damage, such as the kidneys, heart, or lungs, or the development of more severe symptoms.
The duration of tick fever, including Mediterranean spotted fever, can vary depending on factors such as the specific tick-borne infection, individual factors, and the timeliness and effectiveness of treatment. Tick fever can last for several days to a few weeks. With appropriate and timely antibiotic treatment, tick fever symptoms often start improving within a few days.
Tick fever, also known as tick-borne rickettsiosis, is a  group of diseases caused by many species of bacteria transmitted to humans through the bite of infected ticks. The most common types of tick fever include Rocky Mountain spotted fever, ehrlichiosis, and anaplasmosis. Symptoms like rashes, flu-like symptoms, joint pain, nausea and vomiting, lethargy, and confusion in an individual are indications of tick fever.
Indian Tick Typhus Fever, also known as Indian tick typhus or Indian tick-borne rickettsiosis, is a type of tick-borne illness caused by the bacteria Rickettsia conorii. It is primarily found in certain regions of India and neighboring countries. The primary vector is the brown dog tick (Rhipicephalus sanguineus), which is commonly found on dogs and can bite humans as well
If once a person has been infected with tick bite fever and successfully treated, they typically develop immunity to the specific strain of Rickettsia africae that caused their initial infection. This means that they are unlikely to contract the same strain again and experience a recurrence of tick bite fever caused by that particular bacteria. 
The tendency of tick fever to spread depends on several factors, including the specific bacteria involved, the tick species responsible for transmission, and the local ecology and environmental conditions. Factors like tick population and distribution, seasonal variations, tick control measures, and human exposure affect the spreading tendency of tick fever.
Tick-borne diseases, including tick fever, can influence the brain and central nervous system in some circumstances. Not all tick-borne diseases have the same propensity to cause neurological complications. The specific infection and individual factors are key in determining the likelihood and severity of neurological involvement. Experiencing symptoms such as severe headaches, confusion, seizures, or other neurological symptoms needs proper evaluation and management.
Tick fever is not considered a "normal" condition because it is not a common or typical illness that people experience regularly. They are caused by infections transmitted to humans through the bite of infected ticks. While tick bites are relatively common, not all tick bites lead to tick-borne diseases
Yes, tick bite fever, specifically certain types of tick-borne rickettsiosis, can affect the liver. Tick-borne rickettsiosis can cause hepatic involvement and lead to liver inflammation, known as hepatitis. The bacteria can invade the liver tissue and cause liver dysfunction. Symptoms of liver involvement in tick-borne rickettsiosis can include abdominal pain, jaundice, hepatomegaly, elevated liver enzymes, and altered liver function.
Blood tests for tick bite fever are enzyme-linked immunosorbent assay (ELISA), serological tests, and polymerase chain reaction. The timing of the tests is crucial, as antibody levels may take some time to develop after infection. Therefore, repeat testing may be necessary.
Tache noire" is a French term that translates to "black spot" in English, and "boutonneuse fever" refers to a specific infectious disease.  This describes a specific condition known as Mediterranean spotted fever or African tick-bite fever.
Yes, tick fever, including Mediterranean spotted fever, is generally curable with appropriate treatment. The primary treatment for tick-borne infections is the administration of antibiotics, specifically tetracyclines or a related antibiotic called doxycycline. With early diagnosis and treatment, most cases of tick fever respond well to antibiotic therapy.
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Dr. Shubadeep Debabrata Sinha from iCliniq
Dr. Shubadeep Debabrata Sinha

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