The emerging tick-borne pathogen Neoehrlichia mikurensis: first French case series and vector epidemiology

ABSTRACT

Neoehrlichia mikurensis is an intracellular bacterium transmitted in Europe and Asia by ticks of the Ixodes ricinus complex. Interest in this bacterium has increased since it was demonstrated to be responsible for febrile syndromes in patients. To date, most clinical cases have been reported in northern Europe, but case series have also been described in central Europe and China. Notably, thrombotic events occurred during the course of the disease. We investigated the presence of N. mikurensis in 10,885 I. ricinus nymphs in two regions of France (Alsace and Brittany) collected between 2013 and 2020 and in 934 patients suspected of human granulocytic anaplasmosis in Alsace, an endemic area for Lyme borreliosis, using a specific PCR assay. N. mikurensis was detected in 5.42% of the ticks from Alsace, whereas only one (0.03%) tick was found to be positive in Brittany. Spatiotemporal disparities were also noticed within the Alsace region over the four collection sites investigated, and a significant increase in the prevalence of nymphs carrying N. mikurensis was also observed in the last three years of collection. Four out of 934 screened patients were found to be positive for N. mikurensis. Two had malignancies, and the other two were apparently immunocompetent. Superficial thrombosis was noticed in one patient, and long-lasting bacteremia was noted in another patient. These four patients are the first clinical cases of neoehrlichiosis described in France. We suggest including N. mikurensis in the differential diagnosis of post-tick bite febrile syndromes to treat patients and prevent the occurrence of thrombotic complications.

KEYWORDS:

• Tick-borne diseases
• post-tick bite fever
• Neoehrlichia mikurensis
• Neoehrlichiosis
• vector epidemiology

Acknowledgements

We thank Pierre Kieffer, Martin Martinot, Elisabeth Wurtz, Régis Dukic, Geneviève Boess, André Michel, Christophe Strady, Jean François Sagez, Nicolas Lefebvre, Guillaume Gregorowicz and Xavier Argemi for their help in providing clinical data. We also thank the NRC for Borrelia staff for technical help in collecting ticks and especially Filiz Kavla. Finally, we warmly thank Marie-Christine Michellet for the critical reading and English editing of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors thank Santé Publique France which partially funded this study.