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Previous Volume 344:1504-1510 May 17, 2001 Number 20 Next

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ABSTRACT

Background African tick-bite fever occurs after contact with ticks that carry Rickettsia africae and that parasitize cattle and game. Sporadic reports suggest that this infection has specific clinical and epidemiologic features.

Methods We studied patients who were tested for a rickettsial disease after returning from a visit to Africa or Guadeloupe. To assess the value of the microimmunofluorescence assay, Western blotting, and cross-adsorption assays, we compared the results of these tests in 39 patients in whom African tick-bite fever had been confirmed by the polymerase-chain-reaction assay, cell culture, or both; 50 patients with documented R. conorii infection; and 50 blood donors. These diagnostic criteria were then applied to 376 additional patients who had returned from southern Africa and 2 who had returned from Guadeloupe and whose serum was being tested for rickettsial disease.

Results In the 39 patients with direct evidence of R. africae infection, the combination of microimmunofluorescence assay, Western blotting, and cross-adsorption assays showing antibodies specific for R. africae had a sensitivity of 0.56; however, each test had a positive predictive value and a specificity of 1.0. An additional 80 patients were found to have an R. africae infection on the basis of these serologic criteria. Infections with R. africae were acquired by visitors to 11 African countries and Guadeloupe. The illness was generally mild and was characterized by a rash in 46 percent of the patients; the rash was usually maculopapular or vesicular and rarely purpuric. Ninety-five percent of patients had an inoculation eschar or eschars, and 54 percent of these patients had multiple eschars, a finding that is unusual in patients with rickettsial infection.

Conclusions In this series, R. africae was the cause of nearly all cases of tick-bite rickettsiosis in patients who became ill after a trip to sub-Saharan Africa.

Source Information

From the Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseilles, France (D.R., P.E.F., F.F.); the Department of Internal Medicine, Aker University Hospital, Oslo, Norway (M.J.); the Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (T.P.); the Laboratoire de Biologie, Hôpital d'Instruction des Armées Laveran, Marseille Armées, France (J.J.D.); the Divisione Malattie Infettive, Ospedale di Belluno, Belluno, Italy (G.C.); the Department of Microbiology and Infectious Diseases, John Radcliffe Hospital, Oxford, United Kingdom (N.J.); the Medical Department, Kaiser Franz Josef Hospital, Vienna, Austria (H.L.); the Division of Clinical Microbiology, Mayo Clinic, Rochester, Minn. (J.E.R.); and the Department of Medicine, University of Alberta, Edmonton, Alta., Canada (T.J.M.).

Address reprint requests to Dr. Raoult at the Unité des Rickettsies, CNRS:UPRESA 6020, Faculté de Medicine, Université de la Méditerranée, 27 Blvd. Jean Moulin, 13385 Marseilles CEDEX 05, France, or at didier. raoult{at}medecine.univ.mrs.fr.

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