Introduction

Doctors in Britain are likely to recognise that sick travellers returning from the tropics may have infections that are not transmitted in the United Kingdom. They may not be aware that travellers to neighbouring countries in Europe may also return with infections that are not encountered in the United Kingdom. These diseases may then be difficult for doctors in Britain to diagnose, especially when patients present with non-specific features such as fever and rash. Millions of British travellers to Europe are potentially exposed to Mediterranean spotted fever every year. This can present with vague features, but early and specific treatment can help to avoid serious or fatal complications.

Case report

In August 1995 a 14 year old British boy spent two weeks on holiday in a villa in the Algarve, Portugal. A week after returning to Britain he became unwell with nausea, anorexia, and fever. On the third day of illness he developed a non-pruritic rash and was given penicillin for a presumed streptococcal infection. Six days later he was admitted to hospital.

On examination his temperature was 39.4°C. He had a widespread macular erythematous rash with raised purpuric centres (1 (left)). Investigations on admission included a full blood analysis. Haemoglobin concentration was 125 g/l, white cell count 4.2x10 …