Tick-borne diseases are the most prevalent vector-borne diseases in Europe. Knowledge on the incidence and clinical presentation of other tick-borne diseases than Lyme borreliosis and tick-borne encephalitis is minimal, despite the high human exposure to these pathogens through tick bites. Using molecular detection techniques, the frequency of tick-borne infections after exposure through tick bites was estimated.
Ticks, blood samples and questionnaires on health status were collected from patients that visited their general practitioner with a tick bite or erythema migrans in 2007 and 2008. The presence of several tick-borne pathogens in 314 ticks and 626 blood samples of this cohort were analyzed using PCR-based methods. Using multivariate logistic regression, associations were explored between pathogens detected in blood and self-reported symptoms at enrolment and during a three-month follow-up period.
Half of the ticks removed from humans tested positive for Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Candidatus Neoehrlichia mikurensis, Rickettsia helvetica, Rickettsia monacensis, Borrelia miyamotoi and several Babesia species. Among 92 Borrelia burgdorferi s. l. positive ticks, 33% carried another pathogen from a different genus. In blood of sixteen out of 626 persons with tick bites or erythema migrans, DNA was detected from Candidatus Neoehrlichia mikurensis (n = 7), Anaplasma phagocytophilum (n = 5), Babesia divergens (n = 3), Borrelia miyamotoi (n = 1) and Borrelia burgdorferi s. l. (n = 1). None of these sixteen individuals reported any overt symptoms that would indicate a corresponding illness during the three-month follow-up period. No associations were found between the presence of pathogen DNA in blood and; self-reported symptoms, with pathogen DNA in the corresponding ticks (n = 8), reported tick attachment duration, tick engorgement, or antibiotic treatment at enrolment.
Based on molecular detection techniques, the probability of infection with a tick-borne pathogen other than Lyme spirochetes after a tick bite is roughly 2.4%, in the Netherlands. Similarly, among patients with erythema migrans, the probability of a co-infection with another tick-borne pathogen is approximately 2.7%. How often these infections cause disease symptoms or to what extend co-infections affect the course of Lyme borreliosis needs further investigations.
Two most common tick-borne diseases in Europe are Lyme borreliosis and tick-borne encephalitis. Ticks transmit many more pathogens, causing neglected diseases such as anaplasmosis, babesiosis, rickettsiosis and neoehrlichiosis. These diseases are seldom diagnosed, due to their mild and non-characteristic symptoms, but also due to lack of awareness and availability of diagnostic tests. Using molecular detection techniques (polymerase chain reaction or PCR), we estimated the frequency of tick-borne infections in humans after a tick bite and in patients with the first symptoms of Lyme borreliosis, an erythema migrans. About half of the ticks that fed on humans carried one or more tick-borne pathogens, and approximately 2.5% of people that were bitten by ticks were infected with a tick-borne pathogen other than Lyme borreliosis or tick-borne encephalitis. Co-infections of a tick-borne pathogen in patients with an erythema migrans was also approximately 2.5%. Based on these findings, we estimated the incidence of tick-borne infections other than Lyme borreliosis in the Netherlands. How often these infections cause disease or to what extend co-infections affect the course of Lyme borreliosis needs further investigations.