Tick-borne lymphadenopathy acquired in Serbia: Report of two cases

Abstract

Introduction. Acronym tick-borne lymphoadenoathy (TI-BOLA (Dermacentor-borne necrosis erythema and lymphoadenopathy-DEBONEL, scalp eschar associated with neck lymphoadenopathy-SENLAT) comprises clinical diagnosis of tick-borne symptoms of cervical or occipital lymphadenopathy with inoculation eschar at the site of tick bite on scalp. Since the first description, it was proved to be associated with several infectious agents, most frequently Rickettsia slovaca, or less often other spotted fever group Rickettsiae (Rickettsia raoulti and Rickettsia rioja), and gained an emerging infectious disease status in Europe. Dermacentor ticks serve as vectors and possible natural reservoir. The course is in most cases benign and infection is limited. Doxicycline is the recommended initial treatment, both for adult and most cases in children. Case report. Two subjects who acquired the desease caused by tick bites in Vojvodina region of Serbia are presented. Both patients are females. A tick was removed from the scalp, and several days later doxicycline treatment started because of the inflammatory symptoms of lymph node enlargement. Diagnostic eschar appeared in both patients during doxicycline treatment. After a switch to ciprofloxacine, inflammatory symptoms subsided, but the complete healing of scalp necrosis took longer than one month, with residual cicatricial alopecia. Conclusion. Although rare, it is necessary to include TIBOLA in a spectrum of epidemiologic risks in cases of tick bites.

Mediterranean spotted fever-like illness caused by Rickettsia sibirica mongolitimonae, North Macedonia, June 2022

“…On the Balkan peninsula, Turkey is the only country with previous reports of MSF-like illness [1], while MSF cases have been reported in Bulgaria, Croatia, Greece, Romania and Turkey [9][10][11][12][13]. Although MSF is not reported in Serbia, recent reports of tickborne lymphadenopathy [14] and atypical clinical manifestations caused by Rickettsia helvetica [4] indicate circulation of SFGR in the local population.…”

Ixodid ticks and zoonotic tick-borne pathogens of the Western Balkans

“…Research on SFG rickettsiae in Serbia has significantly increased in the last two decades. Using IFAT, Samardžić et al [ 170 ] detected seroreactive human blood sera (9/134) against antigens of Rickettsia conorii , while Gajinov et al [ 171 ] described tick-borne lymphadenopathy (TIBOLA) caused by R. slovaca in two female patients after tick bites. In a recent study, Banović et al [ 172 ] described five confirmed, two suspected and two probable SFG rickettsiae infection cases, and reported that molecular analysis showed intra-species variability in R. helvetica strains infecting humans in Serbia.…”

“… Human Two cases Mf qPCR [ 157 , 166 , 172 , 175 ] R. helvetica Ixodes ricinus , human 7.4–54.0, two cases (humans) PCR-Seq, mf qPCR [ 163 , 166 , 172 – 174 ] R. slovaca Haemaphysalis sp. from human One case mf qPCR [ 171 , 172 ] R. conorii Human 1.9–25.0 IFAT [ 170 ] R. aeshlimanii Ixodes ricinus from humans 3.0 mf qPCR [ 163 ] R. acari Human 4.0–10.4 IFAT [ 170 ] R. felis Ixodes ricinus from humans 4.3 mf qPCR, RT-PCR [ 163 , 166 ] Borrelia spp. Ticks from humans 19.35 RT-PCR [ 166 ] B. burgdorferi s.l Human 8.1–54.2 IFAT, ELISA, WB [ ...…”

A One Health approach to study the circulation of tick-borne pathogens: A preliminary study

“…Serbia has diverse landscapes, with plains in the north, limestone ranges and basins in the east and mountains and hills in the south and southeast. As in the rest of Europe, the most common and widespread human TBD in Serbia is Lyme borreliosis, along with other less frequently diagnosed diseases such as tick-borne encephalitis, human monocytic ehrlichiosis, tick-borne lymphadenopathy, and Crimean-Congo hemorrhagic fever (CCHF) [ [10] , [11] , [12] , [13] ]. Apart from the endemicity of CCHF [ 14 ], little is known about the impact of TBDs on human health in Serbia.…”