A Clear and Present Danger: Tick-borne Diseases in Europe

Paul Heyman; Christel Cochez; Agnetha Hofhuis; Joke van der Giessen; Hein Sprong; Sarah Rebecca Porter; Bertrand Losson; Claude Saegerman; Oliver Donoso-Mantke; Matthias Niedrig; Anna Papa

Disclosures

Expert Rev Anti Infect Ther. 2010;8(1):33-50.

Abstract and Introduction

Abstract

Ticks can transmit a variety of viruses, bacteria or parasites that can cause serious infections or conditions in humans and animals. While tick-borne diseases are becoming an increasing and serious problem in Europe, tick-borne diseases are also responsible for major depressions in livestock production and mortality in sub-Saharan Africa, Latin America and Asia. This review will focus on the most important circulating tick-transmitted pathogens in Europe (Borrelia spp., Anaplasma phagocytophilum, Babesia spp., tick-borne encephalitis virus, Rickettsia spp. and Crimean-Congo hemorrhagic fever virus).

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Table 1. Rickettsial subspecies found in Europe.
Rickettsia spp.	Vectors	Disease	Symptoms
R. conorii conorrii	Rh. sanguineus (I. ricinus)	Mediterranean spotted fever	Rash (97%); single eschar; case–fatality rate without treatment (0–18%)
R. conorii israelensis	Rh. sanguineus	Israeli spotted fever	Rash; eschars are less frequent; mild-to- severe illness; case–fatality rate without treatment (0–3.5%)
R. conorii caspia	Rh. sanguineus Rh. pumilio	Astrakhan spotted fever	Maculopapular rash (94%); eschar (23%); conjunctivitis (34%)
R. slovaca	D. marginatus D. reticulates	Tibola/Debonel	Rash and fever is rare; typical eschar on the scalp with cervical lymphadenopathy; mild illness
R. sibirica mongolitimonae	H. asiaticum H. truncatum	Lymphangitis-associated rickettsiosis	Rash (63%); eschar (75%); lymphangitis (25%)
R. aeschlimannii	H. marginatum marginatum H. marginatum rufipes Rh. appendiculatus	Unnamed	Maculopapular rash; eschar
R. raoultii*	D. reticularis D. marginatus	Unnamed	Nonpathogenic?
R. Helvetica	I. ricinus I. ovatus I. persulcatus I. monospinus	Unnamed	Few documented cases by serology; doubtful clinical cases with perimyocarditis and sarcoidosis
R. massiliae	Rh. muhsamae Rh. lunulatus Rh. sulcatus Rh. turanicus Rh. sanguineus	Unnamed	Few documented reports; fever; maculopapular rash; necrotic lesions in skin; chorioretinitis
R. rhipicehali	Rh. sanguineus D. ocidentalis	Unnamed	Nonpathogenic?
R. monacensis and related^‡	I. ricinus	Nonpathogenic?

*Previously known as DnS14, DnS28 and RpA4.^[243]
^‡Closely related to 'the cadiz agent' and IRS3 and IRS4.
Geographic distributions of tick-borne rickettsiae can be found elsewhere.^{[107,114,244]}
D.: Dermacentor; H.: Hyalomma; I.: Ixodes; R.: Rickettsia; Rh.: Rhipicephalus; Tibola/Debonel: Tick-borne lymphadenopathy/Dermacentor-borne necrosis erythema lymphadenopathy.

Box 1. Prevalent tick species in Europe.
North Europe Dermacentor reticulatus Dermacentor marginatus Haemoaphysialis concinna Hyalinella punctata Ixodes canisuga Ixodes hexagonus Ixodes ricinus
South Europe Boophilus annulatus* Dermacentor marginatus Haemoaphysialis leachi Haemaphysalis parva H. punctata Hyalomma anatolicum anatolicum Hyalomma marginatum marginatum I. canisuga I. hexagonus I. ricinus Rhipicephalus bursa Rhipicephalus sanguineus Rhipicephalus turanicus