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Case Reports
. 2025 Jan 7;1(2):e00010-24.
doi: 10.1128/asmcr.00010-24. eCollection 2025 Mar.

Another traveler's tale: African tick-bite fever

A Brunet #  1 , A Leplatois #  1 , Clement Lier #  2 , A Limelette #  3 , Y N'Guyen  1   4
Affiliations
Case Reports

Another traveler's tale: African tick-bite fever

A Brunet et al. ASM Case Rep. .

Abstract

Background: In the present report, we discuss the clinical and species-specific diagnosis of African tick-bite fever.

Case summary: A 58-year-old man was admitted to the hospital for fever, headache, and myalgia. The clinical examination yielded only two small purpuric lesions with a dark center on the thigh and the abdomen. The patient reported that he had just returned from a 10-day trip to the eastern region of South Africa, and that he had hiked through the bush in Eswatini 7 days before the onset of fever. The white blood cell count showed lymphopenia, and the C reactive protein and alanine aminotransferase levels were mildly elevated. The diagnoses of bacteremia, malaria, COVID 19, and arboviruses were ruled out. Both the diagnoses of African tick-bite fever and Mediterranean spotted fever were plausible because both Rickettsia africae and Rickettsia conorii are present in South Africa. The presence of two skin lesions presumed to be necrotic eschars was a bit more suggestive of African tick-bite fever. Treatment with doxycycline was started once blood serology and a biopsy of the abdominal lesion had been performed. The outcome was rapidly favorable. A PCR assay performed on the abdominal eschar confirmed the involvement of R. africae, while the successive serological assays did not.

Conclusion: Numerous necrotic eschars without secondary maculopapular rash affecting the sole and palms are more commonly observed in African tick-bite fever than in Mediterranean spotted fever.

Keywords: PCR; Rickettsia africae; eschar; serology; tick.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig 1
Fig 1
(A) Photograph of the right thigh (fourth day of fever). (B) Photograph of the abdomen (fourth day of fever). (C) Timeline of the present case.
See this image and copyright information in PMC

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