Article

European Journal of Clinical Microbiology & Infectious Diseases

, Volume 32, Issue 3, pp 317-323

Open Access This content is freely available online to anyone, anywhere at any time.

Seroreactivity for spotted fever rickettsiae and co-infections with other tick-borne agents among habitants in central and southern Sweden

  • A. LindblomAffiliated withUnit of Infectious Diseases, Department of Medical Sciences, Uppsala University
  • , K. WallméniusAffiliated withUnit of Clinical Bacteriology, Department of Medical Sciences, Uppsala University
  • , M. NordbergAffiliated withUnit of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University
  • , P. ForsbergAffiliated withUnit of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping UniversityDepartment of Infectious Diseases, County Council of Östergötland
  • , I. EliassonAffiliated withDepartment of Laboratory Medicine, Norra Älvsborg County Hospital (NÄL)
  • , C. PåhlsonAffiliated withUnit of Clinical Bacteriology, Department of Medical Sciences, Uppsala University
  • , K. NilssonAffiliated withUnit of Infectious Diseases, Department of Medical Sciences, Uppsala UniversityUnit of Clinical Bacteriology, Department of Medical Sciences, Uppsala UniversityCenter of Clinical Research Email author 

Abstract

Patients seeking medical care with erythema migrans or flu-like symptoms after suspected or observed tick bite in the southeast of Sweden and previously investigated for Borrelia spp. and/or Anaplasma sp. were retrospectively examined for serological evidence of rickettsial infection (Study 1). Twenty of 206 patients had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64. Seven of these 20 patients showed seroconversion indicative of recent or current infection and 13 patients had titres compatible with past infection, of which five patients were judged as probable infection. Of 19 patients with medical records, 11 were positive for Borrelia spp. as well, and for Anaplasma sp., one was judged as positive. Five of the 19 patients had antibodies against all three pathogens. Erythema migrans or rash was observed at all combinations of seroreactivity, with symptoms including fever, muscle pain, headache and respiratory problems. The results were compared by screening an additional 159 patients (Study 2) primarily sampled for the analysis of Borrelia spp. or Mycoplasma pneumoniae. Sixteen of these patients were seroreactive for Rickettsia spp., of which five were judged as recent or current infection. Symptoms of arthritis, fever, cough and rash were predominant. In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection. The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.