Brouqui P, Harle J R, Delmont J, Frances C, Weiller P J, Raoult D
Unité des Rickettsies, Faculté et Médecine, Hôpital F. Houphoüet Boigny, Marseille, France.
Arch Intern Med. 1997 Jan 13;157(1):119-24.
To characterize the clinical presentation and 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 of fever in patients who are returning from the tropics.
Seven patients who returned from Zimbabwe of the Republic of South Africa and presented with fever.
Cases were recognized clinically by the presence of multiple taches noire and were diagnosed as having a rickettsial infection by identification of the organisms in circulating endothelial cells. The causative role of R africae was further demonstrated using cross-absorption and immunoblotting of patients' serum samples and isolation of the agent from blood and skin biopsy specimens. Isolates were characterized using the restriction fragment length polymorphism-polymerase chain reaction and sequence analysis of the gene that encodes for the 190-kd Rickettsia-specific antigen.
All 7 patients presented with fever and multiple taches noire. Further physical examination of patients revealed lymphadenopathy, lymphangitis, and edema, but there were virtually no signs of a rash. These findings are characteristic of R africae-infected patients and are distinct from those observed in patients with Rickettsia conorii-induced Mediterranean spotted fever. All 7 patients were infected with R africae as demonstrated by immunoblotting or isolation of the agent, and all were cured.
With increasing international travel, a need for the recognition of rickettsial diseases by physicians is becoming more important. Tick-bite fever, a disease caused by R africae and transmitted by Amblyomma ticks, is characterized by multiple taches noire, lymphadenopathy, lymphangitis, and edema, but no rash or a discrete rash. It is a frequent but benign disease that physicians should consider when presented with febrile patients returning from southern Africa.
描述非洲蜱咬热的临床表现及病程，这是一种最近重新发现的由非洲立克次体（立克次体斑点热群中的一个新物种）引起的立克次体病，确定其与钝缘蜱属蜱种的关系，并讨论其在从热带地区归来患者发热病因中的作用。
7名从南非共和国津巴布韦归来且出现发热症状的患者。
通过出现多个黑色斑点在临床上识别病例，并通过在循环内皮细胞中鉴定病原体诊断为立克次体感染。使用患者血清样本的交叉吸收和免疫印迹以及从血液和皮肤活检标本中分离病原体，进一步证明非洲立克次体的致病作用。使用限制性片段长度多态性 - 聚合酶链反应和编码190kd立克次体特异性抗原的基因序列分析对分离株进行鉴定。
所有7名患者均出现发热和多个黑色斑点。对患者进一步体格检查发现有淋巴结病、淋巴管炎和水肿，但几乎没有皮疹迹象。这些发现是非洲立克次体感染患者的特征，与康氏立克次体引起的地中海斑点热患者的表现不同。通过免疫印迹或病原体分离证明所有7名患者均感染了非洲立克次体，且所有患者均治愈。
随着国际旅行的增加，医生认识立克次体病的必要性变得更加重要。蜱咬热是一种由非洲立克次体引起并由钝缘蜱传播的疾病，其特征为多个黑色斑点、淋巴结病、淋巴管炎和水肿，但无皮疹或散在皮疹。这是一种常见但良性的疾病，医生在面对从南部非洲归来的发热患者时应予以考虑。
