title: Two cases of cellulitis in the course of African tick bite fever: a fortuitous association?
abstract: In African tick bite fever (ATBF), inoculation eschar - resulting from disruption of the cutaneous barrier - may be a risk factor for cellulitis. We report 2 cases of ATBF associated with cellulitis. A 77-year-old woman was referred for severe leg cellulitis upon returning from sub-Saharan Africa. She developed erythematous macules. Rickettsia africae was detected by PCR assay from a skin biopsy specimen, and ATBF diagnosis was confirmed. A 75-year-old man was hospitalized after his return from Zimbabwe for a maculopapular exanthema and erysipelas-like rash of the leg. The diagnosis of cellulitis associated with ATBF was confirmed by PCR and serological methods. Both patients were treated for ATBF and cellulitis by a combination of doxycycline and beta-lactam antibiotics, and both had a good recovery. Inoculation eschar may be a risk factor for cellulitis; thus, we hypothesize a non-fortuitous association between ATBF and cellulitis.
authors.affiliation: Department of Dermatology, Tarnier-Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris V, Université René Descartes, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bouvresse
authors.forename: Pascal
authors.initials: P
authors.lastname: Del Giudice
authors.forename: Nathalie
authors.initials: N
authors.lastname: Franck
authors.forename: Marc
authors.initials: M
authors.lastname: Buffet
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Avril
authors.forename: Véronique
authors.initials: V
authors.lastname: Mondain
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Rolain
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupin
mesh_terms: D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012281:Rickettsia / Q000302:isolation & purification; D012282:Rickettsia Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D018570:Risk Assessment; D017282:Tick-Borne Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014195:Travel; D016896:Treatment Outcome; D015030:Zimbabwe; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D004318:Doxycycline