Many patients with ATBF who live in areas with a high number of infections (Africa and the West Indies) do not visit a doctor, as most patients only have mild symptoms.[6] This disease can, however, cause more serious symptoms in travelers who have never been exposed to the Rickettsia africae bacterium before and are not immune.[16] Travelers who present to a doctor after a trip to affected areas can be hard to diagnose, as many tropical diseases cause a fever similar to that of ATBF.[17] Other diseases that may look similar are malaria, dengue fever, tuberculosis, acute HIV and respiratory infections.[17] In addition to questions about symptoms, doctors will ask patients for an accurate travel history and whether he/she was near animals or ticks.[17] Microbiological tests are available for doctors, but are expensive and often must be done by special laboratories.[18]