Ticks

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Ticks are obligate hematophagous arthropods, part of the order Parasitiformes, and along with mites, they constitute the subclass Acari. 
[Left an engorged Lone Star tick]

Almost all ticks belong to one of two major families:

• The Ixodidae– contains over 700 species of hard ticks which have a dorsum totally or partially covered with chitin) containing specimens of the genus Ixodes, Amblyomma, Rhipicephalus, Dermacentor, Haemaphysalis, Cosmiomma, Aponomma, Margaropus, Rhipicentor and Hyalomma
• The Argasidae - contains about 200 species of soft ticks, which have a dorsum without chitin, containing those from the genus Argas, Ornithodoros, Otobius, Antricola, Nothoaspis and Carios

There were, as of 2018, around 18 genera, and 900 species of ticks.  [The family Nuttalliellidae contains only a single species, Nuttalliella namaqua, a tick found in southern Africa].

Description

Ticks are typically 3 to 5 mm long, although as we can see from the photos, some can be extremely small, and virtually invisible once they get into the hair of a human or an animal like a dog.   The tick's bite is painless, as such neither you nor your dog may know you have been infected and some ticks can be as small as a poppy seed or spec of dirt, so it can be easy to overlook them.

Adults have ovoid or pear-shaped bodies which become engorged with blood when they feed, and eight legs. As well as having a hard shield on their dorsal surfaces, hard ticks have a beak-like structure at the front containing the mouthparts whereas soft ticks have their mouthparts on the underside of the body. Both families locate a potential host by odour or from changes in the environment.

Ticks are ectoparasites (external parasites), living by feeding on the blood of mammals, birds, and sometimes reptiles and amphibians.

The tick's mouth is covered with hooks evolved so the tick can hang on for several days of feasting on blood.  A tick digs in using two sets of hooks. Each set looks like a hand with three hooked fingers. The hooks dig in and wriggle into the skin. Then these “hands” bend in unison to perform approximately half-a-dozen ‘breaststrokes’ that pull skin out of the way so the tick can push in a long stubby part called the hypostome.  A tick will generally remain attached until it is gorged with blood, increasing greatly in size, before dropping off. This can take between a few days and 2 weeks

Ticks have four stages to their lifecycle, namely egg, larva, nymph, and adult. Ixodid ticks have three hosts, taking at least a year to complete their lifecycle. Argasid ticks have up to seven nymphal stages (instars), each one requiring a blood meal.

Distribution

Ticks are widely distributed around the world.  They are responsible for major depressions in livestock production and mortality in sub-Saharan Africa, Latin America and Asia.

China has at least 117 tick species from seven genera. In recent years, the reported number of tick-borne infections has increased in this country. Since 1982, more than 30 emerging tick-borne agents have been recognized such that tick-borne diseases are considered to be an emerging threat to public health in mainland China.

Tick-borne diseases are becoming an increasing and serious problem in Europe.  There appears to be a belief that Europe has been spared the worst of these diseases, but evidence shows that ticks and diseases are spreading very rapidly, a situation made worse by the denial of this by the medical profession:

This review will focus on the most important circulating tick-transmitted pathogens in Europe - Borrelia spp., Anaplasma phagocytophilum, Babesia spp., tick-borne encephalitis virus, Rickettsia spp. and Crimean-Congo hemorrhagic fever virus.  PMID:  20014900

There are over twenty species of tick in Britain alone, found on different mammal or bird hosts. They carry a number of diseases, the most well known of which is Lyme disease.   They can be found all across Scotland and particularly in the wetter west, in woodlands, moorlands and long grass.   Scientists have recorded more than 800,000 ticks in just a short stretch of thick vegetation at the side of a path. They are active all through the year, but particularly in summer.

Ticks as pathogen vectors

What makes ticks so dangerous medically is that they act as vectors of a great variety of pathogens including viruses, parasites, and bacteria.  Thus, if one is unfortunate enough to be bitten by a tick, any number of diseases could result.   On a global scale, they represent the most important vectors of pathogens that affect animals.

Their remarkable success as disease vectors is mainly related to their longevity, high reproductive rate and broad host targetting, as well as to their capacity to imbibe a very large quantity of blood over a relatively long period of time.

For most tick-borne pathogens (TBP), transmission to the vertebrate host occurs via the saliva, underscoring the importance of both salivary glands (SG) and saliva in the transmission process. During feeding, ticks inject saliva and absorb their meal in an alternating pattern through the same canal. They are pool feeders, ingurgitating all of the fluids that are exuded into the haemorrhagic pool generated by the bite. TBP are ingested by ticks during their feeding on infected hosts. From the midgut, TBP cross the digestive epithelium and invade the haemocoel, from which they can penetrate the SG epithelium to invade the SG. From there, TBP can be transmitted to a new host via saliva injected during a new blood meal.

Vertebrates react to skin injury inflicted by tick bites by the formation of a haemostatic plug, vasoconstriction, inflammation and tissue remodeling related to wound healing. If unchecked, these processes would cause tick rejection and/or disrupt tick feeding, and arrest their further development. To facilitate the flow of blood and assure feeding, however, ticks have evolved a complex and sophisticated pharmacological armament that blocks pain and itch, inhibits haemostasis, and modulates innate and adaptive immune responses, angiogenesis and wound healing in their hosts.

It is worth adding that many of the illnesses caused by ticks in humans also affect dogs.  Canine Hepatozoonosis, for example, is caused by the dog ingesting a tick infected with H. canis or H. americanum the latter of which can cause a severe, often fatal disease in dogs. The carrier for H. canis is the brown dog tick, and the carrier for H. americanum is the Gulf Coast tick.

Symptoms

Progress has been made medically, as at least after a long and hard battle, doctors are now willing to admit that ticks do cause disease.  The next stage of the battle is to try to get them to be far more aware of the clinical signs of tick-transmitted diseases, because morbidity and mortality as a result of these diseases increases substantially if there are delays in diagnosis and treatment.

It must be kept in mind that the risk of transmission of disease increases with the duration of attachment and generally requires greater than 24 to 48 hours. The degree of tick engorgement or the time since tick exposure and discovery of the tick may be used to establish the likely duration of attachment and the risk of disease transmission.

Having said this, most tick bites are uncomplicated, and result only in benign cutaneous inflammatory reactions that may be pruritic for a few days. As a result of mouthparts being retained at the feeding site, a granuloma may develop. There are no data to indicate that antimicrobial prophylaxsis is beneficial to the tick-bitten patient to prevent disease.

A common sign of infection in Lyme’s disease is a distinctive bulls-eye rash that may appear (though not always) around the area of the bite. As infection spreads several rashes can appear at different sites on the body.  Other symptoms include fatigue, fever, headaches, stiff neck and body aches - similar to the flu. These symptoms may be persistent or may occur intermittently.

Some species, notably the Australian paralysis tick, are also intrinsically venomous and can cause tick paralysis.

African tick bite fever

African tick bite fever (ATBF) is caused by the bacterium Rickettsia africae. The bacterium is spread by ticks of the Amblyomma type. These generally live in tall grass or bush rather than in cities.  Symptoms may include fever, headache, muscles pains, and a rash. At the site of the bite there is typically a red skin sore with a dark center. Onset usually occur 4–10 days after the bite. Complications are rare, however may include joint inflammation.

Anaplasmosis

Anaplasmosis is a disease caused by a rickettsial parasite of ruminants, Anaplasma spp. The microorganisms are Gram-negative, and infect red blood cells. They are transmitted by a number of species of ticks. The Ixodes tick that commonly transmits Lyme disease also spreads anaplasmosis.  This bacterial disease can also be transmitted to dogs. Signs in dogs can include fever, anorexia, thrombocytopenia (decrease in blood platelets), swollen joints, depression, and enlarged lymph nodes. Carriers include the black-legged deer tick.

Babesiosis

Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a parasite that infects red blood cells.  Human babesiosis is most common in the Northeastern and Midwestern United States and parts of Europe, and sporadic throughout the rest of the world. People can get infected with Babesia parasites by the bite of an infected tick, by getting an infected blood transfusion, or by infected mother to baby transmission.  Dogs can get Babesiosis. Symptoms in dogs may include anaemia (the most common sign), fever, vomiting, diarrhoea, jaundice, skin lesions, and potentially kidney failure. Carriers include the brown dog tick and the black-legged (deer) tick.

Bartonella infection

Bartonella is a genus of Gram-negative bacteria. Bartonella species are considered especially important as opportunistic pathogens. They are transmitted by insect vectors such as ticks, fleas, sand flies, and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans. 

Bourbon virus

Bourbon virus is an RNA virus in the genus Thogotovirus of the family Orthomyxoviridae. It was first identified in 2014 in a man from Bourbon County, Kansas, United States, who died after being bitten by ticks. The case is the eighth report of human disease associated with a thogotovirus globally, and the first in the Western hemisphere. In June 2017 a 58-year-old female Missouri State Park employee died from an infection of the Bourbon virus after it had been misdiagnosed.

Boutonneuse fever

Boutonneuse fever (also called Mediterranean spotted fever, fièvre boutonneuse, or Marseilles fever) is caused by the bacterium Rickettsia conorii and transmitted by the dog tick Rhipicephalus sanguineus. Boutonneuse fever can be seen in many places around the world, although it is endemic in countries surrounding the Mediterranean Sea.

Colorado tick fever

Colorado tick fever (CTF) (also called mountain tick fever, American tick fever, and American mountain tick fever) is a viral infection (Coltivirus) transmitted from the bite of the tick Dermacentor andersonii.

Crimean Congo haemorrhagic fever

Crimean–Congo hemorrhagic fever (CCHF) is a viral disease caused by the CCHF virus and typically spread by tick bites. Symptoms of CCHF may include fever, muscle pains, headache, vomiting, diarrhoea, and bleeding into the skin. Onset of symptoms is less than two weeks following exposure. Complications may include liver failure. In those who survive, recovery generally occurs around two weeks after onset.

Otoacariasis

Ticks can crawl into the ear and cause ear problems.   Otoacariasis, the attachment of ticks and mites within the ear canal is a common phenomenon in rural areas in a number of countries.  In one study by the Veterinary Department of Kafkas University in Brazil of human patients with otoacariasis, all ticks were identified as otobius, a species known to act as vectors of a number of diseases.

Ehrlichiosis

Ehrlichiosis is a tickborne bacterial infection, caused by bacteria of the family Anaplasmataceae, genera Ehrlichia and Anaplasma. These obligate intracellular bacteria infect and kill white blood cells. There are a number of Ehrlichia species that can infect dogs in the United States. Symptoms in dogs may include anaemia, fever, depression, lethargy, appetite loss, shortness of breath, joint pain, stiffness, and bruising. Later in the disease, there may be weight loss, bleeding, eye inflammation, diarrhoea, and hind leg swelling. Carriers include the brown dog tick.

Flinders Island spotted fever

Tick bites in Australia can lead to a variety of illnesses in patients. Rickettsial (Rickettsia spp.) infections (Queensland tick typhus, Flinders Island spotted fever and Australian spotted fever) and Q fever (Coxiella burnetii) are the only systemic bacterial infections that are known to be transmitted by tick bites in Australia. The southern reptile tick (Bothriocroton hydrosauri) is found mainly in south-eastern Australia and causes Flinders Island spotted fever due to Rickettsia honei.

Heartland virus infection

The Heartland virus (HRTV) is a tick-borne phlebovirus of the Bhanja virus serocomplex discovered in 2009. The Lone Star Tick transmits the virus to people when feeding on blood. As of 2017, only five Midwestern United States have reported 20 human infections, namely Arkansas, Indiana, Missouri, Oklahoma, and Tennessee.

Intestinal disease , IBS and dysbiosis

Kyasanur Forest Disease Virus (KFDV)

Lyme Disease

[Right a tick before and after engorgement]

Lyme disease (Lyme borreliosis) is caused by at least three species of bacteria belonging to the genus  Borrelia.  Borrelia burgdorferi sensu stricto  is the main cause of Lyme disease in North America, whereas Borrelia afzelii and Borrelia garinii cause most European cases.  It was known that Lyme disease was a tick-borne disease as far back as 1978.

Lyme disease is the most common tick-borne disease in the Northern Hemisphere.  Borrelia is transmitted to humans by the bite of infected ticks belonging to a few species of the genus Ixodes ("hard ticks").  Lyme disease is at last being recognised as a serious disease for humans.  But few people know that it is one of the most commonly diagnosed tick-borne diseases in dogs. Symptoms in dogs include fever, shifting leg lameness, polyarthritis, and generally poor health. In a small number of dogs, Lyme Disease can be fatal. Carriers include the black-legged deer tick.

Morgellan’s disease

May be caused by ticks and either Borrelia bacteria or other organisms.  The presence of the bacteria does not explain why Morgellons filaments are formed - collagen and keratin filaments arise from proliferative keratinocytes and fibroblasts in human epithelial tissue.  But, it is gradually being realised that the ticks may harbour not just bacteria, but a host of other organisms.  One of the organisms found on the tick is a microfilarial worm.

Q fever

Q fever (Coxiella burnetii) is caused by the paralysis tick (Ixodes holocyclus)which is endemic on the east coast of Australia and causes both Queensland tick typhus due to Rickettsia australis and Q fever due to C. burnetii.  The ornate kangaroo tick (Amblyomma triguttatum) occurs throughout much of northern, central and western Australia and also causes Q fever.

Queensland tick typhus (Australian tick typhus)

Tick bites in Australia can lead to a variety of illnesses in patients. These include infection, allergies, paralysis, autoimmune disease, post-infection fatigue and Australian multisystem disorder. The paralysis tick (Ixodes holocyclus) is endemic on the east coast of Australia and causes Queensland tick typhus due to Rickettsia australis

Rheumatoid arthritis

Rheumatoid arthritis is linked to the Borrelia bacteria of the spirochete phylum [a parasite], transmitted primarily by ticks and some by lice.  Juvenile rheumatoid arthritis (JRA) in particular and the arthritis of Lyme borreliosis in children can be the same thing with the same cause – the bacteria.  

Rocky Mountain Spotted Fever

Despite its name, Rocky Mountain Spotted Fever has been reported in almost all of the contiguous United States, Western Canada, and Mexico. It is the most lethal and most frequently reported rickettsial illness in the United States. The disease is caused by Rickettsia rickettsii, a species of bacterium that is spread to humans by Dermacentor ticks. Initial signs and symptoms of the disease include sudden onset of fever, headache, and muscle pain, followed by development of rash. The disease can be difficult to diagnose in the early stages, and without prompt and appropriate treatment it can be fatal.  It can also be fatal in dogs.  Clinical signs in dogs include loss of appetite, fever, depression, joint pain, and swollen lymph nodes. Carriers include the American dog tick and brown dog tick.

Tick-borne encephalitis

In TBE, the tick carries a virus called the Tick-borne encephalitis virus (TBEV) of the family Flaviviridae (the tick often remain firmly attached to the skin for days). Three subtypes of the causative agent are known: the European (Western), the Far Eastern (spring-and-summer encephalitis) and the Siberian.

A very large number of countries are affected by the high prevalence of the virus in ticks including the Baltic States, Slovenia, the Russian Federation, Albania, Austria, Belarus, Bosnia, Bulgaria, China, Croatia, Denmark, Finland, Germany, Greece, Hungary, Italy, Mongolia, Norway, Poland, the Republic of Korea, Romania, Serbia, Slovakia, Slovenia, Sweden, Switzerland, Turkey and Ukraine. The risk is highest when hiking or camping in forested areas up to an altitude of about 1500 m.

Tick-borne relapsing fever

Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus Borrelia, which are transmitted through the bites of lice or soft-bodied ticks (genus Ornithodoros).

Most people who are infected develop sickness between 5 and 15 days after they are bitten. The symptoms may include a sudden fever, chills, headaches, muscle or joint aches, and nausea. A rash may also occur. These symptoms usually continue for 2 to 9 days, then disappear. This cycle may continue for several weeks if the person is not treated

Tularemia

Tularemia, also known as rabbit fever, is an infectious disease caused by the bacterium Francisella tularensis. Symptoms may include fever, skin ulcer, and enlarged lymph nodes. Occasionally, a form that results in pneumonia or a throat infection may occur.  The bacterium is typically spread by ticks, deer flies, or contact with infected animals. It may also be spread by drinking contaminated water or breathing in contaminated dust

West Nile virus

Ticks have also been found to carry this virus.

Cause

Why is the tick population rising and spreading?  Man.

Reduction in tick predators [caused by man] - In nature, undisturbed by man, many bacteria, fungi, rodents, birds, and other living things contribute significantly toward limiting tick populations, as do, for instance, the grooming activities of hosts.  Natural predators of ticks include beetles, spiders, and ants, and parasites such as mites and nematodes.  But man has completely upset the balance of nature by his activities and predators have been decimated by pesticides, insecticides and other human activities.   

Let us take as an example, the hundreds of millions of cats kept as pets around the world.  A 2007 report stated that in the USA alone about 37 million US households owned cats, with an average of 2.2 cats per household giving a total population of around 82 million.  According to the Royal Society for the Protection of Birds, cats in the UK catch up to 275 million prey items a year, of which 55 million are birds. This is the number of prey items which were known to have been caught.  Many of these ‘prey items’ feed on ticks.  Mice do, voles do, rats do, birds do.

Climate change - Another man made cause is climate change:

Climate change, for example, contributes to an expansion in the tick's geographic range at extremes of altitude in central Europe, and at extremes of latitude in Scandinavia.

Change in distribution of tick hosts – the changes in the distribution and abundance of tick hosts affect where the ticks are spreading to and how well they thrive.   The latitudinal and altitudinal spread of the important tick vector Ixodes ricinus (Acari: Ixodidae) in Europe, for example, as well as changes in the distribution within its prior endemic zones is in part related to one of its hosts - roe deer and other cervids [mammals in the deer family].

Prevention

Ticks can climb to the top of foliage and attach to passing animals, generally small mammals, but also humans if they get the chance.  Tick bites are best prevented by people avoiding tick-infested areas. When this is not possible, avoid walking through long grass and areas of thick foliage - consider keeping to paths and tracks in heavily infested areas.

Leave no exposed skin on your legs, feet, ankles or arms - wear long sleeves, tuck trousers into your socks or wear gaiters, choose fabric which is thickly woven.   Wear light-coloured clothing so you can see the dark ticks and remove them - inspect clothing often to remove the ticks.

Spray insect repellent on clothing and socks.

Check yourself, your children and your pets for ticks when you get home, especially your hairline, navel, groin, arm pits, between toes, behind the ears and knees.

Repellants

Essential oils have a use in repelling the ticks.  One chooses one’s oil according to the activity one wishes to obtain

Acaricide   - The name used to describe a substance poisonous to mites or ticks is an Acaricide.   Ticks belong to the arachnid subclass Acari, hence the name Acaricides as the term for a pesticide that kills members of this family.  Over 500 plants or chemicals have Acaricidal activity according to Dr Duke’s phytochemical database including

• Alehoof
• Limonene
• Sulfur powder - a common method of use is to dust clothing or limbs with sulfur powder
• Yarrow

For a full list see this LINK

Ixodicide - "Ixodicides" are substances that specifically kill ticks.  The following plants have Ixodicidal activity according to Dr Duke’s phytochemical database, all appear to rely on the chemical Pilocarpine

• Pilocarpus jaborandi Indian Hemp; Pernambuco Jaborandi
• Pilocarpus microphyllus Maranhao Jaborandi
•  Pilocarpus pennatifolius Paraguay Jaborandi
• Pilocarpus racemosus Guadalupe Jaborandi

Insectifuge  - In contrast, the term Insectifuge is used to describe any substance that drives off insects.  Over 1000 plants have Insectifugal activity according to Dr Duke’s phytochemical database, please follow this LINK 

Treatment – removing ticks from your body

The most important thing to concentrate on NOT doing when you are removing a tack is to squeeze its engorged body.  If it is squeezed in any way whilst it is being removed, then the blood mixed with any pathogens it carries will all be injected into your blood stream and from that point on you will have acquired the pathogens .

Another reliable method of removing a tick without leaving any remnants in your skin is to purchase a tick hook.  Tick hooks come in different sizes for different sizes of tick and are not expensive - they also come with instructions for safe removal.

If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick

Eradication and control

Reducing and controlling tick populations is difficult, if not almost impossible.  One strategy that has been used is habitat modification, including vegetation management by cutting, burning, and herbicide treatment, and drainage of wet areas, but the effect is “often short-lived, and can cause severe ecologic damage”.

Chemicals used to control ticks may cause environmental contamination, and therefore, toxicity for humans and animals. Furthermore, the pesticides once used in an attempt to control ticks are now becoming less effective as the ticks build up resistance, there has understandably been a backlash from the public, who are now demanding safer food and a cleaner environment .

Biologic control methods for ticks include the promotion of natural predators. This has resulted in more studies starting to appear on the pathogens, parasitoides, and predators of ticks

Ongoing research has tended to focus almost exclusively on bio-control, instead of the more obvious solution of controlling men and the constant war they wage against nature, which given that it is nature that sustains us, would seem to be somewhat foolish and unwinnable.

It is worthy of note that the reintroduction of oxpecker birds in some areas of Zimbabwe remains up to now the only known successful attempt at tick biocontrol.  Working with nature and restoring her back to the balanced state of before.

References and further reading

• Jacobson, M., Glossary of Plant-Derived Insect Deterrents, CRC Press,
• Annu Rev Entomol. 1999;44:159-82. Pathogens and predators of ticks and their potential in biological control. Samish M1, Rehacek J.  DOI:  10.1146/annurev.ento.44.1.159
• Ann N Y Acad Sci. 2000;916:172-8.  Biocontrol of ticks.  Samish M1.  Department of Entomology, Kimron Veterinary Institute, Bet Dagan 50250, Israel. MSAMI_VS@netvision.net.il
• Braz J Otorhinolaryngol. 2016 Jul-Aug;82(4):416-21. doi: 10.1016/j.bjorl.2015.07.018. Epub 2015 Nov 6.  Otoacariasis: demographic and clinical outcomes of patients with ticks in the ear canal.  Gökdoğan O1, Çakabay T2, Baran H3, Karabulut B4, Tasdemir C5, Vatansever Z6.  PMID:  26614049
• Crit Care Nurs Clin North Am. 2007 Mar;19(1):27-38.  Rickettsial and other tick-borne infections. - Flicek BF1.  DOI:  10.1016/j.ccell.2006.11.001
• Front Cell Infect Microbiol. 2017; 7: 281. Published online 2017 Jun 22. doi: 10.3389/fcimb.2017.00281 PMCID: PMC5479950  PMID: 28690983  The Essential Role of Tick Salivary Glands and Saliva in Tick Feeding and Pathogen Transmission  Ladislav Šimo,1 Maria Kazimirova,2 Jennifer Richardson,3 and Sarah I. Bonnet1,*
• Front Cell Infect Microbiol. 2018 May 9;8:149. doi: 10.3389/fcimb.2018.00149. eCollection 2018.  Epidemiology, Pathogenesis, and Control of a Tick-Borne Disease- Kyasanur Forest Disease: Current Status and Future Directions.  Shah SZ1, Jabbar B1,2, Ahmed N1, Rehman A3, Nasir H1, Nadeem S1, Jabbar I4, Rahman ZU1, Azam S1.
• Vector Borne Zoonotic Dis. 2013 Apr;13(4):250-5. doi: 10.1089/vbz.2012.1198. Epub 2013 Feb 21.  The relevance of forest fragmentation on the incidence of human babesiosis: investigating the landscape epidemiology of an emerging tick-borne disease.  Walsh MG1
• Exp Appl Acarol. 2013 Feb;59(1-2):219-44. doi: 10.1007/s10493-012-9615-0. Epub 2012 Sep 27.  Changing distributions of ticks: causes and consequences.  Léger E1, Vourc'h G, Vial L, Chevillon C, McCoy KD.
• Expert Rev Anti Infect Ther. 2010 Jan;8(1):33-50. doi: 10.1586/eri.09.118.  A clear and present danger: tick-borne diseases in Europe.  Heyman P1, Cochez C, Hofhuis A, van der Giessen J, Sprong H, Porter SR, Losson B, Saegerman C, Donoso-Mantke O, Niedrig M, Papa A.
• Parasit Vectors. 2013 Jan 2;6:1. doi: 10.1186/1756-3305-6-1.  Driving forces for changes in geographical distribution of Ixodes ricinus ticks in Europe.  Medlock JM1, Hansford KM, Bormane A, Derdakova M, Estrada-Peña A, George JC, Golovljova I, Jaenson TG, Jensen JK, Jensen PM, Kazimirova M, Oteo JA, Papa A, Pfister K, Plantard O, Randolph SE, Rizzoli A, Santos-Silva MM, Sprong H, Vial L, Hendrickx G, Zeller H, Van Bortel W.
• Littman MP, et al. ACVIM small animal consensus statement on Lyme disease in dogs: diagnosis, treatment, and prevention. J Vet Intern Med. 2006; 20:423.
• Diniz P and Breitschwerdt E. Anaplasma phagocytophilum infection (Canine Granulocytic Anaplasmosis). In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier Saunders; 2012: 244-254
• Greene, CE; Breitschwerdt, EB. Rocky Mountain spotted fever, Q Fever, and typhus. In Greene, CE (ed.):Infectious Diseases of the Dog and Cat. W.B. Saunders Co. Philadelphia, PA; 1998;155-162.
• Harris S, Waner T and Neer TM. Ehrlichia canis infection. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier Saunders; 2012: 227-238.
• Birkenheuer A. Babesiosis. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier Saunders; 2012: 771-784.
• Baneth G. Hepatozoon canis infection. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier Saunders; 2012: 750-757.
• Macintire D, Vincent-Johnson N and Potter M. Hepatozoon americanum infection. In: Greene CE, ed. Infectious Diseases of the Dog and Cat. 4th ed. Elsevier Saunders;
• J Rheumatol. 1993 Apr;20(4):739-41.  Positive serology for Lyme borreliosis in patients with juvenile rheumatoid arthritis in a Lyme borreliosis endemic area: analysis by immunoblot.  Sood SK1, Rubin LG, Blader ME, Ilowite NT.
• Prevalence of tick-borne encephalitis virus (TBEV) RNA in Dermacentor reticulatus ticks from natural and urban environment, Poland.  Biernat B, Karbowiak G, Werszko J, Stańczak J.  Exp Appl Acarol. 2014 Jul 22. [Epub ahead of print]  PMID:  25047961
• Proc Natl Acad Sci U S A. 2012 Jul 3;109(27):10942-7. doi: 10.1073/pnas.1204536109. Epub 2012 Jun 18.  Deer, predators, and the emergence of Lyme disease.  Levi T1, Kilpatrick AM, Mangel M, Wilmers CC.  PMID:  22711825
• Proc Biol Sci. 2017 Jul 26;284(1859). pii: 20170453. doi: 10.1098/rspb.2017.0453.  Cascading effects of predator activity on tick-borne disease risk.  Hofmeester TR1, Jansen PA2,3, Wijnen HJ2,4, Coipan EC5, Fonville M5, Prins HHT2, Sprong H5, van Wieren SE2.  PMID:  28724731
• Vet World. 2015 Mar; 8(3): 301–315.   Published online 2015 Mar 12.   doi: 10.14202/vetworld.2015.301-315;  PMCID: PMC4774835; PMID: 27047089  Tick-borne infections in human and animal population worldwide  José Brites-Neto,1 Keila Maria Roncato Duarte,2 and Thiago Fernandes Martins3

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