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A Not-So-Uncommon Illness in International Travelers

Cindy E. Owen, MD; Soon Bahrami, MD; Janine C. Malone, MD; Jeffrey P. Callen, MD; Carol L. Kulp-Shorten, MD

Arch Dermatol. 2006;142:1312-1314.

Background  African tick bite fever is a rickettsial illness that has recently emerged as a significant disease among international travelers. The vector is the Amblyomma tick, which is endemic to sub-Saharan Africa and parts of the eastern Caribbean.

Observations  We describe a middle-aged woman who returned from a mission trip to Zimbabwe with an influenzalike illness and inoculation eschar; she also had a history of travel to a game farm. Biopsy revealed a histopathologic pattern consistent with an infectious pathogenesis. Immunohistochemical staining confirmed the presence of rickettsial organisms. In light of the patient's history, the clinical constellation of signs and symptoms, and the results of ancillary laboratory testing, a diagnosis of African tick bite fever was made. The patient was treated with doxycycline hydrochloride and had an uncomplicated course.

Conclusions  This report further highlights the epidemiological and clinical features of African tick bite fever. With the increase in international travel, it is important to recognize the illness in those who have been to endemic countries and to counsel patients reagarding preventive measures for planned travel.

Author Affiliations: Department of Internal Medicine, Division of Dermatology (Drs Owen, Malone, Callen, and Kulp-Shorten), and Department of Pathology (Drs Bahrami and Malone), University of Louisville School of Medicine, Louisville, Ky.

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