jwissmille

Dtsch Med Wochenschr. 2003 May 9;128(19):1042-7. Related
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[Fever after a tick bite: clinical manifestations and diagnosis
of acute tick bite-associated infections in northeastern
Switzerland]

[Article in German]

Baumann D, Pusterla N, Peter O, Grimm F, Fournier PE, Schar G,
Bossart W, Lutz H, Weber R.

Abteilung Infektionskrankheiten und Spitalhygiene, Departement
fur Innere Medizin, Universitatsspital, Zurich, Schweiz .

BACKGROUND: Different tick-borne infections can cause an acute
febrile illness. The study objectives were to investigate the
clinical manifestations and diagnosis of infections among
patients who presented with fever after a tick-bite, and to
detect newly described pathogens, including Ehrlichia, Babesia
and Rickettsia helvetica, in North-Eastern Switzerland. PATIENTS
AND METHODS:: We studied 75 patients (41 male, 34 female, median
age 38 years, among them 10 children) who had fever within 3
weeks after a tick-bite. Paired sera were tested for antibodies
to Borrelia burgdorferi, tick-borne encephalitis virus, Anaplasma
(Ehrlichia) phagocytophila, Babesia microti, B. divergens, and
Rickettsia helvetica. In addition, microscopy and polymerase
chain reaction was used to detect Ehrlichia. Clinical data were
obtained at baseline and at 1 and 2 year follow-up. RESULTS:
Tick-borne infections were confirmed or possible in 36 (48 %)
patients: 7 (9 %) Erythema migrans, 6 (8 %) other specific
manifestations of Lyme borreliosis, 6 (8 %) Lyme borreliosis
presenting as non-specific febrile illness, 8 (11 %) tick-borne
encephalitis, 7 (10 %) granulocytic ehrlichiosis, 1 B. microti
infection in a traveler from the US and 6 (8 %) dual infections.
In 8 (11 %) patients serological findings were suggesting
possible acute or past R. helvetica infection. CONCLUSION: Among
patients with fever after a tick-bite, Lyme borreliosis was most
frequently found. There was no evidence for babesiosis among the
resident population. Serologic data suggest that human
granulocytic ehrlichiosis and R. helvetica infections may be
endemic in Switzerland. Among 50 % of the patients no tick-borne
infections could be diagnosed.