It Does Not Always Have to be Malaria: Rickettsial Infection in Travelers – an Underestimated Disease

DOI: 10.3238/zfa.2015.0166-0170

german translation / full article

Regina Mertens

Keywords: Rickettsial Infection Tropical Diseases Returning Travelers Neglected Diseases Fever

Background: Fever, arthralgia and severe malaise in travelers returning from tropical countries are main symptoms of different infections such as malaria and dengue fever. However, rare infections such as rickett-siosis should be considered as well. This vector-transmitted disease causes world wide different symptoms, from mild to severe. In the present case, the infection was acquired in South Africa.

Case report: A 52 -year-old traveler presented with undulant fever, flu-like symptoms, joint pain and headaches after returning from South Africa. Previously, the patient traveled for business in different countries, most recently in India. In South Africa he acquired multiple insect bites during a picnic, which were initially interpreted as spider bites and treated with antihistamines. In the following days his condition worsened. After returning to Germany diagnostic assessment and treatment according to tropical medicine guidelines were performed.

Conclusions: Finally a rickettsial infection was found. By initiating immediate antibiotic treatment with doxycycline he rapidly improved and a complete healing was achieved. An early differential diagnosis of rare infectious diseases can avoid early and late complications. Therefore, symptomatic travelers returning from tropical areas should undergo a rapid assessment. The diagnosis is mainly clinical and anamnestic as serological tests convert rather late, and cross-reactions frequently occur between the various rickettsial infections.

(State: 17.04.2015)

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