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Background  The number of new rickettsial species are rapidly increasing, and increasing numbers of  Rickettsia raoultii  ( R .  raoultii ) infection cases have been detected in humans. However, neurological abnormalities caused by  R. raoultii  are rarely reported, especially in northwestern China.    Case presentation  A 36-year-old Kazakh shepherd with an attached tick on part temporalis, presented with right eyelid droop, lethargy, fever, headache, fever (38.0–41.0 °C) and erythematous rash. The examination of cerebrospinal fluid (CSF) showed cerebrospinal pressure of 200 mm H 2 O, leukocyte count of 300.0 × 10 6 /L, adenosine deaminase of 2.15 U/L, and total protein concentration of 0.93 g/L. The diagnosis of  R .  raoultii  infection was confirmed by six genetic markers, and semi-quantified by enzyme-linked immunosorbent assay for rickettsial antigen. The patient gradually recovered after treatment with doxycycline and ceftriaxone.  R .  raoultii  DNA was found both in a tick detached from this patient and in 0.18% (2/1107) of blood samples collected from local shepherds.    Conclusions  This is the first reported case with neurological abnormalities caused by  R. raoultii  in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by  Rickettsia .

A case with neurological abnormalities caused by Rickettsia raoultii in northwestern China