title: Molecular Detection of Tick-Borne Pathogens in Humans with Tick Bites and Erythema Migrans, in the Netherlands.
abstract: BACKGROUND
  Tick-borne diseases are the most prevalent vector-borne diseases in Europe. Knowledge on the incidence and clinical presentation of other tick-borne diseases than Lyme borreliosis and tick-borne encephalitis is minimal, despite the high human exposure to these pathogens through tick bites. Using molecular detection techniques, the frequency of tick-borne infections after exposure through tick bites was estimated.
  
  
  METHODS
  Ticks, blood samples and questionnaires on health status were collected from patients that visited their general practitioner with a tick bite or erythema migrans in 2007 and 2008. The presence of several tick-borne pathogens in 314 ticks and 626 blood samples of this cohort were analyzed using PCR-based methods. Using multivariate logistic regression, associations were explored between pathogens detected in blood and self-reported symptoms at enrolment and during a three-month follow-up period.
  
  
  RESULTS
  Half of the ticks removed from humans tested positive for Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Candidatus Neoehrlichia mikurensis, Rickettsia helvetica, Rickettsia monacensis, Borrelia miyamotoi and several Babesia species. Among 92 Borrelia burgdorferi s. l. positive ticks, 33% carried another pathogen from a different genus. In blood of sixteen out of 626 persons with tick bites or erythema migrans, DNA was detected from Candidatus Neoehrlichia mikurensis (n = 7), Anaplasma phagocytophilum (n = 5), Babesia divergens (n = 3), Borrelia miyamotoi (n = 1) and Borrelia burgdorferi s. l. (n = 1). None of these sixteen individuals reported any overt symptoms that would indicate a corresponding illness during the three-month follow-up period. No associations were found between the presence of pathogen DNA in blood and; self-reported symptoms, with pathogen DNA in the corresponding ticks (n = 8), reported tick attachment duration, tick engorgement, or antibiotic treatment at enrolment.
  
  
  CONCLUSIONS
  Based on molecular detection techniques, the probability of infection with a tick-borne pathogen other than Lyme spirochetes after a tick bite is roughly 2.4%, in the Netherlands. Similarly, among patients with erythema migrans, the probability of a co-infection with another tick-borne pathogen is approximately 2.7%. How often these infections cause disease symptoms or to what extend co-infections affect the course of Lyme borreliosis needs further investigations.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Setareh
authors.initials: S
authors.lastname: Jahfari
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Agnetha
authors.initials: A
authors.lastname: Hofhuis
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Manoj
authors.initials: M
authors.lastname: Fonville
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Joke
authors.initials: J
authors.lastname: van der Giessen
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Sprong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000709:Anaplasma / Q000235:genetics / Q000302:isolation & purification; D000711:Anaplasmataceae Infections / Q000453:epidemiology*; D000818:Animals; D001403:Babesia / Q000235:genetics / Q000302:isolation & purification; D001404:Babesiosis / Q000453:epidemiology*; D001898:Borrelia / Q000235:genetics / Q000302:isolation & purification; D025065:Borrelia burgdorferi / Q000235:genetics / Q000302:isolation & purification; D060085:Coinfection / Q000453:epidemiology; D004269:DNA, Bacterial / Q000097:blood; D004675:Encephalitis, Tick-Borne / Q000453:epidemiology; D015787:Erythema Chronicum Migrans / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018884:Ixodes / Q000382:microbiology*; D016015:Logistic Models; D008193:Lyme Disease / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012281:Rickettsia / Q000235:genetics / Q000302:isolation & purification; D064927:Tick Bites / Q000453:epidemiology*; D017282:Tick-Borne Diseases / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial