Scalp eschar and neck lymphadenopathy by Rickettsia slovaca after Dermacentor marginatus tick bite case report: multidisciplinary approach to a tick-borne disease.

BACKGROUND: Scalp Eschar and Neck LymphAdenopathy after Tick bite is a zoonotic non-pathogen-specific disease most commonly due to Rickettsia slovaca and Rickettsia raoultii. Diagnosis is mostly based only on epidemiological and clinical findings, without serological or molecular corroboration. We presented a clinical case in which diagnosis was supported by entomological identification and by R. slovaca DNA amplifications from the tick vector. CASE PRESENTATION: A 6-year-old child presented with asthenia, scalp eschar and supraclavicular and lateral-cervical lymphadenopathy. Scalp Eschar and Neck LymphAdenopathy After Tick bite syndrome following a Dermacentor marginatus bite was diagnosed. Serological test on serum revealed an IgG titer of 1:1024 against spotted fever group rickettsiae, polymerase chain reaction assays on tick identified Rickettsia slovaca. Patient was successfully treated with doxycycline for 10 days. CONCLUSIONS: A multidisciplinary approach including epidemiological information, clinical evaluations, entomological identification and molecular investigations on tick, enabled proper diagnosis and therapy.

Analysis of the environmental and host-related factors affecting the distribution of the tick Dermacentor marginatus.

Understanding and responding to the ecological, social and economic conditions that facilitate disease emergence and transmission represents a substantial challenge for epidemiologists and health professionals. In this article we integrate knowledge about the human and the vector population, to provide a context from which to examine the underlying causal factors of D. marginatus-borne diseases emergence in the study area. Within this framework we analyse the biotic and abiotic factors that drive D. marginatus population dynamics and the role of its typical host for dispersal. These investigations suggest that D. marginatus is a tick species prone to spatially overlap its presence with human population presence. Then we consider the public health implications for the residents, when simply carrying out trivial outdoor activities may increase the risk to contact an infected tick.

Assessment of using recombinant Ixodes ricinus AV422 saliva protein for confirmation of tick bites in hunting dogs as naturally infested hosts.

Due to the recorded spreading of ticks in past years, a higher incidence of tick-borne diseases (TBDs) can be expected in the future in endemic areas, but can also pose an emerging public health concern in areas where they have not yet been recognized. Assessment of the exposure of vulnerable hosts to ticks would be a very helpful tool for TBD epidemiological studies, as well as for their proper managing. To confirm previous tick bites, the method of choice is detection of antibodies in host serum as markers developed against injected tick saliva proteins during feeding. We recently showed that the recombinant form of Ixodes ricinus AV422 saliva protein (rIrAV422) can serve for detection of markers in experimentally infested rats. Here we examine whether it can be used in the same manner in naturally exposed hosts. We chose hunting dogs as good sentinel animals. The study group consisted of 15 dogs that varied in breed, age, sex, previous tick infestation history and repellent treatment. Western blot analysis with rIrAV422 as an antigen confirmed the presence of tick bite markers in all analysed dogs. For some of the dogs, their previous tick infestation history was unclear, which emphasizes the usefulness of rIrAV422 for revealing it. Since hunting dogs are naturally infested with different ticks, the potential of rIrAV422 in assessment of general exposure to ticks is highlighted. Use of rIrAV422 can also be helpful in veterinary practice and research as a tool for validation of the efficiency of tick repellent products.

A Case of Engorged Female Hard Tick in the External Auditory Canal of an Infant.

An oval-shaped mass with a smooth surface was found in the ear canal of a 22-month-old male infant. Although the mass appeared to be almost entirely blocking the ear canal, it was successfully removed under a surgical microscope without general anesthesia at the outpatient department. Under an optical microscope with hematoxylin and eosin staining, the specimen was observed to have a cuticle with a serrated surface and a pore canal, as well as parts of the capitulum, salivary glands, muscles, midgut, and the legs. The specimen was identified as a hard tick of the family Ixodidae, based on gross and histological findings. This paper is the first report in Korea on the diagnosis and treatment of a tick bite in the ear canal.

Tick Bite Alopecia: A Report and Review.

Tick bites can cause a number of local inflammatory reactions, which are often difficult to differentiate from those induced by other arthropod bites or stings. These include erythematous nodular or pustular lesions, erosive plaques, annular lesions of erythema chronicum migrans, and both scarring and nonscarring inflammatory alopecia. We report a case of nonscarring alopecia in a 21-year-old male who reported a recent history of tick bite to the scalp. The biopsy demonstrated a dense pseudolymphomatous inflammatory infiltrate with numerous eosinophils associated with hair follicle miniaturization and an elevated catagen-telogen count. Signs of external rubbing, including lichen simplex chronicus and the "hamburger sign", were also visualized and are indicative of the associated pruritus. To the authors' knowledge, this is the fifth report of nonscarring tick bite alopecia in the literature and the first in an adult patient. This text will review the classic clinical presentation, histologic findings, and proposed mechanism of tick bite alopecia.

Determination of percentage elongation at break and histopathology of skin from yankasa sheep experimentally infested with Amblyomma variegatum.

Bites of haematophagous ectoparasites cause mechanical injuries and histopathological changes in their hosts' hides and skins whose resultant leathers become unsuitable for certain leather products. The effects of tick bites on the wellbeing of their hosts are known, however, knowledge of their effects on the quality of leathers is scarce. This work investigated the effects of tick bites on the histopathology of skin and the percentage elongation at break (PEB) of shoe upper leathers produced from the skins of Amblyomma variegatum infested Yankasa sheep. A total of nine apparently healthy Yankasa sheep were selectively purchased from the open market and acclimatized for four weeks in the laboratory. Three animals in each of group 1 and 2 were infested with 40 nymphs and 20 adults of Am. variegatum respectively. Group three animals served as uninfested control. All animals were euthanized after the ticks were fully engorged and detached. Skin biopsies at tick attachment points and the uninfested control were taken from flayed skins and processed for histopathological examination. All skins were processed into finished leathers and their PEB determined. Histopathological studies revealed keratinization in all Am. variegatum infested sheep skins, while the un-infested control skins were normal. Mean PEB (%) of leathers were 21.41±3.33SE (nymphs), 36.73±4.44SE (adults) and 47.83±2.78SE (control). Bites of Am. variegatum cause histopathological changes in Yankasa sheep skins that significantly (p = 0.006) reduce the PEB of resultant leathers to less than the acceptable minimum standard of 40 % whose leathers are classified as rejects. In this study, skin of Yankasa sheep infested by nymphs and adults of Am. variegatum ticks resulted in low quality leathers that are unsuitable for standard leather products production and are also of low market value due to keratinization. Sustained efforts need to be undertaken to increase the awareness on the negative impact of tick bites on leather products by encouraging livestock farmers to engage in early treatment of animals infested with ticks.

An instance of parasitism on a human by a nymph of the kangaroo soft tick, Ornithodoros gurneyi Warburton, 1926 (Acari: Argasidae) in South Australia.

The kangaroo soft tick, Ornithodoros gurneyi Warburton, 1926, is a poorly studied argasid of the more arid regions of Australia. Anecdotal accounts have stated that this tick species will bite humans, and yet bites have not been described. Herein we report on an instance of parasitism by a nymph of O. gurneyi on a human, and we provide a summary of confirmed instances of parasitism on humans by this tick based on museum specimens.

Long-Term Itching in a Tourist Following Bite by a Nymph of Dermacentor auratus (Acari: Ixodidae) in Cambodia.

The impact of tick bites during holidays in tropical countries is seldom reported. Here, we describe long-term skin alterations and itching experienced by a German tourist following the bite of a nymph of Dermacentor auratus Supino, 1897 in Cambodia. Tick infestation may be neglected by travelers. Therefore, careful travel history is necessary when travelers report a tick bite after spending holiday in tropical and subtropical countries.

Two Atypical Cases of Tick Bites: A Fully Engorged Tick and Multiple Ticks.

Ticks have a cosmopolitan distribution and, as such, are also found in Japan. Ticks are typically ectoparasites of wild animals, however, humans can also be bitten when visiting environments inhabited by ticks. Herein, we describe two cases with atypical tick bites. Case 1 was an elderly Japanese male patient who presented with a fully engorged tick measuring 20 × 17 × 8 mm; it is rare for ticks to attain a length of 20 mm. Case 2 was an elderly Japanese female with severe dementia who presented with multiple tick bites, which is rare, after going missing for 6 days before being found in a densely wooded area. Ticks are responsible for the transmission of many infectious agents, such as bacteria, viruses and parasites. The National Institute of Infectious Diseases and the Ministry of Health, Labour and Welfare regularly inform citizens of the risks posed by tick bites. However, the tick bites could not be prevented in our patients. Further edification about tick bites, tick-borne diseases, and their prevention are considered necessary in Japan.

Tick exposures and alpha-gal syndrome: A systematic review of the evidence.

Alpha-gal syndrome (AGS) refers to a delayed allergic reaction to galactose-α-1,3-galactose (α-Gal) that occurs following the consumption of mammalian meat or exposure to other animal-based foods and products. Increasing evidence suggests that bites from certain tick species can lead to AGS through sensitization of a person's α-Gal specific IgE levels. This systematic review aimed to summarize the published evidence on this topic to understand post-tick exposure AGS epidemiology and health outcomes. A structured search for literature in eight bibliographic databases was conducted in January, 2020. Grey literature and verification searches were also performed. The exposure of interest was tick bites, and the outcome of interest was AGS. All primary research study designs were eligible for inclusion. References were screened for relevance, and data extraction and risk-of-bias assessment were conducted on relevant studies by two independent reviewers. Data were descriptively and narratively summarized. Of 1390 references screened, 102 relevant articles (103 unique studies) were identified (published from 2009 to 2020). Most studies (76.7 %) were case report or series. These 79 studies reported on 236 post-tick exposure AGS cases from 20 different countries, mostly the United States (33.5 %), Spain (19.5 %), Sweden (18.6 %), and France (12.7 %). The mean case age was 51.3 (SD = 16.7, range 5-85, n = 229), while 68.1 % were male (n = 226). The most commonly reported symptom was urticaria (71.2 %); 51.7 % of cases reported anaphylaxis. Twenty-one observational studies were reported, mostly (95.2 %) among clinical allergy patients. The proportion of AGS cases that recalled tick bites was highly variable across these studies. Three challenge studies evaluating tick exposures and α-Gal levels in α-Gal deficient mice were identified. The existing evidence suggests tick bites lead to α-Gal-specific IgE sensitization, which can cause AGS, but further research is needed to clarify if AGS is only attributable to certain tick species and whether other vectors may trigger AGS. Additional research is needed on risk factors for AGS development, evaluation of diagnostic immunoassays, and the epidemiology and distribution of AGS in different populations. Climate change will likely lead to future cases of AGS in new regions worldwide due to the predicted alteration of suitable tick habitats.

Coinfection of Ixodes scapularis (Acari: Ixodidae) Nymphs With Babesia spp. (Piroplasmida: Babesiidae) and Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) in Wisconsin.

Borrelia burgdorferi, the spirochete that causes Lyme disease, is endemic and widespread in Wisconsin. Research in the northeastern United States has revealed a positive association between Babesia microti, the main pathogen that causes babesiosis in humans, and Bo. burgdorferi in humans and in ticks. This study was conducted to examine associations between the disease agents in the Upper midwestern United States. Ixodes scapularis Say nymphs (N = 2,858) collected between 2015 and 2017 from nine locations in Wisconsin were tested for Babesia spp. and Borrelia spp. using real-time PCR. Two species of Babesia were detected; Ba. microti and Babesia odocoilei (a parasite of members of the family Cervidae). Prevalence of infection at the nine locations ranged from 0 to 13% for Ba. microti, 11 to 31% for Bo. burgdorferi sensu stricto, and 5.7 to 26% for Ba. odocoilei. Coinfection of nymphs with Bo. burgdorferi and Ba. odocoilei was detected in eight of the nine locations and significant positive associations were observed in two of the eight locations. The prevalence of nymphal coinfection with both and Bo. burgdorferi and Ba. microti ranged from 0.81 to 6.5%. These two pathogens were significantly positively associated in one of the five locations where both pathogens were detected. In the other four locations, the observed prevalence of coinfection was higher than expected in all but one site-year. Clinics and healthcare providers should be aware of the association between Ba. microti and Bo. burgdorferi pathogens when treating patients who report tick bites.

Ticks biting humans in the Brazilian savannah: Attachment sites and exposure risk in relation to species, life stage and season.

Information about human tick bites in Brazil is mostly anecdotal. Published information is typically restricted to single tick infestation episodes and does not address human exposure occurring on a daily basis in natural, rural, or green urban areas. We present a comprehensive 2-yr study on human parasitism during a broad survey on ticks within a Brazilian savannah reserve. Overall, 439 tick bites were recorded from the following species: Amblyomma sculptum (n = 331 bites), Amblyomma parvum (n = 64), Amblyomma auricularium (n = 3), Rhipicephalus microplus (n = 2), Dermacentor nitens (n = 1) and 38 Amblyomma spp. ticks. Nymphs accounted for most tick bites (n = 292, 66.5 % of all bites) and these were overwhelmingly A. sculptum (92.8 % of nymphal bites). The main adult tick biting humans was A. parvum (n = 61, 50 % of all adult tick bites) followed closely by A. sculptum (n = 58, 47.5 % of all adult tick bites). Winter was the season with the highest percentage of tick bites (39.7 % of all bites), followed by spring (32.4 %); summer (18.9 %) and autumn (9 %). Amblyomma sculptum adult bites peaked in summer whereas nymphal bites occurred primarily in winter and spring. Amblyomma parvum adult bites peaked in spring and summer. The most common tick attachment sites included the waist, legs and belly, but A. parvum adults were recorded from the head of humans as well. A noteworthy observation was the lack of human parasitism by Amblyomma triste, the third most prevalent species in the environment. This tick species is a frequent human biter in both Uruguay and Argentina where it transmits a pathogen, Rickettsia parkeri, to humans.

Association between lone star tick bites and increased alpha-gal sensitization: evidence from a prospective cohort of outdoor workers.

BACKGROUND: Alpha-gal is an oligosaccharide implicated in delayed anaphylaxis following red meat consumption. Exposure to tick bites has been correlated with development of an allergic response to alpha-gal. However, evidence prospectively linking exposure to a single tick species and an immune response to alpha-gal is lacking. METHODS: We used serum samples from a prior study cohort of outdoor workers in North Carolina, USA, with high exposure to the lone star tick, Amblyomma americanum, to prospectively evaluate the relationship between tick bites and anti-alpha-gal IgE antibodies. RESULTS: Individuals who reported exposure to one or more tick bites were significantly more likely to have a positive change in anti-alpha-gal IgE compared to individuals with no reported tick bites. This relationship was not dependent on time. A trend toward increasing number of tick bites and increased anti-alpha-gal IgE levels was observed but not statistically significant. CONCLUSION: To our knowledge, this is the first study to prospectively link documented exposure to A. americanum bites and increased sensitization to alpha-gal in a cohort of outdoor workers. Our results support the role of A. americanum as likely agents for eliciting an allergic response to red meat, and highlight the importance of preventing tick bites.

Host feeding behaviour of Dermacentor reticulatus males in relation to the transmission of pathogens.

INTRODUCTION: The three-host Dermacentor reticulatus tick transmits many pathogens, which are introduced into the host with saliva during feeding. MATERIAL AND METHODS: The aim of present study was to analyse the behaviour of males of this species on the host in homogeneous sex groups comprising 15 (group I) and 30 (group II) male specimens and in a mixed group composed of 15 males and 15 females (group III). RESULTS: Although the dynamics of attachment of the males to host skin slightly differed between these three groups, there was no statistically significant difference in the duration of the attachment process. The duration of host attachment of the males in groups I, II, and III at 18±2°C and 50 ± 2% RH was 2.43 ± 2.46, 7.75 ± 11.85, and 9.07 ± 10.97 days, respectively. After 7-9-day feeding, the male engorgement weight (MEW) was similar, regardless of the size of the group and the presence or absence of females on the host. Tick males ingest a small amount of host blood. The value of MEW in the three groups did not differ statistically from the weight of unengorged specimens. CONCLUSIONS: The host feeding behaviour of D. reticulatus males and their effective feeding suggest that they may play a role in transmission of pathogens and non-pathogenic microorganisms with tick saliva during blood meal ingestion. Clinical and laboratory diagnostics of human and animal tick-borne diseases as well as epidemiological studies should consider the possibility of pathogen transmission by males of metastriata ticks, which feed on the host for several days.

Immunoproteomic analysis of Borrelia miyamotoi for the identification of serodiagnostic antigens.

The tick-borne spirochete, Borrelia miyamotoi, is an emerging pathogen of public health significance. Current B. miyamotoi serodiagnostic testing depends on reactivity against GlpQ which is not highly sensitive on acute phase serum samples. Additionally, anti-B. miyamotoi antibodies can cross-react with C6 antigen testing for B. burgdorferi, the causative agent of Lyme disease, underscoring the need for improved serological assays that produce accurate diagnostic results. We performed an immunoproteomics analysis of B. miyamotoi proteins to identify novel serodiagnostic antigens. Sera from mice infected with B. miyamotoi by subcutaneous inoculation or tick bite were collected for immunoblotting against B. miyamotoi membrane-associated proteins separated by 2-dimensional electrophoresis (2DE). In total, 88 proteins in 40 2DE immunoreactive spots were identified via mass spectrometry. Multiple variable large proteins (Vlps) and a putative lipoprotein were among those identified and analyzed. Reactivity of anti-B. miyamotoi sera against recombinant Vlps and the putative lipoprotein confirmed their immunogenicity. Mouse anti-B. burgdorferi serum was cross-reactive to all recombinant Vlps, but not against the putative lipoprotein by IgG. Furthermore, antibodies against the recombinant putative lipoprotein were present in serum from a B. miyamotoi-infected human patient, but not a Lyme disease patient. Results presented here provide a comprehensive profile of B. miyamotoi antigens that induce the host immune response and identify a putative lipoprotein as a potentially specific antigen for B. miyamotoi serodetection.

Risk factors for tick exposure in suburban settings in the Northeastern United States.

Prevention of tick-borne diseases requires an understanding of when and where exposure to ticks is most likely. We used an epidemiologic approach to define these parameters for residents of a Lyme-endemic region. Two persons in each of 500 Connecticut households were asked to complete a log each night for one week during June, 2013. Participants recorded their whereabouts in 15min increments (indoors, outdoors in their yard, outdoors on others' private property, or outdoors in public spaces) and noted each day whether they found a tick on themselves. Demographic and household information was also collected. Logs were completed for 934 participants in 471 households yielding 51,895 time-place observations. Median participant age was 49 years (range 2-91 years); 52% were female. Ninety-one participants (9.8%) reported finding a tick during the week, with slightly higher rates among females and minors. Household factors positively associated with finding a tick included having indoor/outdoor pets (odds ratio (OR)=1.7; 95% confidence interval (CI): 1.1-2.9), the presence of a bird feeder in the yard (OR=1.9; CI:1.2-3.2), and presence of an outdoor dining area (OR=2.2; CI:1.1-4.3). Individual factors associated with finding a tick on a given day were bathing or showering (OR=3.7; CI:1.3-10.3) and hours spent in one's own yard (OR=1.2, CI:1.1-1.3). Nineteen participants found ticks on multiple days, more than expected assuming independence (p<0.001). Participants who found ticks on multiple days did not spend more time outdoors but were significantly more likely to be male than those finding ticks on a single day (p<0.03). Our findings suggest that most tick exposures in the study area occurred on private property controlled by the respective homeowner. Interventions that target private yards are a logical focus for prevention efforts.

Pilot study of Ixodes ricinus ticks preference for human ABO blood groups using a simple in vitro method.

INTRODUCTION AND OBJECTIVES: The existence of a blood group preference for ticks is a problem widely discussed among the lay public but often neglected by the scientific community. The Ixodes ricinus tick transmits serious zoonotic diseases such as Lyme borreliosis, tick encephalitis, or anaplasmosis. The preventive strategies include vaccination (if available) and individual measures including the use of repellents and avoidance of risk areas. MATERIAL AND METHODS: Since this topic is relatively neglected in the scientific literature, a simple in vitro method was used. Ticks used in this study were collected in the suburban region of Ruda in Brno, Czech Republic. One hundred active nymphs of the collected ticks were tested for preferences for blood groups, using Petri dishes and blood samples from volunteers. To demonstrate the threat of ticks and the diseases they transmit, the positivity of one of the most abundant zoonosis, Lyme borreliosis, was tested using dark-field microscopy. RESULTS: The results obtained showed that the examined ticks were attracted most by blood group A, whereas the least preferred was group B, which was proved statistically (p <0.05). The mean positivity of collected ticks for the presence of spirochaetes was 9.35%. CONCLUSIONS: The results indicate that the host selection of ticks may be influenced by the physiological or biochemical profile of an individual, such as their blood group. This means that a blood group of an individual can be one of the factors that increase the risk of tick bite and the transmission of dangerous diseases and thus must not be underestimated.

Skin lesions in humans bitten by European pigeon tick Argas reflexus (Fab.) (Ixodida: Argasidae) massively occurring in the Upper Silesian conurbation of south-west Poland.

INTRODUCTION AND OBJECTIVE: The great number of pigeon populations in many European cities promotes the spread of the European pigeon tick (Argas reflexus), the bites of which cause local and systemic reactions. The aim was to study the occurrence of A. reflexus in several cities of Upper Silesia, and skin lesions caused by A. reflexus tick bites in humans. MATERIAL AND METHODS: The results of investigations carried out in 1995-2002 in five cities located in the Upper Silesian conurbation are presented. Specimens of A. reflexus were collected for one hour in attics and lofts inhabited by these ticks. A history of skin lesions caused by bites was taken from residents who had been infested by A. reflexus. The development of skin lesions was monitored for three months in two individuals who had been bitten several times by these arthropods. RESULTS: In the localities, 987 A. reflexus specimens were collected, including 334 females, 269 males, and 384 various nymphal stages. Within one hour, 38-109 ticks specimens were collected at the study sites. Cases of attacks by unengorged A. reflexus were reported in all the habitats located in the residential buildings; the ticks were also found in residents' flats and in staircases. Residents who had been repeatedly attacked by European pigeon ticks developed a strong inflammatory reaction to the components of tick saliva, and had purple papules with necrosis in the centre of the lesion. The tick bite areas exhibited scars and hyperpigmentation. CONCLUSIONS: Individuals attacked by A. reflexus several times are at risk of development of severe persistent local reactions to bites. Pigeon ticks, trophically associated with pigeons present abundantly in the Upper Silesian conurbation and other European urban habitats, pose a serious threat to public health.