Thalmann Patrick, Ehrhard Simone, Summerfield Artur, Ricklin Meret Elisabeth
Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Department of Immunology, Institute of Virology and Immunology, 3147 Mittelhäusern, Switzerland.
Infect Dis Rep. 2023 Mar 1;15(2):150-157. doi: 10.3390/idr15020016.
Ticks represent very important vectors of human and zoonotic pathogens, and tick-borne diseases (TBDs) are diagnosed with increasing frequency. Therefore, the aim of this retrospective study was to describe patients presenting with a complaint of tick bite in the emergency department (ED) of a large university hospital in Switzerland.
Data were collected by searching for keywords in the routine clinic database to identify cases from 1 July 2012 to 30 June 2020. The patients' data were screened for preexisting diseases and demographic and clinical characteristics.
We included 415 patients collected over a period of 8 years, with highest admission frequencies from May to July. Of these, 82% were outpatients, 15.9% admitted to a hospital ward, and five to intensive care. The patients were allocated to three groups. The first group represented patients with erythema chronica migrans (ECM), which is pathognomonic for Lyme borreliosis (n = 45). Accordingly, 89% of cases in this group of patients were treated with antibiotics. The second group represented patients with other tick bite-associated erythema (n = 139). In this group, no particular clinical symptoms or laboratory findings were found. Finally, the largest group represented patients in which the tick bite was no longer visible (n = 201). This group of patients had significantly more evidence of neurological disorders (52%) and were treated at a higher rate with non-steroidal anti-inflammatory (29%) or antiviral (13%) drugs. Although the vaccination status for tick-borne encephalitis virus (TBEV) was not systematically evaluated, at least 10% of the latter group was vaccinated, indicating another source for neurological disease. Furthermore, only 14% of the tested patients were positive for IgM or IgG against TBEV.
This retrospective study indicates the presence of many undiagnosed neurological diseases following tick bites that could be caused by TBEV or an unknown infectious agent. Taken together, although tick bites were not very frequently seen in the present tertiary ED, the frequent presence of neurological symptoms demands a more systematic assessment of vaccination status and TBEV serology as well as further diagnostic evaluations in patients that report tick bites and neurological symptoms.
蜱是人类和人畜共患病病原体的非常重要的传播媒介，蜱传疾病（TBDs）的诊断频率越来越高。因此，这项回顾性研究的目的是描述瑞士一家大型大学医院急诊科（ED）中主诉被蜱叮咬的患者情况。
通过在常规临床数据库中搜索关键词来收集数据，以识别2012年7月1日至2020年6月30日期间的病例。对患者数据进行筛查，以了解其既往疾病以及人口统计学和临床特征。
我们纳入了8年期间收集的415例患者，5月至7月的入院频率最高。其中，82%为门诊患者，15.9%入住医院病房，5例入住重症监护病房。患者被分为三组。第一组为慢性游走性红斑（ECM）患者，这是莱姆病的特征性表现（n = 45）。相应地，该组患者中89%接受了抗生素治疗。第二组为其他与蜱叮咬相关的红斑患者（n = 139）。在这组患者中，未发现特定的临床症状或实验室检查结果。最后，最大的一组为蜱叮咬已不可见的患者（n = 201）。这组患者有明显更多的神经系统疾病证据（52%），且接受非甾体抗炎药（29%）或抗病毒药物（13%）治疗的比例更高。尽管未系统评估蜱传脑炎病毒（TBEV）的疫苗接种状况，但后一组中至少10%接种了疫苗，这表明了神经系统疾病的另一个来源。此外，仅14%的受测患者抗TBEV IgM或IgG呈阳性。
这项回顾性研究表明，蜱叮咬后存在许多未确诊的神经系统疾病，可能由TBEV或未知感染因子引起。总体而言，尽管在目前的三级急诊科中蜱叮咬并不常见，但神经系统症状的频繁出现要求对报告蜱叮咬和神经系统症状的患者进行更系统的疫苗接种状况和TBEV血清学评估以及进一步的诊断评估。
