African Tick Bite Fever in Elderly Patients: 8 Cases in French Tourists Returning from South Africa

Abstract

Ecotourism to sub-Saharan Africa is expanding, and people of advanced age, often with underlying chronic diseases, account for an increasing proportion of travelers. African tick bite fever appears to be more symptomatic in this population. Recommendations advising personal prophylactic measures to prevent tick bites in travelers to regions of endemicity may be particularly important for elderly individuals.

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

“…Recently, more than 100 A. hebraeum ticks were identified on the extremities and trunk of one Japanese woman with a confirmed ATBF diagnosis after she traveled to South Africa (374). The rash is observed in 30 to 88% of patients and is mostly maculo-or papulovesicular (364,367,373). ATBF is a benign disease; nevertheless, a more severe course was described in elderly populations (364,365), and some complications, such as subacute cranial or peripheral neuropathy and chronic fatigue (364,388), internuclear ophthalmoplegia (381), myocarditis (364,376), and cellulitis, have been reported (365).…”

“…The rash is observed in 30 to 88% of patients and is mostly maculo-or papulovesicular (364,367,373). ATBF is a benign disease; nevertheless, a more severe course was described in elderly populations (364,365), and some complications, such as subacute cranial or peripheral neuropathy and chronic fatigue (364,388), internuclear ophthalmoplegia (381), myocarditis (364,376), and cellulitis, have been reported (365). One coinfection with Leishmania tropica was reported after travel to Botswana (389), and one with Coxiella burnetii, the agent of Q fever, was reported after a trip to the Gambia (375).…”

Rickettsiosis as Threat for the Traveller

“…ATBF and MSF are the most frequent tick-borne spotted fever rickettsioses in travellers (Smoak et al, 1996;Fournier et al, 1998;Oteo et al, 2004a;Raoult et al, 2001;Caruso et al, 2002;Jensenius et al, 2003;Roch et al, 2008;Tsai et al, 2008;Consigny et al, 2009;Stephany et al, 2009;Althaus et al, 2010;Jensenius et al, 2004;Boillat et al, 2008;Laurent et al, 2009). For this reason, we will refer to these conditions taking into account that few differences in the incubation period and severity may exist.…”

Tache Noire in African Tick Bite Fever

“…by taking measures to minimize the risk of arthropod bites in bush vegetation likely to be infested with ticks, 1 such as wearing protective clothing and inspection of the skin, 4 which was not performed in the case presented. The clinical diagnosis is supported by serologic analysis and PCR or culture from skin or blood samples.…”

“…The clinical diagnosis is supported by serologic analysis and PCR or culture from skin or blood samples. 1,4,5 …”