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Am. J. Trop. Med. Hyg., 81(5), 2009, pp. 735-739
doi:10.4269/ajtmh.2009.09-0101;
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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African Tick Bite Fever in a Taiwanese Traveler Returning from South Africa: Molecular and Serologic Studies

Kun-Hsien Tsai, Hsiu-Ying Lu, Jyh-Hsiung Huang, Pierre-Edouard Fournier, Oleg Mediannikov, Didier Raoult, AND Pei-Yun Shu*
Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

We report the first imported case of African tick bite fever (ATBF) in a patient from Taiwan who returned from a 10-day trip to South Africa. Diagnosis was confirmed by polymerase chain reaction (PCR) from eschar biopsies. Portions of rickettsial ompA (491 bp) and ompB (273 bp) genes were amplified and subsequent sequencing of PCR product showed its 100% identity with R. africae. Microimmunofluorescence (MIF) assay of patient’s serum on Days 14 and 46 after the onset of illness revealed IgG seroconversion when tested with spotted fever group (SFG) rickettsiae antigens, including R. africae. The patient clinically improved on the third day of 14-day treatment with a combination of ciprofloxacin and minocycline. Based on the patient’s travel history and chronology of clinical symptoms, we strongly suspect that the tick-biting event occurred in Kruger National Park.

Received February 23, 2009. Accepted for publication July 20, 2009.

Financial support: This study was supported in part by Grant 98-0324-01-F-20 from the National Research Program for Genome Medicine and Grant DOH96-DC-2010 from the Taiwan CDC.

* Address correspondence to Pei-Yun Shu, Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, No. 161, Kun-Yang Street, Taipei 11561, Taiwan, R.O.C. E-mail: pyshu{at}cdc.gov.tw

Authors’ addresses: Kun-Hsien Tsai, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C. Hsiu-Ying Lu, Jyh-Hsiung Huang, and Pei-Yun Shu, Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C. Pierre-Edouard Fournier, Oleg Mediannikov, and Didier Raoult, Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.