Tick bite fever – a very South African illness
A black scab where a tick bit, then fever and a severe headache days later. Common here, easily treated, and easily mistaken for flu.
What to look for
Tick bite fever is caused by bacteria transmitted by tick bites and is common across South Africa, particularly after time in grassland or bush. Many people never notice the bite itself.
- An eschar — a small black scab with a red ring around it, at the bite site. This is the most useful clue and is easily missed in the hairline, groin, armpit or behind the knee.
- Fever and chills, typically five days to two weeks after the bite.
- A severe headache, often the dominant symptom.
- Muscle and joint aches, and marked tiredness.
- Tender swollen glands near the bite.
- Sometimes a rash spreading over the body a few days after the fever starts.
Treatment
It responds quickly to a specific antibiotic, usually with clear improvement within a day or two. Most cases are mild to moderate and resolve fully, but it can become severe — particularly in older adults, in people with other conditions, and when treatment is delayed.
The usual treatment, on prescription:
Doxycycline — Doximal, Cyclidox, Adco-Doxycycline, Vibramycin
STIs (chlamydia, syphilis); atypical pneumonia; malaria prophylaxis; tick bite fever; acne (low dose)
Paracetamol — Panado, Painamol, Tylenol, Pacimol
Mild to moderate pain; fever
Removing a tick
- Use fine tweezers, gripping as close to the skin as possible.
- Pull steadily straight out. Do not twist or jerk.
- Do not apply petroleum jelly, nail polish, paraffin, alcohol or a lit match. These make the tick regurgitate into the wound, which increases the chance of infection.
- Clean the area afterwards, and wash your hands.
- Note the date. It matters if a fever follows.
- Do not crush the tick with bare fingers.
Avoiding bites
- Wear long trousers tucked into socks in long grass and bush.
- Use an insect repellent containing DEET on exposed skin.
- Stick to paths and avoid brushing through long grass.
- Check yourself, children and pets thoroughly after being outdoors — including the hairline, behind the ears, armpits, groin and behind the knees.
- Ticks often come in on dogs, so treat pets and check them.
- The sooner a tick is removed the lower the risk, so same-day checking matters.
Common questions
- Do all tick bites cause tick bite fever?
- No — most do not. Only some ticks carry the bacteria. That is why the response to a bite is to remove it properly and watch for fever, rather than to take antibiotics preventively.
- How long after a bite can symptoms start?
- Usually about five days to two weeks. That gap is why the connection is so often missed — by then the bite is forgotten and it just looks like flu.
- Can I catch it from another person?
- No. It is transmitted only by tick bites and does not spread between people.
Sources
- Communicable disease surveillance and clinical guidanceNational Institute for Communicable Diseases, South Africa
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
Last reviewed 4 August 2026.