1921
Volume 99, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Spotted fever group rickettsioses (SFGRs), such as African tick bite fever (ATBF), are among the most commonly diagnosed diseases for ill travelers returning from southern Africa. We summarized demographic, clinical, and diagnostic features of imported SFGR cases in U.S. travelers returning from Africa who had laboratory specimens submitted to the Centers for Disease Control and Prevention. Diagnosis of SFGR was performed by indirect immunofluorescence antibody assay, immunohistochemical staining, polymerase chain reaction (PCR), or culture. Cases were defined as probable SFGR, confirmed SFGR, or confirmed ATBF. Clinical and epidemiological categorical variables were described as counts and proportions; continuous variables were described using geometric mean titers, median, and range. One hundred and twenty-seven patients satisfied laboratory criteria for confirmed or probable SFGR. Fever was the most common symptom ( = 88; 69%), followed by ≥ 1 eschars ( = 70; 55%). Paired serums were submitted for 36 patients (28%); 12 patients (33%) had nonreactive initial serum sample but converted to a titer ≥ 64 with the convalescent sample. Twenty-seven patients (21%) had infection with based on PCR analysis of eschar swab ( = 8) or biopsy ( = 23). Fifteen patients had eschar biopsy or swab samples and serum sample(s) submitted together; 9 (60%) had PCR-positive eschar results and nonreactive acute serology. Health-care providers should consider SFGR when evaluating patients for a febrile illness with eschar and compatible foreign travel history. Polymerase chain reaction testing of eschar biopsies or swabs provides a confirmed diagnosis in early stages of disease; eschar swabs or biopsies are an underutilized diagnostic technique.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0882
2018-05-29
2019-11-20
Loading full text...

Full text loading...

/deliver/fulltext/14761645/99/1/tpmd170882.html?itemId=/content/journals/10.4269/ajtmh.17-0882&mimeType=html&fmt=ahah

References

  1. Jensenius M, 2009. Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996–2008. Emerg Infect Dis 15: 17911798. [Google Scholar]
  2. Jensenius M, Fournier PE, Kelly P, Myrvang B, Raoult D, , 2003. African tick bite fever. Lancet Infect Dis 3: 557564. [Google Scholar]
  3. Kelly P, Lucas H, Beati L, Yowell C, Mahan S, Dame J, , 2010. Rickettsia africae in Amblyomma variegatum and domestic ruminants on eight Caribbean islands. J Parasitol 96: 10861088. [Google Scholar]
  4. Parola P, 2013. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 26: 657702. [Google Scholar]
  5. Mendelson M, Davis XM, Jensenius M, Keystone JS, von Sonnenburg F, Hale DC, Burchard GD, Field V, Vincent P, Freedman DO, GeoSentinel Surveillance Network; , 2010. Health risks in travelers to South Africa: the GeoSentinel experience and implications for the 2010 FIFA world cup. Am J Trop Med Hyg 82: 991995. [Google Scholar]
  6. Jensenius M, Parola P, Raoult D, , 2006. Threats to international travellers posed by tick-borne diseases. Travel Med Infect Dis 4: 413. [Google Scholar]
  7. Rahman A, Tegnell A, Vene S, Giesecke J, , 2003. Rickettsioses in Swedish travellers, 1997–2001. Scand J Infect Dis 35: 247250. [Google Scholar]
  8. Roch N, Epaulard O, Pelloux I, Pavese P, Brion JP, Raoult D, Maurin M, , 2008. African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clin Infect Dis 47: e28e35. [Google Scholar]
  9. Bellini C, Monti M, Potin M, Dalle Ave A, Bille J, Greub G, , 2005. Cardiac involvement in a patient with clinical and serological evidence of African tick-bite fever. BMC Infect Dis 5: 90. [Google Scholar]
  10. Raoult D, 2001. Rickettsia africae, a tick-borne pathogen in travelers to sub-Saharan Africa. N Engl J Med 344: 15041510. [Google Scholar]
  11. Jensenius M, Fournier PE, Vene S, Hoel T, Hasle G, Henriksen AZ, Hellum KB, Raoult D, Myrvang B, Norwegian African Tick Bite Fever Study Group; , 2003. African tick bite fever in travelers to rural sub-Equatorial Africa. Clin Infect Dis 36: 14111417. [Google Scholar]
  12. McQuiston JH, Paddock CD, Singleton J, Jr. Wheeling JT, Zaki SR, Childs JE, , 2004. Imported spotted fever rickettsioses in United States travelers returning from Africa: a summary of cases confirmed by laboratory testing at the Centers for Disease Control and Prevention, 1999–2002. Am J Trop Med Hyg 70: 98101. [Google Scholar]
  13. McDonald JC, MacLean JD, McDade JE, , 1988. Imported rickettsial disease: clinical and epidemiologic features. Am J Med 85: 799805. [Google Scholar]
  14. Neal S, Cieslak P, Hedberg K, Fleming D, , 1998. African tick-bite fever among international travelers–Oregon, 1998. MMWR Morb Mortal Wkly Rep 47: 950952. [Google Scholar]
  15. Smoak BL, McClain JB, Brundage JF, Broadhurst L, Kelly DJ, Dasch GA, Miller RN, , 1996. An outbreak of spotted fever rickettsiosis in U.S. Army troops deployed to Botswana. Emerg Infect Dis 2: 217221. [Google Scholar]
  16. U.S. Departmenf of Commerce, 2016. 2015 United States Resident Travel Abroad. Available at: http://tinet.ita.doc.gov/outreachpages/download_data_table/2015_US_Travel_Abroad.pdf. Accessed April 4, 2018.
  17. U.S. Department of Commerce, 2005. 2004 Profile of U.S. Resident Traveler Visiting Overseas Destinations Reported from: Survey of International Air Travelers. Available at: http://tinet.ita.doc.gov/view/f-2004-101-001/index.html. Accessed April 4, 2018.
  18. Kato CY, Chung IH, Robinson LK, Austin AL, Dasch GA, Massung RF, , 2013. Assessment of real-time PCR assay for detection of Rickettsia spp. and Rickettsia rickettsii in banked clinical samples. J Clin Microbiol 51: 314317. [Google Scholar]
  19. Sumner JW, Durden LA, Goddard J, Stromdahl EY, Clark KL, Reeves WK, Paddock CD, , 2007. Gulf Coast ticks (Amblyomma maculatum) and Rickettsia parkeri, United States. Emerg Infect Dis 13: 751753. [Google Scholar]
  20. Paddock CD, 2014. Phylogeography of Rickettsia rickettsii genotypes associated with fatal Rocky Mountain spotted fever. Am J Trop Med Hyg 91: 589597. [Google Scholar]
  21. Renvoise A, Rolain JM, Socolovschi C, Raoult D, , 2012. Widespread use of real-time PCR for rickettsial diagnosis. FEMS Immunol Med Microbiol 64: 126129. [Google Scholar]
  22. Paddock CD, 1999. Hidden mortality attributable to Rocky Mountain spotted fever: immunohistochemical detection of fatal, serologically unconfirmed disease. J Infect Dis 179: 14691476. [Google Scholar]
  23. Paddock CD, Koss T, Eremeeva ME, Dasch GA, Zaki SR, Sumner JW, , 2006. Isolation of Rickettsia akari from eschars of patients with rickettsialpox. Am J Trop Med Hyg 75: 732738. [Google Scholar]
  24. UNWTO, 2016. UNTWO Tourism Highlights, 2016 Edition. Madrid, Spain: World Tourism Organization.
  25. Bohaty BR, Hebert AA, , 2015. Images in clinical medicine: African tick-bite fever after a game-hunting expedition. N Engl J Med 372: e14. [Google Scholar]
  26. Albizuri Prado F, Sanchez A, Feito M, Mayor A, Rodriguez A, de Lucas R, , 2017. Fever and multiple eschars after an African safari: report of three cases. Pediatr Dermatol 34: e179e181. [Google Scholar]
  27. Jelinek T, Loscher T, , 2001. Clinical features and epidemiology of tick typhus in travelers. J Travel Med 8: 5759. [Google Scholar]
  28. Rolain JM, Jensenius M, Raoult D, , 2004. Rickettsial infections—a threat to travellers? Curr Opin Infect Dis 17: 433437. [Google Scholar]
  29. Maina AN, 2014. High prevalence of Rickettsia africae variants in Amblyomma variegatum ticks from domestic mammals in rural western Kenya: implications for human health. Vector Borne Zoonotic Dis 14: 693702. [Google Scholar]
  30. Socolovschi C, Huynh TP, Davoust B, Gomez J, Raoult D, Parola P, , 2009. Transovarial and trans-stadial transmission of Rickettsiae africae in Amblyomma variegatum ticks. Clin Microbiol Infect 15 (Suppl 2): 317318. [Google Scholar]
  31. Keller C, 2016. High detection rate of Rickettsia africae in Amblyomma variegatum but low prevalence of anti-rickettsial antibodies in healthy pregnant women in Madagascar. Ticks Tick Borne Dis 7: 6065. [Google Scholar]
  32. Nakao R, Qiu Y, Igarashi M, Magona JW, Zhou L, Ito K, Sugimoto C, , 2013. High prevalence of spotted fever group rickettsiae in Amblyomma variegatum from Uganda and their identification using sizes of intergenic spacers. Ticks Tick Borne Dis 4: 506512. [Google Scholar]
  33. Fournier PE, Jensenius M, Laferl H, Vene S, Raoult D, , 2002. Kinetics of antibody responses in Rickettsia africae and Rickettsia conorii infections. Clin Diagn Lab Immunol 9: 324328. [Google Scholar]
  34. Clements ML, Dumler JS, Fiset P, Wisseman CL, Jr. Snyder MJ, Levine MM, , 1983. Serodiagnosis of Rocky Mountain spotted fever: comparison of IgM and IgG enzyme-linked immunosorbent assays and indirect fluorescent antibody test. J Infect Dis 148: 876880. [Google Scholar]
  35. Biggs HM, 2016. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States. MMWR Recomm Rep 65: 144. [Google Scholar]
  36. Socolovschi C, Renvoise A, Brouqui P, Parola P, Raoult D, , 2012. The use of eschar swabs for the diagnosis of African tick-bite fever. Ticks Tick Borne Dis 3: 361363. [Google Scholar]
  37. Philip RN, Casper EA, Ormsbee RA, Peacock MG, Burgdorfer W, , 1976. Microimmunofluorescence test for the serological study of Rocky Mountain spotted fever and typhus. J Clin Microbiol 3: 5161. [Google Scholar]
  38. Mouffok N, Socolovschi C, Benabdellah A, Renvoise A, Parola P, Raoult D, , 2011. Diagnosis of rickettsioses from eschar swab samples, Algeria. Emerg Infect Dis 17: 19681969. [Google Scholar]
  39. Bechah Y, Socolovschi C, Raoult D, , 2011. Identification of rickettsial infections by using cutaneous swab specimens and PCR. Emerg Infect Dis 17: 8386. [Google Scholar]
  40. Strand A, Paddock CD, Rinehart AR, Condit ME, Marus JR, Gilliani S, Chung IH, Fowler VG, Jr., 2017. African tick bite fever treated successfully with rifampin in a patient with doxycycline intolerance. Clin Infect Dis 65: 15821584. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0882
Loading
/content/journals/10.4269/ajtmh.17-0882
Loading

Data & Media loading...

  • Received : 14 Nov 2017
  • Accepted : 11 Mar 2018
  • Published online : 29 May 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error