Table 1.

Pathogen or tick	Tick life stage
Pathogen or tick	Adult females	Adult males	Nymphs	Larvae	Not identified	Total
Borrelia burgdorferi sensu lato	29	3	159	1	2	194
B. afzelii	10	1	115	1	2	132
B. garinii/B. bavariensis	7	1	24	0	0	32
B. burgdorferi sensu stricto	3	0	12	0	0	15
B. valaisiana	5	1	8	0	0	14
B. lusitaniae	1	0	1	0	0	2
B. spielmanii	3	0	3	0	0	6
Co-infections	0	0	4	0	0	4
Rickettsia spp.	14	0	69	37	0	120
R. helvetica	12	0	56	36	0	104
R. monacensis	1	0	6	1	0	8
Candidatus R. mendelii	1	0	3	0	0	4
New endosymbiont	0	0	1	0	0	1
Candidatus R. thierseensis	0	0	1	0	0	1
Not identified	0	0	2	0	0	2
Anaplasmataceae
Candidatus Neoehrlichia mikurensis	5	1	46	1	1	54
Anaplasma phagocytophilum	1	0	29	0	0	30
Babesia spp.	3	0	20	5	0	28
B. microti	3	0	18	0	0	21
B. divergens	0	0	1	0	0	1
B.. venatorum	0	0	1	5	0	6
Relapsing fever borreliae
B. miyamotoi	1	0	20	2	1	24

Table 1. Tickborne pathogens detected in different life stages of ticks after tick bite, Austria, 2015–2018

Table 2.

Variable	Not infected, n = 457		Infected, n = 25		p value
Variable	No. or mean ± SD	Median, % (IQR)	No. or mean ± SD	Median, % (IQR)	p value
Sex
M	214	46.8	12	48.0	1.000
F	243	53.2	13	52.0	NA
Age, y	48.7 ± 14.5	48.5 (36.8–59.1)	52.4 ± 14.0	54.0 (42.9–58.6)	0.216
Use of repellent	17	3.7	2	8.0	0.258
No. ticks	1.3 ± 1.2	1.0 (1.0–1.0)	2.4 ± 3.8	1.0 (1.0–2.0)	<0.001
Time, tick bite to blood test, d†	4.3 ± 4.0	4.0 (2.0–6.0)	3.9 ± 2.1	3.0 (2.0–5.0)	0.645
Duration of tick attachment, d	1.0 ± 2.9	1.0 (0.0–2.0)	1.2 ± 1.2	1.0 (0.0–2.0)	0.668
Tick location
Left leg	119	26.0	15	60.0	<0.001
Right leg	130	28.4	13	52.0	0.022
Left arm	53	11.6	6	24.0	0.106
Right arm	55	12.0	4	16.0	0.530
Head/neck	21	4.6	1	4.0	1.000
Abdomen/chest	71	15.5	4	16.0	1.000
Genital/pelvic area	111	24.3	5	20.0	0.811
Back	46	10.1	4	16.0	0.314
Antimicrobial drug‡	30	6.6	0	0.0	0.39
PCR positive	62	13.6	11	44.0	<0.001
IgG§	57	12.5	6	24.0	0.08
IgM§	30	6.6	2	8.0	0.58
IgG and IgM§	23	5.0	2	8.0	0.37
History of erythema migrans	84	18.0	8	32.0	0.15
Tick engorgement
None	180	39.5	4	16.0	<0.001
Slightly/partially	219	48.0	10	40.0	NA
Fully	57	12.5	11	44.0	NA

Table 2. Comparison of persons infected and not infected with Borrelia burgdorferi sensu lato after tick bite, Austria, 2015–2018*

*IQR, interquartile range; NA, not applicable. †Time between tick bite and first blood test. ‡Received within 4 weeks before tick bite. §Presence of Borrelia-specific antibodies at the first visit.

Table 3.

Parameter	p value	OR (95% CI)
Sex	0.818	0.90 (0.38–2.15)
Age	0.662	1.01 (0.98–1.04)
No. ticks	0.048	1.18 (1.00–1.39)
Tick PCR positive for B. burgorferi	0.001	4.39 (1.78–10.84)
Tick engorgement
Fully	<0.001	9.52 (2.79–32.45)
Slightly/partially	0.229	2.09 (0.63–6.98)
Not engorged	NA	1 (NA)

Table 3. Multiple logistic regression analysis for assessing risk for infection with Borrelia burgdorferi sensu lato after tick bite, Austria, 2015–2018*

*NA, not applicable; OR, odds ratio.

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CME / ABIM MOC

Infections With Tickborne Pathogens After Tick Bite, Austria, 2015-2018

Authors: Mateusz Markowicz, MD; Anna-Margarita Schötta, BSc; Dieter Höss, MD; Michael Kundi, PhD; Christina Schray, MD; Hannes Stockinger, PhD; Gerold Stanek, MD
CME / ABIM MOC Released: 3/18/2021
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 3/18/2022, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for infectious disease specialists and other physicians who care for patients at risk for Borrelia infection.

The goal of this activity is to evaluate variables associated with a higher risk for Borrelia infection after a tick bite.

Upon completion of this activity, participants will:

Assess characteristics of tick bites in the current study
Analyze results of molecular screening of ticks in the current study
Distinguish the rate of positive testing for Borrelia among patients in the current study
Evaluate risk factors for a positive Borrelia infection in the current study

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Faculty

Mateusz Markowicz, MD

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Mateusz Markowicz, MD, has disclosed no relevant financial relationships.

Anna-Margarita Schötta, BSc

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Anna-Margarita Schötta, BSc, has disclosed no relevant financial relationships.

Dieter Höss, MD

Private Medical Office
Thiersee, Tyrol, Austria

Disclosures

Disclosure: Dieter Höss, MD, has disclosed no relevant financial relationships.

Michael Kundi, PhD

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Michael Kundi, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AVIR Green Hills Biotechnology AG; Valneva SE; Vivaldi Biosciences Inc.
Received grants for clinical research from: Pfizer Inc.

Christina Schray, MD

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Christina Schray, MD, has disclosed no relevant financial relationships.

Hannes Stockinger, PhD

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Hannes Stockinger, PhD, has disclosed no relevant financial relationships.

Gerold Stanek, MD

Medical University of Vienna
Vienna, Austria

Disclosures

Disclosure: Gerold Stanek, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Valneva SE

CME Author

Charles P. Vega, MD

Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: GlaxoSmithKline

Editor

Thomas J. Gryczan, MS

Copyeditor
Emerging Infectious Diseases

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Disclosure: Thomas J. Gryczan, MS, has disclosed no relevant financial relationships.

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Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

Associate Director, Accreditation and Compliance
Medscape, LLC

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From Emerging Infectious Diseases

CME / ABIM MOC

Infections With Tickborne Pathogens After Tick Bite, Austria, 2015-2018

Authors: Mateusz Markowicz, MD; Anna-Margarita Schötta, BSc; Dieter Höss, MD; Michael Kundi, PhD; Christina Schray, MD; Hannes Stockinger, PhD; Gerold Stanek, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC Released: 3/18/2021

Valid for credit through: 3/18/2022, 11:59 PM EST

processing....

Abstract and Introduction

Abstract

The aim of this prospective study was to assess the risk for tickborne infections after a tick bite. A total of 489 persons bitten by 1,295 ticks were assessed for occurrence of infections with Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia spp., Babesia spp., Candidatus Neoehrlichia mikurensis, and relapsing fever borreliae. B. burgdorferi s.l. infection was found in 25 (5.1%) participants, of whom 15 had erythema migrans. Eleven (2.3%) participants were positive by PCR for Candidatus N. mikurensis. One asymptomatic participant infected with B. miyamotoi was identified. Full engorgement of the tick (odds ratio 9.52) and confirmation of B. burgdorferi s.l. in the tick by PCR (odds ratio 4.39) increased the risk for infection. Rickettsia helvetica was highly abundant in ticks but not pathogenic to humans. Knowledge about the outcome of tick bites is crucial because infections with emerging pathogens might be underestimated because of limited laboratory facilities.

Introduction

Ticks are vectors for a variety of tickborne pathogens that cause human disease^[1]. The diversity of tickborne pathogens has increased extensively in recent years, supported by progress in the molecular identification of microorganisms^[2]. Clinical studies on the health-related impact of many emerging tickborne pathogens are scarce and information on the epidemiology is limited.

We undertook a comprehensive observational study in Austria to assess the incidence of recognized tickborne infections by applying clinical, serologic, and microbiological endpoints. We conducted a detailed risk analysis of contracting Lyme borreliosis. Our objective was to investigate whether variables such as confirmation of Borrelia burgdorferi sensu lato in ticks, duration of tick attachment, engorgement of ticks, and number of simultaneous tick bites have an impact on the risk for infection. Furthermore, we wanted to know whether the localization of a given tick bite and any previous contact with B. burgdorferi s.l. can affect this risk.

Page 1 of 4

Methods

CME / ABIM MOC Information

Abstract and Introduction
Methods
Results
Discussion

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Medscape, LLC

Table 1.

Table 2.

Table 3.

References

Faculty and Disclosures

Faculty

Mateusz Markowicz, MD

Anna-Margarita Schötta, BSc

Dieter Höss, MD

Michael Kundi, PhD

Christina Schray, MD

Hannes Stockinger, PhD

Gerold Stanek, MD

CME Author

Charles P. Vega, MD

Editor

Thomas J. Gryczan, MS

CME Reviewer

Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

CME / ABIM MOC

Infections With Tickborne Pathogens After Tick Bite, Austria, 2015-2018

Target Audience and Goal Statement

Disclosures

Faculty

Mateusz Markowicz, MD

Anna-Margarita Schötta, BSc

Dieter Höss, MD

Michael Kundi, PhD

Christina Schray, MD

Hannes Stockinger, PhD

Gerold Stanek, MD

CME Author

Charles P. Vega, MD

Editor

Thomas J. Gryczan, MS

CME Reviewer

Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Infections With Tickborne Pathogens After Tick Bite, Austria, 2015-2018

Abstract and Introduction

Abstract

Introduction

Table of Contents