title: [TIBOLA: an emerging clinically polymorphous rickettsiosis].
abstract: BACKGROUND
  TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases.
  
  
  METHODS
  Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case.
  
  
  CONCLUSIONS
  TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.
authors.affiliation: Service de dermatologie, nouvel hôpital d'Estaing, CHU Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France. Electronic address: bibir71@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Rigal
authors.affiliation: Hôpital Henri-Mondor, 50, avenue de la République, 15000 Aurillac, France.
authors.forename: D
authors.initials: D
authors.lastname: Dorcier
authors.affiliation: Service des maladies infectieuses, CHU Gabriel-Monpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: O
authors.initials: O
authors.lastname: Lesens
authors.affiliation: Service de dermatologie, nouvel hôpital d'Estaing, CHU Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Texier
authors.affiliation: Service de dermatologie, nouvel hôpital d'Estaing, CHU Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: D'Incan
mesh_terms: D000818:Animals; D002648:Child; D021821:Communicable Diseases, Emerging; D003870:Dermacentor / Q000382:microbiology*; D003937:Diagnosis, Differential; D005148:Facial Dermatoses / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000175:diagnosis* / Q000209:etiology*; D008875:Middle Aged; D012282:Rickettsia Infections / Q000175:diagnosis* / Q000635:transmission*; D012536:Scalp Dermatoses / Q000175:diagnosis / Q000209:etiology; D012874:Skin Diseases, Infectious / Q000175:diagnosis* / Q000635:transmission*; D017282:Tick-Borne Diseases / Q000175:diagnosis* / Q000635:transmission*
keywords: Alopecia; Alopécie; Escarre d’inoculation; Facial oedema; Inoculation eschar; Rickettsiose; Rickettsiosis; TIBOLA; Tick; Tique; Œdème facial