Case reports: intra-aural tick infestations in humans in Sri Lanka

A checklist of the ticks of Malaysia (Acari: Argasidae, Ixodidae), with lists of known associated hosts, geographical distribution, type localities, human infestations and pathogens

Studies of ticks in Malaysia from past articles were reviewed, resulting in a list of 47 species belonging to seven genera (Argas, Ornithodoros, Amblyomma, Dermacentor, Haemaphysalis, Ixodes, and Rhipicephalus). The most prevalent genus in Malaysia is Haemaphysalis (20 species), followed by Amblyomma (eight species) and Dermacentor (seven species). Out of 47 species, only 28 have bitten humans, mostly belonging to Haemaphysalis. The most researched tick-borne pathogens in Malaysia are Rickettsia and Anaplasma, and most research was focused on the tropical-lineage brown dog ticks, R. sanguineus sensu lato, and the cattle ticks, Haemaphysalis bispinosa and Rhipicephalus microplus. 18 species were excluded from the list due to lack of definite records or dubious findings: Ornithodoros mimon, O. turicata, Amblyomma breviscutatum, A. clypeolatum, A. integrum, A. maculatum, Dermacentor marginatum, D. taiwanensis, Haemaphysalis birmaniae, H. flava, H. humerosa, H. longicornis, H. punctata, H. sulcata, Ixodes holocyclus, Rhipicephalus appendiculatus, R. annulatus and R. bursa. This paper presents the first complete and updated list for Dermacentor and Ixodes tick species in Malaysia since Kohls (1957).  

Human Otoacariasis in Two Climatically Diverse Districts in Sri Lanka: Seasonality, Risk Factors, and Case Notes

PURPOSE

Otoacariasis is a parasitic otopathy reported in many parts of the world. This study presents the seasonal pattern, risk factors, and case notes on human otoacariasis in two climatically different districts: Anuradhapura and Kandy in the Dry and Wet/Intermediate zone of Sri Lanka, respectively.

METHODS

Ticks removed from the ear canal of patients were collected. Risk factors of otoacarisis were determined by a case/control follow-up study.

RESULTS

Nymphal Dermacentor auratus (90.8%) was the main tick species associated otoacariasis. In the Kandy District, infestation was year-round, while in the Anuradhapura District, it was seasonal with a peak in December-February. Children < 10 years were a risk group in both districts. Females were a risk group in the Kandy District. Engagement in outdoor activities was a risk factor in both districts. In addition, the presence of wildlife and domesticated animals were risk factors in the Kandy and Anuradhapura districts, respectively. The treatment protocols in the two hospitals were different. An infant with otoacariasis from the Anuradhapura District developed rickettsia.

CONCLUSIONS

Although the tick species was the same, seasonality, risk groups, and risk factors in the two districts were different which could be due to the establishment and persistence of tick populations influenced by biotic and abiotic factors.

A review on Hyalomma species infestations on human and animals and progress on management strategies

The Hyalomma species of ticks have gained additional attention due to their role in the transmission of Theileria annulata infection in animals and the Crimean-Congo Haemorrhagic Fever (CCHF) virus in humans. Apart from these, many other pathogens viz., other species of Theileria, a few species of Babesia, Rickettsia and viruses are either maintained or transmitted by this tick species. The medium to large size species with longer proboscis has inflicted additional burden on the overall impact of tick infestations. Being a multi-host species, management of the species is very challenging. Presently, the traditional method of tick management using chemical acaricides is found insufficient and unsustainable. Henceforth, the overall burden of tick infestations and tick-borne diseases are increasing gradually. After the successful development of vaccines against cattle tick, Rhipicephalus microplus, the anti-Hyalomma vaccine is considered a feasible and sustainable management option. In the recent past research on herbal acaricides and its possible application for tick control seems promising. Other eco-friendly methods are still under experimental stage. The present review is focused on impact of Hyalomma species infestation on human and animal health with special emphasis on progress on its sustainable management.

The Unexpected Holiday Souvenir: The Public Health Risk to UK Travellers from Ticks Acquired Overseas

Overseas travel to regions where ticks are found can increase travellers' exposure to ticks and pathogens that may be unfamiliar to medical professionals in their home countries. Previous studies have detailed non-native tick species removed from recently returned travellers, occasionally leading to travel-associated human cases of exotic tick-borne disease. There are 20 species of tick endemic to the UK, yet UK travellers can be exposed to many other non-native species whilst overseas. Here, we report ticks received by Public Health England's Tick Surveillance Scheme from humans with recent travel history between January 2006 and December 2018. Altogether, 16 tick species were received from people who had recently travelled overseas. Confirmed imports (acquired outside of the UK) were received from people who recently travelled to 22 countries. Possible imports (acquired abroad or within the UK) were received from people who had recently travelled to eight European countries. Species-specific literature reviews highlighted nine of the sixteen tick species are known to vector at least one tick-borne pathogen to humans in the country of acquisition, suggesting travellers exposed to ticks may be at risk of being bitten by a species that is a known vector, with implications for novel tick-borne disease transmission to travellers.

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Background

Over the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem.

Methods

All cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified.

Results

There were 29 patients with mean age of 46 years (range 22–76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1–55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species.

Conclusions

On contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.

Diversity and distribution of tick species (Acari: Ixodidae) associated with human otoacariasis and socio-ecological risk factors of tick infestations in Sri Lanka

Tick infestation in humans is a major public health concern. The diversity and distribution of tick species associated with human otoacariasis was studied in five districts: Anuradhapura, Kandy, Kurunegala, Nuwara Eliya and Ratnapura in the main agro-climatic zones of Sri Lanka. Ticks from patients attending the ear, nose and throat clinics of the General Hospitals were collected during a 3 year period. In total 426 ticks were collected. Most human otoacariasis cases were reported from Kandy (33.8 %) and the fewest from Nuwara Eliya (8.2 %). Of the five tick species identified, nymphs of Dermacentor auratus constituted 90.6 % of the collection. Rhipicephalus sanguineus, Hyalomma isaaci, Haemaphysalis bispinosa and Otobius megnini were found rarely infesting humans possibly as an accidental host; H. bispinosa and O. megnini in the human ear canal were first time records in Sri Lanka. Females and children under 10 years were identified as risk groups of human otoacariasis. Subsequently, a field study was carried out to determine socio-ecological risk factors of human tick infestations in the five districts. Based on hospital data, eight villages with high prevalence of otoacariasis were selected from each district. A total 40 villages were visited and 1674 household members were interviewed. Involvement in outdoor activities, presence of wild animals around the house, location of the house in close proximity to a forest and occupation were identified as major risk factors.

Ticks infesting wild and domestic animals and humans of Sri Lanka with new host records

An island-wide collection of tick species infesting humans, domesticated and wild animals and questing ticks in domestic and peridomestic environments was carried out during 2009-2011. A total of 30,461 ticks were collected from 30 different hosts and free living stages from the ground. The collection consisted of 22 tick species from 30 different hosts recording 12 tick species from humans, 19 from domesticated animals and 21 from wild animals, with a total of 97 new host records. The most common tick species on humans were Dermacentor auratus and Amblyomma testudinairum, while Haemaphysalis intermedia, Rhipicephalus microplus and Rhipicephalus sanguineus were common in domesticated and wild animals sharing 20 host species. Among the questing ticks, immature D. auratus was the most abundant. Humans and domesticated animals were mostly infested by the nymphal stages while adult ticks were found on wild animals. High number of new host records could be due to domestic animals picking tick species from wildlife and vise versa at the human/animal interface. Habitat destruction due to forest fragmentation has lead to wild animals roaming in urban and semi-urban neighbourhoods increasing the interactions of wild animals with domesticated animals. Wild animals play a significant role as a reservoir of many tick borne infections which can easily be spread to domesticated animals and then to humans via tick infestations. Data in this paper are useful for those interested in tick infesting wild and domestic animals and humans in describing the zoonotic potential of tick borne infections.

Introduction of the exotic tick Hyalomma truncatum on a human with travel to Ethiopia: a case report

An Oregon resident returned from a photography trip to Ethiopia with a male Hyalomma truncatum tick attached to the skin on his lower back. The tick was identified morphologically and deposited in the U.S. National Tick Collection housed at Georgia Southern University, Statesboro, Georgia. The public health importance of Hyalomma species of ticks and diagnostic dilemmas with identifying exotic ticks imported into the U.S. are discussed.

Ticks in the External Auditory Canal

Ticks attack a wide range of vertebrates including humans, and are important vectors of numerous pathogens, e.g. virus, rickettsia, and protozoa. We present a case of ticks found in the external auditory canal. A 12-year-old girl presented to the emergency service with one-day history of right-sided earache. Otological examination found a tick blocking the external auditory canal. The tick was removed under local anaesthesia with a light microscope. After the tick was removed, another tick was detected in the external auditory canal. The second tick was not adhered to the ear canal skin and was mobile. It was also removed completely. The patient's post-procedure course was uneventful. A broad spectrum antibiotic, an analgesic, and an antihistamine were prescribed. Both ticks were sent to the infectious disease laboratory for investigation of Crimean-Congo haemorrhagic fever. They turned out to be Hyalomma species.