¿Dónde está la garrapata? Crucero & casa (resuelto en Atención Primaria) / Where is the tick? Cruise & home (resolved in primary health care)

Trabajar en Atención Primaria supone pensar en las patologías más frecuentes que se dan en nuestro entorno. Un paciente joven que presenta úlceras genitales nos hace pensar en una infección de transmisión sexual. Sin embargo, la falta de respuesta al tratamiento empírico correcto y los resultados de la serología muestran el diagnóstico definitivo: fiebre botonosa mediterránea, con una localización poco común. Debemos recordar que una enfermedad común en nuestro medio puede parecerse a otra igualmente común, por lo que una correcta historia clínica será fundamental para distinguirlas (AU)

Working in primary health care means thinking about the most common pathologies which we encounter in our workplace. A young patient with genital ulcers makes us think of a sexually transmitted infection. However, the lack of response to the correct empirical treatment and serology results show a definitive diagnosis: Mediterranean spotted fever (also known as boutonneuse fever), with a rare location. It should be remembered that a commonly occurring disease in our environment may resemble another equally common one, thus a correct clinical history is fundamental in order to distinguish them (AU)

Tick toxicosis in a dog bitten by Ornithodoros brasiliensis.

Ticks are hematophagous parasites of people and animals and are a public health hazard in several countries. They are vectors of infectious diseases; in addition, the bite of some ticks, mainly from the Ornithodoros genus, may lead to local lesions and systemic illness, referred to as tick toxicosis. In this report, we describe a dog bitten by Ornithodoros brasiliensis, popularly known as the mouro tick. The main clinical findings were disseminated skin rash, pruritus, mucosal hyperemia, lethargy, and fever. Laboratory abnormalities 48 hours after the bites occurred included mild nonregenerative anemia, eosinophilia, basophilia, increased serum creatine kinase activity, increased serum C-reactive protein concentration, and prolonged coagulation times. Tick-borne pathogens were not detected by PCR analysis or serologic testing, supporting the diagnosis of a noninfectious syndrome due to tick bite, compatible with tick toxicosis.

[Toxicoses of ticks (Acari: Ixodida)]. / Toksykozy kleszczowe (Acari: Ixodida).

Toxins have been shown to present in the salivary glands, whole body extracts, and eggs of ticks. They cause histological lesions in the skin, and in various organs of tick hosts. Among toxicoses, tick paralysis is of the greatest medical and veterinary importance. Toxins are secreted by cells "b" of acinus II in salivary glands during tick feeding.

Tick-borne diseases.

Ticks may transmit a variety of human pathogens and are second in importance only to the mosquito as a vector of human disease. The majority of tick-borne diseases are nonspecific in their initial clinical and laboratory presentation and may be confused with a variety of more common illnesses. A history of tick exposure is frequently not available. Although specific serologic tests exist for confirming the diagnosis of many of these diseases, the time required for confirmation of results makes them of little use in the acute situation. Recognition of the epidemiology of tick-borne pathogens and clinical suspicion are of key importance in making the appropriate diagnosis. Early and specific therapy is a principal factor in reducing the morbidity and mortality associated with these diseases.

[Clinical aspects and etiology of acrodermatitis chronica atrophicans]. / Zur Klinik und Atiologie der Acrodermatitis chronica atrophicans.

We followed up nine patients with acrodermatitis chronica atrophicans (ACA) for an average of 2 years (6-44 months). Extradermal symptoms were observed in five patients, three of whom developed systemic signs such as fatigue or general sensitivity to cold; three suffered from cardiac symptoms; and two had joint and/or nervous system involvement. In one patient, erythema migrans and oligoarthralgia preceded the ACA. In most patients, the laboratory tests showed changes often seen in inflammatory diseases; we found an elevation of IgA, IgG and/or IgM in five patients. Using an indirect immunofluorescence test with Ixodes dammini spirochetes as antigen, the patients had more or less elevated IgG antibody titers and insignificant IgM antibody titers; similar results were obtained in some patients when an Ixodes ricinus spirochete isolated in the area of Munich was used as antigen. We believe that ACA is a chronic spirochetosis with manifestations present in the skin, joints, nervous system, and presumably in the heart.

[Etiology of erythema migrans disease and Lyme disease. Review and results of personal study]. / Zur Atiologie von Erythema-migrans-Krankheit und Lyme-Erkrankung. Ubersicht und eigene Untersuchungsergebnisse.

Erythema chronicum migrans (ECM), lymphadenosis cutis benigna and acrodermatitis chronica atrophicans (ACA) have been well known in Europe for a long time as skin diseases induced by tickbites. Earlier hints that these inflammatory dermatoses and associated disorders (erythema migrans disease) might be of spirochetal origin are now supported by the findings of several groups in the USA and Europe. In the United States the endemic occurrence of a new inflammatory disease which seems to be closely related to the European erythema migrans disease was first seen in Lyme, Connecticut, in 1975. This "Lyme disease" is also induced by tick bites and affects mainly skin and joints. In 1982 the isolation of a new spirochetal species cultivated from Ixodes dammini ticks was reported. Antibodies against these Ixodes dammini spirochetes (IDS) were detected by indirect immunofluorescence in patients with Lyme disease. In 1983 spirochetes were shown by Warthin-Starry silver stain in skin biopsies of erythema chronicum migrans, and nearly simultaneously the isolation of spirochetes similar to the IDS from skin, blood and cerebrospinal fluid of Lyme patients was reported in a few cases. Also, in Europe Borrelia-like spirochetes morphologically very similar to the IDS have been isolated from ticks of the indigenous species Ixodes ricinus by transmission to laboratory animals and cultivation in vitro. Antibodies against Ixodes ricinus spirochetes (IRS), but also against known Borrelia species have been shown in most sera of patients with erythema migrans disease, including meningoradiculitis Bannwarth, acrodermatitis chronic atrophicans and lymph-adenosis cutis benigna.(ABSTRACT TRUNCATED AT 250 WORDS)

[Erythema chronicum migrans with Bannwarth syndrome (Garin-Bujadoux-Bannwarth meningopolyneuritis)]. / Erythema chronicum migrans mit Bannwarth-Syndrom (Meningopolyneuritis Garin-Bujadoux-Bannwarth).

A 54-year-old male had erythema chronicum migrans (ECM), lymphocytic meningitis, and intense pain radiating along the distribution of the corresponding dermatomal segments. Neurologic involvement, described as Bannwarth syndrome or meningopolyneuritis Garin-Bujadoux-Bannwarth, is a typical late manifestation of ECM infection and requires high-dose intravenous penicillin therapy.

[Jarisch-Herxheimer reaction in erythema migrans disease]. / Jarisch-Herxheimer-Reaktion bei Erythema-migrans-Krankheit.

A Jarisch-Herxheimer (-like) reaction has been observed in four patients with erythema migrans disease.

Tick-bite fever in South Africa. The occurrence of severe cases on the Witwatersrand.

Tick-bite fever, the variety of tick typhus occurring in southern Africa, is caused by Rickettsia conori var. pijperi and is transmitted by hard or ixodid ticks. It is usually a mild disease, especially in children and young adults, but in middle-aged and elderly patients (and sometimes in young adults) it may assume a severe form. This is characterized by high fever, severe headache, delirium, stupor and occasionally coma, and a profuse maculopapular rash which becomes haemorrhagic and is associated with petechiae in the skin and later, but rarely, by the development of gangrene of the fingers and toes. During these severe attacks the central nervous system may be involved and marked disorders of liver and kidney function sometimes lead to kidney failure and the need for treatment and dialysis in an intensive care unit. Three illustrative cases are described in which diagnosis was delayed. One patient died; 2 patients responded to administration of tetracycline. The danger of allowing tick-infested dogs onto one's bed is stressed. Infections transmitted by dog ticks tend to be more severe than those acquired via ticks from the bushveld, possibly because they so often occur in middle-aged and elderly patients. Serological tests have recently indicated that there are antigenic differences between 'suburban' and 'bushveld' strains; these clearly require further study.

Combined recordings of compound nerve action potentials and spinal cord evoked potentials in differential diagnosis of spinal root lesions.

Three cases are presented to demonstrate the diagnostic value of sensory neurography in combination with somatosensory evoked potentials in the diagnosis of proximally located neuropathy and its differentiation to centrally located demyelinating processes. Simultaneous recording of cortical and spinal evoked potentials, as well as peripheral nerve action potentials, revealed in two cases (herpes zoster, Guillain-Barré syndrome) a site of lesion at the spinal roots suggesting radiculitis and in one case (tick bite) a site of lesion central to the source of lumbar evoked potentials suggesting myelitis. In all cases almost complete recovery of sensory conduction velocities suggests a complete repair myelination not previously described.

Tick paralysis in three children. The diversity of neurologic presentations.

Reviewed are 3 cases of tick paralysis in children each with a different presentation. One child presented with an ascending flaccid weakness, another with weakness and cerebellar signs, and a third with pure cerebellar signs. Ixodes scapularis, the black-legged deer tick, was the offending tick in Case 3 and apparently has not been previously reported to cause paralysis in humans. Because of the potential for a fatal outcome, it is imperative to consider tick paralysis in any child with an ascending flaccid weakness or acute ataxia.

Neuromuscular paralysis caused by tick envenomation.

The Australian scrub-tick Ixodes holocyclus causes a series of significant toxic effects in its victims. The most important feature of tick envenomation is neuromuscular paralysis. Children poisoned by ticks may manifest only local motoneural effects, usually facial paralysis. Progressive ascending flaccid paralysis occurs if the removal of an embedded tick is delayed. The specific neurological features of tick-bite are discussed in the light of a series of 6 children who all showed signs of tick paralysis. Tick venom is known to slow nerve conduction, and may have a botulinum-like effect at the neuromuscular junction. The literature on the neurological effects of tick-envenomation is reviewed.

The clinical features of tick bite.

The clinical features of bites by the Australian scrub tick, Ixodes holocyclus, are reviewed. Eight cases of tick bite are summarized, including six new cases of tick paralysis in children. In almost all cases neuroparalysis became worse transiently, after the tick had been removed. One child with life-threatening respiratory and bulbar palsy received canine antitick antivenene, with rapid reversal of clinical signs. The differential diagnosis of tick bite includes all acute childhood diseases which can affect the motor units; the importance of including the possibility of tick envenomation in the differential diagnosis of acute weakness or paralysis in children is illustrated. The clinical features of neuromuscular paralysis are described, together with a review of the tick's local effects at the bite site.

[Tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth)]. / Durch Zecken übertragene Meningo-polyneuritis

The meningopolyneuritis first described in 1922 by Garin and Bujadoux develops after a tick bite. At the site of the bite in some of the cases, erythema chronicum migrans develops first. Severe pains follow in this area which may spread to other parts of the body. Then peripheral paralysis appears with asymmetrical distribution. The motor cerebral nerves, especially the facial nerve, are also frequently affected. Mild sensitivity disorders occur with no systematic arrangement. There is a lymphocyte pleocytosis of 100-2600/3 mm3 and an increase in protein of varying intensity, meningeal symptoms usually being absent. The disease persists for 3-5 months. Apart from rare residual, the prognosis is favorable.