Localized Medium-Vessel Vasculitis From a Tick Bite.

ABSTRACT: Tick bites are known to induce a variety of inflammatory reaction patterns. Here, we present a novel case of medium-vessel vasculitis as a localized response to a known tick bite. It is important to recognize the histology associated with a tick bite response to prevent misdiagnosis and potential overtreatment of a vasculitic condition.

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.

Oxidative and local histopathological response on skin wound of horses due to Amblyomma sculptum tick parasitism.

Amblyomma sculptum is frequently observed parasitizing horses, responsible for economic losses, damage to the host''s skin and transmission of pathogens. The oxidative stress profile and inflammatory mechanisms involved in this parasitism remain poorly studied. Thus, this study aimed to assess the histopathological changes and oxidative profile responses of horses in the attachment site of A. sculptum to find variations that indicate resistance and susceptibility between the breeds to this tick, based on the hypothesis that resistant animals have a greater inflammatory response and lesser number of attached ticks. We analyzed female horses of two breeds, Mangalarga Marchador and Breton Postier, naturally infested by Amblyomma sculptum. The ticks were counted and full-thickness excisional skin wounds of 10 mm were made on the perineal region on the attachment site of partially engorged females for histological and biochemical analyzes. The occurrence of the tick on the skin caused an increase in cellularity, inflammatory infiltrate, mast cells, pyknotic nuclei, and changes in the fibrous components of the matrix. The negative correlation observed between tick infestation and inflammatory response indicated that animals with greater inflammatory response tend to have less tick infestation. The oxidative stress markers, MDA, PCN and NO not present great variation; however, between the antioxidant enzymes levels, SOD was higher in tick attachment of Breton Postier skin, this may mean that these animals had higher oxidative enzymatic activity and consequently less tissue damage, while the GST dropped in the attachment sites compared to the control, which may indicate that animals were in a state of significant oxidative stress or raises the question of the possibility of enzymatic sequestration by ticks. No significant differences were found in the resistance of the two breeds since most of the analyzes varied due to the presence or absence of the tick attached to the skin. We draw attention to the importance of studying characteristics of the animal's antioxidant responses to the tick and the action of tick saliva on antioxidant enzymes and ROS because these characteristics are interdependent with the inflammatory response.

A Fatal Case of Rickettsiosis From South Africa.

ABSTRACT: We present a case of fatal Rickettsiosis from South Africa.

Severe Fever With Thrombocytopenia Syndrome With Q Fever Coinfection in an 8-Year-Old Girl.

We report a case of an 8-year-old Korean girl diagnosed with severe fever with thrombocytopenia syndrome with Q fever coinfection after playing with a dog and being bitten by a tick in a suburb in South Korea. The clinical findings and treatment were summarized. To the best of our knowledge, this case is the youngest patient reported to have been diagnosed with severe fever with thrombocytopenia syndrome and Q fever from South Korea.

Seasonality and anatomical location of human tick bites in the United Kingdom.

Tick bites on humans can occur in a variety of habitats and may result in the transmission of tick-borne pathogens, such as the causative agent of Lyme borreliosis (LB), Borrelia burgdorferi sensu lato. As the risk of transmission of this pathogen to the host increases with the duration of tick feeding, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection. Performing a thorough body examination for ticks following potential exposure is recommended by tick awareness campaigns. Knowledge of where on the body feeding ticks are frequently found, and at which times of year peak tick exposure occurs, provides important information for public health messaging and may aid those bitten by ticks to engage more effectively with tick-checking behaviour. This paper summarizes human tick bites in the United Kingdom (UK) during 2013-2018 reported to Public Health England's passive Tick Surveillance Scheme and further examines the anatomical location and seasonality of bites from the most commonly encountered tick and LB vector Ixodes ricinus. A total of 1,328 tick records from humans were received of which 93% were I. ricinus. Humans were most commonly bitten by I. ricinus nymphs (70% bites). Tick bites were recorded on all parts of the body, but there were significant differences in their anatomical location on adults and children. Most tick bites on adults occurred on the legs (50%), whereas on children tick bites were mostly on the head and neck (43%). Bites from I. ricinus were recorded throughout the year but were most numerous during May to August. This study adds to the body of research on the seasonality and anatomical location of human tick bites in temperate Europe and highlights the importance of data collected through passive surveillance in addition to research and epidemiological studies.

Un taxidermista en la consulta / A taxidermist in the clinic

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Clinical Findings Associated with Ornithodoros brasiliensis Tick Parasitism in Travelers, Southern Brazil.

We report a series of clinical cases associated with parasitism by the Ornithodoros brasiliensis tick in a group of travelers in the Caxias do Sul municipality, Southern Brazil. These cases draw attention to underdiagnosed noninfectious syndromes caused by ticks with restricted local distributions.

Cutaneous histopathology of the tick-bite region in severe fever with thrombocytopenia syndrome.

A case of severe fever with thrombocytopenia syndrome (SFTS) in which a skin biopsy from the tick-bite region was analyzed is reported. The patient was a 72-year-old woman who developed fever and thrombocytopenia after a tick bite. SFTS was diagnosed from polymerase chain reaction (PCR) analysis of a blood sample. Histopathological analysis of a skin biopsy specimen from the tick-bite region showed CD20-positive perivascular and interstitial immunoblastic cells, which were positive to anti-SFTS virus (SFTSV) nucleoprotein antibody. In addition, SFTSV RNA was detected by real-time PCR from this biopsy specimen. Moreover, hemophagocytosis was also found in the tick-bite region. To the best of our knowledge, this is the first report to analyze the details of the tick-bite region of skin in SFTS, and the first to detect virus-infected cells in the skin. The present findings may help elucidate the mechanisms of entry of SFTSV.

The prevalence and clinical characteristics of tick-borne diseases at One Sentinel Hospital in Northeastern China.

Northeastern China is a region of high tick abundance, multiple tick-borne pathogens and likely human infections. The spectrum of diseases caused by tick-borne pathogens has not been objectively evaluated in this region for clinical management and for comparison with other regions globally where tick-transmitted diseases are common. Based on clinical symptoms, PCR, indirect immunofluorescent assay and (or) blood smear, we identified and described tick-borne diseases from patients with recent tick bite seen at Mudanjiang Forestry Central Hospital. From May 2010 to September 2011, 42% (75/180) of patients were diagnosed with a specific tick-borne disease, including Lyme borreliosis, tick-borne encephalitis, human granulocytic anaplasmosis, human babesiosis and spotted fever group rickettsiosis. When we compared clinical and laboratory features to identify factors that might discriminate tick-transmitted infections from those lacking that evidence, we revealed that erythema migrans and neurological manifestations were statistically significantly differently presented between those with and without documented aetiologies (P < 0.001, P = 0.003). Twelve patients (6.7%, 12/180) were co-infected with two tick-borne pathogens. We demonstrated the poor ability of clinicians to identify the specific tick-borne disease. In addition, it is necessary to develop specific laboratory assays for optimal diagnosis of tick-borne diseases.

Report of Non-Lyme, Erythema Migrans Rashes from New Jersey with a Review of Possible Role of Tick Salivary Toxins.

Erythema migrans (EM) rashes once considered pathognomonic of Lyme disease (LD) have been reported following bites of arthropods that do not transmit LD and in areas with no LD. Also, EM rashes have been reported in association with organisms other than members of Borrelia burgdorferi sensu lato complex. Arthropod saliva has chemicals that have effects on the host and pathogen transmission. Tick saliva has protein families similar to spiders and scorpions and even substances homologous to those found in snakes and other venomous animals. Ticks "invertebrate pharmacologists" have a sophisticated arsenal of chemicals that assist in blood feeding, pathogen transmission, and suppressing host defenses. No organisms have been isolated from many EM rashes. We propose that tick salivary toxins may play a role in the causation of rashes and laboratory abnormalities in tick-borne diseases. The role of tick salivary toxins needs further exploration. Cases of Lyme-like EM rashes referred to as STARI (Southern Tick-Associated Rash Illness) following bites of the lone star tick, Amblyomma americanum, in the United States have been reported predominantly in Southeastern Missouri and a few in South Carolina, North Carolina, Georgia, and one case each in Mississippi and Long Island, New York. Although there is one report of Borrelia lonestari in a patient with a rash, biopsies of 31 cases of STARI, with cultures and PCR, failed to show a relationship. Distribution of A. americanum, whose bites are associated with STARI, now extends along the East Coast of the United States, including New Jersey, up to the Canadian border. As far as we are aware, there have been no prior reports of Lyme-like rashes in New Jersey. In this study, we present case examples of 2 Lyme-like rashes, variations of EM rashes, and a brief review of studies that suggest a role of tick salivary toxins in tick-borne diseases.

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.

Skin manifestations of tick bites in humans.

Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Skin manifestations of tick bites in humans

Abstract: Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

[Tick-borne infections in Denmark].

The castor bean tick, Ixodes ricinus, is common in woodlands in most of Denmark. Besides Borrelia burgdorferi, it can harbour a number of pathogenic microorganisms such as tick-borne encephalitis virus, Anaplasma phagocytophilum, Rickettsia helvetica, Francisella tularensis, Candidatus Neoehrlichia mikurensis, Bartonella spp., Borrelia miyamotoi and Babesia spp. These tick-borne infections should be a differential diagnostic consideration during the tick season in Denmark. We review the distribution, clinical manifestations, diagnosis and treatment of these microorganisms.