Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes

• Published in: European journal of clinical microbiology & infectious diseases Vol. 33; no. 8; pp. 1449 - 1456
• Main Authors: Dubourg, G., Socolovschi, C., Del Giudice, P., Fournier, P. E., Raoult, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2014; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Animals; Antigens; Arachnids; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Biopsy; Borrelia burgdorferi; Child; Child, Preschool; Coxiella burnetii; Dermacentor - microbiology; Dermacentor marginatus; Erythema; Etiology; Female; Genetic testing; Humans; Immune system; Infections; Infectious diseases; Insect bites; Internal Medicine; Ixodes ricinus; Ixodidae; Lymphatic Diseases - epidemiology; Lymphatic Diseases - microbiology; Lymphatic Diseases - pathology; Male; Medical Microbiology; Medical sciences; Middle Aged; Neck; Patients; Prospective Studies; Questionnaires; Rickettsia Infections - epidemiology; Rickettsia Infections - microbiology; Rickettsia Infections - pathology; Rickettsia sibirica; Scalp - pathology; Scalp Dermatoses - epidemiology; Scalp Dermatoses - microbiology; Scalp Dermatoses - pathology; Seasonal distribution; Serology; Syndrome; Tick Bites - epidemiology; Tick Bites - microbiology; Tick Bites - pathology; Tick-Borne Diseases - epidemiology; Tick-Borne Diseases - microbiology; Tick-Borne Diseases - pathology; Young Adult; France; Francisella Tularensis; Ixodes Ricinus; Tick Bite; Borrelia Burgdorferi; Coxiella Burnetii; Infection; Skin disease; Multiple; Microbiology; Scalp; Adenopathy; Bite; Sore; Neck
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-014-2090-2

The clinical and epidemiological features of 56 patients with scalp eschar associated with neck lymphadenopathy after a tick bite (SENLAT) syndrome were evaluated at the National French Rickettsial Center. Eschar swabs, crusts, and biopsies as well as ticks and blood samples were acquired for molecular and serological assays. SENLAT predominantly affects children ( p  < 0.05), followed by 40- to 70-year-olds, and it is found mostly in women ( p  < 0.05). The seasonal distribution has two peaks: one in the spring (55%) and one in the autumn (30%). The etiological agent was identified in 18 cases, which include Rickettsia slovaca in 13 cases with incidences of two co-infections with Rickettsia raoultii and one case caused by Rickettsia sibirica mongolitimonae . Other possible agents that were found in attached ticks were Candidatus R. rioja , Coxiella burnetii , and Borrelia burgdorferi . The tick vector was Dermacentor marginatus in almost all cases, with the exception of one case, in which Ixodes ricinus was identified as the vector. Our findings show that SENLAT is a clinical entity characterized as a local infection controlled by the immune system and is neither pathogen- nor vector-specific.