Tick-Borne Diseases Beyond Lyme and TBE: Anaplasmosis, Babesiosis and Rickettsia

Hiker in trousers tucked into socks walking a sunlit autumn woodland path lined with tall grass and ferns, typical tick habitat in Europe

Key takeaways

  • Lyme disease and TBE are not the only infections ticks carry. In Europe, ticks can also transmit anaplasmosis, babesiosis, several spotted fever rickettsioses, tularaemia and, in the south-east, Crimean-Congo haemorrhagic fever (CCHF).
  • The same tick can carry more than one germ. The common castor bean tick (Ixodes ricinus) can carry the bacteria behind Lyme disease and anaplasmosis, as well as Babesia parasites, so co-infections are possible.
  • Most of these diseases start with flu-like symptoms such as fever, headache, chills and aching muscles, often days to a few weeks after a bite that may have gone unnoticed.
  • Many are treatable when recognised early. Telling your doctor about a recent tick bite or time outdoors helps them think beyond Lyme disease.
  • Prevention is the same for all of them: avoid bites with clothing and a repellent recommended against ticks, check your body daily and remove ticks promptly.

When people in Europe think about tick bites, two diseases usually come to mind: Lyme disease (borreliosis) and tick-borne encephalitis (TBE). They are the most common and best known, but they are not the whole story. Ticks are efficient carriers of bacteria, parasites and viruses, and a handful of less familiar tick-borne diseases are diagnosed every year across the continent. This guide explains the main tick-borne diseases beyond Lyme and TBE, including anaplasmosis, babesiosis and rickettsia infections, where they occur, which symptoms to watch for, and why the same simple prevention habits protect against all of them.

Why ticks carry so many different diseases

Ticks feed only a few times in their lives, but each blood meal can last several days. During those meals they pick up microbes from deer, rodents, birds and other animals, and can pass them on at the next bite. Because a single tick often feeds on different hosts during its larval, nymph and adult stages, it can collect more than one pathogen along the way.

Different tick species also carry different diseases. In most of central and northern Europe, the main species that bites people is Ixodes ricinus. In southern Europe, the brown dog tick (Rhipicephalus sanguineus), Dermacentor ticks and Hyalomma ticks play a bigger role. Where you walk, and in which season, shapes which infections are realistic risks.

The main tick-borne diseases beyond Lyme and TBE

Disease Cause Main ticks in Europe Where it occurs Typical early signs
Anaplasmosis Bacterium Anaplasma phagocytophilum Ixodes ricinus Widespread across Europe Fever, headache, chills, muscle aches; rash is uncommon
Babesiosis Parasites of the genus Babesia that infect red blood cells Ixodes ricinus Sporadic cases across Europe Often no symptoms; fever, tiredness, dark urine; severe in people without a spleen
Spotted fever rickettsioses Bacteria of the genus Rickettsia Brown dog tick, Dermacentor, Ixodes Mediterranean region; some types across central Europe Fever, headache, a dark scab (eschar) at the bite, sometimes a rash
Tularaemia Bacterium Francisella tularensis Several species (ticks are one of several routes) Patchy across Europe, more in the north and east Fever, an ulcer at the bite, swollen lymph nodes
Crimean-Congo haemorrhagic fever (CCHF) Virus Hyalomma Balkans, Turkey, parts of Spain and south-eastern Europe Sudden high fever, muscle pain; can become severe

Anaplasmosis

Human granulocytic anaplasmosis is caused by Anaplasma phagocytophilum, a bacterium that infects white blood cells. In Europe it is carried by the same tick that spreads Lyme disease, so it occurs in many of the same woodland and meadow habitats. Symptoms usually appear one to two weeks after a bite and include fever, headache, chills and muscle aches. Unlike Lyme disease, anaplasmosis rarely causes a skin rash, which is one reason it can be overlooked. It is treated with antibiotics, and early treatment matters, especially for older adults and people with weakened immune systems.

Babesiosis

Babesiosis is caused by microscopic Babesia parasites that live inside red blood cells, in a way that resembles malaria. Many infections cause no symptoms at all. When symptoms do appear, they can include fever, chills, sweats, tiredness and signs of red blood cell breakdown such as dark urine. Human cases in Europe are rare but can be serious, particularly in people who have had their spleen removed, who have weakened immunity or who are elderly. Babesiosis can also be passed on through blood transfusions, which is why blood services take it into account.

Spotted fever rickettsioses

Rickettsiae are small bacteria that cause a group of illnesses known as spotted fevers. The best known in Europe is Mediterranean spotted fever, carried mainly by the brown dog tick and seen most often in summer around the Mediterranean. A typical sign is a small black scab at the bite site, called an eschar or tache noire, followed by fever and often a rash.

In central Europe, Dermacentor ticks can transmit another rickettsial infection often referred to as TIBOLA or SENLAT. It usually follows a tick bite on the scalp and causes a scab there, swollen lymph nodes in the neck and sometimes fever. Rickettsial infections respond to antibiotics, so mentioning the bite and the scab to a doctor is important.

Tularaemia

Tularaemia, sometimes called rabbit fever, is caused by the bacterium Francisella tularensis. Ticks are only one route of infection; people can also catch it from handling infected hares and rodents, from biting flies or from contaminated water. After a tick bite, it typically causes fever, a skin ulcer where the bite was and swollen, tender lymph nodes nearby. It is uncommon in most of Europe and treatable with antibiotics.

Crimean-Congo haemorrhagic fever (CCHF)

CCHF is a viral disease carried by Hyalomma ticks, large ticks with striped legs that actively move towards people and animals. It is established in parts of the Balkans and Turkey, and cases have been reported in Spain. Infections are rare, but the disease can become severe, with sudden high fever, muscle pain and, in some cases, bleeding. Public health agencies such as ECDC monitor the spread of Hyalomma ticks closely because a warmer climate may help them expand their range. There is no widely available vaccine, so avoiding bites is the main protection.

Co-infections: when one bite carries more than one germ

Because Ixodes ricinus can carry Borrelia (Lyme disease), Anaplasma and Babesia at the same time, a single bite can occasionally cause more than one infection. Co-infection can make symptoms more intense or less typical, and it is one reason doctors may consider further tests if someone treated for Lyme disease does not improve as expected. For an overview of the most common tick-borne infection, see our guide Lyme Disease: Key Facts and How to Avoid Tick Bites.

Symptoms after a tick bite: when to see a doctor

Many tick bites go unnoticed, so it helps to think about recent outdoor time as well as known bites. Contact a doctor if, in the days or weeks after being in tick habitat, you notice:

  • fever, chills, headache or aching muscles that feel like flu outside flu season,
  • an expanding red rash, or a dark scab or ulcer where a tick was attached,
  • swollen, tender lymph nodes near a bite, for example in the neck after a scalp bite,
  • unusual tiredness, dark urine or yellowing of the skin,
  • any symptoms after travel to southern or south-eastern Europe where you were bitten by a large tick.

Tell the doctor where and when you were outdoors and whether you removed a tick. That context helps them consider anaplasmosis, rickettsial infections or other causes rather than focusing only on Lyme disease. Keeping a photo of the tick or the bite, with a date, can also help.

Prevention works against all of them

The good news is that you do not need a separate strategy for each disease. Whatever the germ, it reaches you through a bite, so the protective steps recommended by ECDC and CDC are the same:

  1. Dress for tick habitat: long, light-coloured trousers tucked into socks and closed shoes make ticks easier to see and harder to reach skin.
  2. Use a repellent recommended against ticks on exposed skin, and reapply according to the label.
  3. Stay on paths and avoid brushing through tall grass, bracken and undergrowth where possible.
  4. Check your whole body after being outdoors, including the scalp, behind the ears, armpits, groin and behind the knees.
  5. Remove attached ticks promptly with fine-tipped tweezers or a tick tool. Our step-by-step guide on how to remove a tick safely explains the technique.
  6. Check pets and gear, since dogs in particular can bring brown dog ticks into the home.

How incognito® helps

Since every tick-borne disease begins with a bite, reducing bites is the most practical way to reduce risk. incognito® repellents are DEET-free and use PMD (Citrepel®), a plant-based active derived from Cymbopogon winterianus (Java citronella). PMD belongs to the class of repellent ingredients recognised by health authorities alongside DEET. Our formulas are clinically proven, vegan, biodegradable and recommended against both mosquitoes and ticks.

For walks, gardening, camping and trips to southern Europe, the Active Tick Protection Bundle brings together the repellent spray, a roll-on for targeted areas such as ankles, neck and behind the ears, and an SPF 30 sunblock with insect repellent. Always follow the product label for application and age guidance, and keep up your daily tick check.

FAQs

What diseases can ticks carry besides Lyme disease?
In Europe, ticks can also carry tick-borne encephalitis (TBE), anaplasmosis, babesiosis, spotted fever rickettsioses, tularaemia and, in parts of south-eastern Europe, Crimean-Congo haemorrhagic fever. Most are rare, and many are treatable when diagnosed early.

Can one tick bite give you more than one disease?
Yes. The castor bean tick can carry the bacteria behind Lyme disease and anaplasmosis as well as Babesia parasites, so co-infections are possible, although uncommon.

What are the symptoms of anaplasmosis?
Anaplasmosis usually causes fever, headache, chills and muscle aches one to two weeks after a tick bite. A rash is uncommon. It is treated with antibiotics, so see a doctor if you develop these symptoms after time in tick habitat.

Is babesiosis dangerous?
Many babesiosis infections cause no symptoms, but it can be serious for people without a spleen, people with weakened immunity and older adults. Anyone in these groups should seek medical advice promptly if they develop fever after a tick bite.

What does a black scab after a tick bite mean?
A dark scab (eschar) at the bite site, especially with fever, headache or swollen lymph nodes, can be a sign of a rickettsial infection. Show it to a doctor and mention the tick bite.

Does the TBE vaccine protect against other tick-borne diseases?
No. The TBE vaccine protects only against tick-borne encephalitis. Avoiding bites, checking your body and removing ticks promptly remain essential for all other tick-borne infections.

Sources

This article is for general information only and does not replace medical advice. If you feel unwell after a tick bite or after time outdoors in tick habitat, contact your doctor or a pharmacist.