Tick-borne lymphadenopathy: a new infectious disease in children.
OBJECTIVE
To describe the epidemiologic and clinical aspects of patients with tick-borne lymphadenopathy (TIBOLA).


METHODS
The study included all patients treated in our hospital who presented characteristic clinical signs of TIBOLA consisting in the presence of an inoculation lesion after a tick bite with regional lymphadenopathies. The study was carried out at the "Corporació Parc Taulí" hospital in the city of Sabadell, Barcelona, Spain. The inclusion period was from April 2000 to April 2006. Serology tests were performed for Rickettsia conorii, R. slovaca, and Borrelia burgdorferi. The presence of Rickettsia was assessed by means of polymerase chain reaction (PCR)-restriction fragment length polymorphism (PCR-RFLP) and linear-after-the exponential-PCR in blood, skin biopsy, and ticks from the patients.


RESULTS
Thirty-six patients fulfilled the inclusion criteria. Twenty-eight patients were children. In most cases, infection occurred between the months of October and April. In 34 patients the tick bite was on the scalp. A necrotic eschar surrounded by a perilesional erythematous halo was observed in 29 cases. All patients had painful regional lymphadenopathies. Serology for R. conorii was positive in 8 cases and for R. slovaca in 2. PCR was negative. The tick, identified as Dermacentor marginatus, was studied in 7 patients. Four of the 7 D. marginatus were positive for sequences compatible with R. slovoca as determined by RFLP or DNA sequencing. Thirty-three patients received antibiotic treatment. Progress was satisfactory in all cases.


CONCLUSIONS
TIBOLA is present in Catalonia (Northeastern Spain) mainly in children. Although clinical and epidemiologic manifestations are very specific microbiologic confirmation is difficult.
Porta
Ferran Segura
FS
Department of Infectious Diseases, Corporació Sanitària Parc Taulí-Institut Universitari (UAB), Sabadell, Barcelona, Spain. fsegura@cspt.es
Nieto
Esperanza Antón
EA
Creus
Bernat Font
BF
Espín
Tomás Muñoz
TM
Casanova
Francisco Javier Travería
FJ
Sala
Isabel Sanfeliu
IS
García
Sergio Lario
SL
Aguilar
Jesus Luelmo
JL
Vilaseca
Mariela Quesada
MQ
D000293:Adolescent; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi / Q000302:isolation & purification; D002648:Child; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D003870:Dermacentor / Q000382:microbiology; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications / Q000473:pathology; D008193:Lyme Disease / Q000175:diagnosis / Q000453:epidemiology; D008206:Lymphatic Diseases / Q000209:etiology*; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D012150:Polymorphism, Restriction Fragment Length; D012281:Rickettsia / Q000302:isolation & purification; D012282:Rickettsia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D017422:Sequence Analysis, DNA; D013030:Spain / Q000453:epidemiology; D017282:Tick-Borne Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial