Diversity and Co-infection with Other Tick Borne Pathogens in Ticks.

Identifying as the causative agent of Lyme disease in 1981 was a watershed moment in understanding the major impact that tick-borne zoonoses can have on public health worldwide, particularly in Europe and the USA. The medical importance of tick-borne diseases has long since been acknowledged, yet little is known regarding the occurrence of emerging tick-borne pathogens such as spp., spp., spp., " Neoehrlichia mikurensis", and tick-borne encephalitis virus in questing ticks in Romania, a gateway into Europe. The objective of our study was to identify the infection and co-infection rates of different genospecies along with other tick-borne pathogens in questing ticks collected from three geographically distinct areas in eastern Romania. We collected 557 questing adult and nymph ticks of three different species (534 , 19 , and 4 ) from three areas in Romania. We analyzed ticks individually for the presence of eight different genospecies with high-throughput real-time PCR. Ticks with were then tested for possible co-infections with spp., spp., " Neoehrlichia mikurensis", and tick-borne encephalitis virus. spp. was detected in ticks from all sampling areas, with global prevalence rates of 25.8%. All eight genospecies were detected in ticks: (14.8%), (8.8%), (5.1%), (4.9%), (0.9%), s.s (0.4%), and (0.2%). Regarding pathogen co-infection 64.5% of infected were positive for more than one pathogen. Associations between different genospecies were detected in 9.7% of ticks, and 6.9% of ticks tested positive for co-infection of spp. with other tick-borne pathogens. The most common association was between and (4.3%), followed by and (3.0%). The most frequent dual co-infections were between spp. and spp., (1.3%), and between spp. and " Neoehrlichia mikurensis" (1.3%). The diversity of tick-borne pathogens detected in this study and the frequency of co-infections should influence all infection risk evaluations following a tick bite.