Boutonneuse fever (also called Mediterranean spotted fever, fièvre boutonneuse, or Marseilles fever or ' tick bite fever') is a fever as a result of a Rickettsia infection caused by the bacterium Rickettsia conorii and transmitted by the dog tick Rhipicephalus sanguineus. Boutonneuse fever can be seen in many places around the world, although it is endemic in countries surrounding the Mediterranean Sea. This disease was first described in Tunisia in 1910 by Conor and Bruch and was named boutonneuse (French for "spotty") due to its papular skin rash characteristics.
After an incubation period of around seven days, the disease manifests abruptly with chills, high fevers, muscular and articular pains, severe headache and photophobia. The location of the bite forms a black ulcerous crust (tache noire). Around the fourth day of the illness an exanthem (widespread rash) appears, first macular and then maculopapular and sometimes petechial.
The diagnosis is made with serologic methods, either the classic Weil-Felix test (agglutination of Proteus OX strains ), ELISA or immunofluorescence assays in the bioptic material of the primary lesion.
The illness can be treated with tetracyclines (doxycycline is the preferred treatment), chloramphenicol, macrolides or fluoroquinolones.