MEDITERRANEAN SPOTTED FEVER IN ALGERIA

A Critical Review of Epidemiological Transitions, Emerging Pathogen Diversity, and the Case for a One Health Strategy.

Authors

  • Asia Beneldjouzi Laboratoire d'éco-épidémiologie Parasitaire et génétique des Population, Dely Brahim, Alger, Algérie Author
  • Lydia Hamrioui Laboratoire d'éco-épidémiologie Parasitaire et génétique des Population, Dely Brahim, Alger, Algérie Author
  • Idir Bitam Centre de recherche en Agropastoralisme, Djelfa, Algérie Author
  • Naouel Eddaikra Laboratoire d'éco-épidémiologie Parasitaire et génétique des Population, Dely Brahim, Alger, Algérie Author

DOI:

https://doi.org/10.58395/2ncncb61

Abstract

Mediterranean spotted fever (MSF) has been recognised as an endemic disease in Algeria for over half a century, yet critical questions regarding its true burden, evolving clinical spectrum, and emerging pathogen diversity remain unanswered. This review critically synthesises epidemiological, entomological, and clinical data from Algeria spanning 1951 to 2025, with the aim of identifying knowledge gaps and proposing a forward-looking research agenda. Evidence confirms persistent circulation of Rickettsia conorii across diverse ecological zones, with Rhipicephalus sanguineus as the primary vector. However, molecular surveys have increasingly detected a widening array of spotted fever group rickettsiae—including R. aeschlimannii, R. massiliae, R. slovaca, and novel genotypes—in ticks infesting livestock, dogs, and wildlife, suggesting that the traditional MSF paradigm centred on a single pathogen-vector pair is no longer tenable. Clinically, severe neurological and systemic forms are reported with unexpected frequency, yet population-based incidence data are virtually absent due to underdiagnosis and fragmented surveillance. We argue that Algeria stands at an epidemiological crossroads: environmental change, land-use pressure, and expanding vector-host interactions are likely to intensify transmission and complicate disease patterns. To address this, we propose a national MSF research and control framework structured around four pillars: (i) establishment of sentinel surveillance networks integrating human, animal, and vector data; (ii) molecular characterisation of rickettsial strains to link genotype with clinical phenotype; (iii) ecological studies to model vector distribution under climate scenarios; and (iv) capacity building for decentralised molecular diagnostics. Without such investments, MSF will remain a hidden burden and a missed opportunity for preventing severe, disabling, and potentially fatal infections.

Downloads

Download data is not yet available.

References

1. Spernovasilis N, Markaki I, Papadakis M, Mazonakis N, Ierodiakonou D. Mediterranean Spotted Fever: Current Knowledge and Recent Advances. Trop Med Infect Dis. 2021;6(4):172. https://doi.org/10.3390/tropicalmed6040172

2. Brufau-Cochs M, Alamon-Reig F. Mediterranean spotted fever. Med Clin (Barc). 2024;162(10):e41. https://doi.org/10.1016/j.medcli.2023.10.028

3. Baltadzhiev I, Zaprianov Z, Baltadjiev A. Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data. Med Princ Pract. 2021;30(4):369-375. https://doi.org/10.1159/000516167

4. Chugh S, Kumari P, Goel S, Biswal M, Sehgal IS, Sekar A. Rickettsia conorii infection with fatal complication. Autops Case Rep. 2022;12:e2021392. https://doi.org/10.4322/acr.2021.392

5. Bouchaib H, Amrane A, Sevestre J, Bitam I, Parola P. Mediterranean spotted fever and peripheral facial nerve palsy: a rare neurological complication. Int J Infect Dis. 2022;117:15-17. https://doi.org/10.1016/j.ijid.2022.01.050

6. Gu XL, Wang R, Zhou CM, et al. Natural Mediterranean Spotted Fever Foci, Qingdao, China. Emerg Infect Dis. 2022;28(12):2524-2527. https://doi.org/10.3201/eid2812.221097

7. Sgroi G, Iatta R, Carelli G, et al. Rickettsia conorii Subspecies israelensis in Captive Baboons. Emerg Infect Dis. 2023;29(4):841-843. https://doi.org/10.3201/eid2904.221176

8. Benabdellah A, Mouffok N, Bensaad M, Belkadi Kouied A, Razik F. Mediterranean-spotted fever: clinical and laboratory characteristics of 34 children in Oran (Algeria). Pathol Biol (Paris). 2007;55(10):539-542. https://doi.org/10.1016/j.patbio.2007.07.016

9. Mouffok N, Parola P, Lepidi H, Raoult D. Mediterranean spotted fever in Algeria--new trends. Int J Infect Dis. 2009;13(2):227-235. https://doi.org/10.1016/j.ijid.2008.06.035

10. Wenjun LI, Mouffok N, Rovery C, Parola P, Raoult D. Genotyping Rickettsia conorii detected in patients with Mediterranean spotted fever in Algeria using multispacer typing (MST). Clin Microbiol Infect. 2009;15 Suppl 2:281-283. https://doi.org/10.1111/j.1469-0691.2008.02236.x

11. Bouchaib H, Eldin C, Laroche M, Raoult D, Parola P. Tick- and flea-borne rickettsioses in Tizi-Ouzou, Algeria: Implications for travel medicine. Travel Med Infect Dis. 2018;26:51-57. https://doi.org/10.1016/j.tmaid.2018.11.005

12. Ghaoui H, Adam IN, Basher Nosiba S, et al. Serological and Molecular Detection of Rickettsia spp in Patients with Meningeal Syndrome in Northern Algeria. Mediterr J Hematol Infect Dis. 2025;17(1):e2025046. https://doi.org/10.4084/MJHID.2025.046

13. Bitam I, Parola P, Matsumoto K, et al. First molecular detection of R. conorii, R. aeschlimannii, and R. massiliae in ticks from Algeria. Ann N Y Acad Sci. 2006;1078:368-372. https://doi.org/10.1196/annals.1374.073

14. Kernif T, Messaoudene D, Ouahioune S, Parola P, Raoult D, Bitam I. Spotted fever group rickettsiae identified in Dermacentor marginatus and Ixodes ricinus ticks in Algeria. Ticks Tick Borne Dis. 2012;3(5-6):380-381. https://doi.org/10.1016/j.ttbdis.2012.10.012

15. Beneldjouzi A, Lafri I, Djerbouh A, et al. Molecular Evidence of Spotted Fever Group Rickettsiae in Ticks and Fleas Collected from Some Wild and Domestic Animals in Different Biotopes in Algeria. J Arthropod Borne Dis. 2024;18(4):328-345. https://doi.org/10.18502/jad.v18i4.19339

16. Ullah S, Alouffi A, Almutairi MM, et al. First Report of Rickettsia conorii in Hyalomma kumari Ticks. Animals (Basel). 2023;13(9):1488. https://doi.org/10.3390/ani13091488

17. Socolovschi C, Gaudart J, Bitam I, Huynh TP, Raoult D, Parola P. Why are there so few Rickettsia conorii conorii-infected Rhipicephalus sanguineus ticks in the wild? PLoS Negl Trop Dis. 2012;6(6):e1697. https://doi.org/10.1371/journal.pntd.0001697

18. Epidemiological Reports (REM). Algiers: Ministry of Health; 2000-2002.

19. Blanc G. Rickettsia (Coxiella) burnetii (Derrick) au Maroc et accessoirement en Algérie et en Afrique Equatoriale; étude expérimentale. Rev Belg Pathol Med Exp. 1951;21(1):17-36.

20. Bernard JG, Bereni J, Hainaut J. Aspect Actuel Des Rickettsioses En Algérie: Present Status Of The Rickettsioses In Algeria. Bull Soc Pathol Exot Filiales. 1963;56:620-628.

21. Mouffok N, Benabdellah A, Richet H, et al. Reemergence of rickettsiosis in Oran, Algeria. Ann N Y Acad Sci. 2006;1078:180-184. https://doi.org/10.1196/annals.1374.033

22. Benredjem W, Leulmi H, Bitam I, Raoult D, Parola P. Borrelia garinii and Rickettsia monacensis in Ixodes ricinus ticks, Algeria. Emerg Infect Dis. 2014;20(10):1776-1777. https://doi.org/10.3201/eid2010.140265

23. Mokrani K, Tebbal S, Raoult D, Fournier PE. Human rickettsioses in the Batna area, eastern Algeria. Ticks Tick Borne Dis. 2012;3(5-6):364-366. https://doi.org/10.1016/j.ttbdis.2012.10.017

24. Dib L, Lafri I, Boucheikhchoukh M, Dendani Z, Bitam I, Benakhla A. Seasonal distribution of Rickettsia spp. in ticks in northeast Algeria. New Microbes New Infect. 2018;27:48-52. https://doi.org/10.1016/j.nmni.2018.11.002

25. Laatamna A, Strube C, Bakkes DK, et al. Molecular detection of tick-borne pathogens in Rhipicephalus sanguineus sensu stricto collected from dogs in the steppe and high plateau regions of Algeria. Acta Trop. 2022;234:106582. https://doi.org/10.1016/j.actatropica.2022.106582

26. Zeroual F, Leulmi H, Bitam I, Benakhla A. Molecular evidence of Rickettsia slovaca in spleen of wild boars in northeastern Algeria. New Microbes New Infect. 2018;24:17-20. https://doi.org/10.1016/j.nmni.2018.03.008

27. Abdelkadir K, Palomar AM, Portillo A, Oteo JA, Ait-Oudhia K, Khelef D. Presence of Rickettsia aeschlimannii, Candidatus Rickettsia barbariae and Coxiella burnetii in ticks from livestock in Northwestern Algeria. Ticks Tick Borne Dis. 2019;10(4):924-928. https://doi.org/10.1016/j.ttbdis.2019.04.018

28. Dahmani M, Loudahi A, Mediannikov O, Fenollar F, Raoult D, Davoust B. Molecular detection of Anaplasma platys and Ehrlichia canis in dogs from Kabylie, Algeria. Ticks Tick Borne Dis. 2015;6(2):198-203. https://doi.org/10.1016/j.ttbdis.2014.12.007

29. Djerbouh A, Kernif T, Beneldjouzi A, et al. The first molecular detection of Rickettsia aeschlimannii in the ticks of camels from southern Algeria. Ticks Tick Borne Dis. 2012;3(5-6):374-376. https://doi.org/10.1016/j.ttbdis.2012.10.014

30. Boucheikhchoukh M, Mechouk N, Benakhla A, Raoult D, Parola P. Molecular evidence of bacteria in Melophagus ovinus sheep keds and Hippobosca equina forest flies collected from sheep and horses in northeastern Algeria. Comp Immunol Microbiol Infect Dis. 2019;65:103-109. https://doi.org/10.1016/j.cimid.2019.05.010

31. Khaldi M, Socolovschi C, Benyettou M, et al. Rickettsiae in arthropods collected from the North African Hedgehog (Atelerix algirus) and the desert hedgehog (Paraechinus aethiopicus) in Algeria. Comp Immunol Microbiol Infect Dis. 2012;35(2):117-122. https://doi.org/10.1016/j.cimid.2011.11.007

32. Aouadi A, Benkacimi L, Zan Diarra A, et al. Microorganisms associated with the North African hedgehog Atelerix algirus and its parasitizing arthropods in Algeria. Comp Immunol Microbiol Infect Dis. 2022;80:101726. https://doi.org/10.1016/j.cimid.2021.101726

33. Marx R, Néel R, Lafare H. A propos d'une petite épidémie de typhus historique en Algérie. Contribution a l'étude de la valeur du séro-diagnostic en milieu non vacciné. Bull Soc Pathol Exot Filiales. 1966;59(2):172-177.

34. Ducroiset B. Un cas de rickettsiose à R. Mooseri, d'origine professionnelle probable, chez un platrier, peintre. Arch Mal Prof. 1968;29(12):710-712.

35. Niang M, Brouqui P, Raoult D. Epidemic typhus imported from Algeria. Emerg Infect Dis. 1999;5(5):716-718. https://doi.org/10.3201/eid0505.990515

36. Mouffok N, Parola P, Raoult D. Murine typhus, Algeria. Emerg Infect Dis. 2008;14(4):676-678. https://doi.org/10.3201/eid1404.071376

37. Mouffok N, Socolovschi C, Renvoise A, Parola P, Raoult D. Diagnosis of rickettsioses from eschar swab samples, Algeria. Emerg Infect Dis. 2011;17(10):1968-1969. https://doi.org/10.3201/eid1710.110332

38. Birg ML, La Scola B, Roux V, Brouqui P, Raoult D. Isolation of Rickettsia prowazekii from blood by shell vial cell culture. J Clin Microbiol. 1999;37(11):3722-3724. https://doi.org/10.1128/JCM.37.11.3722-3724.1999

39. Lafri I, Leulmi H, Baziz-Neffah F, et al. Detection of a novel Rickettsia sp. in soft ticks (Acari: Argasidae) in Algeria. Microbes Infect. 2015;17(11-12):859-861. https://doi.org/10.1016/j.micinf.2015.09.010

40. Zurita A, Djeghar R, Callejón R, Cutillas C, Parola P, Laroche M. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry as a useful tool for the rapid identification of wild flea vectors preserved in alcohol. Med Vet Entomol. 2019;33(2):185-194. https://doi.org/10.1111/mve.12351

41. Parola P, Davoust B, Raoult D. Tick- and flea-borne rickettsial emerging zoonoses. Vet Res. 2005;36(3):469-492. https://doi.org/10.1051/vetres:2005004

42. Narra HP, Sahni A, Alsing J, et al. Comparative transcriptomic analysis of Rickettsia conorii during in vitro infection of human and tick host cells. BMC Genomics. 2020;21(1):665. https://doi.org/10.1186/s12864-020-07077-w

43. Rehácek J. Rickettsiae and their ecology in the Alpine region. Acta Virol. 1993;37(4):290-301.

44. Derne B, Weinstein P, Musso D, Lau C. Distribution of rickettsioses in Oceania: past patterns and implications for the future. Acta Trop. 2015;143:121-133. https://doi.org/10.1016/j.actatropica.2014.10.012

45. Mencke N. Future challenges for parasitology: vector control and 'One health' in Europe: the veterinary medicinal view on CVBDs such as tick borreliosis, rickettsiosis and canine leishmaniosis. Vet Parasitol. 2013;195(3-4):256-271. https://doi.org/10.1016/j.vetpar.2013.04.007

Downloads

Published

2026-09-19

Issue

Section

Articles

How to Cite

(1)
Beneldjouzi, A.; Hamrioui, L.; Bitam, I.; Eddaikra, N. MEDITERRANEAN SPOTTED FEVER IN ALGERIA: A Critical Review of Epidemiological Transitions, Emerging Pathogen Diversity, and the Case for a One Health Strategy. Probl Infect Parasit Dis 2026, 54 (2), 53-66. https://doi.org/10.58395/2ncncb61.