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Tick-Borne Infections

Bacterial, viral, and parasitic infections transmitted by ticks, including Lyme disease, rickettsioses, anaplasmosis, ehrlichiosis, babesiosis, and tick-borne encephalitis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Tick-Borne Infections?

Tick-borne infections (TBIs) are diseases transmitted by hard or soft ticks acting as vectors for bacterial, viral, and parasitic pathogens. Major examples include Lyme borreliosis (Borrelia burgdorferi/garinii/afzelii), spotted fever group rickettsioses (Rickettsia rickettsii, R. conorii), Mediterranean spotted fever, anaplasmosis (Anaplasma phagocytophilum), ehrlichiosis (Ehrlichia chaffeensis), babesiosis (Babesia microti, divergens), Crimean-Congo hemorrhagic fever (CCHF) virus, tick-borne encephalitis (TBE) virus, tularemia (Francisella tularensis), Powassan virus, relapsing fever borreliae, and emerging Heartland and Bourbon viruses.

Geographic distribution determines clinical possibilities: Lyme is widespread in temperate Northern Hemisphere; CCHF is endemic in Turkey and parts of Middle East and Africa; TBE is common in Central/Eastern Europe and Russia; spotted fevers depend on local rickettsial species. Co-infections are well described, especially Lyme with anaplasmosis or babesiosis. Severity ranges from mild self-limited illness to multi-organ failure and death.

Diagnosis combines exposure history (tick bite, hiking, livestock contact, geographic travel), clinical features (eschar, erythema migrans, cytopenias, hemorrhage, neurologic deficit), and laboratory testing (PCR, serology, blood smear for Babesia, EIA, Western blot, viral RT-PCR). Empirical doxycycline is started early in suspected bacterial TBI before laboratory confirmation; antiviral therapy is supportive in most viral TBIs, with ribavirin debated for CCHF. Prevention is by personal protective measures, tick checks, prompt tick removal, and TBE vaccination in endemic areas.

Symptoms

Fever, chills
Headache, myalgia
Erythema migrans (Lyme — bullseye rash)
Eschar (Mediterranean spotted fever, scrub typhus)
Petechial or maculopapular rash (rickettsioses)
Lymphadenopathy regional to bite
Fatigue, malaise
Arthralgia, arthritis (Lyme late)
Facial palsy, meningitis (Lyme neuroborreliosis, TBE)
Carditis with AV block (Lyme)
Hemolytic anemia (babesiosis)
Thrombocytopenia, leukopenia (anaplasmosis, ehrlichiosis, CCHF)
Elevated transaminases
Hemorrhage, bleeding (CCHF — petechiae, gingival, GI)
Encephalitis, seizures (TBE, Powassan)
Eschar with regional lymphadenitis (tularemia)
Conjunctivitis (oculoglandular tularemia)
Multi-organ failure in severe disease

Risk Factors

Outdoor activity in endemic areas (forest, grassland, livestock farm)
Hiking, camping, hunting
Occupational exposure (farmers, foresters, veterinarians)
Tick attachment >24-48 hours (Lyme transmission)
Inadequate protective clothing, repellent
Travel to endemic regions (Mediterranean, Russia, Central Europe, Turkey, USA)
Spring-summer-early autumn season
Pets in household carrying ticks indoors
Immunosuppression (severity)
Older age, comorbidities
Lack of TBE vaccination in endemic Europe
Splenectomy (babesiosis severity)
Pregnancy (some infections more severe)
Failure to perform tick checks

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Tick bite with fever, rash, or systemic symptoms
  • Erythema migrans (any size or shape)
  • Eschar with regional lymphadenopathy
  • Petechial or hemorrhagic rash
  • Meningitis or encephalitis after outdoor exposure
  • Severe headache, neck stiffness, confusion in endemic season
  • Bleeding, severe thrombocytopenia in CCHF endemic area
  • Hemolytic anemia, dark urine, jaundice (babesiosis)
  • Pregnancy with tick-borne illness suspicion
  • Immunocompromised patient with febrile illness after outdoor exposure

Treatment Methods

01
Detailed exposure history: location, season, activity, tick removal time
02
Examine entire skin, scalp, axilla, groin for ticks or eschar
03
Remove attached ticks with fine forceps, steady traction; do not crush; save for testing if needed
04
CBC, peripheral smear (intraerythrocytic Babesia), CMP, transaminases, coagulation, lactate
05
Serologic testing: Lyme EIA + Western blot (two-tier); rickettsial IFA; CCHF, TBE PCR/serology
06
PCR: Anaplasma, Ehrlichia, Babesia, CCHF, TBE
07
Blood smear for Borrelia (relapsing fever) and Babesia
08
Lumbar puncture if meningoencephalitis suspected
09
Empirical doxycycline 100 mg PO/IV BID for suspected rickettsioses, anaplasmosis, ehrlichiosis, Lyme — even in children when suspicion high
10
Lyme: doxycycline, amoxicillin, or cefuroxime; ceftriaxone IV for late neuroborreliosis or carditis
11
Babesiosis: atovaquone + azithromycin (mild), clindamycin + quinine (severe); exchange transfusion in severe parasitemia or splenectomized
12
CCHF: supportive care, isolation precautions; ribavirin considered with caution per local guidelines
13
TBE: supportive ICU care; no specific antiviral
14
Tularemia: streptomycin or gentamicin first-line; doxycycline or ciprofloxacin alternative
15
Powassan, Heartland, Bourbon: supportive
16
Hospital admission for severe disease, hemodynamic instability, severe cytopenias, neurologic involvement
17
Isolation and PPE for CCHF (high-containment biosafety)
18
Public health reporting for CCHF, tularemia, Lyme (depending on jurisdiction)
19
Prevention: DEET/permethrin repellents, long sleeves and pants tucked in, tick checks every few hours, prompt removal, pet tick prevention
20
TBE vaccination in endemic areas; pre-travel counseling
21
Single-dose doxycycline post-exposure prophylaxis for Lyme in selected high-risk cases (engorged Ixodes tick attached >36 hours in endemic area)
22
Patient education on tick avoidance, removal technique, symptom monitoring
23
Follow-up for chronic Lyme symptoms, post-treatment Lyme syndrome, post-CCHF rehabilitation

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.