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Tickborne Diseases Abroad

  • Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union; in northwestern China; central Asia; southern Europe; Africa; the Middle East; and the Indian subcontinent.
  • Imported tickborne spotted fevers (rickettsial infections) have caused infection in returning travelers. In the U.S., the most frequently diagnosed rickettsial infection associated with international travel is caused by Rickettsia africae (the agent of African spotted fever).
  • Kyasanur forest disease is found in southern India and is typically associated with exposure to ticks while harvesting forest products. Additionally, a similar virus has been described in Saudi Arabia (Alkhurma hemorrhagic fever virus).
  • Lyme disease can be contracted in temperate forested regions throughout Europe and northern Asia although it is more common in eastern and central Europe than western Europe. In contrast to North America, Lyme disease can be caused by several different species of Borrelia burgdorferi and may have somewhat different symptoms. The initial rash, or erythema migrans (EM), may last longer but have less associated inflammation than the EM produced by U.S. infections. Additionally, not all tests in the U.S. will reliably detect infection with European species. Providers who suspect European-acquired Lyme disease should request testing using a C6 ELISA assay as a stand-alone diagnostic test. Additional information is available from the group, European Concerted Action on Lyme Borreliosis (EUCALB), regarding European Lyme disease serologic tests.
  • Omsk Hemorrhagic Fever (OHF) occurs in the western Siberia regions of Omsk, Novosibirsk, Kurgan, and Tyumen. It may be also be acquired by direct contact with infected muskrats.
  • Tickborne encephalitis (TBE) occurs in some forested areas in Europe and Asia, from eastern France to northern Japan and from northern Russia to Albania. TBE is caused by TBE virus, a flavivirus that is closely related to Powassan virus. TBE virus has three subtypes: European, Siberian, and Far Eastern. TBE virus is primarily transmitted to humans by infected Ixodes species ticks. It can also be acquired by ingesting unpasteurized dairy products (such as milk and cheese) from infected goats, sheep, or cows.

Note: Anaplasmosis, babesiosis, ehrlichiosis, tularemia, tickborne relapsing fever, Rocky Mountain spotted fever, and Powassan disease can also be acquired internationally.

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