Two brothers from Michigan, ages 50 and 55, developed fevers, headache, myalgias, and skin lesions after big game hunting in South Africa.

The brothers had traveled from Traverse City to South Africa in mid-May and returned twelve days later. While there they engaged in five day guided big game hunts at two locations, one hunt originating from a "camp" north of Johannesburg and the second near Harrismith to the southeast of Johannesburg. The accommodations were relatively luxurious, and food and beverages were supplied by their hosts. Mosquito netting was not used at night. Prior to travel the brothers had received appropriate travel related immunizations and were prescribed atovaquone/proguanil for malaria prophylaxis.

Hunting required traveling through thick underbrush. The hunts were quite successful as the brothers succeeded in killing game including eland, impala, gemsbok, wildebeest, hartebeest and others. Carcases of the animals were often noted to be loaded with ticks, and the brothers noted at least one of their guides had what appeared to be numerous insect bites. Neither brother was aware of any insect bites on themselves, and they stopped taking malarial prophylaxis within a day or two of arrival in the first camp as the weather was cool, they saw no mosquitoes, and their guides indicated there was minimal risk.

Both brothers, generally in good health, began to feel ill on their airplane flight back to the United States (11 days after first arriving in South Africa). Both experienced malaise and a sense of warmth. Over the next few days both developed waxing and waning fevers to 101^o accompanied by myalgias and occasional chills. One brother developed significant headache, the other a cough, and both developed skin lesions. Pictured at left are sores noted on one of the two men. In both cases pictured there was associated with the sores painful regional lympadenopathy (epitrochlear related to the elbow, inguinal to the leg). They also had sparsely distributed papular rashes involving the extremities and torsos (see upper photo).

Although the patients appeared moderately ill, their examinations were essentially normal except for the skin findings and the adenopathy. CBCs and comprehensive metabolic panels were normal except one of the two brothers had a very modest thrombocytopenia (plts 134).