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Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes

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Abstract

The clinical and epidemiological features of 56 patients with scalp eschar associated with neck lymphadenopathy after a tick bite (SENLAT) syndrome were evaluated at the National French Rickettsial Center. Eschar swabs, crusts, and biopsies as well as ticks and blood samples were acquired for molecular and serological assays. SENLAT predominantly affects children (p < 0.05), followed by 40- to 70-year-olds, and it is found mostly in women (p < 0.05). The seasonal distribution has two peaks: one in the spring (55%) and one in the autumn (30%). The etiological agent was identified in 18 cases, which include Rickettsia slovaca in 13 cases with incidences of two co-infections with Rickettsia raoultii and one case caused by Rickettsia sibirica mongolitimonae. Other possible agents that were found in attached ticks were Candidatus R. rioja, Coxiella burnetii, and Borrelia burgdorferi. The tick vector was Dermacentor marginatus in almost all cases, with the exception of one case, in which Ixodes ricinus was identified as the vector. Our findings show that SENLAT is a clinical entity characterized as a local infection controlled by the immune system and is neither pathogen- nor vector-specific.

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Acknowledgements

We would like to thank Dr Duclos Casalongo for the photos.

Funding source

IHU Méditerranée Infection.

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None to declare.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE; Research Unit on Infectious and Tropical Emerging Diseases) UM 63 CNRS 7278 IRD 198 INSERM U1095, Faculty of Medicine, Aix-Marseille University, Marseille, France

    G. Dubourg, C. Socolovschi, P. E. Fournier & D. Raoult

  2. Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique, Hôpitaux de Marseille, Marseille, France

    G. Dubourg, C. Socolovschi, P. E. Fournier & D. Raoult

  3. Unité des Maladies Infectieuses et Dermatologie, Hôpital Bonnet, Centre Hospitalier Intercommunal de Fréjus–Saint-Raphaël, Fréjus-Saint-Raphaël, France

    P. Del Giudice

  4. URMITE – UMR CNRS 6236, IRD 198, Faculté de Médecine, 27 Bd Jean Moulin, 13005, Marseille, France

    D. Raoult

Authors
  1. G. Dubourg
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  2. C. Socolovschi
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  3. P. Del Giudice
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  4. P. E. Fournier
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  5. D. Raoult
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Correspondence to D. Raoult.

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Dubourg, G., Socolovschi, C., Del Giudice, P. et al. Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes. Eur J Clin Microbiol Infect Dis 33, 1449–1456 (2014). https://doi.org/10.1007/s10096-014-2090-2

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  • DOI: https://doi.org/10.1007/s10096-014-2090-2

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