Classification of patients referred under suspicion of tick-borne diseases, Copenhagen, Denmark.

To provide better care for patients suspected of having a tick-transmitted infection, the Clinic for Tick-borne Diseases at Rigshospitalet, Copenhagen, Denmark was established. The aim of this prospective cohort study was to evaluate diagnostic outcome and to characterize demographics and clinical presentations of patients referred between the 1st of September 2017 to 31st of August 2019. A diagnosis of Lyme borreliosis was based on medical history, symptoms, serology and cerebrospinal fluid analysis. The patients were classified as definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome. Antibiotic treatment of Lyme borreliosis manifestations was initiated in accordance with the national guidelines. Patients not fulfilling the criteria of Lyme borreliosis were further investigated and discussed with an interdisciplinary team consisting of specialists from relevant specialties, according to individual clinical presentation and symptoms. Clinical information and demographics were registered and managed in a database. A total of 215 patients were included in the study period. Median age was 51 years (range 17-83 years), and 56 % were female. Definite Lyme borreliosis was diagnosed in 45 patients, of which 20 patients had erythema migrans, 14 patients had definite Lyme neuroborreliosis, six had acrodermatitis chronica atrophicans, four had multiple erythema migrans and one had Lyme carditis. Furthermore, 12 patients were classified as possible Lyme borreliosis and 12 patients as post-treatment Lyme disease syndrome. A total of 146 patients (68 %) did not fulfil the diagnostic criteria of Lyme borreliosis. Half of these patients (73 patients, 34 %) were diagnosed with an alternative diagnosis including inflammatory diseases, cancer diseases and two patients with a tick-associated disease other than Lyme borreliosis. A total of 73 patients (34 %) were discharged without sign of somatic disease. Lyme borreliosis patients had a shorter duration of symptoms prior to the first hospital encounter compared to patients discharged without a specific diagnosis (p<0.001). When comparing symptoms at presentation, patients discharged without a specific diagnosis suffered more often from general fatigue and cognitive dysfunction. In conclusion, 66 % of all referred patients were given a specific diagnosis after ended outpatient course. A total of 32 % was diagnosed with either definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome; 34 % was diagnosed with a non-tick-associated diagnosis. Our findings underscore the complexity in diagnosing Lyme borreliosis and the importance of ruling out other diseases through careful examination.

[Clinical approach and main tick-borne rickettsiosis present in Latin America]. / Aproximación clínica y principales rickettsiosis transmitidas por garrapatas presentes en Latinoamérica.

Tick-borne rickettsial diseases are potentially life threatening infections that in Latin America have an emerging and reemerging character. Until few years ago, Rickettsia rickettsia was the only tick-borne rickettsia present in America; but nowadays several other species such as R. parkeri and R. massiliae are causing disease in humans in the region. In addition, new species are being described; although their pathogenicity has not been confirmed they should be considered as potential pathogens. Since the microbiological diagnosis of rickettsioses can take days or weeks, a high clinical suspicion and early start of appropriate treatment are crucial. In this review the distribution and main clinical manifestations of tick-borne rickettsial diseases in Latin America are detailed. Since R. felis has been found in ticks and the role of this vector has not been clarified, we have included a section about this pathogen.

Aproximación clínica y principales rickettsiosis transmitidas por garrapatas presentes en Latinoamérica / Clinical approach and main tick-borne rickettsiosis present in Latin America

Tick-borne rickettsial diseases are potentially life threatening infections that in Latin America have an emerging and reemerging character. Until few years ago, Rickettsia rickettsia was the only tick-borne rickettsia present in America; but nowadays several other species such as R. parkeri and R. massiliae are causing disease in humans in the region. In addition, new species are being described; although their pathogenicity has not been confirmed they should be considered as potential pathogens. Since the microbiological diagnosis of rickettsioses can take days or weeks, a high clinical suspicion and early start of appropriate treatment are crucial. In this review the distribution and main clinical manifestations of tick-borne rickettsial diseases in Latin America are detailed. Since R. felis has been found in ticks and the role of this vector has not been clarified, we have included a section about this pathogen.

Las rickettsiosis transmitidas por garrapatas son infecciones potencialmente letales, que en Latinoamérica tienen carácter emergente y re-emergente. Hasta hace escasos años, la única rickettsiosis transmitida por garrapatas era causada por Rickettsia rickettsii, pero en la actualidad existen otras especies como R. parkeri y R. massiliae que están provocando enfermedad en humanos en la región. Por otro lado, se están describiendo candidatos a nuevas especies de Rickettsia, que aunque no han probado su patogenicidad deben considerarse como potencialmente patógenos. Dado que el diagnóstico microbiológico puede tardar días o semanas, resulta fundamental una alta sospecha clínica y la instauración precoz de un tratamiento adecuado. En esta revisión se detalla la distribución y principales manifestaciones clínicas de las rickettsiosis transmitidas por garrapatas en Latinoamérica. Se ha incluido una sección sobre la infección por R. felis, por haberse encontrado esta especie en garrapatas, y no haberse aclarado el papel de este vector en su ciclo epidemiológico.

Prevalence of tick-borne pathogens in Ixodes ricinus and Dermacentor reticulatus ticks from different geographical locations in Belarus.

Worldwide, ticks are important vectors of human and animal pathogens. Besides Lyme Borreliosis, a variety of other bacterial and protozoal tick-borne infections are of medical interest in Europe. In this study, 553 questing and feeding Ixodes ricinus (n = 327) and Dermacentor reticulatus ticks (n = 226) were analysed by PCR for Borrelia, Rickettsia, Anaplasma, Coxiella, Francisella and Babesia species. Overall, the pathogen prevalence in ticks was 30.6% for I. ricinus and 45.6% for D. reticulatus. The majority of infections were caused by members of the spotted-fever group rickettsiae (24.4%), 9.4% of ticks were positive for Borrelia burgdorferi sensu lato, with Borrelia afzelii being the most frequently detected species (40.4%). Pathogens with low prevalence rates in ticks were Anaplasma phagocytophilum (2.2%), Coxiella burnetii (0.9%), Francisella tularensis subspecies (0.7%), Bartonella henselae (0.7%), Babesia microti (0.5%) and Babesia venatorum (0.4%). On a regional level, hotspots of pathogens were identified for A. phagocytophilum (12.5-17.2%), F. tularensis ssp. (5.5%) and C. burnetii (9.1%), suggesting established zoonotic cycles of these pathogens at least at these sites. Our survey revealed a high burden of tick-borne pathogens in questing and feeding I. ricinus and D. reticulatus ticks collected in different regions in Belarus, indicating a potential risk for humans and animals. Identified hotspots of infected ticks should be included in future surveillance studies, especially when F. tularensis ssp. and C. burnetii are involved.

[Far-eastern spotted fever: description of new infectious disease].

Historical data concerning description and identification of etiology of tick-borne spotted fever in Russia are presented in the paper. Review of studies shows that by uncovering the etiology of tick-borne spotted fever in the Russian Far East, an emerging disease may be discovered. Another, different from classical Rickettsia sibirica, bacteria causes spotted fever there. The application of described methods resulted in first isolation of etiological agent of far-eastern spotted fever, Rickettsia heilongjiangensis, strains from patients.

[Tick borne diseases]. / Durch Zecken übertragene Krankheiten.

It is known for many years that tick-borne diseases have worldwide a high economical impact on farming industry and veterinary medicine. But only in the last twenty years the importance of such diseases were notified in human medicine by the medical community and the public with emerging of the tick borne encephalitis virus and the description of Borrelia burgdorferi. It is often forgotten that many other infectious agents as bacteria, virus, Rickettsia or protozoa can be transmitted by ticks. Such diseases are rarely diagnosed in Europe either they are overlooked and misdiagnosed or they are connected with special professional activities. The development of new regions for tourism with different out door activities (adventure trips, trekking, hunting) leads to an exposure to different tick borne diseases, which are often misdiagnosed.

[Tick-borne rickettsioses of domestic ruminants: taxonomic elements and laboratory diagnosis]. / Les rickettsioses des ruminants domestiques transmises par les tiques: elements taxonomiques et diagnostic de laboratoire.

Tick-borne rickettsioses are diseases which remain comparatively unknown to field veterinarians. The authors present a literature review, focusing on taxonomic aspects and on laboratory diagnosis.

Serologically detected "new" tick-borne zoonoses in eastern Croatia.

AIM: To establish serologically a contact with causative agents of human monocytic and granulocytic ehrlichiosis, human babesiosis, recently detected rickettsioses, and Lyme disease in individuals with a history of tick bite from three counties in eastern Croatia. METHODS: Seroepidemiologic testing was performed in 102 subjects with a history of tick bite, who either requested examination for a tick bite or were suspected of having tick-borne disease. The study was carried out during the 1998-1999 period in the area of the Vukovar-Srijem, Osijek-Baranya, and Brod-Posavina counties. Serum analysis was performed by indirect immunofluorescence assay for the detection of antibodies to causative agents of human monocytic and granulocytic ehrlichiosis (Ehrlichia chaffeensis and human granulocytic ehrlichiosis agent), human babesiosis (Babesia divergens), and rickettsiosis. Enzyme-linked immunosorbent assay was used for the detection of antibodies to the spirochete Borrelia burgdorferi, the cause of Lyme disease. The assays were performed at the Department of Microbiology, Osijek Public Health Institute in Osijek, and their results were confirmed at the Department of Microbiology and Immunology, School of Medicine in Ljubljana, Slovenia. RESULTS: Ehrlichia chaffensis antibodies were detected in 5 sera, and antibodies to the causative agent of human granulocytic ehrlichiosis in 7 sera. A low titer of antibodies to the etiologic agent of babesiosis (Babesia microti) was detected only in a single serum. Eight sera that were positive for rickettsial antibodies contained rather high titers of antibodies against Rickettsia conorii, the agent of Mediterranean fever, and Rickettsia rickettsii, the agent of Rocky Mountain spotted fever. In six out of these 8 sera, antibodies to Rickettsia typhi, the cause of murine typhus, were detected possibly as a cross-reaction with some "newly detected" rickettsia circulating in this part of Europe, most likely Rickettsia slovaca. Positive titer of antibodies to Borrelia burgdorferi was detected in 15 sera. CONCLUSION: The agents of human monocytic and granulocytic ehrlichiosis and of possibly newly detected rickettsiae were indirectly demonstrated to circulate in eastern parts of Croatia. The results obtained by IFA failed to provide definite evidence for the circulation of the human babesiosis agent, because the IFA used in our study detected Babesia microti, which prevails in the USA, but not Babesia divergens, which is the predominant cause of the disease in Europe. Serologic evidence for Borrelia burgdorferi infection was demonstrated in 80% of the subjects suspected of having the skin manifestation of Lyme disease.

[Enzootic reservoir for new Ixodes ricinus-transmitted infections]. / Enzootyczne zródla nowych infekcji przenoszonych przez kleszcze Ixodes ricinus.

In the last decade new tick-transmitted zoonoses have emerged as threats to the public health in Europe. They are mostly due to infection by Borrelia burgdorferi s.I., Babesia divergens, B. microti and Ehrlichia sp. All these pathogens are transmitted by the rodent-feeding ticks of Ixodes persulcatus "complex". Also there is first serological information of coexistence of antibodies to B. burgdorferi, B. microti and Ehrlichia sp. in human exposured to these multiple tick-transmitted pathogens. Actually in Poland, the identification of the host species that act as zoonotical reservoir for these pathogens on which the competent vector becomes infected, is crucial to understand the dynamics of enzootic cycle of these pathogens. It is also important to assess the risk factor of infection in different habitats, especially in environmental condition where changing in farming system has left great land area under grassland or pasture, e.g. in Mazury Lakes District. Under such circumstances, susceptible rodent species, at least for two of these pathogens: B. micrnti and B. burgdorfen s.l., increasingly became competent reservoirs. This aspect is currently receiving considerable attention in Europe.

Survey of tick-borne diseases in dogs infested with Rhipicephalus sanguineus at a kennel in Okayama Prefecture, Japan.

Serological tests were performed to investigate extent of tick-borne diseases in dogs infested with Rhipicephalus sanguineus at a kennel in Okayama Prefecture. Three of 22 dogs (13.6%) were positive for Ehrlichia canis. Two of 19 dogs (10.5%) were positive for Rickettsia japonica. Three of 22 dogs (13.6%) were positive for Babesia gibsoni. None of these animals were positive for Coxiella burnetii or Hepatozoon canis. A microfilaria was detected in a drop smear of hemolymph from an engorged female tick, however, species was not determined. It is possible that these ticks can transmit pathogens to domestic dogs which are rare in Japan.