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However, neurological abnormalities caused by <jats:italic>R. raoultii<\/jats:italic> are rarely reported, especially in northwestern China.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 36-year-old Kazakh shepherd with an attached tick on part temporalis, presented with right eyelid droop, lethargy, fever, headache, fever (38.0\u201341.0\u2009\u00b0C) and erythematous rash. The examination of cerebrospinal fluid (CSF) showed cerebrospinal pressure of 200\u2009mm H<jats:sub>2<\/jats:sub>O, leukocyte count of 300.0\u2009\u00d7\u200910<jats:sup>6<\/jats:sup>\/L, adenosine deaminase of 2.15\u2009U\/L, and total protein concentration of 0.93\u2009g\/L. The diagnosis of <jats:italic>R<\/jats:italic>. <jats:italic>raoultii<\/jats:italic> infection was confirmed by six genetic markers, and semi-quantified by enzyme-linked immunosorbent assay for rickettsial antigen. The patient gradually recovered after treatment with doxycycline and ceftriaxone. <jats:italic>R<\/jats:italic>. <jats:italic>raoultii<\/jats:italic> DNA was found both in a tick detached from this patient and in 0.18% (2\/1107) of blood samples collected from local shepherds.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This is the first reported case with neurological abnormalities caused by <jats:italic>R. raoultii<\/jats:italic> in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by <jats:italic>Rickettsia<\/jats:italic>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-019-4414-4","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T06:51:48Z","timestamp":1568184708000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["A case with neurological abnormalities caused by Rickettsia raoultii in northwestern China"],"prefix":"10.1186","volume":"19","author":[{"given":"Zhihui","family":"Dong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicheng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songsong","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbo","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wumei","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,9,11]]},"reference":[{"issue":"7","key":"4414_CR1","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1136\/jnnp-2014-308722","volume":"86","author":"UK Misra","year":"2014","unstructured":"Misra UK, Kalita J, Mani VE. 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(Letter Number: 2017\u2013112-03). Written informed consent was obtained for all research participants.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"796"}}