Cardiac involvement in a patient with clinical and serological evidence of African tick-bite fever

Abstract

Background: Myocarditis and pericarditis are rare complications of rickettsiosis, usually associated with Rickettsia rickettsii and R. conorii. African tick-bite fever (ATBF) is generally considered as a benign disease and no cases of myocardial involvement due to Rickettsia africae, the agent of ATBF, have yet been described.

Rickettsioses and Q fever in travelers (2004–2013)

“…Neurological complications have been reported in 6.6% of cases, involving irritability and depressed mood [17]; six other cases involved paresthesia and motor weakness, hemifacial pain and paresthesia and unilateral sensorineural hearing loss [35], and internuclear ophthalmoplegia was reported in one case [33]. Cardiac complications were also reported with the description of the first case of myocarditis associated with ATBF in a German traveler to Swaziland [36]. Coinfection with other travel-associated infections has also been reported.…”

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

“…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).…”

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

“…However, the clinical aspect of the lymphangitis-associated rickettsiosis is a deep, erythematosus, stringlike lymphangitis [31,32], whereas we observed a pale erythematous streak in patient 8. Only 1 case of myocarditis has been previously reported, in a male patient with African tick bite fever who was 35 years old [21]. Neuropsychiatric disorders have been rarely reported in adults with African tick bite fever [27,28,33].…”

“…Complications, such as prolonged fever [12], reactive arthritis [11], peripheral nerve involvement [19], encephalitis [20], and myocarditis [21], have been reported on rare occasions. However, rickettsial diseases may be more severe in elderly patients with underlying chronic diseases [22].…”