{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:17:55Z","timestamp":1787818675610,"version":"build-2784847793"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"DOI":"10.1007\/s15010-026-02948-y","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:29:00Z","timestamp":1787815740000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A rare case of spotted fever group rickettsiosis in southern Iran: diagnostic challenges and review"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5601-5151","authenticated-orcid":false,"given":"Elham","family":"Barahimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0136-6755","authenticated-orcid":false,"given":"Abbas","family":"Poudat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3924-2069","authenticated-orcid":false,"given":"Mehdi","family":"Hassani-Azad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-7649","authenticated-orcid":false,"given":"Parivash","family":"Davoodian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9243-3660","authenticated-orcid":false,"given":"Fatemeh","family":"Khajavi-Mayvan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1207-1511","authenticated-orcid":false,"given":"MohammadHosein","family":"Sheybani-Arani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2948_CR1","doi-asserted-by":"crossref","unstructured":"Rovery C, Brouqui P, Raoult D. Questions on Mediterranean spotted fever a century after its discovery. Emerg Infect Dis J. 2008;14(9):1360. https:\/\/wwwnc.cdc.gov\/eid\/article\/14\/9\/07-1133_article","DOI":"10.3201\/eid1409.071133"},{"key":"2948_CR2","doi-asserted-by":"publisher","unstructured":"Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis. 2001;32(6):897\u2013928. https:\/\/doi.org\/10.1086\/319347.","DOI":"10.1086\/319347"},{"key":"2948_CR3","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1741-7007-7-6","volume":"7","author":"LA Weinert","year":"2009","unstructured":"Weinert LA, Werren JH, Aebi A, Stone GN, Jiggins FM. Evolution and diversity of rickettsia bacteria. BMC Biol. 2009;7:6.","journal-title":"BMC Biol"},{"issue":"10","key":"2948_CR4","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.2217\/fmb.13.102","volume":"8","author":"SK Sahni","year":"2013","unstructured":"Sahni SK, Narra HP, Sahni A, Walker DH. Recent molecular insights into rickettsial pathogenesis and immunity. Future Microbiol. 2013;8(10):1265\u201388.","journal-title":"Future Microbiol"},{"key":"2948_CR5","doi-asserted-by":"crossref","unstructured":"Klein D, Beth-Din A, Cohen R, Lazar S, Glinert I, Zayyad H, et al. New spotted fever group rickettsia isolate, identified by sequence analysis of conserved genomic regions. Pathogens. 2019;9(1).","DOI":"10.3390\/pathogens9010011"},{"issue":"5537","key":"2948_CR6","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1126\/science.1061471","volume":"293","author":"H Ogata","year":"2001","unstructured":"Ogata H, Audic S, Renesto-Audiffren P, Fournier PE, Barbe V, Samson D, et al. Mechanisms of evolution in Rickettsia conorii and R. prowazekii. Science. 2001;293(5537):2093\u20138.","journal-title":"Science"},{"key":"2948_CR7","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1471-2180-5-11","volume":"5","author":"Y Zhu","year":"2005","unstructured":"Zhu Y, Fournier PE, Eremeeva M, Raoult D. Proposal to create subspecies of Rickettsia conorii based on multi-locus sequence typing and an emended description of Rickettsia conorii. BMC Microbiol. 2005;5:11.","journal-title":"BMC Microbiol"},{"issue":"3","key":"2948_CR8","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.idc.2008.03.003","volume":"22","author":"C Rovery","year":"2008","unstructured":"Rovery C, Raoult D. Mediterranean spotted fever. Infect Dis Clin North Am. 2008;22(3):515\u201330.","journal-title":"Infect Dis Clin North Am"},{"issue":"7","key":"2948_CR9","first-page":"333","volume":"176","author":"A Mart\u00edn Farf\u00e1n","year":"1985","unstructured":"Mart\u00edn Farf\u00e1n A, Ju\u00e1rez Fern\u00e1ndez C, Calbo Torrecillas F, Porras Ballesteros J, D\u00edaz Recio M, Recio FB. Clinico-epidemiological study of 164 cases of boutonneuse fever. Rev Clin Esp. 1985;176(7):333\u20139.","journal-title":"Rev Clin Esp"},{"key":"2948_CR10","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1186\/s40064-015-1042-3","volume":"4","author":"P Crespo","year":"2015","unstructured":"Crespo P, Seixas D, Marques N, Oliveira J, da Cunha S, Meli\u00e7o-Silvestre A. Mediterranean spotted fever: case series of 24 years (1989\u20132012). Springerplus. 2015;4:272.","journal-title":"Springerplus"},{"issue":"2","key":"2948_CR11","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/s10096-002-0879-x","volume":"22","author":"E Ant\u00f3n","year":"2003","unstructured":"Ant\u00f3n E, Font B, Mu\u00f1oz T, Sanfeliu I, Segura F. Clinical and laboratory characteristics of 144 patients with mediterranean spotted fever. Eur J Clin Microbiol Infect Dis. 2003;22(2):126\u20138.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2948_CR12","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/1471-2334-6-60","volume":"6","author":"C Colomba","year":"2006","unstructured":"Colomba C, Saporito L, Polara VF, Rubino R, Titone L. Mediterranean spotted fever: clinical and laboratory characteristics of 415 Sicilian children. BMC Infect Dis. 2006;6:60.","journal-title":"BMC Infect Dis"},{"key":"2948_CR13","doi-asserted-by":"publisher","unstructured":"Demeester R, Claus M, Hildebrand M, Vlieghe E, Bottieau E. Diversity of life-threatening complications due to Mediterranean spotted fever in returning travelers. J Travel Med. 2010;17(2):100\u20134. https:\/\/doi.org\/10.1111\/j.1708-8305.2009.00391.x.","DOI":"10.1111\/j.1708-8305.2009.00391.x"},{"issue":"8","key":"2948_CR14","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1093\/jac\/dkr218","volume":"66","author":"E Botelho-Nevers","year":"2011","unstructured":"Botelho-Nevers E, Rovery C, Richet H, Raoult D. Analysis of risk factors for malignant Mediterranean spotted fever indicates that fluoroquinolone treatment has a deleterious effect. J Antimicrob Chemother. 2011;66(8):1821\u201330.","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"2948_CR15","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1093\/infdis\/147.3.607","volume":"147","author":"MA Piras","year":"1983","unstructured":"Piras MA, Calia G, Saba F, Gakis C, Andreoni G. Glucose-6-phosphate dehydrogenase deficiency in male patients with Mediterranean spotted fever in Sardinia. J Infect Dis. 1983;147(3):607\u20138. https:\/\/doi.org\/10.1093\/infdis\/147.3.607.","journal-title":"J Infect Dis"},{"key":"2948_CR16","doi-asserted-by":"crossref","unstructured":"Raoult D, Zuchelli P, Weiller PJ, Charrel C, San Marco JL, Gallais H et al. Incidence, clinical observations and risk factors in the severe form of mediterranean spotted fever among patients admitted to hospital in Marseilles 1983\u20131984. J Infect. 1986;12(2):111\u20136. https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0163445386935085","DOI":"10.1016\/S0163-4453(86)93508-5"},{"issue":"1","key":"2948_CR17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/j.1749-6632.2003.tb07378.x","volume":"990","author":"R De Sousa","year":"2003","unstructured":"De Sousa R, N\u00f3brega SD, Bacellar F, Torgal J. Mediterranean spotted fever in Portugal. Ann New York Acad Sci. 2003;990(1):285\u201394. https:\/\/doi.org\/10.1111\/j.1749-6632.2003.tb07378.x.","journal-title":"Ann New York Acad Sci"},{"key":"2948_CR18","doi-asserted-by":"publisher","unstructured":"Parola P, Paddock Christopher D, Socolovschi C, Labruna Marcelo B, Mediannikov O, Kernif T, et al. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev. 2013;26(4):657\u2013702. https:\/\/doi.org\/10.1128\/cmr.00032-13.","DOI":"10.1128\/cmr.00032-13"},{"key":"2948_CR19","doi-asserted-by":"publisher","unstructured":"de Sousa R, Fran\u00e7a A, N\u00f2brega SD, Belo A, Amaro M, Abreu T, et al. Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. J Infect Dis. 2008;198(4):576\u201385. https:\/\/doi.org\/10.1086\/590211.","DOI":"10.1086\/590211"},{"issue":"6","key":"2948_CR20","doi-asserted-by":"publisher","first-page":"e7577","DOI":"10.1002\/ccr3.7577","volume":"11","author":"M Farrokhnia","year":"2023","unstructured":"Farrokhnia M, Shafieipour S, Nakhaie M, Rukerd MRZ. Mediterranean spotted fever as a non-endemic disease in the southeast of Iran: diagnosis and treatment based on specific skin lesion. Clin Case Rep. 2023;11(6):e7577.","journal-title":"Clin Case Rep"},{"issue":"3","key":"2948_CR21","first-page":"256","volume":"12","author":"M Farrokhnia","year":"2020","unstructured":"Farrokhnia M, Ghalejoogh ZY, Rohani M, Ghasemi A, Esmaeili S, Mostafavi E. Cases of Mediterranean spotted fever in southeast of Iran. Iran J Microbiol. 2020;12(3):256.","journal-title":"Iran J Microbiol"},{"issue":"2","key":"2948_CR22","doi-asserted-by":"publisher","first-page":"485","DOI":"10.3201\/eid2802.211023","volume":"28","author":"S Esmaeili","year":"2022","unstructured":"Esmaeili S, Latifian M, Khalili M, Farrokhnia M, Stenos J, Shafiei M, et al. Fatal case of Mediterranean spotted fever associated with septic shock, Iran. Emerg Infect Dis. 2022;28(2):485.","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"2948_CR23","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12879-022-07291-9","volume":"22","author":"M Latifian","year":"2022","unstructured":"Latifian M, Khalili M, Farrokhnia M, Mostafavi E, Esmaeili S. Rickettsia conorii subsp. israelensis infection: a case report from southeast Iran. BMC Infect Dis. 2022;22(1):320.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"2948_CR24","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s12879-024-09002-y","volume":"24","author":"A Hosseininasab","year":"2024","unstructured":"Hosseininasab A, MoradKasani S, Mostafavi E, Baseri N, Sadeghi M, Esmaeili S. Rickettsia conorii subsp. israelensis infection in a pediatric patient presenting skin rash and abdominal pain: a case report from Southeast Iran. BMC Infect Dis. 2024;24(1):114.","journal-title":"BMC Infect Dis"},{"key":"2948_CR25","doi-asserted-by":"publisher","first-page":"101641","DOI":"10.1016\/j.nmni.2025.101641","volume":"68","author":"H Naderi","year":"2025","unstructured":"Naderi H, Nameghi MH, Vakilian A, Barzegar Z, Ghannad FR, Esmaeili S. Febrile encephalopathy following a tick bite: a case report of Rickettsia conorii infection from Northeast Iran. New Microbes New Infect. 2025;68:101641.","journal-title":"New Microbes New Infections"},{"key":"2948_CR26","unstructured":"Rickettsia conorii IFA Slide. 2024. https:\/\/www.vircell.com\/en\/products\/rickettsia-ifa"},{"key":"2948_CR27","doi-asserted-by":"publisher","unstructured":"Rolain JM, Raoult D. Genome comparison analysis of molecular mechanisms of resistance to antibiotics in the Rickettsia genus. Ann New York Acad Sci. 2005;1063(1):222\u201330. https:\/\/doi.org\/10.1196\/annals.1355.035","DOI":"10.1196\/annals.1355.035"},{"issue":"11","key":"2948_CR28","doi-asserted-by":"publisher","first-page":"2715","DOI":"10.1128\/jcm.35.11.2715-2727.1997","volume":"35","author":"B La Scola","year":"1997","unstructured":"La Scola B, Raoult D. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol. 1997;35(11):2715\u201327.","journal-title":"J Clin Microbiol"},{"issue":"12","key":"2948_CR29","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1111\/j.1469-0691.2004.01019.x","volume":"10","author":"P Brouqui","year":"2004","unstructured":"Brouqui P, Bacellar F, Baranton G, Birtles R, Bjoersdorff A, Blanco J, et al. Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect. 2004;10(12):1108\u201332.","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"2948_CR30","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1089\/vbz.2016.1966","volume":"17","author":"A Portillo","year":"2017","unstructured":"Portillo A, De Sousa R, Santib\u00e1\u00f1ez S, Duarte A, Edouard S, Fonseca IP, et al. Guidelines for the detection of Rickettsia spp. Vector Borne Zoonotic Dis. 2017;17(1):23\u201332.","journal-title":"Vector-Borne Zoonotic Dis"},{"issue":"4","key":"2948_CR31","doi-asserted-by":"publisher","first-page":"172","DOI":"10.3390\/tropicalmed6040172","volume":"6","author":"N Spernovasilis","year":"2021","unstructured":"Spernovasilis N, Markaki I, Papadakis M, Mazonakis N, Ierodiakonou D. Mediterranean spotted fever: current knowledge and recent advances. Trop Med Infect Dis. 2021;6(4):172.","journal-title":"Trop Med Infect Disease"},{"issue":"19","key":"2948_CR32","doi-asserted-by":"publisher","first-page":"4431","DOI":"10.3390\/molecules25194431","volume":"25","author":"V Blanda","year":"2020","unstructured":"Blanda V, D\u2019Agostino R, Giudice E, Randazzo K, La Russa F, Villari S, et al. New real-time PCRs to differentiate Rickettsia spp. and Rickettsia conorii. Molecules. 2020;25(19):4431.","journal-title":"Molecules"},{"issue":"12","key":"2948_CR33","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1586\/eri.12.139","volume":"10","author":"E Botelho-Nevers","year":"2012","unstructured":"Botelho-Nevers E, Socolovschi C, Raoult D, Parola P. Treatment of Rickettsia spp. infections: a review. Expert Rev Anti Infect Therapy. 2012;10(12):1425\u201337.","journal-title":"Expert Rev Anti-infective Therapy"},{"issue":"1","key":"2948_CR34","first-page":"213","volume":"33","author":"LS Blanton","year":"2019","unstructured":"Blanton LS. The rickettsioses: a practical update. Infect Dis Clin. 2019;33(1):213\u201329.","journal-title":"Infect Disease Clin"},{"issue":"2","key":"2948_CR35","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1086\/338068","volume":"34","author":"A Cascio","year":"2002","unstructured":"Cascio A, Colomba C, Antinori S, Paterson DL, Titone L. Clarithromycin versus azithromycin in the treatment of Mediterranean spotted fever in children: a randomized controlled trial. Clin Infect Dis. 2002;34(2):154\u20138.","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2948_CR36","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1128\/AAC.01814-15","volume":"60","author":"E Anton","year":"2016","unstructured":"Anton E, Mu\u00f1oz T, Traver\u00eda FJ, Navarro G, Font B, Sanfeliu I, et al. Randomized trial of clarithromycin for Mediterranean spotted fever. Antimicrob Agents Chemother. 2016;60(3):1642\u20135.","journal-title":"Antimicrob Agents Chemother"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02948-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02948-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02948-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:29:03Z","timestamp":1787815743000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02948-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":36,"alternative-id":["2948"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02948-y","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Hormozgan University of Medical Sciences Ethical Committee approved the study under the ethical code IR.HUMS.REC.1404.145.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient to publish this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A large language model (ChatGPT, OpenAI) was used solely to assist with language editing and stylistic improvements. The tool was not used to generate scientific content, analyse data, or draw conclusions. The authors reviewed and verified all content and take full responsibility for the manuscript.","order":5,"name":"Ethics","label":"Large language model","group":{"name":"EthicsHeading","label":"Declarations"}}]}}