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Tick Bite


Presentation

  • CASE PRESENTATION: The patient, that travelled in an endemic area, presented typical inoculation eschars, and a seroconversion against R. africae, was admitted for chest pains and increased cardiac enzymes in the context of an acute myocarditis.[ncbi.nlm.nih.gov]
  • PATIENTS: Seven patients who returned from Zimbabwe of the Republic of South Africa and presented with fever.[ncbi.nlm.nih.gov]
  • 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).[ncbi.nlm.nih.gov]
  • Two patients presented regional lymphadenitis and one a mild local lymphangitis. Though a cutaneous rash is described in 15-46% of cases, no rash was observed in our series. ATBF was confirmed by serology.[ncbi.nlm.nih.gov]
Difficulty Walking
  • Symptoms may include general weakness, difficulty walking, ascending paralysis, and bulbar paralysis with diplopia, culminating in respiratory failure. In Europe, toxin-mediated paralysis has rarely been noted.[ncbi.nlm.nih.gov]
Italian
  • Abstract In May 1999, a cluster of cases of African tick-bite fever was detected in six Italian tourists who had returned from South Africa. All of the patients had moderate fever and cutaneous eschars.[ncbi.nlm.nih.gov]
Diplopia
  • Symptoms may include general weakness, difficulty walking, ascending paralysis, and bulbar paralysis with diplopia, culminating in respiratory failure. In Europe, toxin-mediated paralysis has rarely been noted.[ncbi.nlm.nih.gov]
Tinnitus
  • A 52-year-old man developed fever, headache, tinnitus, and painful joints. He reported a tick bite contracted during a summer holiday in the Netherlands, followed by erythema on his left arm three weeks earlier.[ncbi.nlm.nih.gov]
Skin Lesion
  • Abstract We report 3 cases of Queensland tick typhus (QTT) and 1 case of African tick bite fever in which the causative rickettsiae were detected by PCR of eschar and skin lesions in all cases. An oral mucosal lesion in 1 QTT case was also positive.[ncbi.nlm.nih.gov]
  • Physicians in the United States and other non-African countries who see travelers returning from southern parts of Africa who give a history of recent tick bite and/or present with multiple, crusted or vesicular skin lesions should be alert to this diagnosis[ncbi.nlm.nih.gov]
  • A 58-year old housewife consulted us about 1 cm sized, dark-brownish, bean-like mass which was dropped spontaneously from indurated skin lesion on her abdomen. The mass was identified morphologically as an engorged female Ixodes nipponensis.[ncbi.nlm.nih.gov]
  • Abstract In May 1998, the Oregon Health Division received a report from a local physician that nine persons developed annular skin lesions accompanied by influenza-like symptoms within 8 days of leaving southern Africa.[ncbi.nlm.nih.gov]
  • African tick bite fever is a recently described, acute febrile illness with characteristic skin lesions. It is caused by Rickettsia africae, which is transmitted to humans by ticks of the Amblyomma genus.[ncbi.nlm.nih.gov]
Alopecia
  • We report a case of nonscarring alopecia in a 21-year-old male who reported a recent history of tick bite to the scalp.[ncbi.nlm.nih.gov]
  • Tick bite alopecia is seldom reported in the literature. The condition usually presents as a solitary oval zone of alopecia with a central eschar.[ncbi.nlm.nih.gov]
  • Ticks are a well-known vector for viral, bacterial, and rickettsial infections, many of which are accompanied by cutaneous eruptions, but the bite itself can induce a spectrum of inflammatory reactions, including foreign body granuloma, tick bite alopecia[ncbi.nlm.nih.gov]
Papule
  • We report a 6-year-old girl who developed a red papule on the posterior neck at the site of a previous tick bite. Initial biopsy was performed a year after the bite and the specimen showed a dense lymphoid infiltrate with admixed CD30 cells.[ncbi.nlm.nih.gov]
Indurated Skin Lesion
  • A 58-year old housewife consulted us about 1 cm sized, dark-brownish, bean-like mass which was dropped spontaneously from indurated skin lesion on her abdomen. The mass was identified morphologically as an engorged female Ixodes nipponensis.[ncbi.nlm.nih.gov]
Annular Skin Lesion
  • Abstract In May 1998, the Oregon Health Division received a report from a local physician that nine persons developed annular skin lesions accompanied by influenza-like symptoms within 8 days of leaving southern Africa.[ncbi.nlm.nih.gov]
Arthralgia
  • Rickettsial infection (tick typhus) presents as fever, lethargy, anorexia, arthralgia, generalised rash and a plaque with eschar at the original tick bite site.[aci.health.nsw.gov.au]

Workup

Rickettsia Conorii
  • Abstract Tick bite fever (Rickettsia conorii) is a disease which occurs commonly in South Africa.[ncbi.nlm.nih.gov]
  • The severe form of the disease in these patients appears to have been due to unusually virulent strains of Rickettsia conorii, probably acquired from dog ticks in their homes. All patients recovered on appropriate treatment.[ncbi.nlm.nih.gov]
  • Serologically, there was cross reaction with both Rickettsia conorii and R. rickettsii. DNA sequencing demonstrated R. africae, confirming the diagnosis of African tick bite fever. The patient responded well to minocycline.[ncbi.nlm.nih.gov]
  • These findings are characteristic of R africae-infected patients and are distinct from those observed in patients with Rickettsia conorii-induced Mediterranean spotted fever.[ncbi.nlm.nih.gov]
Rickettsia Typhi
  • Initial Rickettsia typhi titers and many other serologic tests were negative. However, four weeks after admission, R. typhi IgG titer was 1 : 64 and R. rickettsii IgG was 1 : 1024.[ncbi.nlm.nih.gov]
Multiple Ulcerations
  • The dominant clinical feature of his illness was the presence of multiple, ulcerated lesions (tache noires).[ncbi.nlm.nih.gov]
Lymphocytic Infiltrate
  • A biopsy specimen of an eschar had wedge-shaped tissue necrosis, hemorrhage, necrotizing vasculitis of the small venules and arterioles, and a dense perivascular lymphocytic infiltrate in the dermis.[ncbi.nlm.nih.gov]
  • A biopsy of the place of the delayed reaction following the intradermal skin test also showed the presence of dermal and perivascular lymphocytic infiltrates. CONCLUSION: IgE-dependent allergy to Ixodes ricinus can explain allergic reactions.[ncbi.nlm.nih.gov]

Treatment

  • The patient recovered without any sequelae after 7 days treatment with doxycycline.[ncbi.nlm.nih.gov]
  • Initial treatment with doxycycline had failed and he had now developed signs of meningoencephalitis. Laboratory tests showed an increased white cell count (16.1 x 10(9)/1), and elevated ESR (51/1h).[ncbi.nlm.nih.gov]
  • Emergency physicians should recognise this possibility following a tick bite and be prepared to give treatment such as adrenaline rapidly. Patients should be referred to an allergist after recovery.[ncbi.nlm.nih.gov]
  • United States and other non-African countries who see travelers returning from southern parts of Africa who give a history of recent tick bite and/or present with multiple, crusted or vesicular skin lesions should be alert to this diagnosis and institute treatment[ncbi.nlm.nih.gov]
  • Oral doxycycline led to clearance of the disease after few days of treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The mechanism for hair loss is poorly understood, but the prognosis for hair regrowth appears to be favorable.[ncbi.nlm.nih.gov]
  • Prognosis If no infectious organisms have been transmitted by the tick, you should recover from symptoms within a day or two. The outlook for specific tick-borne illnesses varies.[drugs.com]

Etiology

  • Although the etiology of intermediate cell histiocytosis is not well understood, this case raises the possibility that such infiltrates may represent an inflammatory reaction in some patients.[ncbi.nlm.nih.gov]
  • The EM-like eruptions, which were of unknown etiology, often followed the bite of the Lone Star tick (Amblyomma americanum) and the rash is called STARI (southern tick-associated rash illness).[ncbi.nlm.nih.gov]
  • […] course of African tick-bite fever, a recently rediscovered rickettsiosis caused by Rickettsia africae (a new species within the spotted fever group of rickettsiae), to establish its relationship with Amblyomma tick species, and to discuss its role in the etiology[ncbi.nlm.nih.gov]
  • The etiological agent of ATBF is Rickettsia africae, an emerging tick-borne pathogenic bacterium. We describe herein a cluster of five cases of ATBF occurring in Swiss travelers returning from South Africa.[ncbi.nlm.nih.gov]

Epidemiology

  • CONCLUSIONS: This report further highlights the epidemiological and clinical features of African tick bite fever.[ncbi.nlm.nih.gov]
  • Diagnosis was made on the basis of clinical, epidemiologic and serologic findings that we describe in detail. Serology was performed using microimmunofluorescence (MIF) assay 2 weeks, 6 weeks and 14 months after the commencement of symptoms.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • People who download The Tick App are also invited to participate in an epidemiological study describing things like where they live and what they do so researchers can get a sense of their risk factors for tickborne illnesses.[self.com]
Sex distribution
Age distribution

Prevention

  • For more information on ticks and preventing tick bites, visit: U.S.[herald-union.com]
  • Author information 1 Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina. 2 Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia. 3 ViiV Healthcare, Research Triangle Park, North[ncbi.nlm.nih.gov]
  • These results show that there is still a lot of potential for prevention through consistent symptom control.[zhaw.ch]
  • 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 regarding preventive measures for planned travel.[ncbi.nlm.nih.gov]
  • References Preventing tick bites. Atlanta: Centers for Disease Control and Prevention; 16 May 2018 [accessed 2 Jul 2018]. Tick removal and testing. Atlanta: Centers for Disease Control and Prevention; 21 May 2018 [accessed Jul 2 2018].[poison.org]

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