[Ticks and the pediatrician]

The match between ticks and pediatricians in Italy is usually a seasonal event related to the spring and summer trips and to the increasing of outdoor activity that sun and warm weather allow, both for children and ticks. So cared parents reach emergencies asking for tick removal but more often after the tick has yet been removed by empirical manoeuvres and after the killing and the destruction of the "enemy". We have scheduled, in the years 2002-2003, the 167 children that reached our unit for a tick bite; they where 92 males (mean age four years) and 75 females (mean age five years). Two of them had only a questionable tick bite but one had erythema on the lateral side of the left ankle, fever of obscure origin and weakness with generalised malaise. She was six years old and she lived with a dog on which, in more instances, ticks where found, but she never noticed ticks on her body. The dog had positive levels of anti rickettsial and anti borrelia antibodies but no evidence of conclamate illness. In this girl we found high titers of anti borrelia antibodies that WB testing confirmed to be anti B. burgdoferi. We diagnosed Lyme disease and treated the girl with amoxicillin (50 mg/kg/day) for three weeks achieving the complete relief of symptomatology till today. Three children with conclamate tick bite had positive levels of anti Rickettsia conorii antibodies with increasing levels at a twenty days control; two (aged four and five years) of them had a full symptomatology (tache noire, satellite lymphadenopathy, fever, and maculopapular erythema) for Meditarranean spotted fever; the latter (three years old) had an atypical form with the complete absence of maculopapular erythema. The therapy was clarithromycin (15 mg/kg/day) for three weeks. In Campania, in the years 2002/2003 on 167 children with tick bite that reached our unit, we found only four pathological correlable events; so are our ticks not infected? But we don't know how many children where tick bited and if there were other children with Lyme disease or Rickettsial disease because of the lack of a pediatric reference centre for "tick bite diseases" and the incomplete and late diffusion of knowledge on these diseases. Other Italian regions and such as Trentino Alto Adige, Veneto, and Friuli Venezia Giulia had a remarkable officially notified number of cases of Lyme disease and in Sicilia, Sardegna and Lazio there were numerous officially notified Rickettsial diseases. So we hope that Campania may be an happy island but we also think that a more effective cooperation between pediatricians and veterinarians and the creation of regional reference centres for tick bite diseases may arise a surveillance net to prevent the diffusion of these world wide emerging diseases and so that parents can achieve an univoque and useful information, the only way to defeat the fear of ignorance.