1: Dtsch Med Wochenschr. 2003 May 9;128(19):1042-7.  Links
[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.

PMID: 12736854 [PubMed - indexed for MEDLINE]