By Gary M. White, MD

African tick bite fever (ATBF) is a self-limited disease caused by R. africae, an intracellular bacterium.


After an incubation period of 5 to 10 days, patients have symptoms that include myalgias, arthralgias, fever, and headache: 53% to 100% of patients have at least 1 inoculation eschar (so called tache noir). Patients may develop diffuse macular or vesicular skin eruptions and rarely neuropsychiatric symptoms, myocarditis, and subacute neuropathy.

Rarely, a reactive arthritis may complicate 5% of travel-associated ATBF cases, and some patients may develop subacute cranial or peripheral neuropathy.


The diagnosis may be confirmed in several ways [Infect Ecol Epidemiol. 2017 Aug 2;7(1):1343081]. Seroconversion typical occurs weeks to a month after onset. More immediate results may be obtained using swabs, fluid and skin biopsy.


A 7-10 day course of doxycycline is the standard treatment.


Fever and a black eschar in a patient who had been hunting in Africa 2 weeks prior. N Engl J Med 2015; 372:e14


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