DOCSLIB.ORG

Multiple Pruritic Papules from Lone Star Tick Larvae Bites

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Multiple Pruritic Papules from Lone Star Tick Larvae Bites OBSERVATION Multiple Pruritic Papules From Lone Star Tick Larvae Bites Emily J. Fisher, MD; Jun Mo, MD; Anne W. Lucky, MD Background: Ticks are the second most common vec- was treated with permethrin cream and the lesions re- tors of human infectious diseases in the world. In addi- solved over the following 3 weeks without sequelae. The tion to their role as vectors, ticks and their larvae can also organism was later identified as the larva of Amblyomma produce primary skin manifestations. Infestation by the species, the lone star tick. larvae of ticks is not commonly recognized, with only 3 cases reported in the literature. The presence of mul- Conclusions: Multiple pruritic papules can pose a di- tiple lesions and partially burrowed 6-legged tick larvae agnostic challenge. The patient described herein had an can present a diagnostic challenge for clinicians. unusually large number of pruritic papules as well as tick larvae present on her skin. Recognition of lone star tick Observation: We describe a 51-year-old healthy woman larvae as a cause of multiple bites may be helpful in simi- who presented to our clinic with multiple erythematous lar cases. papules and partially burrowed organisms 5 days after exposure to a wooded area in southern Kentucky. She Arch Dermatol. 2006;142:491-494 ATIENTS WITH MULTIPLE PRU- acteristic clinical and diagnostic features of ritic papules that appear to be infestation by larvae of Amblyomma species bitespresentachallengetothe and may help clinicians make similar di- clinician. We present a case of agnoses in the future. a healthy 51-year-old woman whowasbittenbymultiplelarvaeofthetick, P REPORT OF A CASE Amblyomma species, most likely A ameri- canum or the lone star tick. Ticks have been recognizedashumanparasitesforthousands A 51-year-old white woman presented with of years and are the second most common multiple, diffuse, intensely pruritic pap- vector of human infectious disease after ules and papulovesicles (Figure 1). Five mosquitos.1 Their role in the transmission days prior to her presentation, the pa- of several human infectious diseases has tient was boating on a lake in southern Kentucky. On 2 occasions, she had dis- For editorial comment robed in a wooded area near the lake, leav- ing her clothes on the ground for several see page 497 minutes before redressing. One day after the second time she undressed, the pa- been known since the beginning of the 20th tient noted the onset of an erythematous century.1 In particular, Amblyomma species pruritic rash that progressed with addi- have been identified as the vector for tional lesions over the next few days. several human diseases including Rocky She visited several physicians in the fol- Mountain spotted fever, Q fever, ehrlichio- lowing days who variously diagnosed infes- sis, tularemia, and African tick bite fever tationswith“no-see-ums”(forwhichshewas Author Affiliations: Division of via salivary secretions. In addition to being prescribed cetirizine hydrochloride [Zyrtec; Pediatric Dermatology vectors for human diseases, ticks can cause Pfizer US, New York, NY] and a 5-day course (Drs Fisher and Lucky) and severalprimarydermatologicmanifestations of prednisone), bedbugs, and finally pubic Department of Pathology including erythematous papules, skin hem- lice (for which she was given a prescription (Dr Mo), Cincinnati Children’s Hospital Medical Center, and orrhages, papular urticaria, diffuse derma- of 5% permethrin cream). Despite numer- Department of Dermatology, titis, necrotic ulcers, prurigo, erythema ousshowersandscrubs,therashprogressed, The University of Cincinnati migrans–like rash, and patchy alopecia, but and the patient began to note the presence School of Medicine (Drs Fisher reports of primary infestations are rare.2-5 of tiny dark “bugs” attached to her skin in and Lucky), Cincinnati, Ohio. The present report summarizes the char- the centers of many of the papules. (REPRINTED) ARCH DERMATOL/ VOL 142, APR 2006 WWW.ARCHDERMATOL.COM 491 ©2006 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 Figure 1. Multiple erythematous papules on a 51-year-old woman seen 5 days after her exposure to wooded area. Figure 3. Amblyomma species, microscopic view, showing 6-legged larval A B form. COMMENT Ticks are obligate blood-sucking arthropods that para- sitize every class of vertebrate in almost every region of the world. They are currently considered to be second only to mosquitoes as vectors of human infectious dis- eases in the world.1 The life cycle of most hard ticks requires 2 years for completion and includes the egg, the 6-legged larva or Figure 2. Organism partially burrowed in the skin. A, The organism appears “seed tick,” the 8-legged immature nymph, and the as a dark spot. B, Close-up view of the organism on the skin, later identified 8-legged reproductively mature adult. All stages except as Amblyomma species larva, the lone star tick. the egg require a blood meal for morphogenesis.6,7 The larvae emerge from eggs deposited on the ground and then She presented to our dermatology clinic for further crawl up grasses and other low vegetation where they can recommendations before using the permethrin cream. In easily attach to passing animals or humans.2 The tick clings the clinic, we found hundreds of red, blanching papules to hair or clothing, waits until the host is at rest, moves and papulovesicles on her trunk and extremities, espe- to an appropriate exposed area of the host’s body, and cially in areas that had been under her clothing. On close then bites. inspection, we found dark, 1-mm organisms in the cen- It appears that this patient must have undressed near ter of many of the papules. Under magnification, these a nest of newly hatched tick larvae that were attracted to were determined to be bugs of unknown type whose heads her clothing and attached themselves before transfer- were partially burrowed under the skin (Figure 2). Sev- ring to her skin when she redressed. Ticks inject an an- eral of the organisms were removed with forceps and vi- esthetic similar to lidocaine, which usually makes their sualized in mineral oil under the microscope; they were bites painless. A tick may spend up to 24 hours on the rotund, 6-legged organisms (Figure 3). host before biting and then feed for 2 hours to 7 days be- The patient was instructed to complete a single overnight fore dropping off.8 After completion of a blood meal at 1 application of 5% permethrin cream and try to scrub off the site, the larva typically drops to the ground where it molts organisms the next morning. The initial diagnosis was in- to become a nymph.3 The larval and nymphal stages are festation by chigger mites, but because of the unusual na- so small they often are not seen until they have fully en- ture of the presentation, including the large size and num- gorged with blood. This may account for the patient not ber of organisms and the fact that the organisms were still noticing the ticks until the fourth or fifth day of her in- attached and burrowed, this diagnosis was questioned. festation. Sample organisms were sent for definitive identifica- For most tick-borne diseases, it appears that the tick tion to the C. Wayne Ellett Plant and Pest Diagnostic Cen- must remain attached for 24 to 48 hours before disease ter of Ohio State University, Columbus, and found to be transmission occurs.9 Among the 13 genera of Ixodidae, the larvae of Amblyomma species, most likely A ameri- 3 are known to transmit disease to humans in the United canum, the lone star tick. The patient’s pruritus began States: Amblyomma, Dermacentor, and Ixodes.7 All stages to resolve approximately 2 days after application of the of Amblyomma except the egg are capable of transmit- permethrin cream, and the erythematous papules gradu- ting disease.2,3 ally resolved over the next 3 weeks. She has not had any Amblyomma americanum is the most common spe- further complications. cies of Amblyomma found in the United States. It is named (REPRINTED) ARCH DERMATOL/ VOL 142, APR 2006 WWW.ARCHDERMATOL.COM 492 ©2006 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 the lone star tick due to the prominent white dot on the NH). In a study comparing these 3 tools with tweezers, back of the adult female and is abundant in the south cen- it was found that all of these tools were more effective tral and southeastern United States. Amblyomma ameri- than tweezers in removing nymph-stage ticks.14 canum and Amblyomma cajennense ticks will feed on small There are no data to indicate that prophylactic treat- or large mammals during any stage of their life cycle and ment with antibiotics after a tick bite reduces the risk of are commonly found on white-tailed deer.2,10 They are disease transmission in all cases. A recent randomized known to transmit several human diseases including ehrli- trial showed that a single 200-mg dose of doxycycline chiosis (Ehrlichia chaffeensis) in the mid-Atlantic, south administered within 72 hours after a recognized Ixodes central, southeastern, and western (California) states; tu- scapularis bite had an efficacy of 87% in preventing ery- laremia (Francisella tularensis) in the southeastern and thema migrans. The number needed to treat to prevent south central states; and, less commonly, Rocky Moun- 1 case of erythema migrans was 36 among people with tain spotted fever (Rickettsia rickettsi) and Q fever (Coxi- any I scapularis bite and 12 among people with bites from ella burnetii). Amblyomma americanum is a rare cause of engorged nymphal I scapularis.15 The possible effects of tick paralysis.6 In the past several years, A americanum prophylactic treatment on other infections transmitted has been shown to be the vector for an erythema migrans– by deer ticks and on strains of Borrelia in Europe and like rash illness termed “southern tick-associated rash ill- Asia, as well as its use to prevent Lyme disease in chil- ness” (STARI) caused by Borrelia lonestari.11-13 dren, have not been evaluated.
Load more

Recommended publications
  • HIV (Human Immunodeficiency Virus)
    TABLE OF CONTENTS AFRICAN TICK BITE FEVER .........................................................................................3 AMEBIASIS .....................................................................................................................4 ANTHRAX .......................................................................................................................5 ASEPTIC MENINGITIS ...................................................................................................6 BACTERIAL MENINGITIS, OTHER ................................................................................7 BOTULISM, FOODBORNE .............................................................................................8 BOTULISM, INFANT .......................................................................................................9 BOTULISM, WOUND .................................................................................................... 10 BOTULISM, OTHER ...................................................................................................... 11 BRUCELLOSIS ............................................................................................................. 12 CAMPYLOBACTERIOSIS ............................................................................................. 13 CHANCROID ................................................................................................................. 14 CHLAMYDIA TRACHOMATIS INFECTION .................................................................
    [Show full text]
  • Laboratory Diagnostics of Rickettsia Infections in Denmark 2008–2015
    biology Article Laboratory Diagnostics of Rickettsia Infections in Denmark 2008–2015 Susanne Schjørring 1,2, Martin Tugwell Jepsen 1,3, Camilla Adler Sørensen 3,4, Palle Valentiner-Branth 5, Bjørn Kantsø 4, Randi Føns Petersen 1,4 , Ole Skovgaard 6,* and Karen A. Krogfelt 1,3,4,6,* 1 Department of Bacteria, Parasites and Fungi, Statens Serum Institut (SSI), 2300 Copenhagen, Denmark; [email protected] (S.S.); [email protected] (M.T.J.); [email protected] (R.F.P.) 2 European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), 27180 Solnar, Sweden 3 Scandtick Innovation, Project Group, InterReg, 551 11 Jönköping, Sweden; [email protected] 4 Virus and Microbiological Special Diagnostics, Statens Serum Institut (SSI), 2300 Copenhagen, Denmark; [email protected] 5 Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut (SSI), 2300 Copenhagen, Denmark; [email protected] 6 Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark * Correspondence: [email protected] (O.S.); [email protected] (K.A.K.) Received: 19 May 2020; Accepted: 15 June 2020; Published: 19 June 2020 Abstract: Rickettsiosis is a vector-borne disease caused by bacterial species in the genus Rickettsia. Ticks in Scandinavia are reported to be infected with Rickettsia, yet only a few Scandinavian human cases are described, and rickettsiosis is poorly understood. The aim of this study was to determine the prevalence of rickettsiosis in Denmark based on laboratory findings. We found that in the Danish individuals who tested positive for Rickettsia by serology, the majority (86%; 484/561) of the infections belonged to the spotted fever group.
    [Show full text]
  • Tick- and Flea-Borne Rickettsial Emerging Zoonoses Philippe Parola, Bernard Davoust, Didier Raoult
    Tick- and flea-borne rickettsial emerging zoonoses Philippe Parola, Bernard Davoust, Didier Raoult To cite this version: Philippe Parola, Bernard Davoust, Didier Raoult. Tick- and flea-borne rickettsial emerging zoonoses. Veterinary Research, BioMed Central, 2005, 36 (3), pp.469-492. 10.1051/vetres:2005004. hal- 00902973 HAL Id: hal-00902973 https://hal.archives-ouvertes.fr/hal-00902973 Submitted on 1 Jan 2005 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Vet. Res. 36 (2005) 469–492 469 © INRA, EDP Sciences, 2005 DOI: 10.1051/vetres:2005004 Review article Tick- and flea-borne rickettsial emerging zoonoses Philippe PAROLAa, Bernard DAVOUSTb, Didier RAOULTa* a Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, 13385 Marseille Cedex 5, France b Direction Régionale du Service de Santé des Armées, BP 16, 69998 Lyon Armées, France (Received 30 March 2004; accepted 5 August 2004) Abstract – Between 1984 and 2004, nine more species or subspecies of spotted fever rickettsiae were identified as emerging agents of tick-borne rickettsioses throughout the world. Six of these species had first been isolated from ticks and later found to be pathogenic to humans.
    [Show full text]
  • The Returning Traveller with Fever
    PG133-138 3/10/05 4:35 PM Page 133 THE TRAVELLER WITH FEVER THE RETURNING TRAVELLER WITH FEVER As numbers of visitors returning from exotic destinations in less developed parts of the world increase, the challenges to the physician grow. Travellers face a number of health risks during their journeys. The majority of incidents are related to trauma or to underly- ing co-morbid disease, most commonly cardiovascular dis- ease. Infectious diseases however are a significant problem and range from the potentially life-threatening, such as malaria, to those that are more mundane, such as travellers’ diarrhoea. This article will focus on the traveller who returns with a suspected infectious disease and will discuss a diag- nostic approach, before describing important syndromes and their common causes. HISTORY LUCILLE BLUMBERG JOHN FREAN Pyrexial illness is a presentation of most travel-associated MB BCh, MMed (Microbiol), MB BCh, MMed (Path), infectious diseases, but many common infections such as DTM&H, DOH, DCH DTM&H, MSc (Med Parasitol) influenza and pneumonia also occur in the tropics or may be Specialist Microbiologist Specialist Microbiologist acquired en route to and from exotic regions. Patients may National Institute for National Institute for also have chronic or recurrent medical problems that are Communicable Diseases and Communicable Diseases and unrelated to their tropical exposure. In approaching a pyrexi- University of the University of the al patient, therefore, a general medical history should elicit Witwatersrand Witwatersrand Johannesburg Johannesburg the presence of underlying conditions, particularly those John Frean qualified at the associated with increased risk of infections such as diabetes, Lucille Blumberg is currently University of the malignancy, HIV infection, splenectomy, and pregnancy.
    [Show full text]
  • Knowledge, Attitudes and Practices on African Tick Bite Fever of Rural
    Katswara and Mukaratirwa BMC Infectious Diseases (2021) 21:497 https://doi.org/10.1186/s12879-021-06174-9 RESEARCH ARTICLE Open Access Knowledge, attitudes and practices on African tick bite fever of rural livestock communities living in a livestock-wildlife interface area in the Eastern Cape Province of South Africa Tandiwe Katswara1 and Samson Mukaratirwa1,2* Abstract Background: African tick bite fever (ATBF) caused by Rickettsia africae and transmitted by Amblyomma spp. ticks is one of the zoonotic tick-borne fevers from the spotted fever group (SFG) of rickettsiae, which is an emerging global health concern. There is paucity of information regarding the occurrence and awareness of the disease in endemic rural livestock farming communities living in livestock-wildlife interface areas in South Africa. Methods: The purpose of the study was to assess the level of knowledge, attitudes and practices on ticks and ATBF infection from a community living in livestock-wildlife interface areas in South Africa. A focus group discussion (FGD) was carried out followed by verbal administration of a standardized semi-structured questionnaire a month later to 38 rural livestock farmers (23 from Caquba area and 15 from Lucingweni area where A. hebraeum was absent). An FGD was conducted in Caquba (situated at the livestock-wildlife interface where Amblyomma hebraeum was prevalent on cattle and infected with Rickettsia africae) in the O.R. Tambo district of the Eastern Cape province of South Africa. Results: Results from the FGD and questionnaire survey showed that participants from the two rural communities were not aware of ATBF and were not aware that ticks are vectors of the disease.
    [Show full text]
  • ORIGINAL ARTICLES Tick Bite Fever and Q Fever
    ORIGINAL ARTICLES Tick bite fever and Q fever – a South African perspective John Frean, Lucille Blumberg Tick bite fever (TBF) and Q fever are zoonotic infections, Taxonomy and classification highly prevalent in southern Africa, which are caused by Molecular taxonomic methods based on ribosomal and other different genera of obligate intracellular bacteria. While TBF gene nucleotide sequence homologies have allowed more than was first described nearly 100 years ago, it has only recently 30 species and subspecies of rickettsiae to be distinguished been discovered that there are several rickettsial species to date.2 Before the availability of these modern techniques, transmitted in southern Africa, the most common of which rickettsiae were divided on clinical and serological criteria is Rickettsia africae. This helps to explain the highly variable into three groups: the spotted fever group, the typhus clinical presentation of TBF, ranging from mild to severe or group, and scrub typhus. The sole agent of scrub typhus even fatal, that has always been recognised. Q fever, caused has been assigned to a new genus and is now called Orientia by Coxiella burnetii, is a protean disease that is probably tsutsugamushi. Historically, several diseases in the first two extensively under-diagnosed. Clinically, it also shows a groups have been recognised in southern Africa; while scrub wide spectrum of severity, with about 60% of cases being typhus could potentially be seen in returning travellers, it does clinically inapparent. Unlike TBF, Q fever may cause chronic not occur naturally in the region. Molecular taxonomy now infection, and a post-Q fever chronic fatigue syndrome places the agent of Q fever, C.
    [Show full text]
  • African Tick-Bite Fever: a New Entity in the Differential Diagnosis of Multiple Eschars in Travelers
    International Journal of Infectious Diseases 14S (2010) e274–e276 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Case Report African tick-bite fever: a new entity in the differential diagnosis of multiple eschars in travelers. Description of five cases imported from South Africa to Switzerland Fabrice Althaus a, Gilbert Greub b,c,*, Didier Raoult d, Blaise Genton a a Travel clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland b Center for Research on Intracellular Bacteria, Institute of Microbiology, University of Lausanne, Switzerland c Infectious Disease Service, University Hospital, Lausanne, Switzerland d Unite´ des Rickettsies, Universite´ de la Me´diteranne´e, Marseille, France ARTICLE INFO SUMMARY Article history: African tick-bite fever (ATBF) is a newly described spotted fever rickettsiosis that frequently presents Received 10 September 2009 with multiple eschars in travelers returning from sub-Saharan Africa and, to a lesser extent, from the Accepted 10 November 2009 West Indies. It is caused by the bite of an infected Amblyomma tick, whose hunting habits explain the Corresponding Editor: William Cameron, typical presence of multiple inoculation skin lesions and the occurrence of clustered cases. The Ottawa, Canada etiological agent of ATBF is Rickettsia africae, an emerging tick-borne pathogenic bacterium. We describe herein a cluster of five cases of ATBF occurring in Swiss travelers returning from South Africa. The co- Keywords: incidental infections in these five patients and the presence of multiple inoculation eschars, two features African tick-bite fever pathognomonic of this rickettsial disease, suggested the diagnosis of ATBF.
    [Show full text]
  • Tropical Fevers: Part A. Viral, Bacterial, and Fungal
    5A.1 CHAPTER 5 Tropical Fevers: Part A. Viral, bacterial, and fungal John Frean and Lucille Blumberg 1. INTRODUCTION Pyrexial illness is a presentation of many diseases particularly associated with tropical environments, but one should remember that many common infections, such as influenza and tuberculosis, also occur in the tropics or may be acquired en route to and from exotic locales. Febrile patients may also have chronic or recurrent medical problems that are unrelated to their tropical exposure, including non-infectious disease e.g. autoimmune or malignant conditions. In approaching a pyrexial patient, therefore, a general medical history should aim to elicit the presence of any underlying conditions, particularly those associated with increased risk of infections such as diabetes, neoplastic conditions, HIV infection, splenectomy, and pregnancy. The history of the current illness will determine the duration (acute or chronic) and pattern, if any, of fever; signs and symptoms which may be important in suggesting possible aetiologies are headache and other central nervous system involvement; myalgia and arthralgia; photophobia and conjunctivitis; skin rashes and localised lesions; lymphadenopathy, hepatomegaly, and splenomegaly; jaundice, and anaemia. The geographic and travel history, both recent and past, is of course of vital importance. The onset of illness in relation to known incubation periods and time of possible exposure can help to include or eliminate various infectious diseases (see Table 1). The areas visited and the nature of the travel may also be helpful in suggesting the likely exposures, e.g. business travel confined to city hotels has a different risk profile compared to river-rafting adventures.
    [Show full text]
  • Tick Bite Fever in South Africa
    CPD Article Tick bite fever in South Africa aFrean J, MMed(Micro), MSc(Med Parasitol), FFTM, FACTM aBlumberg L, MMed(Micro), FFTM(Glasgow) bOgunbanjo GA, FCFP(SA), MFamMed, FACRRM, FACTM aNational Health Laboratory Service, National Institute for Communicable Diseases (NICD), Johannesburg bDepartment of Family Medicine & PHC, University of Limpopo (Medunsa Campus), Pretoria Correspondence to: Assoc Prof John Frean, e-mail: [email protected] Abstract Tick bite fever has been a constant feature of the South African medical landscape. While it was recognised many years ago that there was a wide spectrum of clinical severity of infection, only recently has it been established that there are two aetiological agents, with different epidemiologies and clinical presentations. Rickettsia conorii infections resemble the classical Mediterranean spotted fever (fièvre boutonneuse), and patients are sometimes at risk of severe or even fatal complications. On the other hand, African tick bite fever is a separate entity caused by Rickettsia africae and tends to be a milder illness, with less prominent rash and little tendency to progress to complicated disease. Irrespective of the agent, the treatment of choice for tick bite fever in South Africa remains doxy- cycline or tetracycline, and the role of macrolide and quinolone antibiotics is still unclear, or at least restricted. This article has been peer reviewed. Full text available at www.safpj.co.za SA Fam Pract 2008;50(2):33-35 Introduction Discussion The rickettsiae comprise a diverse group of bacterial organisms The earliest description of the disease resembling boutonneuse or responsible for various clinical entities globally. With a couple of Mediterranean spotted fever in southern Africa dates back to 1911.
    [Show full text]
  • African Tick Bite Fever
    Ticks as Vectors and African Tick Bite Fever Alex Heaney 3/9/12 Lesson Summary 1. Ticks as Disease Vectors 2. African Tick Bite Fever Ticks • Arthropoda – 2 types of ticks that are vectors for human disease • Hard ticks (Ixodidae class) • soft ticks (Argasidae class) Picture Credit: www.floridahealth.com Life Cycle of a Hard Tick Connecting to a Host • Questing: ticks feed by perching in low vegetation and waiting for a mammal to walk by Photo Credit: Local Public Health Institute of Massachusetts http://www.masslocalinstitute.org Connecting to a Host • Questing • Ticks use chemical stimuli, airborne vibrations, and body temperatures to locate mammals Photo Credit: Local Public Health Institute of Massachusetts http://www.masslocalinstitute.org Ticks as Disease Vectors • transmit a greater variety of pathogenic micro- organisms than any other arthropod vector group • Bacteria/virus/protozoa in saliva of tick o Injected during a blood meal Photo Credit: Lyme Disease Action http://www.lymediseaseaction.org.uk/about-ticks/tick- animation/ Ticks as Disease Vectors • Hypostoma attaches to the host’s skin using hooks Photo by Larisa Vredevoe, UC. Davis Picture from (Parola, 2001) Ticks as Disease Vectors Substances secreted into skin • Cementing substance – Glues the hypostoma in place • Immunosuppressive, Anti-inflammatory chemicals – Helps the tick go unnoticed by the host • Anticoagulant – Allows blood to go where it needs to go in the body All help the pathogen to establish a foothold in the host Epidemiology of Tick Borne Diseases Ticks
    [Show full text]
  • Educational Workshop
    Educational Workshop EW14: Pathogenic intracellular bacteria arranged with ESCAR (ESCMID Study Group for Coxiella, Anaplasma, Rickettsia and Bartonella) Convenors: Gilbert Greub (Lausanne, CH) Pierre-Edouard Fournier (Marseille, FR) Faculty: Amel Omezzine Letaief (Sousse, TN) Pierre-Edouard Fournier (Marseille, FR) Achilleas Gikas (Heraklion, GR) Gilbert Greub (Lausanne, CH) Letaief –Spotted fever rickettsiosis Tick-Borne rickettsial pathogens Spotted Fever Group Rickettsioses (SFGR) Amel Omezzine Letaief, MD Farhat Hached Hospital ; Sousse - Tunisia 22/04/2009 ESCAR, 19th ECCMID - Helsinki 1 Session objectives ? True or False ? •There are multiple SFGR •SFGR are of limited geographic distribution •Clinical features are specific of rickettsia species •SFGR are severe diseases •Diagnosis of SFGR is difficult to confirm •Therapy of SFGR has been optimized 22/04/2009 ESCAR, 19th ECCMID - Helsinki 2 Clinical case • A 55-year-old Finnish man, traveled to Africa and south Europe : Cruise on the mediterranean sea for 10 days, on September • 5 days after return : Abrupt onset of fever (40°C) Loss of appetite, Headache Abdominal pain 1 episode of diarrheae • No medical history, no medication 22/04/2009 ESCAR, 19th ECCMID - Helsinki 3 3 Letaief –Spotted fever rickettsiosis Clinical case Continues… _______________________________________ •Physical examination at day 3 : –No signs of severe sepsis –Fever + generalized maculo-papular rash –Purpuric lesions on legs - Biological tests including : –blood smears (-), –blood cell count, normal •And Rickettsioses!!… SFGR ? 22/04/2009 ESCAR, 19th ECCMID - Helsinki 4 22/04/2009 ESCAR, 19th ECCMID - Helsinki 5 Which Rickettsia ? Order : Rickettsiales et Bartonellaceae (Bartonella + Rochalimaea) Tribu : Rickettsiaceae Anasplasmataceae Genus : Orientia Rickettsia O tsutsugamushi Typhus group (Spotted Fever Group) (scrub typhus) Epidemic typhus R.prowazekii R rickettsii RMSF Murine typhus R.typhi R.
    [Show full text]
  • African Tick-Bite Fever in Traveler Returning to Slovenia from Uganda
    LETTERS recommend (9), screening of HIV-infected patients who African Tick-Bite Fever in are sexually active with multiple partners should be con- ducted every 3–6 months for early detection of syphilis Traveler Returning to and initiation of proper treatment to prevent transmission Slovenia from Uganda and progression to late syphilis. Petra Bogovic, Stanka Lotric-Furlan, Misa Korva, Acknowledgments Tatjana Avsic-Zupanc We thank the clinical staff at the AIDS Clinical Center (Tokyo, Japan) for assistance. Author affiliations: University Medical Center Ljubljana, Ljubljana, Slovenia (P. Bogovic, S. Lotric-Furlan); Institute of Microbiology This study was supported by Grant-in-Aids for AIDS research and Immunology, Ljubljana (M. Korva, T. Avsic-Zupanc) from the Japanese Ministry of Health, Labour, and Welfare (H23-AIDS-001 and H24-AIDS-003). DOI: http://dx.doi.org/10.3201/eid2210.160650 To the Editor: African tick-bite fever (ATBF) is a well References known disease in travelers to sub-Saharan Africa (1). The 1. Clark EG, Danbolt N. The Oslo study of the natural history of causative agent, Rickettsia africae, is transmitted to hu- untreated syphilis; an epidemiologic investigation based on a mans by ticks of the genus Amblyomma (1,2). R. africae restudy of the Boeck-Bruusgaard material; a review and appraisal. has been isolated or detected in ticks, humans, or both in J Chronic Dis. 1955;2:311–44. http://dx.doi.org/10.1016/0021- 9681(55)90139-9 22 sub-Saharan countries (3). Most ATBF cases have been 2. Noel CB, Moeketsi K, Kies B. Cavernous sinus syndrome, an described in tourists returning from countries to which it atypical presentation of tertiary syphilis: case report and review is endemic, most often from South Africa, Zimbabwe, and of the literature.
    [Show full text]