Ticks infesting humans and associated pathogens: a cross-sectional study in a 3-year period (2017-2019) in northwest Italy

Tick-borne pathogens in ticks removed from humans in Northern Italy, 2018-2023

The rising prevalence and transmission of tick-borne pathogens (TBPs) represent a significant public health issue all over the world, including in Italy. The region of Lombardy, in Northern Italy, is particularly endemic for TBPs. While evidence indicates a high exposure risk to infected ticks, there is a lack of data on ticks collected from humans. Therefore, a long-term surveillance programme was implemented from 2018 to 2023 to identify selected pathogens in ticks retrieved from humans. The presence of Rickettsia spp., Borrelia burgdorferi sensu lato complex, Francisella spp., Coxiella burnetii and tick-borne encephalitis virus was evaluated. A total of 2,453 ticks were collected and most belonged to the species Ixodes ricinus (93.5 %; n = 2,293). Additionally, Ixodes spp. (n = 35), Ixodes hexagonus (n = 7), Rhipicephalus sanguineus (sensu lato) species complex (n = 16), Dermacentor spp. (n = 5), Dermacentor reticulatus (n = 7) and Dermacentor marginatum (n= 1) were identified. The nymph stage was the prevalent life stage at retrieval (n = 1,778), followed by adults (n = 443) and larvae (n = 134). Overall, 18.7 % (459/2,453) of ticks were infected with at least one pathogen and co-infections were found in 6.3 % (29/459) of the positive ticks. In the examined sample, the frequency of infection in adult ticks (90/443; 20.3 %) was higher than that observed in nymphs (335/1778; 18.8 %). The most frequently detected pathogens were Borrelia burgdorferi s.l. (10.1 %) and Rickettsia spp. (10 %). Interestingly, Francisella tularensis and Coxiella burnetii were found to be of low prevalence, suggesting a lower exposure of humans to these diseases, despite still posing a serious threat to human health due to their pathogenicity. This study raises awareness about the potential risk of tick-borne diseases in Northern Italy.

Assessing zoonotic risk in a fenced natural park in northwestern Italy: integrating camera traps for a vector-host approach to investigate tick-borne pathogens

Tick-borne diseases are among the major widespread emerging zoonotic diseases, and their circulation in the environment is influenced by a broad range of abiotic and biotic factors, including the abundance of vectors and vertebrate hosts. In this study, we estimated the prevalence of tick-borne pathogens and the impact of wildlife head count on their circulation in a lowland natural area in northwestern Italy. We collected ticks and camera trap pictures from 14 sampling points every 2 weeks for 1 year and identified pathogens through molecular analyses: Babesia capreoli, B. microti-like, Borrelia burgdorferi sensu lato (s.l.), Rickettsia of the spotted fever group (SFG), Theileria capreoli, and Anaplasma phagocytophilum. We modeled the presence of B. capreoli, B. microti-like, B. burgdorferi s.l., and SFG Rickettsia on head counts of wild ungulates and mesocarnivores. We tested a global model including all collected ticks, as well as a model focusing solely on Ixodes ricinus nymphs, the species, and the developmental stage most associated with zoonotic infection risk. The highest prevalence was obtained for B. microti-like (13%) and SFG Rickettsia (11%), and, for most pathogens, no differences were detected among tick species and their developmental stages. Mesocarnivores showed an additive effect on B. microti-like and B. burgdorferi s.l., while wild ungulates, non-competent for transmission of our target pathogens, showed a dilutive effect. These findings confirm the circulation of relevant tick-borne pathogens in the study area and show the use of camera trap data in predicting tick-borne pathogens' risk by targeting host species which may have an indirect impact and are more easily addressed by monitoring and control strategies.

Evaluation of Risk Factors Influencing Tick-Borne Infections in Livestock Through Molecular Analyses

Climate changes and human-related activities are identified as major factors responsible for the increasing distribution and abundance of vectors worldwide and, consequently, of vector-borne diseases (VBDs). Farmed animals, during grazing or in establishments with the absence of biosecurity measures, can easily be exposed to wildlife showing high-risk of contagion of several infectious diseases, including VBDs. Furthermore, livestock represents an interface between wildlife and humans, and thus, promoting the transmission pathway of VBDs. Little is known about the presence and prevalence of VBDs in livestock in Southern Italy; therefore, the present study evaluated the circulation of zoonotic VBDs in livestock and potential risk of exposure. A total of 621 whole blood samples belonging to cattle and buffaloes (n = 345) and small ruminants (n = 276) were examined by molecular examinations for the detection of tick-borne pathogens (TBPs). High prevalence (66.3%) for at least one agent was observed. Moreover, the risk of exposure related to environmental features was assessed, as follows: presence of humid areas, high-density of animals, and sample collection during May. These results show a high circulation of TBPs among livestock and underline the need for surveillance in high-risk habitats for public health.

Epidemiology and clinical characteristics of Mediterranean spotted fever suspects in a university hospital, Tunisia, 2000-2020

Mediterranean spotted fever (MSF) is a rickettsial disease caused by Rickettsia conorii, transmitted by brown dog ticks, and endemic in the Mediterranean region. Its incidence is increasing, with varied presentations and potential complications because of delayed diagnosis. This study retrospectively included 173 adult patients hospitalized for MSF at La Rabta University Hospital, Tunis, from 2000 to 2020. Patients, predominantly male (67.6%) and averaging 40 years of age, mostly resided in urban areas (82.7%). Animal exposure was reported in 74.6%, and cases peaked during the hot season (68.8%), with no cases in winter months. The classic triad of fever, rash, and eschar was observed in 69.9%, with maculopapular lesions affecting palms and soles in 83.8%. Headache (64.5%), myalgia (60.7%), and arthralgia (57.2%) were also common. Laboratory findings included elevated white blood cell count (36.4%), thrombocytopenia (48%), and increased aspartate aminotransferase (50.9%). Treatment with doxycycline (n = 161) resolved fever within 2.8±1.3 [1-5] days. Complications, including encephalitis, chorioretinitis, anterior uveitis and vasculitis, occurred in 2.3% of cases, but all patients recovered without relapse. No significant risk factors for severe forms were identified. Improved awareness of MSF's clinical features may be the key to an early diagnosis and successful treatment.

The prevalence of pathogens in ticks collected from humans in Belgium, 2021, versus 2017

BACKGROUND

Ticks carry a variety of microorganisms, some of which are pathogenic to humans. The human risk of tick-borne diseases depends on, among others, the prevalence of pathogens in ticks biting humans. To follow-up on this prevalence over time, a Belgian study from 2017 was repeated in 2021.

METHODS

During the tick season 2021, citizens were invited to have ticks removed from their skin, send them and fill in a short questionnaire on an existing citizen science platform for the notification of tick bites (TekenNet). Ticks were morphologically identified to species and life stage level and screened using multiplex qPCR targeting, among others, Borrelia burgdorferi (sensu lato), Anaplasma phagocytophilum, Borrelia miyamotoi, Neoehrlichia mikurensis, Babesia spp., Rickettsia helvetica and tick-borne encephalitis virus (TBEV). The same methodology as in 2017 was used.

RESULTS

In 2021, the same tick species as in 2017 were identified in similar proportions; of 1094 ticks, 98.7% were Ixodes ricinus, 0.8% Ixodes hexagonus and 0.5% Dermacentor reticulatus. A total of 928 nymphs and adults could be screened for the presence of pathogens. Borrelia burgdorferi (s.l.) was detected in 9.9% (95% CI 8.2-12.0%), which is significantly lower than the prevalence of 13.9% (95% CI 12.2-15.7%) in 2017 (P = 0.004). The prevalences of A. phagocytophilum (4.7%; 95% CI 3.5-6.3%) and R. helvetica (13.3%; 95% CI 11.2-15.6%) in 2021 were significantly higher compared to 2017 (1.8%; 95% CI 1.3-2.7% and 6.8%; 95% CI 5.6-8.2% respectively) (P < 0.001 for both). For the other pathogens tested, no statistical differences compared to 2017 were found, with prevalences ranging between 1.5 and 2.9% in 2021. Rickettsia raoultii was again found in D. reticulatus ticks (n = 3/5 in 2021). Similar to 2017, no TBEV was detected in the ticks. Co-infections were found in 5.1% of ticks. When combining co-infection occurrence in 2017 and 2021, a positive correlation was observed between B. burgdorferi (s.l.) and N. mikurensis and B. burgdorferi (s.l.) and B. miyamotoi (P < 0.001 for both).

CONCLUSIONS

Although the 2021 prevalences fell within expectations, differences were found compared to 2017. Further research to understand the explanations behind these differences is needed.

Tick-borne diseases at the crossroads of the Middle East and central Europe

OBJECTIVES

The Balkan Peninsula, acting as a crossroad between central Europe and the Middle East, presents diverse ecosystems supporting various tick species capable of transmitting TBDs. This study focuses on Serbia and North Macedonia, both endemic for TBDs, aiming to investigate human-biting ticks' prevalence, TBD prevalence, and major TBPs in blood samples.

PATIENTS AND METHODS

This prospective observational study was conducted in 2022 at two medical centers, involving 45 patients from Novi Sad, Serbia, and 17 patients from Skopje, North Macedonia. All participants had either a tick still attached or had had one removed within the preceding 48 h. The study consisted in clinical evaluations of patients and testing of patient samples and ticks for tick-borne pathogens using a High-Throughput pathogen detection system based on microfluidic real-time PCR. In addition, the study assessed the genetic diversity of the identified pathogens.

RESULTS

Ixodes ricinus was the most prevalent tick species, with varying infestation rates across various body parts. Tick species and feeding times differed between Novi Sad and Skopje. TBPs were prevalent, with Rickettsia spp. dominant in Skopje and a mix including Rickettsia aeschlimannii, Rickettsia monacensis, Anaplasma phagocytophilum, and Borrelia afzelii in Novi Sad. Subclinical bacteremia occurred in 8.06% of cases, mostly involving Anaplasma spp. Clinical manifestations, primarily local hypersensitivity reactions, were observed in six patients. Phylogenetic analysis confirmed R. aeschlimannii and R. monacensis identity, highlighting genetic differences in gltA gene sequences.

CONCLUSIONS

This study sheds light on the prevalence and diversity of TBPs in tick-infested individuals from Serbia and North Macedonia, contributing valuable insights into the epidemiology of TBDs in the Balkan region.

Identification of Rickettsia spp. in Ticks Removed from Tick-Bitten Humans in Northwestern Spain

Tick-borne rickettsioses (TBRs) are distributed worldwide and are recognized as important emerging vector-borne zoonotic diseases in Europe. The aim of this study was to identify tick-associated Rickettsia among ticks removed from humans, and to track how tick populations and their associated pathogens have changed over the years. For this purpose, we conducted a tick surveillance study in northwestern Spain between 2018 and 2022. Ticks were morphologically identified and analyzed for the presence of rickettsial pathogens through the amplification of the citrate synthase (gltA) and the outer membrane protein A (ompA) genes. PCR products were sequenced and subjected to phylogenetic analyses. We collected 7397 ticks, with Ixodes ricinus being the species most frequently isolated. Based on the PCR results, Rickettsia DNA was detected in 1177 (15.91%) ticks, and 10 members of Rickettsia were identified: R. aeschlimannii, R. conorii subsp. conorii, R. conorii subsp. raoultii, R. massiliae, R. monacensis, R. sibirica subsp. mongolitimonae, R. slovaca, R. helvetica, Candidatus R. barbariae, and Candidatus R. rioja. Some of these Rickettsia have gone previously undetected in the study region. There is clear geographic and seasonal expansion not only of tick populations, but also of the associated Rickettsia. The comparison of our data with those obtained years ago provides a clear idea of how the spatiotemporal distributions of ticks and their associated Rickettsiae have changed over the years.

Prevalence of Lyme Disease and Relapsing Fever Borrelia spp. in Vectors, Animals, and Humans within a One Health Approach in Mediterranean Countries

The genus Borrelia has been divided into Borreliella spp., which can cause Lyme Disease (LD), and Borrelia spp., which can cause Relapsing Fever (RF). The distribution of genus Borrelia has broadened due to factors such as climate change, alterations in land use, and enhanced human and animal mobility. Consequently, there is an increasing necessity for a One Health strategy to identify the key components in the Borrelia transmission cycle by monitoring the human-animal-environment interactions. The aim of this study is to summarize all accessible data to increase our understanding and provide a comprehensive overview of Borrelia distribution in the Mediterranean region. Databases including PubMed, Google Scholar, and Google were searched to determine the presence of Borreliella and Borrelia spp. in vectors, animals, and humans in countries around the Mediterranean Sea. A total of 3026 were identified and screened and after exclusion of papers that did not fulfill the including criteria, 429 were used. After examination of the available literature, it was revealed that various species associated with LD and RF are prevalent in vectors, animals, and humans in Mediterranean countries and should be monitored in order to effectively manage and prevent potential infections.

Distant genetic variants of Anaplasma phagocytophilum from Ixodes ricinus attached to people

BACKGROUND

Although the tick-borne pathogen Anaplasma phagocytophilum is currently described as a single species, studies using genetic markers can distinguish groups of variants associated with different hosts, pathogenicity, zoonotic potential and biotic and geographic niches. The objective of our study was to investigate the genetic diversity of A. phagocytophilum and Ixodes ricinus ticks attached to people.

METHODS

In collaboration with a commercial diagnostic company, a total of 52 DNA samples were obtained from ticks that tested positive for A. phagocytophilum by quantitative PCR. The genetic profile of each sample was determined using the groEL and ankA genes. Identification of the tick species was confirmed by partial sequencing of the COI subunit and a portion of the TROSPA gene.

RESULTS

All 52 ticks were identified as I. ricinus. Two protocols of nested PCR amplifying 1293- and 407-bp fragments of groEL of A. phagocytophilum yielded amplicons of the expected size for all 52 samples. Among all sequences, we identified 10 unique genetic variants of groEL belonging to ecotype I and ecotype II. The analysis targeting ankA was successful in 46 of 52 ticks. Among all sequences, we identified 21 unique genetic variants phylogenetically belonging to three clusters.

CONCLUSIONS

Our results indicate that ticks attached to people harbor distant genetic variants of A. phagocytophilum, some of which are not recognized as zoonotic. Further studies are needed to determine the risk of human infection by genetic variants other than those designated as zoonotic.

The Risk of Exposure to Ticks and Tick-Borne Pathogens in a Spa Town in Northern Poland

The aim of this study was to determine the potential risk of human exposure to tick-borne infection in a recreation areas in a spa town located in northern Poland. Questing Ixodes ricinus and Dermacentor reticulatus ticks were collected in the spring of 2018. Tick-borne microorganisms were detected by PCR. Species were identified based on RFLP and the sequencing of DNA. In total, 38.3% of the ticks (34.6% of I. ricinus and 48.6% of D. reticulatus) were infected. The prevalence was 14.9% for Borrelia spp., 10.6% for Babesia spp. and 17.7% for Rickettsia spp. No Anaplasma phagocytophilum was detected. Spirochaetes B. afzelii, B. garinii and B. burgdorferi s.s. were detected only in I. ricinus ticks (20.2%). The differences in the infection rates of Babesia spp. between I. ricinus (7.7%) and D. reticulatus (18.9%) were not significant. DNA of B. canis and B. venatorum were identified in both tick species. B. microti were detected in D. reticulatus ticks. The prevalence of Rickettsia spp. was significantly higher in D. reticulatus (37.8%) than that in I. ricinus (10.6%). R. raoultii was identified only in D. reticulatus and R. helvetica in I. ricinus. Co-infections of at least two pathogens were recognized in 13% of positive ticks.

Serology for Borrelia spp. in Northwest Italy: A Climate-Matched 10-Year Trend

Ticks are hematophagous parasites that can transmit a variety of human pathogens, and their life cycle is dependent on several climatic factors for development and survival. We conducted a study in Piedmont and Aosta Valley, Italy, between 2009 and 2018. The study matched human sample serologies for Borrelia spp. with publicly available climatic and meteorological data. A total of 12,928 serological immunofluorescence assays (IFA) and Western blot (WB) tests were analysed. The median number of IFA and WB tests per year was 1236 (range 700–1997), with the highest demand in autumn 2018 (N = 289). In the study period, positive WB showed an increasing trend, peaking in 2018 for both IgM (N = 97) and IgG (N = 61). These results were consistent with a regional climatic variation trending towards an increase in both temperature and humidity. Our results suggest that coupling data from epidemiology and the environment, and the use of a “one health” approach, may provide a powerful tool in understanding disease transmission and strengthen collaboration between specialists in the era of climate instability.

Tick exposure and risk of tick-borne pathogens infection in hunters and hunting dogs: a citizen science approach

Citizen science may be described as a research involving communities and individuals, other than scientists. Following this approach, along with the evidence of a high prevalence of Rickettsia spp. in Dermacentor marginatus from wild boars in hunting areas of southern Italy, this study aimed to assess the occurrence of tick‐borne pathogens (TBPs) in ticks collected from hunters and their hunting dogs. From October 2020 to May 2021, ticks were collected from wild boar hunters (n = 347) and their dogs (n = 422) in regions of southern Italy (i.e., Apulia, Basilicata, Calabria, Campania and Sicily). All ticks were morphologically identified, classified according to gender, feeding status, host, geographic origin, and molecularly screened for zoonotic bacteria. Adult ticks (n = 411) were collected from hunters (i.e., n = 29; 8.4%; mean of 1.6 ticks for person) and dogs (i.e., n = 200; 47.4%; mean of 1.8 ticks for animal) and identified at species level as D. marginatus (n = 240, 58.4%), Rhipicephalus sanguineus sensu lato (n = 135, 32.8%), Rhipicephalus turanicus (n = 27, 6.6%) and Ixodes ricinus (n = 9, 2.2%). Overall, 45 ticks (i.e., 10.9%, 95% CI: 8.3‐14.3) tested positive for at least one tick‐borne agent, being Rickettsia slovaca the most frequent species (n = 37, 9.0%), followed by Rickettsia raoultii, Rickettsia aeschlimannii, Rickettsia monacensis, Coxiella burnetii, Borrelia lusitaniae and Candidatus Midichloria mitochondrii (n = 2, 0.5% each). Data herein presented demonstrate a relevant risk of exposure to TBPs for hunters and hunting dogs during the hunting activities. Therefore, the role of hunters to monitor the circulation of ticks in rural areas may be considered an effective example of the citizen science approach, supporting the cooperation toward private and public health stakeholders.

Low Risk Perception about Ticks and Tick-Borne Diseases in an Area Recently Invaded by Ticks in Northwestern Italy

Risk perception, together with the adoption of measures to prevent tick bites, may strongly influence human exposure to ticks and transmitted pathogens. We created a questionnaire to evaluate how people perceive the health risk posed by ticks in an area recently invaded by these arthropods, in the western Italian Alps. Moreover, through a collaborative effort with park rangers and physicians, we investigated which tick species bite humans and their infection with pathogens (Borrelia burgdorferi s.l., Anaplasma phagocytophilum, and spotted-fever group Rickettsiae). Apart from two Dermacentor marginatus bites, we identified Ixodes ricinus (n = 124) as the main species responsible for tick bites. The investigated pathogens infected 25.4% of tested I. ricinus. The evaluation of the engorgement rate of biting I. ricinus revealed that they had been likely feeding on humans for 24 h or more, suggesting a high probability of pathogen transmission. Indeed, the questionnaires revealed that people infrequently adopt preventive measures, such as inspecting the body for ticks, although most respondents claimed that ticks are a threat to human health. Having suffered from previous tick bites was positively associated with the adoption of personal protection measures. Given the increasing incidence of tick-borne diseases in the region, the public should be better informed about the possibility of being bitten by infected ticks in order to mitigate the risk.