Boutonneuse fever is also known as Mediterranean tick-borne fever, describing the mode of transmission and the original main geographic region of this bacterial disease. After an incubation period of several days, infected individuals develop fever, rashes, general impairment of well-being, and muscle and joint pain. Basically, boutonneuse fever is an infectious disease that is rarely life-threatening.
What is boutonneuse fever?
A tick bite or tick bite can transmit various diseases into the host organism. The best known of these is Lyme disease. However, in other countries, other diseases are also possible from ticks. Boutonneuse fever is one of the infectious diseases caused by the bacteria of the Rickettsia strain. After the bite of a tick infected with rickettsiae, a black, button-like focus of inflammation forms at the site of the bite. The derivation of the name also comes from this typical feature, as “bouton” is the French word for button. Boutonneuse fever-transmitting ticks are mainly found in the Mediterranean region. However, due to climate change and a northward direction of spread, Mediterranean tick-borne fever is now also found in the cooler, northern parts of Europe. The course of the disease is only severe or even fatal in rare cases. For the most part, a pre-existing illness or a weakened immune system must be present for boutonneuse fever to cause such a severe course.
Causes
Boutonneuse fever infection is caused only by infected ticks. During a tick bite, the tick first bites into and injures the skin. It absorbs blood and, towards the end of this absorption, spits out the contents of its stomach. This gets into the wound. The rickettsiae are in the stomach contents and are given the opportunity to pass from the tick host to the human. In the body, the rickettsiae cause an infection that is similar in parts to the flu. This includes fatigue, fever and aching limbs. A noticeable feature of boutonneuse fever is the change in the skin immediately around the bite site. A rash with a dark patch of skin can be seen. Mediterranean tick-borne fever is one of the milder fever infections transmitted by tick bites.
Symptoms, complaints, and signs
Unlike other tick-borne diseases, such as Lyme disease or meningoencephalitis, the first symptoms of infection with rickettsiae appear a very short time after the insect bite, if infection has occurred. As a rule, those affected do not notice that they have contracted boutonneuse fever, as the accompanying symptoms are usually similar to those of a flu-like infection. About five to ten days after the tick bite, patients often feel tired and suffer from headaches. In most cases, fever and joint or muscle pain are also present. Sensitive patients also experience swelling of the lymph nodes, but usually only to an extent that is not uncommon with colds. In a more severe course, abdominal pain, nausea and vomiting as well as red spots on the skin or a skin rash may occur. Occasionally, patients also develop conjunctivitis. The few symptoms typical of the disease do not appear in every patient. However, small blue-black ulcers often form at the injection site. If the ulcers occur, there is almost always swelling of the lymph nodes and a reddish skin rash. Symptoms last from a few days to two weeks, depending on the severity of the course.
Diagnosis and course
To diagnose boutonneuse spotted fever, the treating physician takes a detailed history with a focus on tick bite events within the past five to seven days. This is supplemented by a visual diagnosis of the area around the bite site or, if boutonneuse fever is suspected without a specific bite event, a thorough examination of the body for abnormal sites. Accurate determination of boutonneuse fever can be made via a blood test and the establishment of a bacterial culture. It is especially helpful if the tick that caused the bite is still present. If left untreated, boutonneuse fever may resolve on its own after several days of illness.If the affected patients are weakened in their immune system, the course of the disease of Mediterranean tick-borne fever can intensify. Boutonneuse fever is fatal in a small percentage of those affected.
Complications
Unlike other tick-borne diseases, such as Lyme disease or meningoencephalitis, the first symptoms of infection with rickettsiae appear a very short time after the insect bite, if infection has occurred. As a rule, those affected do not notice that they have contracted boutonneuse fever, as the accompanying symptoms are usually similar to those of a flu-like infection. About five to ten days after the tick bite, patients often feel tired and suffer from headaches. In most cases, fever and joint or muscle pain are also present. Sensitive patients also experience swelling of the lymph nodes, but usually only to an extent that is not uncommon with colds. In a more severe course, abdominal pain, nausea and vomiting as well as red spots on the skin or a skin rash may occur. Occasionally, patients also develop conjunctivitis. The few symptoms typical of the disease do not appear in every patient. However, small blue-black ulcers often form at the injection site. If the ulcers occur, there is almost always swelling of the lymph nodes and a reddish skin rash. Symptoms last from a few days to two weeks, depending on the severity of the course.
When should you see a doctor?
With a tick bite should always go to a doctor. Medical advice is indicated at the latest when the first symptoms of boutonneuse fever appear. In particular, nausea and vomiting, fever, headache and skin rashes should be clarified immediately. If a red stripe forms at the site of the bite, an infection must be assumed and treated immediately. Rapid diagnosis greatly improves the chances of successful treatment and prevents serious complications and long-term damage. However, slight redness at the bite site does not always require treatment. If the inflammation recedes within a few days after the first visit to the doctor, no further examination is necessary. If there is no improvement in the symptoms after a few days, further treatment steps must be taken. This is especially true if symptoms such as swelling of the lymph nodes or blackish-blue ulcers at the bite site occur. Conjunctivitis and muscle and joint pain are also clear warning signs of infection with boutonneuse fever and require immediate medical attention.
Treatment and therapy
In the vast majority of cases, boutonneuse fever can be cured by administration of antibiotics. If possible, treatment should begin as soon as possible after the first signs of illness appear. Doxycycline has proven effective for boutonneuse fever. Shortly after starting treatment with this agent, the symptoms improve. If this does not apply, the diagnosis of boutonneuse fever should be checked. Other tick bite infections show similar symptoms but have a more serious course, so treatment with other antibiotics and a more accurate diagnosis of the pathogens must be checked. In high-risk groups such as debilitated individuals or those with allergies, hospitalization may be required for boutonneuse fever. High fever and persistent nausea and vomiting are significant factors for hospitalization. This is also true if renal impairment or signs of meningitis develop during the course of the illness. Regardless of the severity of the Mediterranean tick-borne fever infection, patients should be provided with analgesic and antipyretic medications to alleviate symptoms.
Outlook and prognosis
Boutonneuse fever is a bacterial disease that requires urgent medication and medical treatment. Only professional treatment can have a positive effect on the overall course of the disease. Boutonneuse fever is transmitted by a tick bite, so there is usually always a bite site where the tick may even still be present. If the tick is still in the wound, the animal should be removed by a doctor.Otherwise, the wound may become infected and blood poisoning may even occur. Affected persons initially suffer from flu-like symptoms. There are aching limbs, headaches, an increased temperature, nausea and also vomiting. Around the existing bite site, the skin will turn very dark. Even with medical and drug treatment, this discoloration will definitely occur. After four to five days, the individual symptoms will subside, provided the affected person has a strong immune system. Boutonneuse fever can also be overcome without any treatment. However, without such treatment, a much more unpleasant course of the disease is to be expected. Individual symptoms will intensify significantly, complicating the overall course of the disease, so affected individuals with treatment will have a much more positive outlook for a quick recovery.
Prevention
Prevention for boutonneuse spotted fever is comprehensive tick precautions, since a vaccine is not available. This includes appropriate clothing in tick-infested areas. Dogs that are frequent targets of ticks should be treated with appropriate tick products to avoid the possibility of carrying boutonneuse fever near humans in the first place. If a tick is removed, it should be kept frozen until after the incubation period of boutonneuse fever has passed to facilitate pathogen determination.
Follow-up
In most cases, no special follow-up is needed for boutonneuse fever. It is an easily treated disease that is not associated with any particular complications. The affected person should pay attention to the regular intake of medication in order to limit the symptoms completely. Only in rare cases is hospitalization necessary. However, renal function should be monitored during treatment to detect meningitis at an early stage. In the case of boutonneuse fever, the wound should also be well treated and covered with a bandage to prevent inflammation or even blood poisoning. The affected person needs a lot of rest and must recover. Sports activities or other physical exertion should generally be avoided. A healthy diet has a positive effect on the further course of the disease. In the case of the disease, the patient should also avoid alcohol and nicotine. Life expectancy is not negatively affected by Boutonneuse fever. After treatment, the affected person should protect himself particularly well from the ticks in the respective areas in order to avoid a recurrence. Especially in tall grass or after a long stay outdoors, the entire body should be checked for ticks.
What you can do yourself
Boutonneuse fever is a serious bacterial infection. Pure self-therapy is strongly discouraged. The best form of prevention for boutonneuse fever is to avoid the cause, which is bites from the brown dog tick. Those vacationing in high-risk areas should avoid tall grass and low bushes and shrubs when spending time outdoors and hiking. After spending time outdoors, the entire body and clothing should be checked for ticks. Long pants and long-sleeved outerwear help to detect ticks before they have taken hold. However, the primary host of the brown dog tick is actually dogs. The four-legged friend should therefore not be brought into a risk area. If this cannot be avoided, the animal must be checked for ticks, preferably several times a day. Close physical contact with the dog, especially sleeping together in the same bed, should be avoided at all costs during this time. In addition, special collars can keep parasites away. In addition, it is important to ensure that the immune system is intact. Sufficient sleep, a vegetable diet rich in vitamins, and abstaining from too much sugar, alcohol and nicotine contribute to this. In naturopathy, the immune system is also strengthened by taking ascorbic acid (vitamin C) and extracts of red coneflower.
