Serologic Study of Rickettsioses among Acute Febrile Patients in Central Tunisia N. KAABIA, a J.M. ROLAIN, b M. KHALIFA, a E. BEN JAZIA, a F. BAHRI, a D. RAOULT, b AND A. LETA ¨ IEF a a Internal Medicine and Infectious Diseases Unit, CHU F, Hached Sousse Tunisia b Unit´ e des Rickettsies, CNRS UMR 6020, Facult´ e de M´ edecine Marseille-France ABSTRACT: Although Mediterranean spotted or “boutonneuse” fever (MSF) has been documented in central Tunisia, other spotted fever group rickettsioses (SFGR) and typhus group rickettsioses (TGR) have received little attention in our region. We sought to determine the role of rick- ettsioses, Q fever, ehrlichioses, and bartonelloses among patients with acute fever. The results of this study of 47 persons with acute fever of un- determined origin are reported in this paper. We concluded that SFGR, murine typhus, and acute Q fever are common causes of acute isolate fever in summer in central Tunisia and should be investigated systemat- ically in patients with acute fever of unknown origin. KEYWORDS: rickettsia; epidemiology; Q fever; bartonella; ehrlichia; Tunisia INTRODUCTION Rickettsiae are gram-negative and obligate intracellular bacteria belonging to the  group of Proteobacteria. 1 In the Mediterranean basin, especially in North Africa, there are few reports on the prevalence of human rickettsiosis, Q fever, and ehrlichiosis. In Tunisia, although Mediterranean spotted fever (MSF) is endemic, other rickettsial infections were reported among patients with acute febrile illness and the prevalence of antibodies against Coxiella burnetii (C. burnetii) has been reported to be as high as 26% in central Tunisia. 2,3,4 In addition, numerous other infectious agents are responsible for acute febrile illnesses (such as vector-borne bacterial and viral diseases, typhoid fever, and malaria). These causes vary by region, climatic conditions, and endemicity of some diseases. 5 In our region, we recently noted two outbreaks of West Nile virus (WNV) infection. 6,7 In this report we attempted to evaluate the prevalence Address for correspondence: Amel Letaief, Service de M´ edecine Interne et Maladies Infectieuses, CHU F, Hached-Sousse 4000 Tunisia. Voice/fax: +216-73-21-11-83. e-mail: amel.letaief@famso.rnu.tn Ann. N.Y. Acad. Sci. 1078: 176–179 (2006). C  2006 New York Academy of Sciences. doi: 10.1196/annals.1374.126 176