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Nathalie M. Delfos, Emile F. Schippers, Didier Raoult, Leo G. Visser, Fever and Vesicular Rash in a Traveler Returning from South Africa, Clinical Infectious Diseases, Volume 39, Issue 5, 1 September 2004, Pages 741–742, https://doi.org/10.1086/423281
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Diagnosis: African tick-bite fever with a vesicular rash.
The geographical history, the incubation period, and the presence of a typical inoculation lesion, or eschar, on the right leg (figure 1) were suggestive of a rickettsial infection. The patient was treated with doxycycline (200 mg for the first dose, then 100 mg once per day for 1 week). The antimicrobial therapy was continued when the skin eruption appeared, and the fever and skin eruption disappeared within a week. Levels of IgM and IgG antibodies to Rickettsia africae were determined by indirect immunofluorescence; in acute-phase serum, their titers were 1:16 and 0, respectively, and in convalescent-phase serum, their titers were 1:32 and 1:128, respectively. Because of known cross-reactivity between Rickettsia conorii and R. africae, cross-adsorption and Western blot assays were performed (by D.R.). After adsorption of serum samples with R. conorii, there remained 1 band of 120 kDa representing R. africae antigen but no bands representing R. conorii antigen, whereas after adsorption with R. africae, results were negative for both antigens. This finding confirmed that the infection was caused by R. africae.
