Vector / Transmission:

cat-scratch surface wounds (25,000 cases are reported in the USA annually), Ixodes ricinus (Germany/Europe: up to 40% contaminated ticks), Ixodes scapularis (deer tick)

Typical symptoms:

Papulae/rash and regional lymphadenopathy

Atypical symptoms:

tiredness (nearly 100%), headache (80%), amyostasia, muscle twitches, tremors, seizures, fever in the mornings (30%, in phases up to six weeks, otherwise 1-3 weeks), chills, skin pain, swollen lymphnodes, arthralgia (often), myalgia, insomnia, depression, agitation, severe mood swings, amentia, lack of concentration and alertness, dizziness, anxiety, outbursts, antisocial behaviour, restlessness, gastritis, intestinal symptoms, sore soles (especially in the morning), tender subcutaneous nodules along the extremities, occasional lymphadenopathy and light sweats

incubation time: 3–38 days

Complications:

endocarditis, bacilliary angiomatosis, retinitis, epilepsy, aseptic meningitis, hepatosplenomegalia, tonsillitis, cerebral arteritis, encephalitis

Risk factors:

bites by ticks, lice, sand flies, scratches by cats, immune suppression (children)