Koorts en vesiculopapuleus exantheem na verblijf in Zuid-Afrika, door infectie met Rickettsia africae

- A 26-year-old woman, who had visited the Krugerpark in South Africa 5 days before, presented with fever, a skin lesion with a black crust (eschar), lymphadenopathy and a vesiculo papular rash. The clinical diagnosis ‘Rickettsia africae infection’ was confirmed by specific serological tests. A second patient aged 43 years, whose vesicular rash did not respond to flucloxacillin had been in the Krugerpark one week before and on examination was found with 2 eschars. Based on epidemiological and clinical grounds African tick fever can be distinguished from Mediterranean spotted fever (fièvre boutonneuse). In the Netherlands specific diagnostic tests are not available. For treatment the distinction is not necessary; treatment is with tetracyline or doxycycline. Both patients recovered upon this treatment.