Scalp eschar and neck lymph adenopathy after a tick bite (SENLAT) in Tuscany, Italy (2015–2022)

Abstract

Introduction The Scalp Eschar and Neck Lymph Adenopathy After a Tick Bite (SENLAT) syndrome is frequently caused by Rickettsia slovaca and Rickettsia raoultii. Only six microbiologically confirmed SENLAT cases have been reported in Italy between 1996 and 2021. We report ten cases of SENLAT seen between 2015 and 2022 in a tertiary care center in Tuscany, Italy. Cases presentation All patients were women; most common symptoms were scalp eschar on the site of tick bite (100%) and cervical lymphadenopathy (90%). No microbiological identification was obtained. Persistent alopecia, for several months to years, was observed in four patients. The known difficulty of microbiological diagnosis in SENLAT was worsened, in our cases, by factors as the absence of ticks available for identification and microbiological study, and antibiotic treatment administration previous to microbiological tests. Conclusion The report highlights the presence of SENLAT in Italy, aiming to raise the awareness toward the emergence of this clinical entity.

Tick Infestation on the Scalp Leading to Misguided Medical Consultation: A Case Report

“…Environmental factors influencing the development and distribution of ticks encompass favorable conditions for reproduction, spanning regions with diverse climates, high humidity, and the presence of livestock [1]. The duration of tick attachment varies from 1 to 10 days, with symptoms emerging between 1 and 14 days after the presumed tick bite [4]. The symptoms in the present case emerged after 5 days of having contact with a cow.…”

“…The SENLAT is another complication characterized as a nonpathogen-specific reaction to the bites of Dermacentor ticks [4,10]. The preference for ticks to bite children's or women's scalps is attributed to the parasite's affinity for hairy hosts.…”

“…They frequently target wild, hairy mammals and can cause diverse complications when biting humans, including skin granulomas, erythema chronicum-like lesions, and skin abscess formation. Moreover, ticks secrete saliva containing anti-coagulants and antiinflammatory proteins, posing a risk of transmitting pathogenic diseases like Crimean-Congo hemorrhagic fever, Lyme disease, and tularemia [1,3,4]. Notably, the emerging concept of scalp eschar and neck lymphadenopathy (SENLAT) after tick bite enhances understanding of tick-related health issues.…”

“…The SENLAT is characterized by a tick bite on the scalp, followed by the development of an eschar at the bite site and neck lymphadenopathy. Common accompanying symptoms include fever, myalgia, neck pain, and headaches [4]. Tick bites, beyond causing SENLAT, may lead to various clinical manifestations like local or secondary infection at the bite site, foreign body granuloma due to retained mouthparts, local contact/irritant allergic dermatitis, ascending paralysis, and even anaphylaxis [3].…”