final program.qxd - Parallels Plesk Panel

PP 6.6
Tick-borne-lymphadenopathy (TIBOLA) : an emerging infectious disease in France
Rapp C, Ficko C,Imbert P,Barruet R, Debord T
Department of infectious and tropical diseases Military Hospital Bégin, 94163 Saint-
Mandé, France
Rickettsia slovaca is an emerging rickettsiosis described for the first time in France in
1997. Its underrated clinical presentation must be distinguished from Lyme Borreliosis.
A 73 year old woman, without past record, presented in June 2005 with a scalp lesion
associated with cervical lymph nodes. Fifteen days previously, she had a tick bite while
she was in the Nîmes region. Lyme disease diagnosis was suspected in the presence of
a scalp erythema halo, headaches and arthralgias. A treatment by amoxicilline had been
initiated. The examination showed a scalp eschar, a localized alopecia and tender
occipital adenopathies. The blood count was normal and the ALAT were twice the normal
level. A 200 mg/day doxycycline cure was administered during 5 days. The R. slovaca
serology was not contributory but the Western Blot (serum) showed R. slovaca specific
antibodies. The dead tick PCR analysis confirmed the presence of R. slovaca, the cell
culture was negative. The outcome was marked by a residual alopecia at the bite site.
This new TIBOLA case report due to R. slovaca confirms the emergence of this infection
which is transmitted to man by the Dermacentor genus ticks. The inoculation eschar which
is sometimes associated with an erythema halo must not be confused with the Lyme
disease's erythema chronicum migrans better known by practitioners. As it is suggested
in our case, the scalp localization and lymphadenopathy are suggestive signs. Diagnosis
confirmation relies on techniques carried out on skin biopsies from the inoculation eschar
particularly and also on the serum or the conserved tick. These techniques are only
available in the Marseille Rickettsial diseases National Research Center.
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