By NewsDesk  @bactiman63

The South Africa National Institute for Communicable Diseases (NICD) reported on the death of 43-year-old man in Klerksdorp, North West Province due to tick bite fever.

The timeline of the case is as follows:

Image/Robert Herriman

On 19 October 2022, a 43-year-old male, with no known comorbidities, visited his local GP with flu-like symptoms including fever and sweating. On history, he reported that he worked as a farmer and had helped to extinguish a veld fire two weeks prior. He also reported no significant travel or exposure
history in the weeks before his initial presentation.

Of note, the patient stated his fear surrounding tick bite fever and so, antibody testing for rickettsial disease was performed and baseline bloods were taken. According to his GP, no eschars were found on examination. The patient was then prescribed antibiotics and discharged home while awaiting outstanding blood results.

A few days later on 21 October 2022, the patient’s condition deteriorated. He was admitted to Vryburg Private Hospital and another class of antibiotics was prescribed as well as additional tests performed. At this time, the preliminary antibody results for both brucellosis and rickettsial disease were negative, while the new results showed severe liver dysfunction (ALP=269, GGT=338, ALT=299, AST=207), a negative respiratory viral panel and negative hepatitis screening. This worsening picture, along with an episode of syncope and the abnormal blood results prompted the referral of the patient to Klerksdorp-Tshepong Tertiary Hospital (KTTH).

The patient was received at KTTH and seen by a cardiologist, who quickly referred the patient on to a physician. By this time, the patient’s condition was reported to be severe and on examination, the physician noted two eschar type lesions in the groin area. Rickettsia testing was repeated, however specimens were misplaced, so these additional tests were never performed. Whilst admitted, the patient suffered an episode of status epilepticus, but due to his deteriorating condition, a scan was not performed. In the meantime, he was started on high-dose doxycycline and steroids, amongst others, but unfortunately passed away on 26 October 2022 due to septicemia and multiorgan failure with refractory shock.

Subscribe to Outbreak News TV on YouTube

A blood sample was sent to the NICD laboratory for a multitude of tests and a PCR test for rickettsial disease came back positive on both serum and plasma specimens, confirming that the patient has in fact died of tick bite fever.

Tick bite fever, otherwise known as rickettsial disease is a bacterial infection that is transmitted by ticks. In South Africa, there are two types of tick bite fever, namely the Mediterranean spotted fever-like (MSF), caused by dog ticks, and the African tick bite fever (ATBF) caused by Amblyomma or ‘bont’ ticks, with the latter being associated with rural farming and outdoor activities in the bush.