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Tick-Borne Lymphadenopathy: A New Infectious Disease in Children

Porta, Ferran Segura MD, PhD*†; Nieto, Esperanza Antón MD*†; Creus, Bernat Font MD*; Espín, Tomás Muñoz MD; Casanova, Francisco Javier Travería MD; Sala, Isabel Sanfeliu MSc†§; García, Sergio Lario PhD*; Aguilar, Jesus Luelmo MD; Vilaseca, Mariela Quesada PhD*†

The Pediatric Infectious Disease Journal: July 2008 - Volume 27 - Issue 7 - p 618-622
doi: 10.1097/INF.0b013e31816b1947
Original Studies

Objective: To describe the epidemiologic and clinical aspects of patients with tick-borne lymphadenopathy (TIBOLA).

Patients and Methods: The study included all patients treated in our hospital who presented characteristic clinical signs of TIBOLA consisting in the presence of an inoculation lesion after a tick bite with regional lymphadenopathies. The study was carried out at the “Corporació Parc Taulí” hospital in the city of Sabadell, Barcelona, Spain. The inclusion period was from April 2000 to April 2006. Serology tests were performed for Rickettsia conorii, R. slovaca, and Borrelia burgdorferi. The presence of Rickettsia was assessed by means of polymerase chain reaction (PCR)-restriction fragment length polymorphism (PCR-RFLP) and linear-after-the exponential-PCR in blood, skin biopsy, and ticks from the patients.

Results: Thirty-six patients fulfilled the inclusion criteria. Twenty-eight patients were children. In most cases, infection occurred between the months of October and April. In 34 patients the tick bite was on the scalp. A necrotic eschar surrounded by a perilesional erythematous halo was observed in 29 cases. All patients had painful regional lymphadenopathies. Serology for R. conorii was positive in 8 cases and for R. slovaca in 2. PCR was negative.

The tick, identified as Dermacentor marginatus, was studied in 7 patients. Four of the 7 D. marginatus were positive for sequences compatible with R. slovoca as determined by RFLP or DNA sequencing. Thirty-three patients received antibiotic treatment. Progress was satisfactory in all cases.

Conclusions: TIBOLA is present in Catalonia (Northeastern Spain) mainly in children. Although clinical and epidemiologic manifestations are very specific microbiologic confirmation is difficult.

Supplemental Digital Content is Available in the Text.

From the *Department of Infectious Diseases, Corporació Sanitària Parc Taulí—Institut Universitari (UAB), Sabadell, †Department of Medicine, Universitat Autònoma de Barcelona (UAB), ‡Department of Paediatrics, §Laboratory of Microbiology, UDIAT, and ¶Department of Dermatology, Corporació Sanitària Parc Taulí—Institut Universitari (UAB), Sabadell, Barcelona, Spain.

Accepted for publication January 28, 2008.

This work was supported by a FIS 060536, Grant from “Fondo de Investigaciones Sanitarias” (Health Research Fund), Madrid, Spain, and supported in part by “Ministerio de Sanidad y Consumo,” Instituto de Salud Carlos III-FEDER, Spanish Network for Research in Infectious Diseases (REIPI RD06/008).

Address for correspondence: Ferran Segura Porta, MD, PhD, Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain. E-mail:

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© 2008 Lippincott Williams & Wilkins, Inc.