Keywords
anaplasmosis
babesiosis
bartonellosis
tularemia
epidemiology
clinical picture
diagnostics
prevention
treatment
How to Cite
Abstract
Tick-borne diseases constitute a group of unique infections with a gradually expanding geographical spread, extremely diverse, often uncharacteristic clinical expression and increasing pathogenicity for humans. Due to the promotion of an active lifestyle associated with tourist and recreational activities in the natural environment, often in forested areas, regions of lush meadows and wild pastures, the risk of accidental transmission of tick-borne pathogens to the human body is significantly increasing. On the other hand, prolonged life expectancy, often accompanying chronic diseases that reduce the efficiency of the immune system, as well as widely used immunosuppressive or immunomodulatory therapies are factors that significantly increase the risk of developing more severe symptoms and long-term clinical consequences of these rarely suspected infections. Anaplasmosis Etiological factor Human granulocytic anaplasmosis (HGA), formerly called granulocytic ehrlichiosis, is an infectious disease caused by microorganisms of the species Anaplasma phagocytophilum (formerly Ehrlichia phagocytophilum). These are Gram-negative bacteria, obligatory intracellular parasites, showing tropism to human neutrophilic granulocytes. Development cycle This disease can develop both in humans and animals. Infections have been recorded in numerous species of domestic and wild animals. Fatal cases have been observed among sheep, cattle, reindeer, deer, moose, dogs, and humans. The most common cause of HGA is a tick bite from the genus Ixodes. In Poland and Europe, this is usually I. ricinus. The presence of A. phagocytophilum has also been confirmed in other tick species occurring in Europe, such as I. hexagonus, I. trianguliceps, and I. persulcatus. Bacterial strains pathogenic to humans can be transmitted by ticks through transmission from horses, dogs, some species of ruminants, hedgehogs, foxes, or wild boars. Infection can also occur transplacentally, through blood transfusion from an infected person, or contact with meat of infected animals – however, these cases are sporadically recorded. Epidemiology Endemic areas of HGA worldwide include the northeastern and north-central parts of the United States and California. The first case in Europe was registered in Slovenia in 1995. HGA incidence is seasonal; most cases are recorded from April to October, related to atmospheric conditions favorable to infections. People living in rural areas, hunters, foresters, farmers, and those practicing outdoor sports are at particular risk. In Europe, HGA occurs much less frequently than in the USA. This is not due to differences in the occurrence of A. phagocytophilum among Ixodes ticks – in both cases it is about 3%. Approximately 300 cases of HGA in humans have been reported in Europe so far. This is relatively few considering the widespread presence of the pathogen in ticks and animals, as HGA is the most common tick-borne disease in Europe. This may be due to the often asymptomatic course of HGA. Cases are frequently reported in Austria, Belgium, Croatia, Czech Republic, France, the Netherlands, Germany, Norway, Portugal, Poland, Slovakia, Slovenia, Switzerland, Sweden, the United Kingdom, and Italy. Studies in Poland show the presence of antibodies indicating past HGA infection in 2–5% of healthy blood donors. In western Norway, this was found in 16% of similar blood samples. In Belgium, the value ranges from 14–17%, while in Switzerland it is only 1.13%. Tests for specific antibodies indicating past HGA infection are not routinely performed among donors.
References
Ismail N., Bloch K.C., McBride J.W.: Human ehrlichiosis and anaplasmosis. Clin Lab Med 2010; 30 (1): 261–292. doi:10.1016/j.cll.2009.10.004.
Rikihisa Y.: The tribe Ehrlichieae and ehrlichial diseases. Clin Microbiol Rev 1991; 4(3): 286–308. doi: 10.1128/cmr.4.3.286.
Kmieciak W., Ciszewski M., Szewczyk E.M.: Choroby odkleszczowe w Polsce – występowanie i trudności diagno- styczne. Medycyna pracy 2016; 67(1): 73–87.
Matei I.A., Estrada-Peña A., Cutler S.J. i in.: A review on the eco-epidemiology and clinical management of human granulocytic anaplasmosis and its agent in Europe. Parasit Vectors 2019; 12(1): 599. doi: 10.1186/s13071-019-3852-6.
Jahfari S., Coipan E.C., Fonville M. i in. Circulation of four Anaplasma phagocytophilum ecotypes in Europe. Parasit Vectors 2014; 7: 365. doi: 10.1186/1756-3305-7-365.
Silaghi C., Skuballa J., Thiel C. i in.: The European hedgehog (Erinaceus europaeus) – a suitable reservoir for variants of Anaplasma phagocytophilum? Ticks Tick Borne Dis 2012; 3(1): 49–54. doi: 10.1016/j.ttbdis.2011.11.005.
Bakken J.S., Krueth J.K., Lund T. i in.: Exposure to deer blood may be a cause of human granulocytic ehrlichiosis. Clin Infect Dis 1996; 23(1): 198. doi: 10.1093/clinids/23.1.198. PMID: 8816164.
Brouqui P., Bacellar F., Baranton D. i in.: Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect 2004; 10(12): 1108–1132. doi: 10.1111/j. 1469-0691.2004.01019.x.
Horowitz H.W., Kilchevsky E., Haber S. i in.: Perinatal transmission of the agent of human granulocytic ehrlichiosis. N Engl J Med 1998; 339(6): 375–378. doi: 10.1056/ NEJM199808063390604. PMID: 9691104.
Townsend R.L., Moritz E.D., Fialkow L.B. i in.: Probable transfusion-transmission of Anaplasma phagocytophilum by leukoreduced platelets. Transfusion 2014; 54(11): 2828– 2832. doi: 10.1111/trf.12675.
Hayes E.B.: Looking the other way: preventing vector-borne disease among travelers to the United States. Travel Med Infect Dis 2010; 8(5): 277–284. doi: 10.1016/j.tma- id.2010.07.006.
Stuen S.: Anaplasma phagocytophilum – the most widespread tick-borne infection in animals in Europe. Vet Res Commun 2007; 31(Suppl 1): 79–84. doi: 10.1007/s11259-007- 0071-y.
Christova I., Schouls L., van de Pol I. i in.: High prevalence of granulocytic ehrlichiae and Borrelia burgdorferi sensu lato in Ixodes ricinus ticks from Bulgaria. J Clin Microbiol 2001; 39(11): 4172–4174. doi: 10.1128/JCM.39.11.4172- 4174.2001.
Egyed L, Élő P., Sréter-Lancz Z. i in.: Seasonal activity and tick-borne pathogen infection rates of Ixodes ricinus ticks in Hungary. Ticks Tick Borne Dis 2012; 3(2): 90–94. doi: 10.1016/j.ttbdis.2012.01.002. Review of Medical Practice, 2025; Vol. XXXI, No. 250
Rojko T., Ursic T., Avšič-Županc T. i in.: Seroprevalence of human anaplasmosis in Slovene forestry workers. Ann NY Acad Sci 2006; 1078: 92–94. doi: 10.1196/ annals.1374.012.
Bakken J.S., Dumler J.S.: Human granulocytic anaplasmosis. Infect Dis Clin North Am 2015; 29(2): 341–355. doi:10.1016/j.idc.2015.02.007.
Dumler J.S.: The biological basis of severe outcomes in Anaplasma phagocytophilum infection. FEMS Immu- nol Med Microbiol 2012; 64 (1): 13–20. doi: 10.1111/j. 1574-695X.2011.00909.x.
Chapman A.S., Bakken J.S., Folk S.M., i in.: Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis – United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 2006; 5 (RR–4): 1–27.
Sanchez E., Vannier E., Wormser G.P. i in.: Diagnosis, tre- atment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: A Review. JAMA 2016; 315(16): 1767–1777. doi:10.1001/jama.2016.2884.
Aguero-Rosenfeld M.E.: Diagnosis of human granulocytic ehrlichiosis: state of the art. Vector Borne Zoonotic Dis 2002; 2(4): 233–239. doi: 10.1089/153036602321653815.
Siński E.: Pasożytnicze pierwotniaki krwi potencjalnym zagrożeniem bezpieczeństwa krwiodawstwa w świetle donie- sień prezentowanych na konferencji „Aktualne problemy do- tyczące czynników zakaźnych przenoszonych przez krew” (10 marca 2017 r., Warszawa). J Transf Med 2017; 10(2): 67–72.
Krause P.J.: Human babesiosis. Int J Parasitol 2019; 49(2): 165–174. doi: 10.1016/j.ijpara.2018.11.007.
Gray J.S., Estrada-Peña A., Zintl A.: Vectors of babesiosis. Annu Rev Entomol 2019; 64(1): 149–165. doi: 10.1146/an- nurev-ento-011118-111932.
Mosqueda J., Olvera-Ramirez A., Aguilar-Tipacamu G. i in.: Current advances in detection and treatment of babesiosis. Curr Med Chem 2012; 19(10): 1504–1518. doi: 10.2174/092986712799828355.
Fiecek B., Matławska M., Gołąb E. i in.: Ryzyko transmisji chorób zakaźnych przenoszonych przez kleszcze poprzez transfuzję krwi. Post Mikrobiol 2020; 59(2): 129–137. doi: 10.21307/PM-2020.59.2.010.
Gubernot D.M., Lucey C.T., Lee K.C. i in.: Babesia infection through blood transfusions: reports received by the US Food and Drug Administration, 1997–2007. Clin Infect Dis 2009; 48(1): 25–30. doi: 10.1086/595010.
Szymczak J., Syta A., Tołkacz K. i in.: Babeszjoza – nowe wyzwanie w transfuzjologii? J Transf Med 2017; 10(3): 90– 98.
Villatoro T., Karp J.K.: Transfusion – transmitted babesiosis. Arch Pathol Lab Med 2018; 143(1): 130–134. doi: 10.5858/ arpa.2017-0250-RS.
Jalovecka M., Sojka D., Ascencio M. i in.: Babesia life cycle – when phylogeny meets biology. Trends Parasitol 2019; 35(5): 356–368. doi: 10.1016/j.pt.2019.01.007.
Ayoob A.L., Hackner S.G., Prittie J.: Clinical management of canine babesiosis. J Vet Emerg Crit Care (San Antonio) 2010; 20 (1): 77–89. doi: 10.1111/j.1476-4431.2009.00489.x.
Ueti M.W., Johnson W.C., Kappmeyer L.S. i in.: Comparative analysis of gene expression between Babesia bovis blood stages and kinetes allowed by improved genome annotation. Int J Parasitol 2021; 51(2–3): 123–136. doi: 10.1016/j.ijpa- ra.2020.08.006.
Homer M.J., Aguilar-Delfin I., Telford S.R. i in.: Babesio- sis. Clin Microbiol Rev 2000; 13(3): 451–469. doi: 10.1128/ CMR.13.3.451.
Gajda P., Rustecka P., Kalicki B.: Human babesiosis – a little-known tick-borne disease. Pediatr Med Rodz 2015; 11(1): 75–82. doi: 10.15557/PIMR.2015.0006.
Haselbarth K., Tenter A.M., Brade V. i in.: First case of human babesiosis in Germany – clinical presentation and mo- lecular characterisation of the pathogen. Int J Med Microbiol 2007; 297(3): 197–204. doi: 10.1016/j.ijmm.2007.01.002.
European Centre for Disease Prevention and Control (ECDC).: Communicable disease threats report. Babesiosis – United Kingdom 2020. Week 32, 2-8 August 2020, p. 5. https://www.ecdc.europa.eu/sites/default/files/ documents/ Communicable-disease-threats-report-08-aug-2020.pdf (do- stęp: 27.02.2025).
Ord R.L., Lobo C.A.: Human babesiosis: pathogens, prevalence, diagnosis and treatment. Curr Clin Microbiol Rep 2015; 2(4): 173–181. doi: 10.1007/s40588-015-0025-z.
Wójcik-Fatla A., Zając V., Sawczyn A. i in.: Babesia spp. in questing ticks from eastern Poland: prevalence and species diversity. Parasitol Res 2015; 114(8): 3111–3116. doi: 10.1007/s00436-015-4529-5.
Welc-Falęciak R., Pawełczyk A., Radkowski M. i in.: First report of two asymptomatic cases of human infection with Babesia microti (Franca, 1910) in Poland. Ann Agric Environ Med 2015; 22(1): 51–54. doi: 10.5604/12321966.1141394.
Humiczewska M., Kuźna-Grygiel W.: Przypadek importowanej ludzkiej babesiozy. Wiad Parazytol 1997; 43(2): 227– 229.
Krause P.J., Gewurz B.E., Hill D. i in.: Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis 2008; 46(3): 370–376. doi: 10.1086/525852.
Gorenflot A., Moubri K., Precigout E. i in.: Human babesiosis. Ann Trop Med Parasitol 1998; 92(4): 489–501. doi: 10.1080/00034989859465.
Vannier E.G., Diuk-Wasser M.A., Mamoun B.C. i in.: Babesiosis. Infect Dis Clin North Am 2015; 29(2): 357–370. doi: 10.1016/j.idc.2015.02.008.
Krause P.J., Auwaerter P.G., Bannuru R.R. i in.: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on diagnosis and management of ba- besiosis. Clin Infect Dis 2021; 72(2): e49–e64. doi:10.1093/ cid/ciaa1216.
Vial H.J., Gorenflot A.: Chemotherapy against babesiosis. Vet Parasitol 2006; 138(1–2): 147–160. doi: 10.1016/j.vet-par.2006.01.048.
Tylewska-Wierzbanowska S.: Bartonelozy – nowe zagrożenie dla zdrowia człowieka. Nowa Klinika 2004; 11(7–8): 750–752.
Cheslock M.A., Embers M.E.: Human bartonellosis: an underappreciated public health problem? Trop Med Infect Dis 2019; 4(2): 69. doi: 10.3390/tropicalmed4020069.
Sytykiewicz H., Karbowiak G., Werszko J. i in.: Molecular screening for Bartonella henselae and Borrelia burgdorferi sensu lato co-existence within Ixodes ricinus populations in central and eastern parts of Poland. Ann Agric Environ Med 2012; 19(3): 451–456.
Welc-Falęciak R.: Współczesna wiedza o zakażeniach wywołanych przez pałeczki Bartonella. Przegl Epidemiol 2009; 63: 11–17.
Guz K., Doroszkiewicz W.: Biologia, ekologia i chorobotwórczość pałeczek z rodzaju Bartonella. Post. Mikrobiol 2009; 48(1): 43–54.
Sowula K., Składzień J., Szaleniec J. i in.: Otolaryngological symptoms in patients treated for tick-bor- ne diseases. Otolaryngol Pol 2018; 72(1): 30–34. doi: 10.5604/01.3001.0011.5948.
Podsiadły E., Karbowiak G., Tylewska-Wierzbanowska S.: Presence of Bartonella spp. in Ixodidae ticks. Clin Microbiol Infect 2009; Suppl 2: 120–121. doi: 10.1111/j. 1469-0691.2008.02196.x.
Levytska V.A., Mushinsky A.B., Zubrikova D. i in.: Detection of pathogens in ixodid ticks collected from animals and vege- tation in five regions of Ukraine. Ticks Tick Borne Dis 2021; 12(1): 101586. doi: 10.1016/j.ttbdis.2020.101586.
Podsiadły E., Chmielewski T., Marczak R. i in.: Barto- nella henselae in the human environment in Poland. Scand J Infect Dis 2007; 39(11–12): 956–962. doi: 10.1080/00365540701449385.
Fiecek B., Chmielewski T., Tylewska-Wierzbanowska S.: Zakażenia Bartonella spp. ze szczególnym uwzględnieniem chorób oczu. Post Mikrobiol 2012; 51(1): 47–53.
Chmielewski T., Kuśmierczyk M., Fiecek B. i in.: Tick-borne pathogens Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii and Rickettsia spp. may trigger endocarditis. Adv Clin Med 2019; 28(7): 937–943. doi: 10.17219/ acem/94159.
Angelakis E., Billeter S.A., Breitschwerdt E.B. i in.: Potential for tick-borne bartonelloses. Emerg Infect Dis 2010; 16(3): 385–391. doi: 10.3201/eid1603.091685.
Angelakis E., Pulcini C., Raoult D.: Scalp eschar and neck lymphadenopathy caused by Bartonella henselae after tick bite. Clin Infect Dis 2010; 50(4): 549–551. doi: 10.1086/650172.
Fiecek B., Chmielewski T., Lewandowska G. i in.: Characteristics of Bartonella spp. infections in Poland in the years 2009-2012 identified in the laboratory of National Institute of Public Health – National Institute of Hygiene. Przegl Epidemiol 2013; 67(4): 637–640, 725–727.
Brouqui P., Raoult D.: Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 2001; 14(1): 177–207. doi: 10.1128/CMR.14.1.177-207.2001.
Gouriet F., Fenollar F., Patrice J.Y. i in.: Use of shell-vial cell culture assay for isolation of bacteria from clinical specimens: 13 years of experience. J Clin Microbiol 2005; 43(10). doi: 10.1128/JCM. 43.10.4993-5002.2005.
Okaro U., Addisu A., Casanas B. i in.: Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev 2017; 30(3): 709–746. doi: 10.1128/ CMR.00013-17.
Vayssier-Taussat M., Moutailler S., Michelet L. i in.: Next generation sequencing uncovers unexpected bacterial pa- thogens in ticks in western Europe. PLoS One 2013; 8(11): e81439. doi: 10.1371/ journal.pone.0081439.
Imbimbo C., Karrer U., Wittwer M. i in.: Tularemia in children and adolescents. Pediatr Infect Dis, 2020; 39(12): e435–e438. doi: 10.1097/INF.0000000000002932.
Yeni D.K., Büyük F., Ashraf A. i in.: Tularemia: A re-emerging tick-borne infectious disease. Folia Microbiol (Praha) 2021; 66(1): 1–14. doi: 10.1007/s12223-020-00827-z.
Nigrovic L.E., Wingerter S.L.: Tularemia. Infect Dis Clin North Am 2008; 22(3): 489–504. doi: 10.1016/j.idc.2008.03.004.
Mierzyńska D., Hermanowska-Szpakowicz T.: Tularemia jako potencjalna broń bioterrorystów. Medycyna Pracy 2002; 53(3): 279–281.
Kłapeć T., Cholewa A.: Tularemia – wciąż groźna zoonoza. Med Ogólna Nauki Zdr 2011; 17(3): 155–160.
Świtaj K., Olszyńska-Krowicka M., Żarnowska-Prymek H. i in.: Tularaemia after tick exposure – typical presentation of rare disease misdiagnosed as atypical presentation of common diseases: a case report. Cases J 2009; 2: 7954. doi: 10.4076/1757-1626-2-7954.
Maurin M.: Francisella tularensis, tularemia and serological diagnosis. Front Cell Infect Microbiol 2020; 10: 512090. doi: 10.3389/fcimb.2020.512090.
Moniuszko A., Pancewicz S., Czupryna P. i in.: Postać węzłowa tularemii po pokłuciu przez stawonogi – opis przypadków. Przegl Epidemiol 2010; 64: 73–75.
Czarkowski M.P., Cielebąk E., Kondej B. i in..: Choroby zakaźne i zatrucia w Polsce w 2018 roku. Warszawa: Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny, Zakład Epidemiologii Chorób Zakaźnych i Nadzoru, Główny Inspektorat Sanitarny, Departament Przeciwepidemiczny i Ochrony Sanitarnej Granic; 2019. 1–168.
Czarkowski M.P., Niewęgłowska A., Szmulik-Misiurek K. i in..: Choroby zakaźne i zatrucia w Polsce w 2019 roku. Warszawa: Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny, Zakład Epidemiologii Chorób Zakaźnych i Nadzoru, Główny Inspektorat Sanitarny, Departament Przeciwepidemiczny i Ochrony Sanitarnej Granic; 2020. 1–168.
Czarkowski M.P., Wielgosz U.: Choroby zakaźne i zatrucia w Polsce w 2023 roku. Warszawa: Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny – Państwowy Instytut Badawczy, Zakład Epidemiologii Chorób Zakaźnych i Nadzoru, Główny Inspektorat Sanitarny, Departament Przeciwepidemiczny i Ochrony Sanitarnej Granic; 2024. 1–176.
Potz-Biedermann C., Schwendemann L., Schröppel K. i in.: Ulceroglandular tularemia. J Dtsch Dermatol Ges 2011; 9(10): 806–808. doi: 10.1111/j.1610-0387.2011.07670.x.
Jacob D., Barduhn A., Tappe D. i in.: Outbreak of tularemia in a group of hunters in Germany in 2018 – Kinetics of antibody and cytokine responses. Microorganisms 2020; 8(11): 1645. doi: 10.3390/microorganisms8111645.
Mulligan M.J., Stapleton J.T., Keitel W.A. i in.: Tularemia vaccine: safety, reactogenicity, “Take” skin reactions, and antibody responses following vaccination with a new lot of the Francisella tularensis live vaccine strain – a phase 2 randomized clinical trial. Vaccine 2017; 35(36): 4730-4737. doi: 10.1016/j.vaccine.2017.07.024.
Dennis D.T., Inglesby T.V., Henderson D.A. i in.: Tularemia as a biological weapon: medical and public health management. JAMA 2001; 285(21): 2763–2773. doi: 10.1001/ jama.285.21.2763.
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