1277. African Tick Bite Fever in a Pregnant Woman with Atypical Presentation: A Case Report and Review of the Literature
Session: Poster Abstract Session: Travel/Tropical Medicine and Parasitology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Rickettsia africae, the agent of African Tick Bite Fever (ATBF), is an increasingly recognized cause of fever in the returning traveler. The diagnosis and treatment of ATBF in returning travelers with the classic triad of fever, headache and eschar has been well-described.  However, the diagnosis of ATBF in travelers presenting with atypical exam findings, and optimal treatment of this infection in the pregnant host are poorly described in the medical literature.

Methods:  In this report, we present a case of ATBF in a pregnant woman who developed atypical symptoms. We conducted a review of the available literature to find appropriate management of ATBF during pregnancy. 

Results:  A previously healthy 30 year old woman, at 20 weeks gestation, recently returned from Swaziland. Five days later, she developed fevers to 101, headache, neck pain, a tache noir lesion on her left shoulder with regional lymphadenopathy.  She was initially treated with azithromycin, but on day 2 of treatment, developed painful vaginal ulcers and continued with generalized illness. A full gynecologic work-up for alternative causes of the ulcers was negative. Based on a review of the literature, rifampin was added on day 3. By day 5 of therapy, all her symptoms, including vaginal ulcers, were improved or resolved.  Biopsy of the shoulder lesion revealed lymphocytoclastic infiltration and serology revealed IgG positivity to R. africae of 1:128.

Conclusion: To our knowledge, this is the first case of ATBF in a pregnant woman reported in the literature and the first report of vaginal ulcers associated with the disease.  Available data for treatment is either in-vitro or based on trials of macrolides conducted in children with Mediterranean Spotted Fever.  In vitro data reveals azithromycin resistance in ATBF, while rifampin has demonstrated susceptibility.  We found case reports of Mediterranean Spotted Fever in pregnant women, one of which failed azithromycin and responded to rifampin. Treatment in our case was based on published in-vitro susceptibility data.  The patient’s progression of illness, manifested by continued symptoms and development of vaginal lesions, while on azithromycin, and improvement once initiated on rifampin, support findings of possible azithromycin failure.


Subject Category: T. Travel/tropical medicine and parasitology

Allison Bearden, MD, MPH, Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, Madison, WI, Anna Haemel, MD, Medicine and Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI and Christopher Crnich, MD, MS, Section of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI

Disclosures:

A. Bearden, None

A. Haemel, None

C. Crnich, None

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