History: A healthy 41 year old man was bitten by a tick while on safari in the Kruger National Park in South Africa. He developed severe fever and malaise 5 days later. A characteristic red skin sore with a dark centre and surrounding erythema (eschar, tache noir) developed at the site of the tick bite. The travel history and clinical picture were strongly suggestive of a tick borne fever.
Diagnostic Procedures: The diagnosis of tick bite fever caused by rickettsia (spotted fever group) was proven serologically. The clinical course of the disease was complicated by myocarditis, indicated by an elevated troponin I and later confirmed by cardio-MRI. The complicated clinical course and the singular eschar suggested Rickettsia conorii as the etiological agent.
Clinical Course: The rickettsial infection was treated with doxycycline, which led to a rapid improvement of the patient's clinical status. However, recovery from this imported infection was delayed due to myocarditis.
Conclusion: Rickettsioses should be included in the differential diagnosis in travellers returning from Africa. The clinical course is usually mild but can be complicated by involvement of major organs even in formerly healthy young people.
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