Dunaj Justyna, Moniuszko-Malinowska Anna, Swiecicka Izabela, Andersson Martin, Czupryna Piotr, Rutkowski Krzysztof, Zambrowski Grzegorz, Zajkowska Joanna, Grygorczuk Sambor, Kondrusik Maciej, Świerzbińska Renata, Pancewicz Sławomir
Medical University of Białystok, Department of Infectious Diseases and Neuroinfections, Żurawia 14 E, 15-540 Bialystok, Poland.
Medical University of Białystok, Department of Infectious Diseases and Neuroinfections, Żurawia 14 E, 15-540 Bialystok, Poland.
Adv Med Sci. 2018 Mar;63(1):167-172. doi: 10.1016/j.advms.2017.09.004. Epub 2017 Nov 7.
The aim of the study was the evaluation of the frequency of infections and co-infections among patients hospitalized because of non-specific symptoms after a tick bite.
Whole blood, serum and cerebrospinal fluid samples from 118 patients hospitalised for non-specific symptoms up to 8 weeks after tick bite from 2010 to 2013 were examined for tick-borne infections. ELISA, Western blot and/or molecular biology (PCR; fla gene; 16S rRNA; sequencing) and thin blood smears (MDD) were used. Control group included 50 healthy blood donors. All controls were tested with PCR and serology according to the same procedure as in patients.
Out of 118 patients 85 (72%) experienced headaches, 15 (13%) vertigo, 32 (27%) nausea, 17 (14%) vomiting, 37 (31%) muscle pain, 73 (62%) fever and 26 (22%) meningeal signs. 47.5% were infected with at least one tick-borne pathogen. Borrelia burgdorferi sensu lato infection was confirmed with ELISA, Western blot in serum and/or (PCR (fla gene) in whole blood in 29.7% cases. In blood of 11.9% patients Anaplasma phagocytophilum DNA (16S rRNA gene) was detected; in 0.9% patients 1/118 Babesia spp. DNA (18S rRNA gene) was also detected. Co-infections were observed in 5.1% of patients with non-specific symptoms. B. burgdorferi s.l. - A. phagocytophilum co-infection (5/118; 4.2%) was most common. In 1/118 (0.8%) A. phagocytophilum - Babesia spp. co-infection was detected. All controls were negative for examined pathogens.
Non-specific symptoms after tick bite may be caused by uncommon pathogens or co-infection, therefore it should be considered in differential diagnosis after tick bite.
本研究旨在评估因蜱叮咬后出现非特异性症状而住院的患者中感染及合并感染的发生率。
对2010年至2013年间因蜱叮咬后出现非特异性症状而住院的118例患者，在蜱叮咬后8周内采集的全血、血清和脑脊液样本进行蜱传播感染检测。采用酶联免疫吸附测定（ELISA）、免疫印迹法和/或分子生物学方法（聚合酶链反应（PCR）；鞭毛蛋白基因（fla基因）；16S核糖体RNA（16S rRNA）；测序）以及薄血涂片（MDD）检测。对照组包括50名健康献血者。所有对照均按照与患者相同的程序进行PCR和血清学检测。
118例患者中，85例（72%）出现头痛，15例（13%）出现眩晕，32例（27%）出现恶心，17例（14%）出现呕吐，37例（31%）出现肌肉疼痛，73例（62%）出现发热，26例（22%）出现脑膜刺激征。47.5%的患者感染了至少一种蜱传播病原体。通过ELISA、血清免疫印迹法和/或全血PCR（fla基因）确诊莱姆病螺旋体广义种感染的病例占29.7%。在11.9%患者的血液中检测到嗜吞噬细胞无形体DNA（16S rRNA基因）；在0.9%（1/118）患者中还检测到巴贝斯虫属DNA（18S rRNA基因）。在出现非特异性症状的患者中，5.1%观察到合并感染。莱姆病螺旋体广义种 - 嗜吞噬细胞无形体合并感染（5/118；4.2%）最为常见。在1/118（0.8%）患者中检测到嗜吞噬细胞无形体 - 巴贝斯虫属合并感染。所有对照的检测病原体均为阴性。
蜱叮咬后的非特异性症状可能由罕见病原体或合并感染引起，因此在蜱叮咬后的鉴别诊断中应予以考虑。
