African Tick-bite Fever in French Travelers

1804 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 11, November 2005 County Health Department for further testing and speciation. It was first tested with a fluorescein-conjugated antibody for Neisseria gonorrhoeae; results were negative. A RapID NH panel (Remel, Lenexa, KS, USA) was performed that identified the isolate as M. osloensis with a 99.7% probability. Ideally, the isolate would have undergone more comprehensive genotypic and phenotypic characterization. However, as a presumed Neisseria species, it was subjected to the usual testing protocol at the health department. Chlamydial culture was performed by using buffalo green monkey kidney cells (Viromed, Minnetonka, MN, USA) grown under standard conditions. No viral inclusions were seen, and the culture did not react with chlamydial antibodies (Trinity Biotech, Bray, Ireland). Because the child responded rapidly to antimicrobial drug treatment, no further workup of the bacterial isolate was considered. The child was healthy 3 days later and was discharged to his home with topical erythromycin and instructions to his parents to follow up with his primary care physician. Neonatal ophthalmia is a potentially serious, sight-threatening infection that may be caused by sexually transmitted pathogens. Accordingly, this clinical presentation warrants prompt diagnosis and appropriate therapy. At the same time, suspicion of a sexually transmitted disease causes immense social turmoil. Specific bacterial cultures are essential for precise microbiologic diagnosis and treatment. Cultures of conjunctival specimens from our patient grew M. osloensis. Clinically, this patient’s infection was indistinguishable from other causes of neonatal ophthalmia. The differential diagnosis includes other agents such as N. gonorrhoeae, Chlamydia trachomatis, M. catarrhalis, Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Rarely, gram-negative enteric organisms may be implicated (9). Viruses, such as adenovirus or herpesvirus, are also a potential cause but were unlikely in this case. Finally, social issues must be considered. When an infant is seen with neonatal ophthalmia, a physician will often presume it to be gonococcal or chlamydial and assume the mother is positive for these infections. Recognizing that Moraxella species, including M. osloensis, may produce an identical clinical picture should limit presumptions regarding sexually transmitted diseases until a precise microbiologic diagnosis is made.