African Tick Bite Fever in a Taiwanese Traveler Returning from South Africa: Molecular and Serologic Studies

We report the first imported case of African tick bite fever (ATBF) in a patient from Taiwan who returned from a 10-day trip to South Africa. Diagnosis was confirmed by polymerase chain reaction (PCR) from eschar biopsies. Portions of rickettsial ompA (491 bp) and ompB (273 bp) genes were amplified and subsequent sequencing of PCR product showed its 100% identity with R. africae. Microimmunofluorescence ( MIF) assay of patient 's serum on Days 14 and 46 after the onset of illness revealed IgG seroconversion when tested with spotted fever group (SFG) rickettsiae antigens, including R. africae. The patient clinically improved on the third day of 14-day treatment with a combination of ciprofloxacin and minocycline. Based on the patient's travel history and chronology of clinical symptoms, we strongly suspect that the tick-biting event occurred in Kruger National Park