Tick-borne lymphadenopathy (TIBOLA; also known as scalp eschar and neck lymphadenopathy after tick bite [SENLAT] and Dermacentor species-borne necrosis erythema and lymphadenopathy [DEBONEL]) is a rickettsial disease caused by Rickettsia slovaca (and less frequently, Rickettsia rioja and Rickettsia raoultii). TIBOLA is considered an emerging infectious disease in Europe, where it is now the second most common rickettsial disease. The prevalence of TIBOLA is higher in the colder seasons (autumn, winter, and spring) when its predominant vector, the Dermacentor marginatus tick, is most active.

Children and young adult women are more commonly affected. The tick favors hairy locations, particularly the scalp. Following a tick bite, there is an incubation period of days to weeks. An erythematous papule or pustule then develops at the inoculation site, soon evolving into a necrotic eschar that persists for 1-2 months with painful regional lymphadenopathy. Facial edema can accompany these findings. The necrotic eschar may heal with scarring alopecia. Additional symptoms, including low-grade fever, headache, myalgia, arthralgia, vertigo, anorexia, fatigue, and dizziness, may be noted. TIBOLA is usually a benign illness, though a prolonged course of up to 18 months could occur without treatment.