Tick bite fever in southern Africa

Abstract

Tick bite fever is a well-known zoonotic disease in southern Africa, caused by ixodid ticktransmitted rickettsial pathogens of the spotted fever group, which target endothelial cells, producing widespread vasculitis.Two epidemiological and clinical forms of the condition can be distinguished, namely African tick bite fever and Mediterranean spotted fever-like infection.Tick bite fever is generally a mild illness, but delayed diagnosis and inappropriate treatment may lead to severe, potentially fatal, disease resembling bacterial sepsis, viral haemorrhagic fever, malaria, or other serious infections.Along with compatible epidemiological history, common clinical diagnostic features at initial presentation are fever, headache, rash, myalgia and eschar; tender regional lymphadenopathy is common.Clinical diagnosis is sufficient to warrant treatment, because serological response is slow to develop; while PCR of eschar material is an additional or alternative diagnostic option, this method may not be readily available.The treatment of choice J o u r n a l P r e -p r o o f is doxycycline, with macrolides as second-line antibiotics.Personal prevention revolves around awareness of risk and measures to limit exposure to ticks.As a zoonosis with a wide range of reservoir hosts, the disease cannot be eliminated but risk can be reduced by application of One Health principles.