Mediterranean Spotted Fever and Early Neonatal Sepsis: the Transmission of Rickettsia conorii via the Placenta: A Case Report

Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. The classic clinical triad comprises high fever, an inoculation eschar, and a maculopapular non-pruritic rash. Serological testing is the most frequently used diagnostic method. Treatment involves antibiotics, preferably doxycycline. A two-day-old neonate developed sepsis and a skin rash. There was a high index of suspicion for MSF because the mother and four of her children were diagnosed with MSF in synchronization with the clinical presentation of this neonate. As far as one knows, congenital rickettsia as a cause of early neonatal sepsis has not been reported. However, limited data were reported using animal models. There are several challenges regarding its diagnosis and the selection of proper antibiotics for this age group. This paper discusses the challenges of its diagnosis, treatment, and impact on the neonate, this paper also reviews the literature regarding placental transmission of Rickettsia conorii. To the best of our knowledge, this is the first case study reporting that the early neonatal sepsis is caused by R. conorii (the Moroccan strain) in Jordan. Physicians caring for pregnant women and neonates living in areas with endemic MSF should consider the possibility of MSF in febrile patients and initiate early appropriate treatment based on a high index of suspicion.