Infective Endocarditis Due to Q Fever From a Tick Bite: A Case Report.

Infection from Coxiella burnetti causes Q fever that manifests with vague symptoms. We report a case of an individual admitted to the hospital with recurrent fevers with a history of multiple tick bites. Further workup revealed examination and laboratory findings consistent with Q fever endocarditis. Fevers resolved with doxycycline and hydroxychloroquine. Our case highlights that suspicion for Q fever should be maintained in patients presenting to the hospital with fevers of unknown origin for prompt recognition and appropriate treatment.

Alpha-Gal Syndrome and Cardiac Surgery.

Galactose-alpha-1,3-galactose (alpha-gal) is a carbohydrate expressed by all mammals except for humans and certain old-world primates. It can be found in a plethora of products derived from mammals, including milk, organs, skeletal muscle and gelatin, in addition to products prepared with mammalian cells or constituents. In the late 2000s, an association between tick bites and the development of immunoglobulin E antibodies to the alpha-gal carbohydrate was discovered. The term "alpha-gal syndrome" (AGS) was then coined to describe allergic reactions to mammalian meat or other alpha-gal-containing products derived from mammals. Symptoms are often delayed several hours from consumption and can be urticarial and/or gastrointestinal. Medications and bioprosthetic inserts derived from mammals were also noted to cause allergic reactions in affected patients. Cardiac surgery, in particular, is considered high risk, given that unfractionated heparin has a bovine or porcine origin and is administered in large doses for cardiopulmonary bypass. Bioprosthetic valves have similar origins and risks. Awareness of AGS in cardiac surgery patients can lead to decreased risk preoperatively and inform management perioperatively and postoperatively. In this narrative review, we have reviewed the published literature relevant to AGS in patients undergoing cardiac surgery and shared our treatment approach.

A case of tick bite on the perianal region.

Key Clinical Message: Tickborne diseases have become the threats to the health of people worldwide, accounting for nearly 80% patients with vectorborne diseases in the United States. Early diagnosis and proper treatment play a significant role in the management. Close contacts should be screened for delayed symptoms associated with tickborne diseases. Abstract: This study describes a rare case of a 72-year-old Chinese man presented with a 5-day history of painful nodules on the perianal region, indicating tick bite. Tickborne diseases become the threats to the health of people worldwide. Untreated cases may result in several serious inflammatory complications. Manual removal of ticks with fine forceps is effective for preventing the transmission of tickborne infections. People (who have been bitten by a tick) and close contacts should be screened for delayed symptoms associated with tickborne diseases.

Infection Rates and Characterisation of Rickettsia africae (Rickettsiaceae) Detected in Amblyomma Species from Southern Africa.

Tick-borne rickettsioses are considered among the oldest known vector-borne zoonotic diseases. Among the rickettsiae, Rickettsia africae is the most reported and important in Africa, as it is the aetiological agent of African tick bite fever (ATBF). Studies describing the prevalence of R. africae in southern Africa are fragmented, as they are limited to small geographical areas and focused on Amblyomma hebraeum and Amblyomma variegatum as vectors. Amblyomma spp. ticks were collected in Angola, Mozambique, South Africa, Zambia and Zimbabwe during the sampling period from March 2020 to September 2022. Rickettsia africae was detected using the ompA gene, while characterisation was conducted using omp, ompA, ompB and gltA genes. In total, 7734 Amblyomma spp. ticks were collected and were morphologically and molecularly identified as Amblyomma eburneum, A. hebraeum, Amblyomma pomposum and A. variegatum. Low levels of variability were observed in the phylogenetic analysis of the R. africae concatenated genes. The prevalence of R. africae ranged from 11.7% in South Africa to 35.7% in Zambia. This is one of the largest studies on R. africae prevalence in southern Africa and highlights the need for the inclusion of ATBF as a differential diagnosis when inhabitants and travellers present with flu-like symptoms in the documented countries.

Risk of Ixodes ricinus Bites in a Population of Forestry Workers in an Endemic Region in France.

The progressing worldwide increases in tick occurrence and tick-borne diseases calls for the development of new prevention strategies to reduce their impact on human and animal health. Defining the risk of exposure to tick bites is therefore essential. Forestry workers are at high risk of tick bites. We set up an explorative study among forestry workers in the Alsace region in eastern France to measure the different factors affecting the risk of Ixodes ricinus tick bites during their activities in forests. For one year, forestry workers recorded the presence of ticks on their clothes and tick bites every time they were working in teams in different forest ecosystems. Questions about the prevention measures they followed were also noted. Among the 32 participants, we were able to differentiate between groups having a high, neutral, or low risk of being bitten. The median tick bite number per year was 4 (0-8). We tried to identify individual as well as environmental factors affecting the risk of tick bites. Factors influencing the risk were the seasonal peak of tick activity in May and June, the time of exposure, and the forest ecosystems visited during the year. Additional factors potentially affecting the risk were also identified.

Effects of permethrin-treated uniforms on tick submissions to a military passive tick surveillance program.

Permethrin-treated clothing is often recommended as a first line of defense against tick-borne diseases. In 2012, the permethrin factory-treated Army Combat Uniform was first made available to active duty Soldiers, Army National Guard, Army Reserve Enlisted Soldiers, and the Senior/Junior Reserve Officers Training Corps. Subsequently, Air Force and Marine Corps personnel were also offered permethrin factory-treated uniforms. Here, we use the passive surveillance data collected through the Military Tick Identification/Infection Confirmation Kit (MilTICK) program to determine the effectiveness of permethrin-treated uniforms at protecting Department of Defense personnel from exposure to tick-borne pathogens in the United States. We analyzed whether submissions by self-reported users of the permethrin-treated uniforms had smaller proportions of engorged ticks, certain cohorts of MilTICK users were better protected than others, and specific tick species were better repelled than others. We found that permethrin use resulted in significantly lower proportions of engorged ticks submitted across MilTICK users. Army and Army National Guard personnel reported more permethrin-treated uniform use than other services. For submissions from active duty personnel serving in uniform, the proportion of tick engorgement in the presence of permethrin increased over time, possibly indicating that permethrin-treated uniforms suffer from reduced performance over the life of the garment. We also found that while permethrin reduced all tick species' ability to feed until engorgement or repletion, blacklegged tick adult females were better able to resist permethrin's lethal effects than lone star tick and American dog tick adult females. Permethrin-treated clothing plays an important role in keeping military personnel safe from tick-borne diseases.

A Rare Tick Tale: A Novel Case of the Australian Paralysis Tick Causing Multiple Cranial Neuropathies.

The Australian paralysis tick (Ixodes holocyclus) is found along the east coast of Australia. Tick bites may result in paralysis ranging from muscular weakness to ascending paralysis requiring respiratory support. Ocular complications and facial nerve involvement are rare. We present a rare occurrence of tick-bite-associated visual loss, proptosis, and multiple cranial neuropathies not previously reported in the literature. The tick was removed, and the patient's symptoms improved following treatment with steroids and oral doxycycline. The vision and sensory changes are not explained by the Ixodes toxin; thus, we hypothesize this is related to orbital apex inflammation.

Willingness and capacity of publicly-funded vector control programs in the USA to engage in tick management.

BACKGROUND: The vast majority of vector-borne diseases in the USA are associated with mosquitoes or ticks. Mosquito control is often conducted as part of community programs run by publicly-funded entities. By contrast, tick control focuses primarily on individual residential properties and is implemented predominantly by homeowners and the private pest control firms they contract. We surveyed publicly-funded vector control programs (VCPs), presumed to focus mainly on mosquitoes, to determine what tick-related services they currently offer, and their interest in and capacity to expand existing services or provide new ones. METHODS: We distributed a survey to VCPs in the Northeast, Upper Midwest and Pacific Coast states of the USA, where humans are at risk for bites by tick vectors (Ixodes scapularis or Ixodes pacificus) of agents causing Lyme disease and other tick-borne diseases. The data we report are based on responses from 118 VCPs engaged in vector control and with at least some activities focused on ticks. RESULTS: Despite our survey targeting geographic regions where ticks and tick-borne diseases are persistent and increasing public health concerns, only 11% (12/114) of VCPs reported they took direct action to suppress ticks questing in the environment. The most common tick-related activities conducted by the VCPs were tick bite prevention education for the public (70%; 75/107 VCPs) and tick surveillance (48%; 56/116). When asked which services they would most likely include as part of a comprehensive tick management program, tick bite prevention education (90%; 96/107), tick surveillance (89%; 95/107) and tick suppression guidance for the public (74%; 79/107) were the most common services selected. Most VCPs were also willing to consider engaging in activities to suppress ticks on public lands (68%; 73/107), but few were willing to consider suppressing ticks on privately owned land such as residential properties (15%; 16/107). Across all potential tick-related services, funding was reported as the biggest obstacle to program expansion or development, followed by personnel. CONCLUSIONS: Considering the hesitancy of VCPs to provide tick suppression services on private properties and the high risk for tick bites in peridomestic settings, suppression of ticks on residential properties by private pest control operators will likely play an important role in the tick suppression landscape in the USA for the foreseeable future. Nevertheless, VCPs can assist in this effort by providing locally relevant guidelines to homeowners and private pest control firms regarding best practices for residential tick suppression efforts and associated efficacy evaluations. Publicly-funded VCPs are also well positioned to educate the public on personal tick bite prevention measures and to collect tick surveillance data that provide information on the risk of human encounters with ticks within their jurisdictions.

Clinical Presentation and Outcomes of Alpha-Gal Syndrome.

BACKGROUND AND AIMS: Alpha-gal syndrome (AGS) is an IgE-mediated allergic reaction to galactose-α-1,3-galactose, primarily linked with Lone Star tick bites in the United States. It presents with symptoms ranging from urticaria and gastrointestinal (GI) manifestations to delayed anaphylaxis following red meat consumption. We aimed to study AGS patients' clinical manifestations, diagnosis, and outcomes. METHODS: A retrospective chart review of patients who underwent serological testing for suspected AGS between 2014 and 2023 at Mayo Clinic was performed. Patients with positive serology were age and sex matched with those who tested negative. Clinical characteristics of seropositive cohort with and without GI symptoms were compared, and outcomes assessed. RESULTS: Of 1260 patients who underwent testing, 124 tested positive for AGS. They were matched with 380 seronegative control subjects. AGS patients reported a higher frequency of tick bites (odds ratio [OR], 26.0; 95% confidence interval [CI], 9.8-68.3), reported a higher prevalence of urticaria (56% vs 37%; P = .0008), and were less likely to have asthma (OR, 0.4; 95% CI, 0.3-0.7). They had a lower prevalence of heartburn (6% vs 12%; P = .03) and bloating (6% vs 13%; P = .03). A total of 47% had GI symptoms, and a higher proportion were female than those without GI symptoms (69% vs 35%; P = .002). During a mean follow-up of 27 months, 22 of 40 patients reported symptom resolution after avoiding red meat, and 7 were able to transition to regular diet. CONCLUSIONS: A diagnosis of AGS should be strongly considered in patients with a history of tick bites and clinical presentation of allergic or GI manifestations. Dietary intervention is effective in most but not all patients.

A case of alpha-gal syndrome: Recall urticaria and 10 years of measurements of IgE to galactose-α-1,3-galactose.

Alpha-gal IgE level can change rapidly. Reassessment of a patient's alpha-gal IgE level may be helpful in the patient's clinical follow-up. Pruritus related to the site of a previous tick bite strengthens the diagnosis of alpha-gal syndrome.

Three cases of African tick bite fever diagnosed in Quebec City: A case series.

African tick bite fever is a rickettsiosis of the spotted fever group that is endemic to sub-Saharan Africa and the Caribbean. It is characterized by eschars at the inoculation sites and a maculopapular rash which may be purpuric. We describe three cases that were diagnosed in Quebec City.

Rickettsia africae infections in sub-Saharan Africa: A systematic literature review of epidemiological studies and summary of case reports.

Rickettsia africae is a tick-borne bacteria known to cause African tick bite fever (ATBF). While the disease was first described more than 100 years ago, knowledge of transmission risk factors and disease burden remain poorly described. To better understand the burden of R. africae, this article reviewed and summarized the published literature related to ATBF epidemiology and clinical management. Using a systematic approach, consistent with the PRISMA guidelines, we identified more than 100 eligible articles, including 65 epidemiological studies and 41 case reports. Most reports described R. africae in ticks and livestock, while human studies were less common. Human disease case reports were exclusively among returning travellers from non-endemic areas, which limits our disease knowledge among at-risk populations: people living in endemic regions. Substantial efforts to elucidate the ATBF risk factors and clinical manifestations among local populations are needed to develop effective preventative strategies and facilitate appropriate and timely diagnosis.

Knowledge and perception of equine ticks and tick-borne diseases of Pennsylvania horse owners and caretakers.

There is limited data on current knowledge of Pennsylvania horse caretakers on tick-borne diseases (TBDs), tick identification, and tick management practices. This study aimed to determine tick knowledge, concern, and management among Pennsylvania equine caretakers using an online survey. Descriptive statistics and one-way ANOVA tests were used to analyze data. The survey received 894 responses (539 completed) from Pennsylvania equine owners and caretakers. The largest proportion of respondents cared for 3-5 horses (31 %), followed by 2 horses (27 %). Veterinarian-confirmed diagnosis rates of two TBDs, Lyme disease and anaplasmosis, were 38 % and 22 %, respectively. Most respondents (39 %) were moderately confident in recognizing Lyme disease, while most (44 %) were not confident at all in recognizing anaplasmosis. Most respondents (69 %) were either extremely or very concerned about their horses contracting any TBDs. Tick bite and TBD prevention methods used by equine caretakers included performing tick checks, using on-animal repellents, and conducting pasture/landscape management. Ten knowledge-based questions were asked, and the mean correct score was 3.97 ± 2.18 out of 10 possible points. There were significant positive associations between higher knowledge scores and previous veterinarian-confirmed equine Lyme disease diagnosis, higher concern level of TBDs, and higher frequency of tick checks. With increased equine TBD prevalence and high levels of horse owner concern about TBD, Extension educators should focus on teaching about TBDs and managing ticks on horses and farms.

An Abnormal Presentation of Rocky Mountain Spotted Fever: A Case Report.

The intracellular coccobacilli Rickettsia rickettsii causes Rocky Mountain Spotted Fever, a potentially fatal illness. This bacterium is transmitted to humans through a tick vector. Patients classically present with a triad of symptoms, including fever, headache, and a rash that begins on the extremities and spreads proximally to the trunk. Diagnosis of this disease can prove difficult when patients have unusual symptoms, such as hypertensive crisis. In this case report, we present a 29-year-old male who arrived at the emergency room with altered mental status and a hypertensive crisis after his family reported one week of changes in his behavior. The patient had no evidence of ticks, tick bites, fever, or rash. Positive findings in the emergency room included a WBC of 14.9 × 109. All other physical exams, imaging, and laboratory findings were non-contributory. The patient was promptly given IV hydralazine to control his blood pressure and empiric IV ceftriaxone for potential infection, and he was admitted for observation. Over the course of three days, WBC levels decreased, and his altered mental status improved. On day 3, the patient remembered a tick crawling across his hand, and this prompted the ordering of immunoglobulin levels for tick-borne illnesses. IgM for RMSF was positive. This case presentation illustrates the need for clinicians to keep the potential diagnosis of RMSF high on the differential, even in the presence of a paucity of symptoms, as prompt treatment with doxycycline can be lifesaving. This case may also be one of the first reported in the literature of hypertension being a symptom of Rocky Mountain Spotted Fever. It is plausible, however, that this patient's hypertension was due to an acute stress response.

Tick Bite Alopecia in an Adult Female Patient.

Ticks are well-known vectors for transmitting disease and cause a variety of cutaneous manifestations to their afflicted host. Tick bite alopecia serves as a lesser-known illustration of this phenomenon, as few cases are documented in the literature. Scarring and nonscarring forms of tick-induced alopecia are described, with the latter being more common. This case highlights an adult female patient who developed a localized oval zone of midparietal scalp hair loss two months after the detection and removal of several ticks on her scalp. The chronicled events, clinical findings, and histopathology results further confirm a particular pattern of manifestation for tick bite alopecia. This case illustrates the importance of recognizing and considering tick bites as a possible cause of focal hair loss, given a similar presentation and historical account.

Repellent activity of the non-host semiochemical (E)-2-octenal against Amblyomma sculptum and Amblyomma dubitatum ticks under field conditions.

Amblyomma ticks pose a significant public health threat due to their potential to transmit pathogens associated with rickettsial diseases. (E)-2-octenal, a compound found in donkeys (Equus asinus), exhibits strong repellent properties against Amblyomma sculptum nymphs under laboratory conditions. This study assessed the effectiveness of the (E)-2-octenal in wearable slow-release devices for personal human protection against Amblyomma ticks under natural conditions. Slow-release devices treated with (E)-2-octenal and untreated controls were prepared and tested on two volunteers walking through a tick-infested area in Goiania, Brazil. The experiment was conducted twice daily for three series of 10 days, with each volunteer wearing two devices attached to each leg, one on the ankle and one just above the thigh. Volunteers with control and treated devices exchanged them between rounds. Also, the daily release rate of (E)-2-octenal from the slow-release devices was determined in the laboratory, increasing significantly from 0.77 ± 0.14 µg/day on the first day to 9.93 ± 1.92 µg/day on the 4th day and remaining constant until the 16th day. A total of 5409 ticks were collected from both volunteers. Treated devices resulted in recovering fewer ticks (n = 1,666; 31%) compared to untreated devices (control: n = 3,743; 69%). (E)-2-octenal effectively repelled Amblyomma spp. larvae, A. sculptum adults, and exhibited pronounced repellency against A. dubitatum nymphs and adults. These findings suggest the potential of (E)-2-octenal delivered by wearable slow-release devices as a green-based repellent. Further improvements, however, are necessary to provide better protection for humans against A. sculptum and A. dubitatum in field conditions.

Discrepancy between IDSA and ESGBOR in Lyme disease: Individual participant meta-analysis in Türkiye.

BACKGROUND: The evidence on the prevalence of Lyme borreliosis (LB) is limited, but there is a suspicion of overdiagnosis of LB in recent years. We reviewed the LB diagnosis and treatment-related data in Türkiye, based on the Infectious Diseases Society of America (IDSA) 2020 and European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis (ESGBOR) 2018 guidelines. By detecting the disagreements between these two, we outlined the areas to be improved for future guidelines. METHODS: We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics. RESULTS: We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment. CONCLUSION: Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.

New insights into the systematics of the afrotropical Amblyomma marmoreum complex (Acari: Ixodidae) and the genome of a novel Rickettsia africae strain using morphological and metagenomic approaches.

The Amblyomma marmoreum complex includes afrotropical species, such as Amblyomma sparsum, a three-host tick that parasitizes reptiles, birds, and mammals, and is a recognized vector of Ehrlichia ruminantium. However, the lack of morphological, genetic and ecological data on A. sparsum has caused considerable confusion in its identification. In this study, we used microscopy and metagenomic approaches to analyze A. sparsum ticks collected from a puff adder snake (Bitis arietans) in southwest Senegal (an endemic rickettsioses area) in order to supplement previous morphological descriptions, provide novel genomic data for the A. marmoreum complex, and describe the genome of a novel spotted fever group Rickettsia strain. Based on stereoscope and scanning electron microscopy (SEM) morphological evaluations, we provide high-quality images and new insights about punctation and enameling in the adult male of A. sparsum to facilitate identification for future studies. The metagenomic approach allowed us assembly the complete mitochondrial genome of A. sparsum, as well as the nearly entire chromosome and complete plasmid sequences of a novel Rickettsia africae strain. Phylogenomic analyses demonstrated a close relationship between A. sparsum and Amblyomma nuttalli for the first time and confirmed the position of A. sparsum within the A. marmoreum complex. Our results provide new insights into the systematics of A. sparsum and A. marmoreum complex, as well as the genetic diversity of R. africae in the Afrotropical region. Future studies should consider the possibility that A. sparsum may be a vector for R. africae.

An 'Exo-Tick' Problem: A Sudden Increase in Tick Bite - A Case Series.

Ticks are blood-sucking arthropod ectoparasites of vertebrates, which are vectors of many diseases. They cause varied skin manifestations, which occur either due to the attachment of the tick to the host or due to the infections it spreads. Dermoscopy serves as a precise diagnostic tool for tick bites and also helps in ensuring complete removal of the tick. Prompt removal and identification of the tick, along with appropriate antibiotic therapy, are important aspects of the management of this condition. Herein, we present a case series of nine patients with tick bites, by ticks of similar morphology but at different body sites and with varied predisposing factors.

[A rare manifestation of Lyme disease]. / Seltene Manifestation einer Borreliose.

A 33-year-old man presented to the authors' general medical practice with a striking alteration to the left nipple. After extensive diagnostic investigation to identify in particular hemato-oncological diseases, a rare manifestation of an infection with Borrelia burgdorferi due to a tick bite was diagnosed. Antibiotic treatment with doxycycline over a period of 3 weeks led to complete restitution of the alteration.