Mediterranean spotted fever in Spain, 1997-2014: Epidemiological situation based on hospitalization records

PLoS One. 2017 Mar 29;12(3):e0174745. doi: 10.1371/journal.pone.0174745. eCollection 2017.

Abstract

Introduction: Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii. In Spain, deficiencies in the official reporting result in misreporting of this disease. This study aims to describe the clinical and temporal-spatial characteristics of MSF hospitalizations between 1997 and 2014.

Materials and methods: We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD). All CMBD's hospital discharges with ICD-9 CM code 082.1 were analyzed. Hospitalization rates were calculated and clinical characteristics were described. Spatial distribution of cases and their temporal behavior were also assessed.

Results: A total of 4,735 hospitalizations with MSF diagnosis were recorded during the study period, out of which 62.2% were male, mean age of 48. Diabetes mellitus, alcohol dependence syndrome, and chronic liver disease occurred in 10.8%, 2.4% and 2.8% hospitalizations, respectively. The median annual hospitalization rate showed a decreasing trend from a maximum of 12.9 in 1997 to a minimum rate of 3.1 in 2014. Most admissions occurred during the summer, showing a significant annual seasonal behavior. Important regional differences were found.

Discussion: Although MSF hospitalization rates have decreased considerably, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and surveillance.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alcoholism / epidemiology
  • Boutonneuse Fever / diagnosis
  • Boutonneuse Fever / epidemiology*
  • Boutonneuse Fever / virology*
  • Chronic Disease
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Female
  • Hospital Records / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Host-Pathogen Interactions
  • Humans
  • International Classification of Diseases
  • Linear Models
  • Liver Diseases / epidemiology
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Retrospective Studies
  • Rickettsia conorii / physiology*
  • Spain / epidemiology
  • Syndrome
  • Young Adult

Grants and funding

This study was supported by Project “PI15/01398”, funded by Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, “Investing in your future”) and the Network Biomedical Research on Tropical Diseases (RICET in Spanish) RD12/0018/0001, supported by the European Regional Development Fund (FEDER) from the European Comission.