Correspondence
Tick-Borne Infection Caused by Rickettsia africae in the West Indies
N Engl J Med 1998; 338:1391-1392May 7, 1998
- Article
To the Editor:
Tick-borne rickettsioses have been suspected but not documented well in the Americas.1 We report a case of Rickettsia africae infection in the West Indies.
In July 1997, a 50-year-old French woman was bitten by a tick on her right foot while on the island of Guadeloupe. A few days later she noted a 0.5-cm erythematous nodular lesion at the bite site, erythema of the right groin, and a low-grade fever. One month later, when back in France, she consulted one of us for fatigue and a low-grade fever. Her physical examination was normal, but the nodular lesion was still present. She had leukopenia, slightly elevated serum alanine aminotransferase and aspartate aminotransferase concentrations, and a positive test for antiphospholipid antibodies. She was treated for three weeks with doxycycline and recovered slowly. We tested serum samples for antibodies against R. conorii and R. africae using immunofluorescence.2 The first serum sample tested had high titers of IgM antibodies (1:1024 against R. africae and 1:512 against R. conorii ). The titers declined with time, indicating recent infection.2 Adsorption studies suggested that the antibodies were directed against R. africae.
R. africae is the recently described agent of tick-bite fever occurring in sub-Sahelian Africa.2 On the basis of our study, it can occur in the New World as well. Furthermore, we recently isolated R. africae from Amblyomma variegatum ticks collected on Guadeloupe (unpublished data), strongly suggesting a focus of R. africae infection there. The geographic distribution of a rickettsiosis is determined by the distribution of its reservoir ticks. A. variegata were introduced into Guadeloupe during the 18th or 19th century with cattle shipped from Africa, where they are known to transmit R. africae and Cowdria ruminantium, the agent of heartwater in cattle.2,3 In the past 30 years, these ticks have propagated in the West Indies, owing to livestock movements or bird migration.3 Our report should alert physicians to the presence of R. africae in the Caribbean islands where A. variegatum ticks occur. The infection, which results in fever, headache, inoculation eschars (often multiple), lymphadenopathy, and inconstant rash,2 is probably underdiagnosed. Moreover, if the spread of A. variegatum ticks continues, R. africae may invade the American mainland.
3 ReferencesPhilippe Parola, M.D.
Université de la Méditerranée, 13385 Marseilles CEDEX 5, FranceJacques Jourdan, M.D.
Centre Hospitalier Universitaire, 30029 Nimes CEDEX 4, FranceDidier Raoult, M.D., Ph.D.
Université de la Méditerranée, 13385 Marseilles CEDEX 5, France1
Morel PC . Etude sur les tiques du bétail en Guadeloupe et Martinique. II. Agents pathogènes transmis par les tiques. Rev Elev Med Vet Pays Trop 1967;20:291-299
Medline2
Raoult D ,Roux V . Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev 1997;10:694-719
Web of Science | Medline3
Barre N ,Garris G ,Camus E . Propagation of the tick Amblyomma variegatum in the Caribbean. Rev Sci Tech 1995;14:841-855
Web of Science | Medline
- Citing Articles (17)
Citing Articles
1
Rosanne W. Wieten, Joppe W.R. Hovius, Emilie J. Groen, Allard C. van der Wal, Peter J. de Vries, Matthijs F.C. Beersma, Ellen Tijsse-Klasen, Hein Sprong, Martin P. Grobusch. (2011) Molecular Diagnostics of Rickettsia africae Infection in Travelers Returning from South Africa to The Netherlands. Vector-Borne and Zoonotic Diseases110919133451008
CrossRef2
Fabrice Althaus, Gilbert Greub, Didier Raoult, Blaise Genton. (2010) African tick-bite fever: a new entity in the differential diagnosis of multiple eschars in travelers. Description of five cases imported from South Africa to Switzerland. International Journal of Infectious Diseases 14, e274-e276
CrossRef3
Jennilee B. Robinson, Marina E. Eremeeva, Patrick E. Olson, Scott A. Thornton, Michael J. Medina, John W. Sumner, Gregory A. Dasch. (2009) New Approaches to Detection and Identification of Rickettsia africae and Ehrlichia ruminantium in Amblyomma variegatum (Acari: Ixodidae) Ticks From the Caribbean. Journal of Medical Entomology 46:4, 942-951
CrossRef4
Philippe Parola, Marcelo B. Labruna, Didier Raoult. (2009) Tick-borne rickettsioses in America: Unanswered questions and emerging diseases. Current Infectious Disease Reports 11:1, 40-50
CrossRef5
Edward F. Hendershot, Daniel J. Sexton. (2009) Scrub typhus and rickettsial diseases in international travelers: A review. Current Infectious Disease Reports 11:1, 66-72
CrossRef6
Cécile Cazorla, Cristina Socolovschi, Mogens Jensenius, Philippe Parola. (2008) Tick-borne Diseases: Tick-borne Spotted Fever Rickettsioses in Africa. Infectious Disease Clinics of North America 22:3, 531-544
CrossRef7
Nathalie Roch, Olivier Epaulard, Isabelle Pelloux, Patricia Pavese, Jean‐Paul Brion, Didier Raoult, Max Maurin. (2008) African Tick Bite Fever in Elderly Patients: 8 Cases in French Tourists Returning from South Africa. Clinical Infectious Diseases 47:3, e28-e35
CrossRef8
Philippe Brouqui, Kotaro Matsumoto. 2007. Bacteriology and Phylogeny of Anaplasmataceae. , 179-198.
CrossRef9
Mogens Jensenius, Lucy Ndip, Bjørn Myrvang. 2007. African Tick-Bite Fever. , 117-124.
CrossRef10
Patrick J. Kelly. (2006) Rickettsia africae in the West Indies. Emerging Infectious Diseases 12:2, 224-226
CrossRef11
Mogens Jensenius, Pierre-Edouard Fournier, Tormod Fladby, Kjell Block Hellum, Tormod Hagen, Tine Priø, Merete Skovdal Christiansen, Sirkka Vene, Didier Raoult, Bjørn Myrvang. (2006) Sub-acute neuropathy in patients with African tick bite fever. Scandinavian Journal of Infectious Diseases 38:2, 114-118
CrossRef12
Mogens Jensenius, Pierre-Edouard Fournier, Didier Raoult. (2004) Tick-borne rickettsioses in international travellers. International Journal of Infectious Diseases 8:3, 139-146
CrossRef13
Mogens Jensenius, Pierre-Edouard Fournier, Patrick Kelly, Bjørn Myrvang, Didier Raoult. (2003) African tick bite fever. The Lancet Infectious Diseases 3:9, 557-564
CrossRef14
Mary Elizabeth Wilson. (2002) Prevention of tick-borne diseases. Medical Clinics of North America 86:2, 219-238
CrossRef15
Raoult, Didier, Fournier, Pierre E., Fenollar, Florence, Jensenius, Mogens, Prioe, Tine, de Pina, Jean J., Caruso, Giuseppe, Jones, Nicola, Laferl, Herman, Rosenblatt, John E., Marrie, Thomas J., . (2001) Rickettsia africae, a Tick-Borne Pathogen in Travelers to Sub-Saharan Africa. New England Journal of Medicine 344:20, 1504-1510
Full Text16
P. Parola, D. Raoult. (2001) Ticks and Tickborne Bacterial Diseases in Humans: An Emerging Infectious Threat. Clinical Infectious Diseases 32:6, 897-928
CrossRef17
Michael J. Burridge, Leigh-Anne Simmons, Sandra A. Allan. (2000) INTRODUCTION OF POTENTIAL HEARTWATER VECTORS AND OTHER EXOTIC TICKS INTO FLORIDA ON IMPORTED REPTILES. Journal of Parasitology 86:4, 700
CrossRef
