Vector-borne infections: a hazard for adventure visitors to Israel

Three vector-borne diseases, Mediterranean spotted fever, cave fever, and simple cutaneous leishmaniasis, are endemic to Israel. These diseases may pose a significant health hazard to visitors to this area. The objective of this article is to supply the essential information concerning these diseases to physicians who are unfamiliar with them, with the intention of preventing disease by better traveler education and enabling prompt recognition and treatment outside the endemic areas. Mediterranean spotted fever is a rickettsiosis transmitted by a dog tick and presenting as a high fever with headache and typical rash. Cave fever is a borrelial infection transmitted by a soft tick and presenting as a relapsing febrile disease. Both diseases can be prevented by avoiding endemic areas and ticks, and respond well to treatment with tetracycline. Cutaneous leishmaniasis is a protozoan infection of the skin transmitted by the sandfly and presenting as an indurated erythematous cutaneous nodule. It responds to topical paromomycin and to intralesional or systemic sodium stibogluconate, but the best policy is to take the proper precautions and avoid infection.