[TIBOLA--a new tick-borne infection]

Twenty-seven cases of a tick-transmitted infection with similar symptoms were seen by the author in the last 14 months. These symptoms do not fit into the known tick-borne infections. The bite caused by a "strikingly big" engorged tick was almost uniformly located on the occipital scalp region. The infection occurred most commonly in young children: the larger half of the patients were less than 10 years of age. The main symptom, presented in all patients, was the enlargement of painful lymph nodes in the region of the tick bite, causing us to name the infection Tick-BOrne LymphAdenopathy ("TIBOLA"). The other major feature, presented more than a half of the cases, was a herpes-like eschar 0.5-3 cm in diameter at the site of the tick bite. The eruption could be surrounded by a circular erythema (6 cases). After healing of the eruption, alopecia remained at the site. The time from the bite to the first symptom varied between 1-30 (mean 8) days. Doxycyclin seemed to shorten the disease. The infection seemed benign since only 4 patients had high fever, while 3 patients had a low grade fever (37-38 degrees C). General symptoms lasted for 3-12 months. Contrary to Lyme borreliosis, which is highly distributed all over in Hungary, the new tick-transmitted infection seems geographically more restricted, with almost all of the patient reporting that the tick bite occurred in a 120 km wide and 200 km long region along the banks of the Danube. Most probably, the disease is caused by a rickettsia infection which is still needed to be proven.