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African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa.
Clin Infect Dis. 2008 Aug 01; 47(3):e28-35.CI

Abstract

BACKGROUND

African tick-bite fever, a tickborne disease caused by Rickettsia africae, is endemic in rural areas of sub-Saharan Africa and in the French West Indies. Most cases reported in the literature occurred in middle-aged, otherwise-healthy persons and corresponded to benign diseases. The course of African tick bite fever in elderly people is less well documented.

METHODS

The medical records of 8 elderly patients infected with R. africae during a trip to South Africa in 2005 are presented to summarize the epidemiologic, clinical, microbiological, treatment, and disease course characteristics.

RESULTS

Eight patients, aged 63-75 years, developed African tick bite fever symptoms after a trip to South Africa. R. africae was grown from cutaneous eschar biopsy specimens obtained from 4 patients, confirming African tick bite fever. We observed unusual findings in this elderly population. Rash was frequent (present in 87.5% of patients), vesicular (in 100% of patients with rash), and often associated with an enanthema (in 50% of patients with rash). Severe clinical manifestations occurred: lymphangitis and myocarditis in 1 patient and suspected brain involvement in 2 patients. We observed severe and long-lasting general symptoms, including fever (in 75% of patients), chills (87.5%), asthenia (50%), anorexia (50%), and weight loss (12.5%). With doxycycline therapy, the outcome was favorable in all cases, but complete recovery was slow.

CONCLUSION

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.

Authors+Show Affiliations

Department of Infectious Diseases, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. MMaurin@chu-grenoble.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

18558881

Citation

Roch, Nathalie, et al. "African Tick Bite Fever in Elderly Patients: 8 Cases in French Tourists Returning From South Africa." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 47, no. 3, 2008, pp. e28-35.
Roch N, Epaulard O, Pelloux I, et al. African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clin Infect Dis. 2008;47(3):e28-35.
Roch, N., Epaulard, O., Pelloux, I., Pavese, P., Brion, J. P., Raoult, D., & Maurin, M. (2008). African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 47(3), e28-35. https://doi.org/10.1086/589868
Roch N, et al. African Tick Bite Fever in Elderly Patients: 8 Cases in French Tourists Returning From South Africa. Clin Infect Dis. 2008 Aug 1;47(3):e28-35. PubMed PMID: 18558881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. AU - Roch,Nathalie, AU - Epaulard,Olivier, AU - Pelloux,Isabelle, AU - Pavese,Patricia, AU - Brion,Jean-Paul, AU - Raoult,Didier, AU - Maurin,Max, PY - 2008/6/19/pubmed PY - 2008/8/12/medline PY - 2008/6/19/entrez SP - e28 EP - 35 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 47 IS - 3 N2 - BACKGROUND: African tick-bite fever, a tickborne disease caused by Rickettsia africae, is endemic in rural areas of sub-Saharan Africa and in the French West Indies. Most cases reported in the literature occurred in middle-aged, otherwise-healthy persons and corresponded to benign diseases. The course of African tick bite fever in elderly people is less well documented. METHODS: The medical records of 8 elderly patients infected with R. africae during a trip to South Africa in 2005 are presented to summarize the epidemiologic, clinical, microbiological, treatment, and disease course characteristics. RESULTS: Eight patients, aged 63-75 years, developed African tick bite fever symptoms after a trip to South Africa. R. africae was grown from cutaneous eschar biopsy specimens obtained from 4 patients, confirming African tick bite fever. We observed unusual findings in this elderly population. Rash was frequent (present in 87.5% of patients), vesicular (in 100% of patients with rash), and often associated with an enanthema (in 50% of patients with rash). Severe clinical manifestations occurred: lymphangitis and myocarditis in 1 patient and suspected brain involvement in 2 patients. We observed severe and long-lasting general symptoms, including fever (in 75% of patients), chills (87.5%), asthenia (50%), anorexia (50%), and weight loss (12.5%). With doxycycline therapy, the outcome was favorable in all cases, but complete recovery was slow. CONCLUSION: 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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18558881/African_tick_bite_fever_in_elderly_patients:_8_cases_in_French_tourists_returning_from_South_Africa_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/589868 DB - PRIME DP - Unbound Medicine ER -