1/25. Tick-borne relapsing fever imported from West Africa: diagnosis by quantitative buffy coat analysis and in vitro culture of borrelia crocidurae. West African tick-borne relapsing fever (TBRF) is difficult to diagnose due to the low number of spirochetes in the bloodstream of patients. Previously, the causative microorganism, borrelia crocidurae, had never been cultured in vitro. TBRF was rapidly diagnosed for two patients returning from western Africa with fever of unknown origin by quantitative buffy coat (QBC) analysis. diagnosis was confirmed by intraperitoneal inoculation of blood specimens from patients into laboratory mice. in vitro experiments showed that QBC analysis may be as much as 100-fold more sensitive than thick smear. Spirochetes were also cultured from blood samples from both patients in modified Kelly's medium and were identified as B. crocidurae by partial sequencing of the PCR-amplified rrs gene. ( info) |
2/25. Imported African tick bite fever: a case report. We describe a patient with African tick-bite fever who acquired his infection while visiting rural areas of south africa and then became sick after returning to the united states. The dominant clinical feature of his illness was the presence of multiple, ulcerated lesions (tache noires). physicians in the United States and other non-African countries who see travelers returning from southern parts of Africa who give a history of recent tick bite and/or present with multiple, crusted or vesicular skin lesions should be alert to this diagnosis and institute treatment with doxycycline. ( info) |
3/25. African tick-bite fever imported into norway: presentation of 8 cases. We report on 8 Norwegian travellers to Southern Africa with African tick-bite fever (ATBF), a recently described spotted fever group rickettsiosis. All patients had acute flu-like symptoms and developed I or multiple inoculation eschars. The patients were treated with either doxycycline or ciprofloxacin, and all recovered. The diagnosis of ATBF was confirmed by the detection of specific IgM antibodies to Rickettsia africae by microimmunofluoroscence in convalescent-phase serum samples. ( info) |
4/25. An incident involving blood sucking by a tick in a suburb in japan. We encountered a patient whose blood was sucked by Haemaphysalis longicornis in the suburb of a business city in Tokushima prefecture in japan. The tick, which had been attached to the lower limb of the patient for one week, measured 10 mm in length. There were no notable objective or subjective findings after the complete extirpation of the tick. The area had not been known in recent history to be a habitat of ticks, and, thus, this case is of importance in terms of predicting future trends of tick-borne diseases in japan. ( info) |
5/25. African tick bite fever: not a spotless rickettsiosis! African tick bite fever is caused by Rickettsia africae, a newly recognized species from south africa. We report the case of a patient with an unusual site of a tick bite and discuss cutaneous differences from other spotted fevers that may help dermatologists with clinical diagnosis. ( info) |
6/25. Spotted fever in hong kong. A previously healthy 7-year-old hong kong-born Caucasian child developed sudden onset fever, followed by a generalized rash and systemic symptoms of rigor and prostration, mucous membrane involvement (conjunctivitis) and arthralgia. He lives in a rural area of hong kong and has been in contact with various domestic animals--rodents, dogs and cows. chloramphenicol 50 mg/kg/day was given on day 4 with rapid response. Subsequent Weil-Felix test and specific serology suggested the diagnosis of rickettsial infection of the spotted fever group. To our knowledge, this is the first confirmed case of spotted fever reported in hong kong. ( info) |
7/25. Human anaplasmosis presenting as atypical pneumonitis in france. Human anaplasmosis is a febrile illness caused by anaplasma phagocytophilum, an intracellular bacterium transmitted by ixodes ticks in the united states and europe. Although cough is reported in 30% of the American cases, interstitial pneumonitis has been noted only once. Of the 9 confirmed cases reported in europe, 3 presented with atypical pneumonitis. A. phagocytophilum should be added to the list of agents responsible for interstitial pneumonitis, especially in areas where human anaplasmosis is endemic. ( info) |
8/25. Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the united states. ticks, including many that bite humans, are hosts to several obligate intracellular bacteria in the spotted fever group (SFG) of the genus Rickettsia. Only rickettsia rickettsii, the agent of rocky mountain spotted fever, has been definitively associated with disease in humans in the united states. Herein we describe disease in a human caused by Rickettsia parkeri, an SFG rickettsia first identified >60 years ago in Gulf Coast ticks (Amblyomma maculatum) collected from the southern united states. Confirmation of the infection was accomplished using serological testing, immunohistochemical staining, cell culture isolation, and molecular methods. Application of specific laboratory assays to clinical specimens obtained from patients with febrile, eschar-associated illnesses following a tick bite may identify additional cases of R. parkeri rickettsiosis and possibly other novel SFG rickettsioses in the united states. ( info) |
9/25. Fatal spotted fever rickettsiosis, kenya. We report a fatal case of rickettsiosis in a woman from the united states living in kenya, who had a history of tick exposure. Immunohistochemical staining of skin, kidney, and liver demonstrated spotted fever group rickettsiae. The clinical findings, severity, and fatal outcome are most consistent with rickettsia conorii infection. ( info) |
10/25. African tick-bite fever: four cases among Swiss travelers returning from south africa. BACKGROUND: African tick-bite fever (ATBF) is a recently described disease belonging to the spotted fever group. It is caused by Rickettsia africae, and cases are mainly diagnosed in travelers returning from sub-Saharan Africa. methods: We report four cases of ATBF among Swiss travelers returning from a 1-month trip in rural south africa. diagnosis was made on the basis of clinical, epidemiologic and serologic findings that we describe in detail. serology was performed using microimmunofluorescence (MIF) assay 2 weeks, 6 weeks and 14 months after the commencement of symptoms. RESULTS: All patients developed the typical eschar and a rash; two had a local lymphadenopathy and one a lymphangitic reaction. Two patients developed transient neuropsychiatric symptoms such as headache, irritability and depressed mood. All four patients had rises in both IgM and IgG classes of anti-R. africae antibodies. After 1 year, only two patients still had measurable circulating antibodies. Cross-reactions with R. conorii were noted. Three patients were cured after a short course of doxycycline; one required 15 days of treatment. CONCLUSIONS: ATBF is a benign disease increasingly being diagnosed in travelers. After ruling out malaria, ATBF diagnosis relies upon a detailed travel history and the classical findings of influenza-like symptoms, fever, one or more necrotic eschars, and rash. serologic tests usually help to confirm the diagnosis. Neuropsychiatric symptoms specifically associated with ATBF are reported here for the first time. ( info) |