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Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning from Africa, 2007-2016.
Am J Trop Med Hyg. 2018 07; 99(1):136-142.AJ

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 (N = 88; 69%), followed by ≥ 1 eschars (N = 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 Rickettsia africae based on PCR analysis of eschar swab (N = 8) or biopsy (N = 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.

Authors+Show Affiliations

Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Epidemiology Elective Program, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29848404

Citation

Cherry, Cara C., et al. "Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning From Africa, 2007-2016." The American Journal of Tropical Medicine and Hygiene, vol. 99, no. 1, 2018, pp. 136-142.
Cherry CC, Denison AM, Kato CY, et al. Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning from Africa, 2007-2016. Am J Trop Med Hyg. 2018;99(1):136-142.
Cherry, C. C., Denison, A. M., Kato, C. Y., Thornton, K., & Paddock, C. D. (2018). Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning from Africa, 2007-2016. The American Journal of Tropical Medicine and Hygiene, 99(1), 136-142. https://doi.org/10.4269/ajtmh.17-0882
Cherry CC, et al. Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning From Africa, 2007-2016. Am J Trop Med Hyg. 2018;99(1):136-142. PubMed PMID: 29848404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of Spotted Fever Group Rickettsioses in U.S. Travelers Returning from Africa, 2007-2016. AU - Cherry,Cara C, AU - Denison,Amy M, AU - Kato,Cecilia Y, AU - Thornton,Katrina, AU - Paddock,Christopher D, Y1 - 2018/05/24/ PY - 2018/6/1/pubmed PY - 2019/8/28/medline PY - 2018/6/1/entrez SP - 136 EP - 142 JF - The American journal of tropical medicine and hygiene JO - Am. J. Trop. Med. Hyg. VL - 99 IS - 1 N2 - 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 (N = 88; 69%), followed by ≥ 1 eschars (N = 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 Rickettsia africae based on PCR analysis of eschar swab (N = 8) or biopsy (N = 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. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/29848404/Diagnosis_of_Spotted_Fever_Group_Rickettsioses_in_U_S__Travelers_Returning_from_Africa_2007_2016_ L2 - http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0882?crawler=true&mimetype=application/pdf DB - PRIME DP - Unbound Medicine ER -