Tick Bite Fever

Description

Medicine Treatment

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ICD-10 code: A77.0-3/A77.8-9/A93.8

DESCRIPTION 

Tick-borne infection due to R. conorii, acquired from dogs, or R. africae, acquired from cattle and game. The hallmark of tick bite fever is the eschar, a round black lesion ± 5 mm in diameter with an inflammatory halo that occurs in about two thirds of patients with R. conorii and in most cases of R. africae infection, where multiple eschars are common. A rash develops on about the third day of illness in about two thirds of patients with R. conorii (less common with R. africae infection). In R. conorii infection the rash is maculopapular and involves the palms and soles. In R. africae infection the rash is sparse and may be vesicular. Headache is a prominent symptom.

MEDICINE TREATMENT 

Non-pregnant:

Treatment duration: Treat for 7 days (if afebrile), or until at least 3 days after the fever has subsided.

• Doxycycline, oral, 100 mg 12 hourly.

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If pregnant:
ICD-10 code: O98.5 + (A77.0-3/A77.8-9/A93.8)

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• Doxycycline, oral, 100 mg 12 hourly for 2 days.

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Then switch to:

• Azithromycin, oral, 500 mg once daily for 3 days.

If patient is unable to tolerate oral therapy:

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• Ciprofloxacin, IV, 400 mg 8 hourly.

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Note:
Ciprofloxacin has inferior efficacy compared to doxycycline. Oral doxycycline should be commenced as soon as possible.

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Note:
Tick bite fever responds rapidly to treatment. Fever persisting for >48 hours after initiation of treatment should prompt consideration of an alternative or additional diagnosis.

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Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025

Chapter 9 Systemic and Healthcare-Associated Infections_9.10 Tick Bite Fever