African Tick Bite Fever in a Taiwanese Traveler Returning from South Africa: Molecular and Serologic Studies

Kun-Hsien Tsai Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Hsiu-Ying Lu Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Jyh-Hsiung Huang Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Pierre-Edouard Fournier Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Oleg Mediannikov Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Didier Raoult Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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Pei-Yun Shu Vector-Borne Viral and Rickettsial Diseases Laboratory, Research and Diagnostic Center, Centers for Disease Control, Department of Health, Taipei, Taiwan, R.O.C.; Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taiwan, R.O.C.; Unité des Rickettsies, WHO Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Faculté de Médecine, Université de la Méditerranée, Marseille, France

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We report the first imported case of African tick bite fever (ATBF) in a patient from Taiwan who returned from a 10-day trip to South Africa. Diagnosis was confirmed by polymerase chain reaction (PCR) from eschar biopsies. Portions of rickettsial ompA (491 bp) and ompB (273 bp) genes were amplified and subsequent sequencing of PCR product showed its 100% identity with R. africae. Microimmunofluorescence (MIF) assay of patient’s serum on Days 14 and 46 after the onset of illness revealed IgG seroconversion when tested with spotted fever group (SFG) rickettsiae antigens, including R. africae. The patient clinically improved on the third day of 14-day treatment with a combination of ciprofloxacin and minocycline. Based on the patient’s travel history and chronology of clinical symptoms, we strongly suspect that the tick-biting event occurred in Kruger National Park.

Author Notes

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