Gastrointestinal and hepatic symptoms of tickborne diseases

Česká verzia

Authors: Mária Budzáková ¹; Jan Trna ^1,2
Authors place of work: Interní oddělení Nemocnice Boskovice ¹; Gastroenterologické oddělení MOÚ Brno ²
Published in the journal: Vnitř Lék 2020; 66(4): 232-235
Category:

Summary

While investigating patients with gastrointestinal (GI) and/or hepatic symptoms, tickborne diseases are only rarely considered to be the cause. However, the Czech Republic is an endemic region for several of tickborne diseases and, therefore, they should be a part of differential diagnosis of GI symptoms of unknown origin. This article describes GI and hepatic symptoms of several tickborne diseases – Lyme disease, ehrlichiosis, Rocky mountain spotted fever, tularemia, Colorado tick fever, tickborne relapsing fever, Q fever and babesiosis. GI and hepatic symptoms are quite common in Lyme disease patients. The prognosis is generally favourable with antibiotics treatment, however, serious courses have been described. Lyme disease should be a part of differential diagnosis of liver tests elevation and GI symptoms in patients from endemic regions regardless erythema migrans presence. Ehrlichiosis should be a part of differential diagnosis of acute febrile illness with GI symptoms especially in the presence of leukopenia/thrombocytopenia and/or liver tests elevation. Tularemia should be considered as a rare etiology of cholestatic hepatopathy and a history of a tick bite. In general, the importance of careful patient interviewing, including the history of a tick bite, can be highlighted also as a part of investigation of patients with seemingly unrelated GI and/or hepatic symptoms.

Keywords:

Babesiosis – Colorado tick fever – ehrlichiosis – gastrointestinal diseases – hepatic diseases – Lyme disease – Q fever – Rocky mountain spotted fever – tick -borne relapsing fever – tularemia – symptoms – symptom

Zdroje

1. Janovská D Epidemiologická situace v České republice. In: Bartůněk P (ed). Lymeská borelióza. 4. vydání. Praha: Grada Publishing 2013, 25–43.

2. Steere AC, Bartenhagen NH, Craft JE et al. The Early Clinical Manifestations of Lyme Disease. Ann Intern Med 1983; 99: 76–82.

3. Schefte DF, Nordentoft T Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis. A Case Report. J Neurogastroenterol Motil 2015; 21: 440–442.

4. Kazakoff MA, Sinusas K, Macchia C Liver function test abnormalities in early Lyme disease. Arch Fam Med 1993; 2: 409–413.

5. Horowitz HW, Dworkin B, Forseter G et al. Liver function in early Lyme disease. Hepatology 1996; 23: 1412–1417.

6. Soloski MJ, Crowder LA, Lahey LJ et al. Serum inflammatory mediators as markers of human Lyme disease activity. PLoS One 2014; 9: e93243.

7. Massaroti EM, Luger SW Rahn DW et al. Treatment of early Lyme disease. Am J Med 1992; 92: 396–403.

8. Zanchi AC, Gingold AR, Theise ND et al. Necrotizing granulomatous hepatitis as an unusual manifestation of Lyme disease. Dig Dis Sci 2007; 52: 2629–2632.

9. Stanek G, Strle F Lyme borreliosis‑from tick bite to diagnosis and treatment. FEMS Micro‑ biol Rev 2018; 42: 233–258.

10. Derdáková M, Lencáková D Association of genetic variability within the Borrelia burgdorferi sensu lato with the ecology, epidemiology of Lyme borreliosis in Europe. Ann Agric Environ Med 2005; 12: 165–172.

11. Wang G, van Dam AP, Schwartz I et al. Molecular typing of Borrelia burgdorferi sensu lato: taxonomic, epidemiological, and clinical implications. Clin Microbiol Rev 1999; 12: 633–653.

12. Stanek G, Reiter M The expanding Lyme Borrelia complex – clinical significance of genomic species? Clin Microbiol Infect 2011; 17: 487–493.

13. Swanson SJ, Neitzel D, Reed KD et al. Coinfections acquired from ixodes ticks. Clin Microbiol Rev 2006; 19: 708–727.

14. Moutailler S, Valiente Moro C, Vaumourin E et al. Co‑infection of Ticks: The Rule Rather Than the Exception. PLoS Negl Trop Dis 2016; 10: e0004539.

15. Stuen S, Granquist EG, Silaghi C Anaplasma phagocytophilum – a widespread multi‑host pathogen with highly adaptive strategies. Front Cell Infect Microbiol. 2013; 3: 31.

16. Comstock LE, Thomas DD Penetration of endothelial cell monolayers by Borrelia burgdorferi. Infect Immun 1989; 57: 1626–1628.

17. Duray PH, Steere AC Clinical pathologic correlations of Lyme disease by stage. Ann NY Acad Sci 1988; 539: 65–79.

18. Aberer E, Brunner C, Suchanek G et al. Molecular mimicry and Lyme borreliosis: a shared antigenic determinant between Borrelia burgdorferi and human tissue. Ann Neurol 1989; 26: 732–737.

19. Middelveen MJ, McClain SA, Bandoski C et al. Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report. Research 2014; 1: 875.

20. Zaidi SA, Singer C Gastrointestinal and hepatic manifestations of tickborne diseases in the United States. Clin Infect Dis 2002; 34: 1206–1212.

21. Olano JP, Hogrefe W, Seaton B et al. Clinical manifestations, epidemiology, and laboratory diagnosis of human monocytotropic ehrlichiosis in a commercial laboratory setting. Clin Diagn Lab Immunol 2003; 10: 891–896.

22. Nutt AK, Raufman J Gastrointestinal and hepatic manifestations of human ehrlichiosis: 8 cases and a review of the literature. Dig Dis 1999; 17: 37–43.

23. Gershel JC Human granulocytic ehrlichiosis presenting as abdominal pain. Pediatrics 2000; 106: 602–604.

24. Wallace BJ, Brady G, Ackman DM et al. Human Granulocytic Ehrlichiosis in New York. Arch Intern Med 1998; 158: 769–773.

25. Schiffman J, Haq M, Procopio F et al. Ehrlichiosis infection in a 5-year‑old boy with neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly. J Pediatr Hematol Oncol 2001; 23: 324–327.

26. Ismail N, McBride JW Tick‑Borne Emerging Infections: Ehrlichiosis and Anaplasmosis. Clin Lab Med 2017; 37: 317–340.

27. Parola P, Paddock CD, Socolovschi C et al. Update on Tick‑Borne Rickettsioses around the World: a Geographic Approach. Clin Microbiol Rev 2013; 26: 657–702.

28. Dahlgren FS, Holman RC, Paddock CD et al. Fatal Rocky Mountain Spotted Fever in the United States, 1999-2007. Am J Trop Med Hyg 2012; 86: 713–719.

29. Walker DH, Henderson FW, Hutchins GM Rocky Mountain spotted fever: mimicry of appendicitis or acute surgical abdomen? Am J Dis Child 1986; 140: 742–744.

30. Middleton DB Rocky Mountain spotted fever: gastrointestinal and laboratory manifestations. South Med J 1978; 71: 629–632.

31. Regan JJ, Traeger MS, Humpherys D et al. Risk factors for fatal outcome from rocky mountain spotted fever in a highly endemic area‑Arizona, 2002-2011. Clin Infect Dis 2015; 60: 1659–1666.

32. Gottlieb M, Long B, Koyfman A The Evaluation and Management of Rocky Mountain Spotted Fever in the Emergency Department: a Review of the Literature. J Emerg Med 2018; 55: 42–50.

33. Randall MB, Walker DH Rocky Mountain spotted fever: gastrointestinal and pancreatic lesions and rickettsial infection. Arch Pathol Lab Med 1984; 108: 963–967.

34. Sahni A, Fang R, Sahni SK et al. Pathogenesis of Rickettsial Diseases: Pathogenic and Immune Mechanisms of an Endotheliotropic Infection. Annu Rev Pathol 2019; 14: 127–152.

35. Kirkland KB, Wilkinson WE, Sexton DJ Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis 1995; 20: 1118–1121.

36. Zellner B, Huntley JF Ticks and Tularemia: Do We Know What We Don’t Know? Front Cell Infect Microbiol 2019; 9: 146.

37. Dienst FT Tularemia: a perusal of three hundred thirty‑nine cases. J La State Med Soc 1963; 115: 114–1127