Scalp eschar and neck lymphadenopathy by Rickettsia slovaca after Dermacentor marginatus tick bite case report: multidisciplinary approach to a tick-borne disease

• Published in: BMC infectious diseases 2021-01, Vol.21 (1), p.103-4, Article 103
• Main Authors: Barlozzari, Giulia, Romiti, Federico, Zini, Maurizio, Magliano, Adele, De Liberato, Claudio, Corrias, Franco, Capponi, Guglielmo, Galli, Luisa, Scarpulla, Manuela, Montagnani, Carlotta
• Format: Article
• Language: English
• Subjects: Animals; Antibiotics; Antibodies; Arachnids; Asthenia; Bacteria; Blood; Care and treatment; Case Report; Case reports; Causes of; Child; Children & youth; Clavicle; DEBONEL; Deoxyribonucleic acid; Dermacentor - classification; Dermacentor - microbiology; Dermacentor marginatus; Development and progression; Diagnosis; DNA; Doxycycline; Doxycycline - therapeutic use; Epidemiology; Erythema; Female; Fever; Humans; Immunoglobulin G; Lymphadenopathy; Lymphadenopathy - diagnosis; Lymphadenopathy - drug therapy; Lymphadenopathy - microbiology; Lymphatic system; Neck; Neck - microbiology; Parasitic diseases; Pathogens; Patients; Polymerase chain reaction; Rickettsia - genetics; Rickettsia - immunology; Rickettsia - isolation & purification; Rickettsia Infections - diagnosis; Rickettsia Infections - drug therapy; Rickettsia Infections - microbiology; Rickettsia slovaca; Scalp; Scalp Dermatoses - diagnosis; Scalp Dermatoses - drug therapy; Scalp Dermatoses - microbiology; SENLAT; Serology; Tick Bites - complications; Tick Bites - microbiology; Tick Bites - parasitology; Tick-borne diseases; Tick-Borne Diseases - diagnosis; Tick-Borne Diseases - drug therapy; Tick-Borne Diseases - microbiology; Tick-borne rickettsioses; Treatment Outcome; Zoonoses
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-05807-3

Scalp Eschar and Neck LymphAdenopathy after Tick bite is a zoonotic non-pathogen-specific disease most commonly due to Rickettsia slovaca and Rickettsia raoultii. Diagnosis is mostly based only on epidemiological and clinical findings, without serological or molecular corroboration. We presented a clinical case in which diagnosis was supported by entomological identification and by R. slovaca DNA amplifications from the tick vector. A 6-year-old child presented with asthenia, scalp eschar and supraclavicular and lateral-cervical lymphadenopathy. Scalp Eschar and Neck LymphAdenopathy After Tick bite syndrome following a Dermacentor marginatus bite was diagnosed. Serological test on serum revealed an IgG titer of 1:1024 against spotted fever group rickettsiae, polymerase chain reaction assays on tick identified Rickettsia slovaca. Patient was successfully treated with doxycycline for 10 days. A multidisciplinary approach including epidemiological information, clinical evaluations, entomological identification and molecular investigations on tick, enabled proper diagnosis and therapy.