|An eschar suggestive of tick bite|
Tick-borne disease Microchapters
For patient information click here
Tick-borne diseases are diseases or illnesses transmitted by ticks. As the incidence of tick-borne illnesses increases and the geographic areas in which they are found expand, it becomes increasingly important that health professionals be able to distinguish the diverse, and often overlapping, clinical presentations of these diseases.
Tick-borne disease Classification
|Borreliosis (Lyme Disease) ||Borrelia burgdorferi sensu lato (bacterium) and B. mayonii||I. scapularis, I. pacificus, I. ricinus, and I. persulcatus||United States:
|Relapsing Fever ||Borrelia Species; Borrelia hermsii, Borellia Parkeri, Borellia duttoni, Borrelia miyamotoi||Ornithodoros species||Widespread:
|Rocky Mountain Spotted Fever ||Rickettsia Rickettsii||Wood Tick (Dermacentor Variabilis), D. andersoni||United States:
|Helvetica Spotted Fever||Rickettsia Helvetica||Ixodes Ricinus (European)||Europe:
|Ehrlichiosis (Anaplasmosis) ||Ehrlichia Chaffeensis, E. Equi||Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis||United States:
|Tularemia ||Francisella Tularensis||D. Andersoni, D. Variabilis||United States:
|Human neoehrlichiosis  ||Neoehrlichia mikurensis||Lone Star Tick (Amblyomma Americanum)'||Widespread:
|Rickettsiosis ||Rickettsia||No specific species identified||Widespread:
|African tick-bite fever ||Rickettsia africae||Amblyomma, Dermacentor, and Rhipicephalus species||Africa:
|Queensland tick typhus  ||Rickettsia austalis||Ixodes species||Widespread:
|Q fever (Typhus-like infection) ||Coxiella burnetii (mimics the mechanisms of Rickettsia)||Ixodes holocyclus and Amblyomma triguttatum||Australia
|Mediterranean spotted fever (Boutonneuse fever)  ||Rickettsia conorii||Brown Dog Tick (Rhipicephalus sanguineus)||Widespread:
|Far Eastern spotted fever ||Rickettsia heilong-jiangensis||Tick||Widespread:
|Aneruptive fever  ||Rickettsia helvetica||Ixodes species||Widespread:
|Flinders Island spotted fever (Thai tick typhus)  ||Rickettsia honei||Tick|| Widespread in Independent Regions
|Japanese spotted fever ||Rickettsia japonica||Tick||Japan
|Mediterranean spotted fever-like disease ||Rickettsia massiliae and R. monacensis||Tick||Widespread:
|Maculatum infection||Rickettsia parkeri||Tick||Americas:
|Tick-borne necrosis and lymphadenopathy ||Rickettsia raoultii||Dermacentor marginatus||Widespread:
|North Asian Tick Typhus ||Rickettsia sibirica||Tick||Widespread:
|Lymphangitis ||Rickettsia sibirica mogolotimonae||'No specific species identified||Widespread:
|TIBOLA  ||Rickettsia slovaca||Dermacentor species||Widespread:
|Tick-borne Meningoencephalitis ||TBEV virus||Ixodes Scapularis, I. Ricinus, I.persulcatus||Widespread:
|Colorado Tick Fever ||CTF virus||Dermacentor andersoni||United States:
|Severe Fever with Thrombocytopenia Syndrome ||SFTS virus||
|Crimean-Congo Hemorrhagic Fever ||CCHF virus||Hyalomma marginatum, Rhipicephalus bursa||Widespread:
|Severe Febrile Illness ||Heartland Virus||Lone Star Tick (amblyomma americanum)||United States:
|Bourbon virus infection||Bourbon virus infection||Lone Star Tick||United States:
|Babesiosis ||Babesia microti, B divergens, B.equi||Ixodes Scapularis, I. pacificus||Widespread:
Tick-borne illnesses are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. Because ticks can harbor more than one disease-causing agent, patients can be infected with more than one pathogen at the same time, compounding the difficulty in diagnosis and treatment.
Life Cycle and Spread of Disease
General Tick Life Cycle
- A tick's life cycle is composed of four stages: hatching (egg), nymph (six legged), nymph (eight legged), and an adult.
- Ticks require blood meal to survive through their life cycle.
- Hosts for tick blood meals include mammals, birds, reptiles, and amphibians. Ticks will most likely transfer between different hosts during the different stages of their life cycle.
- Humans are most often targeted during the nymph and adult stages of the life cycle.
- Life cycle is also dependent on seasonal variation.
- Ticks will go from eggs to larva during the summer months, infecting bird or rodent host during the larval stage.
- Larva will infect the host from the summer until the following spring, at which point they will progress into the nymph stage.
- During the nymph stage, a tick will most likely seek a mammal host (including humans).
- A nymph will remain with the selected host until the following fall at which point it will progress into an adult.
- As an adult, a tick will feed on a mammalian host. However unlike previous stages, ticks will prefer larger mammals over rodents.
- The average tick life cycle requires three years for completion.
- Different species will undergo certain variations within their individual life cycles. 
Spread of Tick-borne Disease
- Ticks require blood meals in order to progress through their life cycles.
- The average tick requires 10 minutes to 2 hours when preparing a blood meal.
- Once feeding, releases anesthetic properties into its host, via its saliva.
- A feeding tube enters the host followed by an adhesive-like substance, attaching the tick to the host during the blood meal.
- A tick will feed for several days, feeding on the host blood and ingesting the host's pathogens.
- Once feeding is completed, the tick will seek a new host and transfer any pathogens during the next feeding process. 
Epidemiology and Demographics
- Tick based infections are generally non-specific in regards to age, race, or gender. (However babesiosis is more frequently observed in older, male populations. An explanation for this has not yet been formulated.) 
- Certain tick-borne illnesses will vary within patient populations when an auto-immune deficiency is present.
- Tick bites are more frequently reported during the spring and summer months which are noted to be in correlation with high tick activity.
- Higher risks are associated with individuals traveling within endemic areas.
- Inoculation within endemic areas is usually the result of a tick bite however transmission has been identified as a result of transfusions or transplantation.
Species and Regions
- Pacific Coast and east of the Rocky Mountains.
- Transmits tularemia and rocky mountain spotted fever.
- Primarily infects humans during the spring and summer months.
- Northeastern and upper Midwest.
- Transmits Lyme disease, babesiosis, anaplasmosis, and Powassan disease.
- Primarily infects humans during the spring, summer, and fall months.
- Widespread throughout the United States.
- Transmits Rocky mountain spotted fever.
- Atlantic Coast and Gulf of Mexico (Along the coast of Northeastern Virginia until the Southern most portions of Florida. From Southeast Florida through the Gulf of Mexico into Texas).
- Transmits Rickettsia parkeri rickettsiosis (spotted fever).
- Colorado, Nevada, eastern California, eastern Oregon, eastern Washington, Idaho, Montana, Wyoming, and Utah.
- Transmits Rocky mountain spotted fever, Colorado tick fever, and tularemia.
Hyalomma Marginatum 
- Widespread: North Africa, Europe, and Asia.
- Transmits Crimean-Congo hemorrhagic fever.
Ixodes Ricinus 
- Widespread throughout Europe and parts of North Africa.
- Transmits encephalitis and Lyme Disease.
Ixodes Persulcatus 
Dermacentor Reticulatus 
Differentiating Tick-Borne Diseases from other Diseases
|Borreliosis (Lyme Disease) ||Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.|
|Relapsing Fever ||Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.|
|Rocky Mountain Spotted Fever||Fever, alterations in mental state, myalgia, rash, and headaches.|
|Helvetica Spotted Fever ||Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.|
|Ehrlichiosis Anaplasmosis ||Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).|
|Tularemia ||Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.|
|Tick-borne meningoencephalitis ||Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.|
|Colorado Tick Fever ||Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.|
|Crimean-Congo Hemorrhagic Fever||Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.|
|Babesiosis ||Non-specific flu like symptoms.|
- The greatest risk factor associated with tick-borne diseases is actually being bitten by a tick.
- Traveling or residing within endemic regions will increase chances of infection.
- Tick activity is generally heightened during certain the spring and summer months.
- Within endemic regions, tick may choose an animal host, including a domesticated animal such as a dog or cat.
- Although rare, cases of blood transfusion and organ transplantation have been recorded as methods of transmission.
- All together, individuals who spend time outdoors and/or have pets that go outdoors in endemic regions are at risk for tick-borne disease. 
A round red rash with a 2-5 mm central black area (eschar, an area of dead tissue) as shown in the photo is suggestive of a tick bite.
In general, specific laboratory tests are not available to rapidly diagnose tick-borne diseases. Serological tests are frequently performed, but may be unreliable in differentiating acute from chronic conditions.
- Antibiotic treatment is often justified based on clinical presentation alone. However all clinical treatments must be tailored according to a patients personal profile; considering age, immunocompetance, pregnancy, allergen profile, splenic function, and current medical status. 
- If there is a collection of pus, the area will need to be incised and drained.
|Borreliosis (Lyme Disease) ||Antibiotics|
|Relapsing Fever ||Antibiotics|
|Rocky Mountain Spotted Fever ||Antibiotics|
|Helvetica Spotted Fever||Antibiotics
|Ehrlichiosis Anaplasmosis ||Antibiotics
|Other Spotted Fevers (Rickettsia bacterial infections) ||Antibiotics
|Tick-borne meningoencephalitis ||No specific drug therapy. May require hospitalization and supportive care, including anti-inflammatory drugs, corticosteroids, or, if necessary, incubation and ventilator support.|
|Colorado Tick Fever ||There are no current therapies associated with Colorado Tick Fever. The majority of patients exhibiting symptoms recover completely, however severe cases require hospitalization.|
|Crimean-Congo Hemorrhagic Fever||Treatment for Crimean-Congo Hemorrhagic Fever is primarily supportive including balancing electrolytes, oxygen abnormalities, and if necessary, hemodynamic support. In vitro, Crimean-Congo Hemorrhagic Fever is responsive to an antiviral treatment with Ribavirin.|
The best way to remove a tick
- Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
- Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. (If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.)
- After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
- Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.
- Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag. 
- Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
- Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
- Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
- Disease Index General Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015
- Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
- Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
- Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz Accessed on December 30, 2015
- Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015
- Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015
- Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015
- General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
- CTF Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
- General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015
- Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
- Life Cycle of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/life_cycle_and_hosts.html Accessed on December 30, 2015
- Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015
- Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015
- General Information (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
- Tick-borne diseases of the United States. Treatment Information Center for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
- Tick Removal. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015
- "Dermatology Atlas".
- Lyme disease
- Tick-borne meningoencephalitis
- Rocky Mountain Spotted Fever
- Relapsing fever
- Colorado tick fever
- Tick paralysis