title: Sub-acute neuropathy in patients with African tick bite fever.
abstract: African tick bite fever (ATBF) caused by Rickettsia africae is an emerging health problem in travellers to sub-Saharan Africa. We here present 6 patients with evidence of long-lasting sub-acute neuropathy following ATBF contracted during safari trips to southern Africa. Three patients developed radiating pain, paresthaesia and/or motor weakness of extremities, 2 had hemi-facial pain and paresthaesia, and 1 developed unilateral sensorineural hearing loss. When evaluated 3-26 months after symptom onset, cerebrospinal fluid samples from 5 patients were negative for R. africae PCR and serology, but revealed elevated protein content in 3 and mild pleocytosis in 1 case. Despite extensive investigations, no plausible alternative causes of neuropathy could be identified. Treatment with doxycycline in 2 patients had no clinical effect. Given the current increase of international safari tourism to sub-Saharan Africa, more cases of sub-acute neuropathy following ATBF may well be encountered in Europe and elsewhere in the y to come.
authors.affiliation: Université de la Méditerranée, Marseille, France. mogens.jensenius@ioks.uio.no
authors.forename: Mogens
authors.initials: M
authors.lastname: Jensenius
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Fournier
authors.forename: Tormod
authors.initials: T
authors.lastname: Fladby
authors.forename: Kjell Block
authors.initials: KB
authors.lastname: Hellum
authors.forename: Tormod
authors.initials: T
authors.lastname: Hagen
authors.forename: Tine
authors.initials: T
authors.lastname: Priø
authors.forename: Merete Skovdal
authors.initials: MS
authors.lastname: Christiansen
authors.forename: Sirkka
authors.initials: S
authors.lastname: Vene
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Bjørn
authors.initials: B
authors.lastname: Myrvang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012282:Rickettsia Infections / Q000150:complications* / Q000503:physiopathology; D013019:South Africa; D013997:Time Factors; D014195:Travel