Laboratory Blood-Based Testing for Non-Lyme Disease Tick-Borne Infections at a National Reference Laboratory.

OBJECTIVES: We evaluated trends in non-Lyme disease tick-borne disease (NLTBI) testing at a national reference laboratory. METHODS: Testing data performed at Quest Diagnostics during 2010 to 2016 were analyzed nationally and at the state level. RESULTS: Testing and positivity for most NLTBIs increased dramatically from 2010 through 2016 based on testing from a large reference laboratory. The number of positive cases, though not as stringent as criteria for public health reporting, generally exceeds that reported by the Centers for Disease Control and Prevention. The frequency of NLTBI in the US is seasonal but testing activity and positive test results are observed throughout all months of the year. Positive results for NLTBI testing mostly originated from a limited number of states, indicating the geographic concentration and distribution of NLTBIs reported in this study. CONCLUSIONS: This report provides an important complementary source of data to best understand trends in and spread of NLTBI.

Tick-Borne Illnesses in the United States.

Close interaction with nature can lead to tick-borne illnesses, which are seen most frequently in primary care clinics when patients present symptoms. Considerable morbidity can result from untreated infections. Fortunately, these illnesses are often easily managed when diagnosed early.

What's eating you? clinical manifestations of Dermacentor tick bites.

Dermacentor ticks are hard ticks found throughout most of North America and are easily identified by their large size, ornate scutum, and prominent dorsal pits. They are important disease vectors and are implicated in transmission of Rocky Mountain spotted fever (RMSF), Colorado tick fever, tularemia, and erlichiosis. They also are an important cause of fatal tick paralysis.

Case Report: A Case of Colorado Tick Fever Acquired in Southwestern Saskatchewan.

Colorado tick fever virus is transmitted by Dermacentor andersoni ticks. In Canada, these ticks are found in the southern regions of British Columbia (Rocky Mountains) and Alberta, as well as southwestern Saskatchewan. Colorado tick fever should be clinically suspected in patients presenting with a biphasic febrile illness and leukopenia following tick exposure in the appropriate geographic area.

Fiebre recurrente transmitida por garrapatas en área rural del sur de España / Tick-borne relapsing fever in a rural area of southern Spain

INTRODUCCIÓN: La fiebre recurrente transmitida por garrapatas (FRTG) es una enfermedad zoonótica producida por espiroquetas del género Borrelia. Es una enfermedad infradiagnosticada en nuestro medio debido al bajo índice de sospecha y a la dificultad en su diagnóstico. El objetivo del estudio es presentar nuestra experiencia en el manejo diagnóstico y terapéutico de la FRTG y revisar la literatura. MÉTODOS: Análisis retrospectivo de pacientes con FRTG ingresados en nuestro centro durante el periodo 2002-2012. Se analizan variables epidemiológicas, clínicas, microbiológicas, tratamiento y resultado. RESULTADO: Se identificaron 9 pacientes con FRTG. La mediana de edad fue de 11 años. Todos los casos ocurrieron durante meses cálidos. La clínica de presentación fue de episodios recurrentes de fiebre con escalofríos, cefalea, vómitos, mialgias y dolor abdominal. Se identificó afectación meníngea en 2 casos. En 2 pacientes existía infección por Borrelia en otros miembros de la familia en el momento del diagnóstico. La media de PCR fue de 187 mg/l y el 56% de casos presentaron trombocitopenia. Se visualizó Borrelia spp. en frotis de sangre periférica en el 67%. Todos los pacientes recibieron tratamiento antibiótico. Se empleó doxiciclina en mayores de 8 años y eritromicina y penicilina en menores de esta edad. Se produjo reacción de Jarisch- Herxheiner en un paciente. La evolución fue satisfactoria en todos los casos, sin secuelas. CONCLUSIONES: Subrayamos la importancia de mantener un elevado índice de sospecha de FRTG en regiones endémicas. El diagnóstico precoz, junto con el correcto tratamiento, permite evitar la aparición de recurrencias febriles y potenciales complicaciones

INTRODUCTION: Tick-borne relapsing fever (TBRF) is a zoonotic disease caused by spirochetes of the genus Borrelia. This disease is underdiagnosed in our area due to a low index of suspicion among clinicians, as well as its difficult diagnosis. This study aims to present our experience in the diagnosis and therapeutic management of TBRF and a literature review. METHODS: A retrospective medical chart review was carried out on children diagnosed of TBRF from 2002 to 2012 in our hospital, and included clinical, epidemiological, microbiological, treatment, and outcome data. RESULTS: Nine children with TBRF were identified. Median age was 11 years. All cases occurred during warm months. The most frequent presenting clinical findings were fever, chills, headache, vomiting, myalgia and abdominal pain. Meningeal involvement was identified in 2 cases. In the case of 2 patients, Borrelia infection was identified in several relatives at the time of diagnosis. Mean C-protein reactive was 187 mg/L, and low platelet counts were observed in 56% of the cases. Borrelia spp. was visualized in peripheral blood smears in 67% of cases. All of the patients received antibiotic treatment. Doxycycline was used in children older than 8 years and erythromycin and penicillin in the younger ones. Jarisch-Herxheiner reaction occurred in one patient. All cases resolved without sequelae. CONCLUSIONS: We emphasize the importance of maintaining a high level of suspicion in endemic regions of TBRF. Early diagnosis and a correct therapy can prevent the appearance of subsequent fever recurrences and potential complications

Detection of Colorado Tick Fever viral RNA in acute human serum samples by a quantitative real-time RT-PCR assay.

A quantitative real-time RT-PCR assay for the detection of Colorado Tick Fever (CTF) viral RNA in human clinical samples is presented. The sensitivity of this assay has been shown to be greater than that of the isolation of virus in Vero cells by standard plaque assay in a direct comparison. The specificity of the CTF quantitative real-time RT-PCR assay was determined by the exclusive detection of CTF viral RNAs when applied to a diverse panel of CTF viral isolates and reference strain agents known to circulate in areas of CTF virus transmission. Lastly, the quantitative real-time RT-PCR assay demonstrated exceptional sensitivity for the detection of CTF viral RNA in acute human serum. The quantitative real-time RT-PCR assay is efficient, sensitive and specific and as such is useful for the detection of CTF viral RNA in the diagnostic or research laboratory.

[Neurologic problems in tick-borne diseases--clinical and diagnostic aspects]. / Problemy neurologiczne w chorobach przenoszonych przez kleszcze--aspekty kliniczne i diagnostyczne.

Tick carried illnesses frequently lead towards neurological complications. The tick-borne encephalitis and borreliosis are the most frequently encountered illnesses having such aetiopathogenesis. In the study there are presented clinical aspects of tick-borne encephalitis and borreliosis with special consideration of various neurological symptomatology. Simultaneously there are discussed current diagnostic rules of the diseases, mainly on the basis of serologic investigation.

Colorado tick fever.

Colorado tick fever, also known as mountain fever and mountain tick fever, is a well-described, viral, tick-borne disease common to the Rocky Mountain region of the United States and Canada. The Rocky Mountain wood tick, Dermacentor andersoni, is the primary vector. The triad of high fever, severe myalgia, and headache is typical, but not specific. Although a self-limited disease in most cases, severe complications may occur. PCR techniques have been developed that allow the diagnosis to be established from the first day of symptoms. Ribavirin may merit consideration in the appropriate clinical setting.

Serologic and molecular diagnosis of Colorado tick fever viral infections.

Molecular and serologic methods usable for the biological diagnosis of Coltivirus infection are reported. We designed a multiplex reverse transcription-polymerase chain reaction system that allowed the simultaneous and specific amplification of three genomic segments from as little as 0.01 plaque-forming units. Another system in the S2 viral segment permitted the differential diagnosis of American and European viral isolates. We also discuss some improvements of previous ELISAs, and the results obtained with paired sera from Colorado tick fever (CTF) virus-infected individuals. Western blot analysis was developed that allowed the detection of antibodies to a 38-kD viral protein in all tested sera. It also enabled the detection of anti-CTF virus antibodies in ELISA-negative sera. Specific IgM antibodies against a synthetic viral peptide could be detected in sera at the acute stage of the infection. Together, these results should permit the diagnosis of Coltivirus infection at any stage of the pathology.

Respiratory manifestations of tick-borne diseases in the Southeastern United States.

Pulmonary signs and symptoms may provide important differential clues to the diagnosis of tick-borne illness incurred in the southern United States.

Hematologic manifestations of viral infections.

Many infections have an impact on the hematologic system. There also are many noninfectious processes associated with abnormalities of the blood and iatrogenic causes such as pharmacologic therapy that also may affect the marrow or circulating cellular elements. Viral disease may impact on one or more components of blood, and familiarity with these associations can assist in anticipating the course of disease and reducing the need to seek out other etiologies for the usually transient hematologic abnormalities that often occur in patients with viral infections.

Dermatologic manifestations of arthropod-borne diseases.

The arthropod-borne rickettsial, borrelial, and bacterial diseases of North America are a diverse group of disorders that produce a wide variety of cutaneous abnormalities. These dermatologic abnormalities are often valuable clinical clues that may reveal or suggest the correct diagnosis to the astute clinician. We review the usual and unusual dermatologic manifestations of Rocky Mountain spotted fever, murine and sylvatic typhus, rickettsialpox, ehrlichiosis, Lyme disease, tick-borne relapsing fever, Colorado tick fever, and tularemia. In some of these diseases, skin manifestations may be diagnostic; in others, dermatologic findings may be the initial and only clues that leads to the initiation of life-saving therapy. In other arthropod-borne infections, the appearance or evolution of the skin rash may be characteristic enough to suggest the proper diagnosis.

Colorado tick fever in a resident of New York City.

When a traveler returns from abroad with a febrile illness, clinicians appropriately concern themselves with a potentially vast array of diagnostic exotica. The patient we describe herein did not leave the United States but nevertheless posed the same clinical dilemma after returning home to New York City from the western United States. This case of Colorado tick fever, acquired on the Utah-Colorado border and first expressed in Manhattan, serves as a useful reminder of the importance of taking a careful travel history for national as well as international travelers.

Tick-borne diseases.

Ticks may transmit a variety of human pathogens and are second in importance only to the mosquito as a vector of human disease. The majority of tick-borne diseases are nonspecific in their initial clinical and laboratory presentation and may be confused with a variety of more common illnesses. A history of tick exposure is frequently not available. Although specific serologic tests exist for confirming the diagnosis of many of these diseases, the time required for confirmation of results makes them of little use in the acute situation. Recognition of the epidemiology of tick-borne pathogens and clinical suspicion are of key importance in making the appropriate diagnosis. Early and specific therapy is a principal factor in reducing the morbidity and mortality associated with these diseases.

Diagnosis of Colorado tick fever virus infection by enzyme immunoassays for immunoglobulin M and G antibodies.

An immunoglobulin M (IgM) capture enzyme immunoassay technique was adapted for the detection of antibody to Colorado tick fever virus in sera from 84 individuals for whom diagnosis had been confirmed by virus isolation or neutralization test. Titers were compared with those for IgG and neutralizing antibodies in these Colorado tick fever cases. IgM antibody titers were higher than neutralizing antibody titers, but neither appeared until 1 to 2 weeks after the onset of illness. Neutralizing antibodies were detected earlier than IgM antibodies, and both were detected with greater frequency than IgG antibodies. Late-convalescent-phase sera contained both neutralizing and IgG antibodies, but IgM was all but undetectable by 2 months after onset. Although the neutralization test may remain the serological test of choice, the enzyme immunoassay for IgM antibody offers a simple and more rapid method of serodiagnosis; the enzyme immunoassay is, however, less sensitive than the neutralization test. Furthermore, because there was a sharp decline in IgM antibody after 45 days, the presence of IgM antibody in a single serum sample provides a basis for the presumptive serodiagnosis of recent Colorado tick fever virus infection.

An overview of Colorado tick fever.

Certain features of Colorado tick fever (CTF) virus and the disease it causes may be relevant to studies on bluetongue virus (BTV), or other orbiviruses. Rapid and easy detection of viral antigen in infected tissues and peripheral blood cells by immunofluorescence staining facilitate diagnosis of the disease. The prolonged (3-4 months) viremia is due to persistent intracellular infection, particularly of erythrocytes, in which the virus is protected from antibody or other host defense mechanisms. This results in more efficient maintenance of the virus cycle in nature, but might lead to adverse effects in the human host. Clues to understanding chronic viral infections or viral immunosuppression might be gained by further research on CTF and other orbiviruses.