High Prevalence and Low Diversity of Rickettsia in Dermacentor reticulatus Ticks, Central Europe.

We collected 1,671 Dermacentor reticulatus ticks from 17 locations in the Czech Republic, Slovakia, and Hungary. We found 47.9% overall prevalence of Rickettsia species in ticks over all locations. Sequence analysis confirmed that all tested samples belonged to R. raoultii, the causative agent of tick-borne lymphadenopathy.

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.

[Rickettsiosis after tick bite: A subtle clinic picture on many occasions, we must be vigilant]. / Rickettsiosis tras la picadura de una garrapata: una clínica sutil en muchas ocasiones, debemos estar atentos.

Rickettsia diseases are a group of tick-borne transmitted diseases, classified into 2 large groups: spotted fevers and typhus fevers. In addition, a new condition has been described recently, known as tick-borne lymphadenopathy. A retrospective series is presented of paediatric cases of rickettsia diseases diagnosed in 2013 and 2014. A total of 8 patients were included, of which 2 of them were diagnosed as Mediterranean spotted fever, and 6 as tick-borne lymphadenopathy. Rickettsia slovaca, Rickettsia sibirica mongolitimonae, and Rickettsia massiliae were identified in 3 of them. Aetiology, clinical features and treatment carried out in each of them are described. The interest of these cases is that, although most have a benign course, the high diagnostic suspicion and early treatment seem to be beneficial for its outcome.

[TIBOLA: an emerging clinically polymorphous rickettsiosis]. / TIBOLA : une rickettsiose en expansion, cliniquement polymorphe.

BACKGROUND: TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases. PATIENTS AND METHODS: Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case. DISCUSSION: TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.

Rickettsia slovaca infection in humans, Portugal.

Fifteen years after the initial detection of Rickettsia slovaca in ticks in Portugal, 3 autochthonous cases of R. slovaca infection were diagnosed in humans. All patients had an eschar on the scalp and lymphadenopathy; 2 patients had facial edema. R. slovaca infection was confirmed by serologic testing, culture, and PCR.

Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy.

BACKGROUND: Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which Rickettsia conorii subsp. israelensis was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion. METHODS: For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays. RESULTS: Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to R. conorii and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from O. tsutsugamushi; also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology. CONCLUSIONS: MSF, especially when caused by R. conorii subsp. israelensis, may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe rickettsial disease and should not lead the physician away from this diagnosis.

Molecular Prevalence of Selected Tick-Borne Pathogens in Dermacentor reticulatus Collected in a Natural Park in Italy.

Dermacentor reticulatus is one of the most important vectors of tick-borne pathogens (TBPs) in Europe causing diseases in animals and humans. A longitudinal study was planned, aimed to detect the molecular prevalence of tick-borne pathogens, i.e., Babesia spp. and the spotted fever group Rickettsiae, and its seasonal variation in D. reticulatus questing ticks to define the temporal infection risk. Ticks were collected monthly over a period of 15 months in a peri-urban park in Lombardy, Italy. DNA extraction and molecular analyses were performed. Statistical analysis was carried out. Out of 488, 53 (P = 10.9%) adult questing ticks were positive for Babesia DNA. A higher prevalence was revealed in male (32/241, P = 13.3%) than in female (21/247, P = 8.5%) ticks. Positive ticks were mostly collected in winter months (P = 13.3%) compared to early (P = 7.9) and late (P = 12.8) spring months. A similar percentage of positive ticks was evidenced in transects 1 and 3 (5.8% and 6.5%, respectively); instead, a significant higher prevalence was recorded in transect 2 (P = 16.0%). Obtained sequences confirmed a homology of 100% with B. canis sequences deposited in GenBank. No ticks tested positive for Rickettsia spp. DNA (0/488, P = 0%). The conspicuous circulation of B. canis infection in D. reticulatus adult questing ticks confirms their role in the epidemiology of canine babesiosis and requires preventive measures for dogs in this recreational area. Even if no tick was positive for the spotted fever group Rickettsia, its capacity as a vector of zoonotic pathogens should not be neglected.

Spotted fever group rickettsiae transmitted by Dermacentor ticks and determinants of their spread in Europe.

Rickettsiae from the spotted fever group, i.e. the etiological agents of tick-borne lymphadenopathy/Dermacentor-borne necrotic erythema and lymphadenopathy (TIBOLA /DEBONEL) syndrome, are associated with ticks, including Dermacentor marginatus and Dermacentor reticulatus. The expansion of these ticks into new areas increases the risk of infection of their hosts with tick-borne pathogens. The study summarises the importance of 2 species from the genus Dermacentor, i.e. D. marginatus and D. reticulatus, in the spread of spotted fever group rickettsiae in various regions of Europe. The study also focuses on the determinants of the presence of vectors and transmission of rickettsiae, as well as the effects of human infections with these pathogens. The climate changes observed nowadays affect vectors and increase the incidence and spread of tick-borne diseases worldwide. Due to the existing risk of exposure to an increasing number of people, knowledge about the course of these serious diseases and their etiological factors should be disseminated among healthcare professionals as well as in society. There is a great challenge for epidemiological services to provide access to medical and veterinary facilities in order to diagnose and treat rickettsioses. Therefore, the development of a strategy for tick control and the popularisation of knowledge concerning prophylaxis of tick-borne diseases is indispensable.

Comparative proteomics of the vector Dermacentor reticulatus revealed differentially regulated proteins associated with pathogen transmission in response to laboratory infection with Rickettsia slovaca.

BACKGROUND: Tick-borne rickettsial diseases are caused by pathogens acquired from hard ticks. In particular, Rickettsia slovaca, a zoonotic infectious bacterium causing tick-borne lymphadenopathy (TIBOLA), is transmitted by the vectors Dermacentor spp. that can be found all over Europe. Although recent studies point out the extreme complexity of bacteria-induced effects in these blood-feeding vectors, the knowledge of individual molecules involved in the preservation and transmission of the pathogen is still limited. System biology tools, including proteomics, may contribute greatly to the understanding of pathogen-tick-host interactions. METHODS: Herein, we performed a comparative proteomics study of the tick vector Dermacentor reticulatus that was experimentally infected with the endosymbiotic bacterium R. slovaca. Rickettsia-free ticks, collected in the southern region of Slovakia, were infected with the bacterium by a capillary tube-feeding system, and the dynamics of infection was assessed by quantitative PCR method after 5, 10, 15 and 27 days. RESULTS: At the stage of controlled proliferation (at 27 dpi), 33 (from 481 profiled) differentially abundant protein spots were detected on a two-dimensional gel. From the aforementioned protein spots, 21 were successfully identified by tandem mass spectrometry. CONCLUSIONS: Although a few discovered proteins were described as having structural or housekeeping functions, the vast majority of the affected proteins were suggested to be essential for tick attachment and feeding on the host, host immune system evasion and defensive response modulation to ensure successful pathogen transmission.

First report of Rickettsia raoultii in field collected Dermacentor reticulatus ticks from Austria.

In a set of pooled field collected Dermacentor reticulatus ticks, Rickettsia raoultii, the causative agent of Tick-borne lymphadenopathy/Dermacentor-borne necrosis erythema and lymphadenopathy, was found for the first time in Austria. The coordinates of the positive locations for tick and pathogen abundance are given and shown in a map.

Isolation and maintenance of Rickettsia raoultii in a Rhipicephalus sanguineus tick cell line.

Rickettsia raoultii, a member of the spotted fever group rickettsiae, has been implicated in cases of DEBONEL/TIBOLA/SENLAT, and has been detected in Dermacentor spp. and Rhipicephalus pumilio ticks by PCR. R. raoultii has been isolated in mammalian and tick cell lines. This study aimed to isolate R. raoultii from Spanish Dermacentor marginatus in tick cell lines. A single adult D. marginatus collected from vegetation in La Rioja (Northen Spain) in October 2012 was surface-sterilised, triturated and aliquots of the homogenate were inoculated into a panel of tick cell lines derived from embryonic Rhipicephalus sanguineus, Rhipicephalus evertsi and Ixodes ricinus. Cultures were maintained at 28 °C with weekly medium changes and checked by Gimenez stain for Rickettsia-like intracellular organisms. After 50 days of incubation, intracellular Rickettsia-like organisms were observed in the R. sanguineus cell line RML-RSE using Gimenez stain. PCR assays and sequencing of fragments of 16S RNA, ompB and ompA genes in DNA extracted from the culture suspension showed 100% identity with R. raoultii. Growth of intracellular microorganisms was not observed in preparations of the other tick cell lines. In conclusion, the tick cell line RML-RSE is a useful system for the isolation and maintenance of R. raoultii.

Rickettsioses in Europe.

Bacteria of the genera Rickettsia and Orientia (family rickettsiaceae, order rickettsiales) cause rickettsioses worldwide, and are transmitted by lice, fleas, ticks and mites. In Europe, only Rickettsia spp. cause rickettsioses. With improvement of hygiene, the risk of louse-borne rickettsiosis (epidemic typhus) is low in Europe. Nevertheless, recrudescent form of Rickettsia prowazekii infection persists. There could be an epidemic typhus outbreak if a body lice epidemic occurs under unfavorable sanitary conditions. In Europe, endemic typhus or Rickettsia typhi infection, transmitted by rats and fleas, causes febrile illness. At the beginning of this century, flea-borne spotted fever cases caused by Rickettsia felis were diagnosed. Flea-borne rickettsiosis should be suspected after flea bites if fever, with or without rash, is developed. Tick-borne rickettsioses are the main source of rickettsia infections in Europe. Apart from Rickettsia conorii, the Mediterranean Spotted Fever (MSF) agent, other Rickettsia spp. cause MSF-like: Rickettsia helvetica, Rickettsia monacensis, Rickettsia massiliae or Rickettsia aeschlimannii. In the 1990s, two 'new' rickettsioses were diagnosed: Lymphangitis Associated Rickettsiosis (LAR) caused by Rickettsia sibirica mongolitimonae, and Tick-Borne Lymphadenopathy/Dermacentor-Borne-Necrosis-Erythema-Lymphadenopathy/Scalp Eschar Neck Lymphadenopathy (TIBOLA/DEBONEL/SENLAT), caused by Rickettsia slovaca, Candidatus Rickettsia rioja and Rickettsia raoultii. Lastly, European reports about mite-borne rickettsiosis are scarce.

Tick-borne lymphadenopathy, an emerging disease.

Tick-borne lymphadenopathy (TIBOLA) is a spotted fever group disease characterized by an eschar and pronounced enlarged lymph nodes after a scalp tick bite. The goal of this synopsis is to review the TIBOLA literature published until May 2013: Forty-one articles (reporting 537 cases) were included. There was a predominance of cases in females and young people. Spain, France, and Hungary reported the majority of cases, and they were mainly reported in the colder seasons. The involved tick bite was frequently on the scalp. Rickettsia slovaca was the most frequent identified bacterium and Dermacentor marginatus the most frequently identified vector. The most prescribed antibiotic was doxycycline. TIBOLA has the potential to emerge outside Europe: improving knowledge of TIBOLA may promote early symptoms recognition and may allow early treatment.