Background and aims: To present our experience on epidemiology of Rickettsia typhi and Rickettsia conorii
infections in a pediatric population in Greece, during the last 9 years (January 2003-October 2011).
Methods: Serum samples from children hospitalized for prolonged fever were tested for R. typhi and R. conorii with
serological assays in a pediatric hospital in Athens. Serological evaluation was performed with an indirect
immunofluorescence assay. The IgM diagnostic titer was set at ≥1:64 and the IgG was set at ≥1:128.
Results: A total of 2720 serum samples were tested. Overall, 26 children (15 male, 11 female, aged 6 months to 15
years old) were screened positive for R. typhi or/and for R. conorii. Of those, 14 children exhibited positive antibodies
only for R. typhi, 4 exclusively for R. conorii, while 8 children yielded positive results for both species. The serum
samples were tested for antibodies against R. conorii and/or R. typhi 6 to 20 days after the onset of fever. The major
clinical manifestations of the infection were, as follows: rash, mainly maculopapular, 47%; splenomegaly, 36%;
lymphadenopathy, 29%; hepatomegaly, 21%. The most frequent laboratory finding was increased transaminase
activity 56.5% (AST: 21 to 240 U/L and ALT: 11 to 170 U/L). The majority of cases (73%) were identified from June to
September. The outcome was favorable for all 26 patients.
Conclusions: Although rickettsiosis is rare in our country, this infection should be considered in every child with
prolonged fever, rash and slight or moderate elevations of both transaminase activity