First human case of Rickettsia sibirica mongolotimonae infection in Northern Greece in a teenager from Thrace.

Dimosthenis Chochlakis, Elpis Mantadakis, Stavros Thomaidis, Yannis Tselentis, Athanassios Chatzimichael, Anna Psaroulaki Psaroulaki

Spotted fever group (SFG) rickettsioses usually present with high fever, a maculopapular rash, and frequently an inoculation eschar at the site of tick bite. Among the SFG species, Rickettsia sibirica mongolitimonae is the etiologic agent of lymphangitis-associated rickettsiosis that has been described in France, Spain, Portugal and Crete. We describe herein a male adolescent from Thrace, Northern Greece with clinical and serological evidence of infection due to this rickettsia species, who recovered uneventfully with appropriate therapy. The patient got infected in the island of Samothraki, the most northern island of the Aegean Sea, during a recent trip. Although R. sibirica mongolitimonae was neither cultivated nor was a PCR performed in a cutaneous specimen from the inoculation eschar, serological testing along with the typical clinical picture makes the diagnosis highly probable. Rickettsia sibirica mongolitimonae appears to be an emerging pathogen in both southern and northern Greece. Physicians caring for patients who have traveled to endemic areas should consider R. sibirica mongolitimonae in the differential diagnosis of any febrile illness associated with a maculopapular rash and an inoculation eschar.