[TIBOLA: an emerging clinically polymorphous rickettsiosis]

Abstract

Background: TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases.

Patients and methods: Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case.

Discussion: TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.

Keywords: Alopecia; Alopécie; Escarre d’inoculation; Facial oedema; Inoculation eschar; Rickettsiose; Rickettsiosis; TIBOLA; Tick; Tique; Œdème facial.