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Contact with horses is a risk factor for tick-borne lymphadenopathy (TIBOLA): a case control study

Kontakt mit Pferden ist ein Riskofaktor für die Zecken-übertragene Lymphadenopathie (TIBOLA). Eine kontrollierte Fallstudie

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Summary

Tick-borne lymphadenopathy (TIBOLA) is an emerging infection caused by Rickettsia slovaca. We describe here the seasonal, age and gender characteristics as well as the association with horse contact as risk factors for acquiring TIBOLA in comparison with another, more frequent tick-borne disease, Lyme borreliosis.

We analysed a dataset of 855 patients diagnosed with either Lyme (n = 805) or TIBOLA (n = 50) disease using Fisher’s exact tests and generalized linear models. Then we performed a matched case-control study in which all TIBOLA patients were paired with one Lyme patient matching in age and gender. We identified the species of ticks collected from the TIBOLA patients (n = 16).

We found that horse contact was significantly more frequent among TIBOLA (34/50; 68 %) than among Lyme patients (110/805; 13.7 %) (OR = 13.35, p < 0.001). The younger age and female gender associated with higher risk of acquiring TIBOLA (OR = 3.99, p < 0.001). Ten of the 16 ticks were D. marginatus, six were D. reticulatus suggesting that both species are responsible for transmitting R. slovaca. Two patients acquired the infection from male ticks. TIBOLA is a tick-borne zoonosis, which might have a specific association with horse contact.

Zusammenfassung

Die durch Zecken übertragene Lymphadenopathie (TIBOLA) ist eine durch Rickettsia slovaca verursachte Infektion. Wir beschreiben in der vorliegenden Arbeit die saisonalen, Alters- und Gechlechts-mäßigen Charakteristika, sowie den Zusammenhang mit Kontakt mit Pferden als Risikofaktor für das Auftreten von TIBOLA im Vergleich zu einer anderen – häufigeren – Zeckenerkrankung, der Lyme Borreliose.

Wir analysierten Daten von 855 Patienten, bei denen entweder eine Lyme Borreliose (n = 805) oder eine TIBOLA (n = 50) diagnostiziert worden war, wobei wir Fischer’s exakten Test oder generalisierte lineare Modelle verwendeten. Außerdem führten wir eine Alters- und Geschlechts-mäßig gematchte Fallkontrollstudie durch, bei der alle TIBOLA-Patienten mit einem im Alter und Geschlecht entsprechenden Patienten mit Lyme Borreliose verglichen wurden. Weiters identifizierten wir die Spezies der Zecken, die von den TIBOLA-Patienten gesammelt wurden (n = 16).

Wir fanden, dass der Kontakt mit Pferden bei Patienten mit TIBOLA wesentlich häufiger (34/50; 68 %) als bei Patienten mit Lyme Borreliose war (110/805; 13,7 %) (OR = 13,35, p < 0,001). Jüngeres Alter und weibliches Geschlecht waren mit einem höheren Risiko, TIBOLA zu bekommen, assoziiert (OR = 3,99, p < 0,001). Zehn der 16 Zecken waren D.marginatus, 6 waren D. reticulatus, wodurch nahe gelegt wird, dass beide Spezies für die Übertragung von R. slovaca verantwortlich sind. Zwei Patienten wurden durch männliche Zecken infiziert. TIBOLA ist eine durch Zecken übertragene Krankheit (Zoonose), die einen spezifischen Zusammenhang mit Pferdekontakt haben könnte.

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Conflict of interest

The authors declare that they have no competing financial interests. They have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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Authors and Affiliations

  1. Centre for Tick-Borne Diseases, Budapest, Visegrádi 14, 1132, Budapest, Hungary

    András Lakos

  2. MTA–ELTE–MTM Ecology Research Group, Budapest, Hungary

    Ádám Kőrösi

  3. Department of Parasitology and Zoology, Faculty of Veterinary Science, Szent István University, Budapest, Hungary

    Gábor Földvári

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  1. András Lakos
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  2. Ádám Kőrösi
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  3. Gábor Földvári
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Correspondence to András Lakos.

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Lakos, A., Kőrösi, Á. & Földvári, G. Contact with horses is a risk factor for tick-borne lymphadenopathy (TIBOLA): a case control study. Wien Klin Wochenschr 124, 611–617 (2012). https://doi.org/10.1007/s00508-012-0217-y

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