title: Emerging tick-borne infections in mainland China: an increasing public health threat.
abstract: Since the beginning of the 1980s, 33 emerging tick-borne agents have been identified in mainland China, including eight species of spotted fever group rickettsiae, seven species in the family Anaplasmataceae, six genospecies in the complex Borrelia burgdorferi sensu lato, 11 species of Babesia, and the virus causing severe fever with thrombocytopenia syndrome. In this Review we have mapped the geographical distributions of human cases of infection. 15 of the 33 emerging tick-borne agents have been reported to cause human disease, and their clinical characteristics have been described. The non-specific clinical manifestations caused by tick-borne pathogens present a major diagnostic challenge and most physicians are unfamiliar with the many tick-borne diseases that present with non-specific symptoms in the early stages of the illness. Advances in and application of modern molecular techniques should help with identification of emerging tick-borne pathogens and improve laboratory diagnosis of human infections. We expect that more novel tick-borne infections in ticks and animals will be identified and additional emerging tick-borne diseases in human beings will be discovered.
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Fang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Xin-Lou
authors.initials: XL
authors.lastname: Li
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Song
authors.initials: S
authors.lastname: Liang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Hong-Wu
authors.initials: HW
authors.lastname: Yao
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Ruo-Xi
authors.initials: RX
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Ye
authors.initials: Y
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Wan-Jun
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Shu-Qing
authors.initials: SQ
authors.lastname: Zuo
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Mai-Juan
authors.initials: MJ
authors.lastname: Ma
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Jiang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: X Frank
authors.initials: XF
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Gray
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Krause
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China (L-Q Fang PhD, K Liu MS, X-L Li MS, H-W Yao MS, R-X Sun BS, Y Sun BS, W-J Chen BS, S-Q Zuo PhD, M-J Ma PhD, H Li PhD, J-F Jiang PhD, Prof W Liu PhD, Prof W-C Cao PhD); College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA (S Liang PhD, Y Yang PhD); Department of Microbiology and Immunology, Indiana University School of Medicine, Barnhill, IN, USA (Prof X F Yang PhD); Duke University School of Medicine, Durham, NC, USA (Prof G C Gray MD); and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and Department of Medicine and Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA (P J Krause MD).
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000710:Anaplasmataceae / Q000472:pathogenicity / Q000502:physiology; D000711:Anaplasmataceae Infections / Q000453:epidemiology* / Q000382:microbiology; D000818:Animals; D001096:Arachnid Vectors / Q000145:classification / Q000382:microbiology*; D001403:Babesia / Q000472:pathogenicity / Q000502:physiology; D001404:Babesiosis / Q000453:epidemiology* / Q000382:microbiology; D015748:Borrelia burgdorferi Group / Q000472:pathogenicity / Q000502:physiology; D002681:China / Q000453:epidemiology; D006801:Humans; D008193:Lyme Disease / Q000453:epidemiology* / Q000382:microbiology; D011634:Public Health / Q000706:statistics & numerical data; D012281:Rickettsia / Q000472:pathogenicity / Q000502:physiology; D012282:Rickettsia Infections / Q000453:epidemiology* / Q000382:microbiology; D017282:Tick-Borne Diseases / Q000453:epidemiology* / Q000382:microbiology; D013987:Ticks / Q000145:classification / Q000382:microbiology*