Abstract
Mediterranean spotted fever (MSF) has been recognised as an endemic disease in Algeria for over half a century, yet critical questions regarding its true burden, evolving clinical spectrum, and emerging pathogen diversity remain unanswered. This review critically synthesises epidemiological, entomological, and clinical data from Algeria spanning 1951 to 2025, with the aim of identifying knowledge gaps and proposing a forward-looking research agenda. Evidence confirms persistent circulation of Rickettsia conorii across diverse ecological zones, with Rhipicephalus sanguineus as the primary vector. However, molecular surveys have increasingly detected a widening array of spotted fever group rickettsiae—including R. aeschlimannii, R. massiliae, R. slovaca, and novel genotypes—in ticks infesting livestock, dogs, and wildlife, suggesting that the traditional MSF paradigm centred on a single pathogen-vector pair is no longer tenable. Clinically, severe neurological and systemic forms are reported with unexpected frequency, yet population-based incidence data are virtually absent due to underdiagnosis and fragmented surveillance. We argue that Algeria stands at an epidemiological crossroads: environmental change, land-use pressure, and expanding vector-host interactions are likely to intensify transmission and complicate disease patterns. To address this, we propose a national MSF research and control framework structured around four pillars: (i) establishment of sentinel surveillance networks integrating human, animal, and vector data; (ii) molecular characterisation of rickettsial strains to link genotype with clinical phenotype; (iii) ecological studies to model vector distribution under climate scenarios; and (iv) capacity building for decentralised molecular diagnostics. Without such investments, MSF will remain a hidden burden and a missed opportunity for preventing severe, disabling, and potentially fatal infections.