Raoult, Bleomycin personal communication). Intrathecal synthesis of B burgdorferi specific antibodies was negative. Culture of CSF on (Barbour-Stoenner-Kelly) BSKH medium was negative. ATBF was the first diagnosis suspected because of the travel destination, the association of tick-bite, and the presence of an inoculation eschar. Recently, in Ethiopia, ATBF was diagnosed in a French man after 1-month travel in this country.[11] Moreover, R africae has been detected in

12/118 Amblyomma lepidum and in 1/2 Amblyomma variegatum ticks collected on cattle in Ethiopia.[12] Radiculopathy was not described in association with this disease.[1] However, the evidence of subacute neuropathy of long-lasting duration had been reported for six patients following ATBF contracted during safari trips to southern Africa.[13] At the WHO Collaborative Center for Rickettsial Diseases and Arthropod-Borne Bacterial Diseases, all sera and skin biopsy samples negative for Rickettsiae from patients with tick-bite history and presence of inoculation eschar are tested for all bacteria transmitted by

ticks, including Coxiella burnetii, Bartonella, Anaplasma, Francisella tularensis, Borrelia, Diplorickettsia, Arsenophonus, Coxiella-like, and Spiroplasma. Using this strategy, only qPCR was positive for TBRF. Unfortunately, the species level identification was not determined because regular PCR remained negative probably because the borrelial DNA load detected using qPCR (known to be more sensitive than regular PCR) was low. Usually, the etiology of this website relapsing fever in Ethiopia is Borrelia recurrentis, the agent of louse-borne relapsing fever that is the most common cause of hospital admission, associated with high morbidity and mortality.[2] Soft ticks that are the main

known vectors of relapsing fever borrelioses do not attach firmly to the skin and cannot be “incompletely DNA ligase removed.” Here, the removed arthropod was probably not Ornithodoros tick, so, it can correspond to a hard tick. Recently, a new Borrelia sp. detected in A cohaerens, hard ticks collected from cattle in Ethiopia was described.[4] This new Borrelia sp. is distant from the groups of the recurrent fever and the Lyme disease that can explain in our case the discordance between the positive results by molecular tools: sequence 100% similarity with Borrelia sp. from relapsing fever group and positive serology for B burgdorferi. Neurological examination after 9 months of this patient showed that weakness and paresthesias disappeared but the persistence of the amyotrophy of the dorsal interossei of the hand resulting in a claw deformity. To the best of our knowledge, escharotic lesion has not been described in TBRF, but radiculopathy is common in tick-borne borreliosis.[14, 15] In patients returning from sub-Saharan Africa, TBRF should be included in differential diagnosis, especially in cases with neurological involvement, even without any systemic symptoms.