{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:17:10Z","timestamp":1761513430540,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,2,10]]},"abstract":"<jats:p>Rickettsial infections are common in southern Europe and the most frequent and lethal type is Mediterranean spotted fever, caused by <jats:italic>Rickettsia conorii<\/jats:italic>. The disease is usually characterised by the classical triad of fever, eschar and rash, and is generally a mild disease in children. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in an 18-year-old man, presenting during summer with fever and persistent headache. The cerebrospinal fluid analysis revealed increased cellularity (107\u2005cells\/\u03bcL), hypoglycorrhachia (50% of glycaemia) and hyperproteinorrhachia (284\u2005mg\/dL). Rickettsial infection was confirmed by serology and the patient was treated with doxycycline, with a favourable outcome. The patient's pet squirrel and\/or associated vectors might be involved in the transmission of <jats:italic>Rickettsia<\/jats:italic> spp. This case underlines the importance of a high clinical suspicion and the benefits of early empirical treatment when facing compatible epidemiological contexts.<\/jats:p>","DOI":"10.1136\/bcr-2013-203283","type":"journal-article","created":{"date-parts":[[2014,3,10]],"date-time":"2014-03-10T05:15:52Z","timestamp":1394428552000},"page":"bcr2013203283","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Rickettsial meningitis"],"prefix":"10.1136","volume":"2014","author":[{"given":"In\u00eas","family":"Salva","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Hospital de Dona Estef\u00e2nia, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"de Sousa","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hospital de Dona Estef\u00e2nia, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,3,10]]},"reference":[{"key":"2025082700243024000_2014.mar10_1.bcr2013203283.1","unstructured":"Eremeeva ME Dasch GA . 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