Ticking on Pandora’s box: a prospective case-control study into ‘other’ tick-borne diseases

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Abstract

Background

Tick-borne pathogens other than Borrelia burgdorferi sensu lato – the causative agent of Lyme borreliosis – are common in Ixodes ricinus ticks. How often these pathogens cause human disease is unknown. In addition, diagnostic tools to identify such diseases are lacking or reserved to research laboratories. To elucidate their prevalence and disease burden, the study ‘Ticking on Pandora’s Box’ has been initiated, a collaborative effort between Amsterdam University Medical Center and the National Institute for Public Health and the Environment.

Methods

The study investigates how often the tick-borne pathogens Anaplasma phagocytophilum, Babesia species, Borrelia miyamotoi, Neoehrlichia mikurensis, spotted fever group Rickettsia species and/or tick-borne encephalitis virus cause an acute febrile illness after tick-bite. We aim to determine the impact and severity of these tick-borne diseases in the Netherlands by measuring their prevalence and describing their clinical picture and course of disease.

The study is designed as a prospective case-control study. We aim to include 150 cases – individuals clinically suspected of a tick-borne disease – and 3 matched healthy control groups of 200 persons each. The controls consist respectively of a group of individuals with either a tick-bite without complaints, the general population and of healthy blood donors. During a one-year follow-up we will acquire blood, urine and skin biopsy samples and ticks at baseline, 4 and 12 weeks. Additionally, participants answer modified versions of validated questionnaires to assess self-reported symptoms, among which the SF-36, on a 3 monthly basis.

Discussion

This article describes the background and design of the study protocol of ‘Ticking on Pandora’s Box’. With our study we hope to provide insight into the prevalence, clinical presentation and disease burden of the tick-borne diseases anaplasmosis, babesiosis, B. miyamotoi disease, neoehrlichiosis, rickettsiosis and tick-borne encephalitis and to assist in test development as well as provide recommendations for national guidelines.

Trial registration

NL9258 (retrospectively registered at Netherlands Trial Register, trialregister.nl in in February 2021).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06190-9.

Related collections

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Author and article information

Contributors

D. Hoornstra:

ORCID: http://orcid.org/0000-0003-0347-2049

pandora@amc.uva.nl

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 29 May 2021

Publication date PMC-release: 29 May 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 501

Affiliations

[1 ]GRID grid.7177.6, ISNI 0000000084992262, Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, , University of Amsterdam, ; P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands

[2 ]GRID grid.31147.30, ISNI 0000 0001 2208 0118, National Institute for Public Health and the Environment (RIVM), , Center of Infectious Disease Control, ; P.O. Box 1 (3720 BA), Bilthoven, The Netherlands

Author information

D. Hoornstra http://orcid.org/0000-0003-0347-2049

Article

Publisher ID: 6190

DOI: 10.1186/s12879-021-06190-9

PMC ID: 8164744

PubMed ID: 34051756

SO-VID: 04e6cef9-40b9-47f0-8c26-421b47a49fb2

License:

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