'Do not dismiss it': U.K. infectious disease experts warn of illness transmitted by bug bites in the Mediterranean

New tick-borne illness, not Lyme disease Cases emerge of a disease spread by ticks. It's not Lyme disease but it can be serious. CTVs Kimberley Johnson reports.

Infectious disease experts in the United Kingdom are highlighting an illness they say is endemic in the Mediterranean basin and are urging for more awareness and early treatment to prevent “severe complications.”

The physicians point to a case of a U.K. man in his 50s who tested positive for the illness, called Mediterranean spotted fever (MSF), after returning home following a trip to the Mediterranean. Their report on the case was published in December in the BMJ,a peer-reviewed medical journal published by the British Medical Association.

The man’s symptoms began a day after he returned from his trip, starting with symptoms of malaise, fever, chills and a severe headache, the report states.

The report included an account by the patient. “In late spring I took a trip to the Mediterranean,” he said.“I was bitten by an insect in the long grass but dismissed it because this often happens. Within a few days of my return home, I started to feel unwell.”

After multiple days of symptoms that were escalating to include shortness of breath, he was hospitalized with sepsis, which is an extreme response to an infection and is life threatening. It involves the body’s immune response turning on its own organs, causing them to fail, according to the U.S. Centers for Disease Control and Prevention.

The sepsis he experienced affected multiple organs and he also developed what’s called a maculopapular rash, which involves flat and raised skin lesions. He also developed eschar, which is a piece of dead tissue that falls off the surface of the skin, on his hips. As well, he had pink eye in both eyes.

He tested positive for Rickettsia spp (spotted fever group bacteria). Doctors concluded that this was most likely a case of MSF, caused by a bacterium called Rickettsia conorii. He was given antibiotics over the course of 14 days in the hospital and was able to recover well, the physicians state.

But in the aftermath of being released from the hospital, the patient did experience “significant” weight loss, an ongoing mild hand tremor, and some hearing impairment. Four months after discharge, the patient finally reported any lasting symptoms were gone.

MSF is in the spotted fever group of illnesses that are almost always transmitted by bugs known as arthropod vectors. They include ticks, mosquitoes, flies and lice.

The illness was first recorded in 1910 in Tunisia, and is most common in Mediterranean countries such as Portugal, particularly in the summer, the infectious disease experts state.

While incidents of MSF have declined in the Mediterranean in the last few years, worldwide cases of rickettsial diseases overall have increased due to climate change and human travel behaviour, they state. Though MSF usually causes mild disease, it can be severe and symptoms can be neurological.

In Canada, the federal government has information on spotted fever diseases on its website, but it does not publicly report cases. Overall, tick-borne illnesses are increasing in Canada and a better testing system is needed to track the cases, researchers said in a study published in November.

In a report published in 2020, Canadian researchers from Public Health Ontario explain that it’s difficult to determine the burden of rickettsial infections in Ontario, as they aren’t reported to public health. Based on the data they had, it seems cases are low, but could be higher with more information, and further research in Ontario is needed.

In this case, the patient had eye inflammation and what the doctors’ called “Purtscher-like retinopathy,” which is when fluid builds up under the retina, and is often associated with traumatic injury. That’s a symptom that hadn’t been previously described with MSF, they state. And that kind of symptom is associated with organ failure and death, they add.

These concerns and the challenges in diagnosing a patient are why the physicians emphasized the need for the public to be aware of the illness and for patients to receive proper treatment as soon as possible.

“Prevention of disease involves regular self-checks, avoidance of ticks and tick habitats, wearing barrier clothing and using insecticides,” the researchers state. “Mortality of MSF in countries such as Portugal is around 3.6 per cent, but can be as high as 60 per cent without treatment.”

That’s why the patient says he wants others to be aware of what he went through.

“If you ever get bitten by an insect, either here or abroad, do not dismiss it,” he states in the report.

“Insect bites can cause as many problems as spider or snake bites which you may take more seriously. If you feel unwell or the bite starts to get red make sure you seek medical advice.