Central infection with Rickettsia felis complicated with stroke: A case series and review

<i>Rickettsia felis</i> (<i>R. felis</i>) is an emerging pathogen primarily transmitted by fleas, with clinical manifestations similar to other rickettsial infections. Although rare, severe cases involving central nervous system complications, such as meningoencephalitis, have been reported. This article presents three cases of <i>R. felis</i> central infections complicated by stroke. Two patients experienced cerebral infarctions, while another had a subarachnoid hemorrhage. Analysis of cerebrospinal fluid revealed common features, including elevated protein levels and increased nucleated cells with lymphocytic predominance. This report emphasizes the importance of considering <i>R. felis</i> as a potential cause of stroke in febrile patients, and highlights the role of advanced diagnostic techniques, such as next-generation sequencing (NGS), in the timely identification of rare pathogens. Early detection and appropriate treatment are crucial for optimizing patient outcomes.