Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model

Hofhuis, Agnetha; Kassteele, Jan van de; Sprong, Hein; Wijngaard, Cees C. van den; Harms, Margriet; Fonville, Manoj; Leeuwen, Arieke Docters van; Simões, Mariana; Pelt, Wilfrid van

doi:10.1371/journal.pone.0181807

Cited by 52 publications

(44 citation statements)

References 38 publications

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“…Even though adults are usually more likely to be infected with B. burgdorferi s.l . (Rauter & Hartung, ; Strnad, Hönig, Růžek, Grubhoffer, & Rego, ), the small size of nymphs means that they can remain unnoticed and stay attached for longer (Falco, Fish, & Piesman, ; Hügli et al, ), increasing the risk of infection to the host (Hofhuis et al, ; Sood et al, ; Tijsse‐Klasen et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies in LB endemic countries have suggested that although the risk of developing LB after being bitten by an infected tick is low, the potential for becoming infected is positively associated with the duration of tick attachment (Fryland et al, ; Hofhuis et al, ; Jacobs et al, ; Nahimana et al, ; Sood et al, ; Tijsse‐Klasen et al, ; Wilhelmsson et al, ). Therefore, the prompt detection and removal of ticks are important for reducing the risk of LB transmission, and for this reason, the promotion of thorough tick checks following potential tick exposure is a mainstay of tick bite prevention campaigns.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from laboratory studies and surveys of tick‐bitten humans suggests that following attachment of an infected tick, the risk of transmission of B. burgdorferi s.l. to the host increases with the duration of tick feeding (Crippa, Rais, & Gern, ; Hofhuis et al, ; Kahl et al, ; Nahimana et al, ; Piesman, Mather, Sinsky, & Spielman, ; Sood et al, ; Tijsse‐Klasen et al, ; Wilhelmsson et al, ). Therefore, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection, and performing a thorough examination of the body to check for feeding ticks following potential exposure is recommended by tick awareness campaigns aiming to reduce LB incidence (Aenishaenslin, Bouchard, Koffi, & Ogden, ; Beaujean et al, ; Mowbray, Amlôt, & Rubin, ; Van Der Heijden, Mulder, Poortvliet, & Van Vliet, ).…”

Section: Introductionmentioning

confidence: 99%

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Seasonality and anatomical location of human tick bites in the United Kingdom

Cull

Pietzsch

Gillingham

et al. 2019

Zoonoses and Public Health

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Tick bites on humans can occur in a variety of habitats and may result in the transmission of tick-borne pathogens, such as the causative agent of Lyme borreliosis (LB), Borrelia burgdorferi sensu lato. As the risk of transmission of this pathogen to the host increases with the duration of tick feeding, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection.Performing a thorough body examination for ticks following potential exposure is recommended by tick awareness campaigns. Knowledge of where on the body feeding ticks are frequently found, and at which times of year peak tick exposure occurs, provides important information for public health messaging and may aid those bitten by ticks to engage more effectively with tick-checking behaviour. This paper summarizes human tick bites in the United Kingdom (UK) during 2013-2018 reported to Public Health England's passive Tick Surveillance Scheme and further examines the anatomical location and seasonality of bites from the most commonly encountered tick and LB vector Ixodes ricinus. A total of 1,328 tick records from humans were received of which 93% were I. ricinus. Humans were most commonly bitten by I. ricinus nymphs (70% bites). Tick bites were recorded on all parts of the body, but there were significant differences in their anatomical location on adults and children. Most tick bites on adults occurred on the legs (50%), whereas on children tick bites were mostly on the head and neck (43%). Bites from I. ricinus were recorded throughout the year but were most numerous during May to August. This study adds to the body of research on the seasonality and anatomical location of human tick bites in temperate Europe and highlights the importance of data collected through passive surveillance in addition to research and epidemiological studies. K E Y W O R D S Ixodes ricinus, public health, tick awarenessThis article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland. | 113CULL et aL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Seasonality and anatomical location of human tick bites in the United Kingdom

Cull

Pietzsch

Gillingham

et al. 2019

Zoonoses and Public Health

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“…In Europe, Ixodes ricinus is the tick species primarily responsible for transmitting B burgdorferi sl, whereas Ixodes persulcatus is predominant in large parts of Russia and Asia 2. On average, in Europe 12% of nymphal and 15% of adult I ricinus ticks are infected with B burgdorferi sl,5 and 2-3% of humans develop Lyme borreliosis after a tick bite,101112 which is similar to the incidence in the US 13…”

Section: Incidence and Epidemiologymentioning

confidence: 84%

Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

113

118

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Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

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“…Another controversial issue is the transmission time that is required for ticks to infect humans with Borrelia species. Although older animal models suggested that transmission of Bbss required 24-48 h of tick feeding, more recent reports of animal and human Borrelia infection challenged this dogma [54][55][56][57][58]. Furthermore, transmission of RFB may occur significantly faster than Bbsl, requiring seconds to a few hours in animal models and humans [59][60][61].…”

Section: Discussionmentioning

confidence: 99%

Lyme Disease: Diversity of Borrelia Species in California and Mexico Detected Using a Novel Immunoblot Assay

Fesler

Shah²,

Middelveen

et al. 2020

Healthcare

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Background: With more than 300,000 new cases reported each year in the United States of America (USA), Lyme disease is a major public health concern. Borrelia burgdorferi sensu stricto (Bbss) is considered the primary agent of Lyme disease in North America. However, multiple genetically diverse Borrelia species encompassing the Borrelia burgdorferi sensu lato (Bbsl) complex and the Relapsing Fever Borrelia (RFB) group are capable of causing tickborne disease. We report preliminary results of a serological survey of previously undetected species of Bbsl and RFB in California and Mexico using a novel immunoblot technique. Methods: Serum samples were tested for seroreactivity to specific species of Bbsl and RFB using an immunoblot method based on recombinant Borrelia membrane proteins, as previously described. A sample was recorded as seropositive if it showed immunoglobulin M (IgM) and/or IgG reactivity with at least two proteins from a specific Borrelia species. Results: The patient cohort consisted of 90 patients residing in California or Mexico who met the clinical case definition of chronic Lyme disease. Immunoblot testing revealed that 42 patients were seropositive for Bbsl (Group 1), while 56 patients were seropositive for RFB (Group 2). Eight patients were seropositive for both Bbsl and RFB species. Group 1 included patients who were seropositive for Bbss (14), B. californiensis (eight), B. spielmanii (10), B. afzelii/B. garinii (10), and mixed infections that included B. mayonii (three). Group 2 included patients who were seropositive for B. hermsii (nine), B. miyamotoi (seven), B. turicatae (nine), and B. turcica (two). In the remaining Group 1 and Group 2 patients, the exact Borrelia species could not be identified using the immunoblot technique. Conclusions: Lyme disease is associated with a diverse group of Borrelia species in California and Mexico. Current testing for Lyme disease focuses on detection of Bbss, possibly resulting in missed diagnoses and failure to administer appropriate antibiotic therapy in a timely manner. The genetic diversity of Borrelia spirochetes must be considered in future Lyme disease test development.

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Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model

Cited by 52 publications

References 38 publications

Seasonality and anatomical location of human tick bites in the United Kingdom

Seasonality and anatomical location of human tick bites in the United Kingdom

Lyme borreliosis: diagnosis and management

Lyme Disease: Diversity of Borrelia Species in California and Mexico Detected Using a Novel Immunoblot Assay

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