Boutonneuse fever transmitted by conjunctival inoculation.

We report three cases (two adult males and a 12-year-old child) of boutonneuse fever produced by inoculation of the conjunctival mucosa (probably through accidental entry of R. conorii fluid into the eyes through rubbing or splashing). All three patients developed similar symptoms of disease, including high fever, headache, maculopapular exanthem, and conjunctivitis, and none had tache noire. Specific immunofluorescent antibodies appeared in these patients' serum mostly after the 2nd week; agglutinins to Proteus OX-19, OX-2 (Weil-Felix reaction) were found. Cure was obtained by oral tetracycline. Conjunctival inoculation of R. conorii producing boutonneuse fever is very rare; this report will probably be one of the first published in the medical literature.