Intravenous Minocycline and Levofloxacin for Treatment of Two Cases of Japanese Spotted Fever

We report herein on two cases of Japanese spotted fever (JSF) treated with intravenous minocycline (MINO) and levofloxacin (LVFX). An 80 year-old woman (Case1) and a 63 year-old man (Case2) with high fever (> 39 degrees C) and wide-spread skin erythema were admitted because they were suspected of having developed JSF. After admission, we treated them with intravenous MINO and LVFX. The patients' fevers were resolved within 36 hours after antibiotics. They were diagnosed as having JSF based on the serological test, and Rickettsia japonica was detected from the genetic findings (PCR analysis from eschar) only in case 1. In the treatment of fulminant JSF (body temperature > 39 degrees C) the prompt administration of a combination of tetracycline and new quinolone has been recommended. The number of cases of JSF and its endemic area are gradually increasing in Japan. As for new quinolones, ciprofloxacin and tosufloxacin have been used against to JSF in Japan, but LVFX may become a new option.