{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:58:48Z","timestamp":1781632728816,"version":"3.54.5"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spotted Fever Group Rickettsiae (SFGR) infection is one of the global public health threats. With the improvement of current hygiene conditions, the incidence of rickettsial infections has significantly decreased compared with previous years; however, in clinical practice, rickettsial infections should still be considered in the differential diagnosis of febrile cases of unknown etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A construction worker, residing in crowded and poor sanitary conditions, presented with high fever and diffuse cutaneous rash, without reporting other associated discomfort. Empirical treatment with cephalosporin antibiotics failed to alleviate the symptoms. Given the unknown etiology of the patient\u2019s high fever and rash, routine etiological tests yielded negative results, with concurrent abnormalities in the white blood cell differential count of the complete blood count. A strong suspicion of infection by an unusual microorganism prompted the performance of metagenomic next-generation sequencing (mNGS) on venous blood. This test identified infection with Rickettsia rickettsii belonging to the spotted fever group, confirming a rickettsial infection. Following the establishment of the etiology, the antimicrobial treatment regimen was adjusted, and the patient was administered doxycycline for antimicrobial therapy. After treatment, the patient\u2019s body temperature returned to normal, the rash resolved, and the patient was discharged in a state of full recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>For patients working at construction sites with poor living conditions who present with high fever and rash but lack evidence of conventional microbial infection, clinicians should enhance their differential diagnostic capabilities and maintain vigilance for the occurrence of rickettsial infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-12735-7","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T10:00:23Z","timestamp":1770026423000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High fever with rash: a case report of spotted fever group rickettsial infection at a construction site"],"prefix":"10.1186","volume":"26","author":[{"given":"Luhang","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zekun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"1","key":"12735_CR1","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1016\/S2589-7500(22)00212-6","volume":"5","author":"YY Zhang","year":"2023","unstructured":"Zhang YY, Sun YQ, Chen JJ, Teng AY, Wang T, Li H, et al. Mapping the global distribution of spotted fever group rickettsiae: a systematic review with modelling analysis. Lancet Digit Health. 2023;5(1):e5\u201315. https:\/\/doi.org\/10.1016\/S2589-7500(22)00212-6. Epub 2022 Nov 21. PMID: 36424337; PMCID: PMC10039616.","journal-title":"Lancet Digit Health"},{"issue":"2","key":"12735_CR2","doi-asserted-by":"publisher","first-page":"106387","DOI":"10.1016\/j.jinf.2024.106387","volume":"90","author":"Z Teng","year":"2025","unstructured":"Teng Z, Zhang X, Zhao N, Dai L, Zhang X, Han L, et al. The increasing prevalence of Japanese spotted fever in China: a dominant rickettsial threat. J Infect. 2025;90(2):106387. https:\/\/doi.org\/10.1016\/j.jinf.2024.106387. Epub 2024 Dec 23. PMID: 39722306.","journal-title":"J Infect"},{"key":"12735_CR3","first-page":"2043","volume-title":"Molecular medical microbiology","author":"D Liu","year":"2014","unstructured":"Liu D. Rickettsia. In: Tang Y-W, Sussman M, Liu D, Poxton I, Schwartzman J, editors. Molecular medical microbiology. 2nd ed. Academic Press; 2014. p. 2043\u201356.","edition":"2nd"},{"key":"12735_CR4","doi-asserted-by":"publisher","first-page":"e286","DOI":"10.1017\/S0950268819001390","volume":"147","author":"MT Robinson","year":"2019","unstructured":"Robinson MT, Satjanadumrong J, Hughes T, Stenos J, Blacksell SD. Diagnosis of spotted fever group rickettsia infections: the Asian perspective. Epidemiol Infect. 2019;147:e286. https:\/\/doi.org\/10.1017\/S0950268819001390. PMID: 31587667; PMCID: PMC6805790.","journal-title":"Epidemiol Infect"},{"issue":"10","key":"12735_CR5","doi-asserted-by":"publisher","first-page":"e0012546","DOI":"10.1371\/journal.pntd.0012546","volume":"18","author":"F Xing","year":"2024","unstructured":"Xing F, Deng C, Huang J, Yuan Y, Luo Z, Lo SKF, et al. Usefulness of next-generation sequencing for laboratory diagnosis of rickettsiosis. PLoS Negl Trop Dis. 2024;18(10):e0012546. https:\/\/doi.org\/10.1371\/journal.pntd.0012546. PMID: 39383151; PMCID: PMC11463775.","journal-title":"PLoS Negl Trop Dis"},{"key":"12735_CR6","doi-asserted-by":"publisher","first-page":"105887","DOI":"10.1016\/j.actatropica.2021.105887","volume":"218","author":"NA Husin","year":"2021","unstructured":"Husin NA, AbuBakar S, Khoo JJ. Current tools for the diagnosis and detection of spotted fever group rickettsia. Acta Trop. 2021;218:105887. https:\/\/doi.org\/10.1016\/j.actatropica.2021.105887. Epub 2021 Mar 11. PMID: 33713627.","journal-title":"Acta Trop"},{"key":"12735_CR7","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1051\/vetres:2005004","volume":"36","author":"P Parola","year":"2005","unstructured":"Parola P, Davoust B, Raoult D. Tick-and flea-borne rickettsial emerging zoonoses. Vet Res. 2005;36:469\u201392. https:\/\/doi.org\/10.1051\/vetres:2005004.","journal-title":"Vet Res"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-12735-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12735-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12735-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:31:39Z","timestamp":1781631099000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-12735-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["12735"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-12735-7","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"assertion":[{"value":"3 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics and informed consent waiver applications were approved by the Ethics Committee of The Fourth Hospital of Hebei Medical University (2025KT017).","order":2,"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 report and any accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"472"}}