The attachment site of ticks has been studied in the context of both animal and human tick preference. In Oklahoma, a study of horses indicated that A. americanum preferentially bites the inguinal area, while I. scapularis and D. albipictus, the moose-tick, primarily bite the chest and axillary region, with D. albipictus often being found on the back18. A survey of dogs and cats across the US identified a similar distribution of ticks on dogs, with the attachment being most common on the abdomen, axillary and inguinal regions. However, this was species-specific with D. variabilis preferring the head and neck specifically19. Cats were more successfully parasitized by I. scapularis which preferred the head and A. americanum, which preferred the tail and perianal region19. This is similar to a study of tick distribution on wild black bears (Ursus americanus) in Pennsylvania, indicating that the primary tick present was I. scapularis and that the greatest numbers were found in association with the ears and muzzle20. In these cases, the ability for ticks to attach to specific areas is most likely a result of the grooming habits and abilities of the animals in question.
Studies of anatomical region preference in humans also reported tick bite-site specificity associated with particular tick species. For example, in Korea, H. longicornis was determined to prefer abdomen and lower extremities (33%) and the abdomen/inguinal area (26.4%)21, which is a behavior similar to that of A. americanum observed here. Although H. longicornis is present in New York1, insufficient numbers were detected to draw definitive conclusions about its biting preference here. Additionally, a study in England (I. ricinus) reported that tick bites were most common in the legs (50%) of adult humans, but in the head and necks of children (43%)22, a differentiation that our survey does not at this time include. A similar phenomenon was observed in Russia, where tick bites were most common on the head and neck of all individuals (39.2%), but were much more common in children (84.9%)23. This study determined that the bite-site of single tick bites that resulted in infection with the Tick-Borne Encephalitis virus (TBEV) were associated with lethal outcomes if the bites were located on the head, neck, arms or axilla, while less lethality was associated with bites to the lower limbs and groin. This is most directly analogous to the transmission of DTV by I. scapularis, suggesting that bite site may have a similar relationship to disease outcomes in the related North American pathogen/vector pair.
Under normal circumstances, ticks exist in sylvatic cycles with specific host preferences based on the tick species and life stage, with spillover to humans occasionally occurring for species with generalist feeding habits. Therefore, the feeding behaviors of ticks are variable, and this influences the ways that the ticks interact with humans.
Ixodes scapularis is less specific in host-site preference
The primary life stages of I. scapularis that bite humans include nymphs and adult females, although males may also be found on humans. The body segment preference of I. scapularis is less specific than for D. variabilis, which prefers the head, and A. americanum, which prefers the thighs and pelvic region. Ixodes scapularis is primarily found on the central trunk, including the groin/pelvic region, the abdomen, the thoracic region, and the head/neck. This varies between the life stages, with more adults found in the thoracic/abdominal region of the body and nymphs being more commonly found on the arms and legs. This is partly due to the substantial size difference between adult and nymph/larval I. scapularis, with larvae being almost imperceptible and nymphs having a total body length of two to four millimeters. This results in nymphs/larvae being much more difficult to see, allowing them to more readily attach to the most visible portions of the human body while adults are restricted mostly to areas covered by clothing and hair.
The presence of ticks on the head and neck indicates that I. scapularis tends to climb, although not with the preference for hair observed with D. variabilis. They appear to spend substantial time moving on the host, a period where they can be removed easily without having had a chance to potentially transmit pathogens by biting. On deer, this corresponds to a preference to move toward the neck and ears where the ticks are more difficult to dislodge24,25. On humans, it results in wide distribution across the whole body with less location specificity than other ticks.
In addition to body region and life stage identification, I. scapularis ticks were also screened for several pathogens to determine if infection status influences host site preference. Anaplasma phagocytophilum, B. microti, and other pathogens (DTV and B. miyamotoi) did not influence the body segment the ticks chose to feed. However, in ticks infected with B. burgdorferi, a statistically significant change in the distribution of tick bites marked by an increased report of tick bites in the midsection and a decreased tick bites in the arms, legs, and head. While this may suggest a change in tick behavior/fitness in response to infection, it may also relate to the differences in infection rates of adult and nymph/larval ticks. Larvae, having never fed, are not infected with B. burgdorferi, and the rate of infection in nymphs is lower than that of adults1. Nymphs are less likely to be infected and are more likely to attach to the arms and legs, which is a potential source of the observed difference in infection rates. However, it remains unclear why this is not observed for the other pathogens that follow the same trend of increased infection rate in adult versus nymph/larval ticks.
Bacterial and protozoal agents transmitted by I. scapularis take several hours for an infectious dose to be transmitted26,27,28. Therefore, prompt detection and removal of ticks is important for preventing tick-borne disease. Furthermore, understanding where the ticks attach allows them to be more easily detected, and also assists in preparing protective clothing for individuals entering tick-endemic areas. Additionally, knowing the biting location of I. scapularis could aid in detecting potential erythema migrans, a skin condition that occurs at the point of B. burgdorferi infected tick exposure in about 80% of cases29, which is highly diagnostic for both Lyme disease and STARI, which is transmitted by A. americanum.
Amblyomma americanum prefers the thighs and groin of subjects
Amblyomma americanum, the lone star tick, is present throughout the southern portion of New York and is particularly dominant on Long Island1. This species is relatively large, fast, and aggressive, feeding on various animals, including deer, medium-sized animals, and birds30. As a generalist feeder, both adult and nymph/larval A. americanum often bite humans in endemic areas. This experiment identified six larvae, 107 nymphs, and 48 adult A. americanum from human sources. The dominance of nymph submissions is likely due to the large size of the tick, making nymphs and adults easier to spot in more visible areas.
In terms of body segment location, all life stages of A. americanum were most often found in the thigh/groin/pelvic region. Considering that most humans encounter ticks while walking through vegetation, the ticks most likely first adhere to the legs and move upward before biting. In this case, the ticks bite rapidly instead of ascending in large numbers to the torso or head. This area is also almost invariably covered in relatively tight-fitting clothing. The closeness of the fabric may also assist in inducing the ticks to feed by slowing their ascent and creating contact to induce biting.
While it does not transmit the same range of pathogens as I. scapularis, A. americanum is still a medically significant species. This species can transmit Ehrlichia chaffeensis and E. ewingii31,32, which are at present rare in New York, but are likely to increase as more A. americanum becomes established. Amblyomma americanum is also associated with Southern Tick-Borne Rash Associated Illness (STARI)11, a disease of unknown etiology that has previously been observed in New York33 and with galactose-alpha-1,3-galactose (alpha-gal) allergy, a reaction to the tick’s saliva that can result in a long term, potentially serious allergic sensitivity to the consumption of red meat. While the attachment time required to transmit or induce these pathogens is still unclear, prompt detection and removal of the tick is still recommended. Knowing the approach of the tick and where it is likely to be found improves this process.
Additionally, it is unclear if the results observed for A. americanum also apply to the related A. maculatum, the vector of Rickettsia parkeri, a cause of spotted fever. These ticks have been observed in the southernmost portions of New York with a high infection rate with R. parkeri34. Since early R. parkeri infection may result in a visible eschar, understanding where the eschar is most likely located can be critical for rapid diagnosis before the onset of severe disease symptoms. Considering the similarities in behavior between the two Amblyomma species, it may have similar preferences to A. americanum. Other escharotic diseases, such as F. tularensis, may also be present and linked to a tick with a highly dissimilar segment preference. The location of the escar itself, therefore, may be at least partially diagnostic for specific pathogens. However, at present, the sample size within this community engaged passive surveillance program is too small to assess its biting behavior in detail.
Dermacentor variabilis exhibits preference for the human head
In this study, D. variabilis was almost exclusively encountered in its adult life stage. This indicates that while the adult ticks are generalist feeders that may bite humans, the nymph and larval stages are not and have much greater host specificity, either feeding exclusively on a specific type of animal or being restricted to the vicinity of animal burrows. The exact identity of the preferred larval and nymphal host of D. variabilis in New York could not be determined from these data, but is presumed to be one or several rodent species, lagomorph, or mesocarnivore with broad distribution across the eastern United States.
Additionally, D. variabilis was unique among the three species of ticks studied here. It had a strong bias toward the head and neck of human hosts, as opposed to a higher preference for the midsection and pelvis/groin with I. scapularis and especially A. americanum. This is clear evidence of climbing behavior, tending upward, but is also indicative of a strong preference for dense hair. In contrast to I. scapularis and A. americanum, D. variabilis in its adult stage is less likely to feed on deer35,36, with a preference for canids36, hence its colloquial name as the “American dog tick”. Hair provides the ticks with the same benefits as feeding on canids. It protects them from being immediately detected and removed, obscuring them until they can feed extensively. This can be of potential medical consequence in the case of tick paralysis, a condition of flaccid paralysis associated with the bite of Dermacentor spp. ticks30. In such cases, prompt removal of the tick is critical for treatment. Therefore, understanding its most likely location can be useful for removal of the tick before the onset of the condition, diagnostically to confirm the presence of the tick, or during treatment to ensure its removal. Considering that the tick will most likely be adult, it should be relatively obvious with careful observation.
Limitations of this study
The data described in this manuscript derived from a set of ticks submitted by general public, with site location from a questionnaire completed upon tick submission. While speciation and pathogen testing were performed under laboratory conditions, the public completed the initial survey and is therefore subject to a level of inherent error and ambiguity. In the context of this study, this mainly concerns whether the body location submitted concerns an attachment or a tick that is still crawling over the potential host in preparation for biting. The term “attachment” may be colloquially interpreted as to contain both categories, or a person can potentially be mistaken about the state of the tick. While ticks filled with blood have fed, the situation is more indeterminate for short-duration attachments where the ticks have not yet begun to engorge. This may introduce some level of error from ticks found on a body segment that were not, at the time of collection, attached. However, the data are overall still useful for predicting the most likely location where ticks of specific species can be found on a person. Studies with test subjects and ticks under controlled conditions may assist in elucidating this matter further. Additionally, this data set was compiled without regard to gender and age group. This data was not collected with this version of the questionnaire; therefore, the tick attachment cannot be stratified by any demographic parameters of tick submitters.
Source: Ecology - nature.com
