Survey of tickborne infections in Denmark

We conducted a study of the distribution and prevalence of tickborne infections in Denmark by using roe deer as sentinels. Blood samples from 237 roe deer were collected during the 2002-2003 hunting season. Overall, 36.6% of deer were Borrelia seropositive, while 95.6% were Anaplasma phagocytophilum positive; all animals were negative for Bartonella quintana and B. henselae by indirect immunofluorescence assay. When a hemagglutination-inhibition test was used, 8.7% of deer were found positive for tickborne encephalitis (TBE)-complex virus. A total of 42.6% were found positive by polymerase chain reaction (PCR) for A. phagocytophilum with significant seasonal variation. All were PCR negative for Rickettsia helvetica. PCR and sequencing also showed a novel bacterium in roe deer previously only found in ticks. The study showed that the emerging pathogen A. phagocytophilum is widely distributed and that a marked shift has occurred in the distribution of TBE-complex virus in Denmark. This finding supports studies that predict alterations in distribution due to climatic changes.

[Climate change in spain and risk of infectious and parasitic diseases transmitted by arthropods and rodents]

Due to Spain's being located near Africa, being a stopping-off point for migrating birds and individuals and due to its climate conditions, nearing those of areas where there are vector-borne diseases, this is a country where this type of diseases could taken on greater importance due to the climate change. The possible risk would result from the geographical spread of already established vectors or due to subtropical vectors adapted to surviving in cooler, dried climates being imported and taking up residence. Hypothetically, the vector-borne diseases subject to be influenced by the climate change in Spain would be those transmitted by dipterans, such as dengue fever, West Nile encephalitis, Rift Valley fever, malaria and leishmaniasis; tick-transmitted diseases, such as Crimean-Congo hemorrhagic fever, tick-borne encephalitis, Lyme disease, spotted fever and endemic relapsing fever; and rodent-transmitted diseases. But the greatest, most viable threat would be the Aedes albopictus mosquito, which would be capable of transmitting viral diseases such as West Nile encephalitis or dengue fever, taking up residence. But, for actual areas of endemia being established, a combination of other factors, such as the massive, simultaneous influx of animal or human reservoirs and the deterioration of the social healthcare conditions and of the Public Health services.

[Babesia microti and Anaplasma phagocytophilum: two emerging zoonotic pathogens in Europe and Hungary]

Babesia microti and Anaplasma phagocytophilum was recently reported with a minimum prevalence of 0.9 and 1.3% in Hungary based on the PCR-sequencing analysis of 452 European sheep ticks (Ixodes ricinus). These results and the epidemiological data of the neighbouring countries indicate that human cases caused by these pathogens may occur in the country. The aim of the present paper is to summarise the current knowledge on the morphology, life cycle and distribution of B. microti and A. phagocytophilum, and the epidemiology, clinical features, diagnosis, treatment and control of babesiosis and granulocytic anaplasmosis.

Containment of arthropod disease vectors

Effective containment of arthropod vectors of infectious diseases is necessary to prevent transmission of pathogens by released, infected vectors and to prevent vectors that escape from establishing populations that subsequently contribute to increased disease. Although rare, past releases illustrate what can go wrong and justify the need for guidelines that minimize risks. An overview of recommendations for insectary facilities, practices, and equipment is provided, and features of four recently published and increasingly rigorous arthropod containment levels (ACLs 1-4) are summarized. ACL-1 is appropriate for research that constitutes the lowest risk level, including uninfected arthropods or vectors that are infected with micro-organisms that do not cause disease in humans, domestic animals, or wildlife. ACL-2 is appropriate for indigenous and exotic arthropods that represent a moderate risk, including vectors infected or suspected of being infected with biosafety level (BSL)-2 infectious agents and arthropods that have been genetically modified in ways that do not significantly affect their fecundity, survival, host preference, or vector competence. ACL-3 is recommended for arthropods that are or may be infected with BSL-3 infectious agents. ACL-3 places greater emphasis on pathogen containment and more restricted access to the insectary than ACL-2. ACL-4 is intended for arthropods that are infected with the most dangerous BSL-4 infectious agents, which can cause life-threatening illness by aerosol or arthropod bite. Adherence to these guidelines will result in laboratory-based arthropod vector research that minimizes risks and results in important new contributions to applied and basic science.

A travel medicine guide to arthropods of medical importance

Guidance has been offered to clinicians so they might better educate and advise travelers how to protect themselves, and evaluate complaints by travelers once they have returned. Any biting arthropod may cause direct injury, and the bite of just one infectious vector can be enough to prove fatal to the unprotected. Travelers and travel medicine practitioners should familiarize themselves with the vectors and vector-borne agents likely to been countered corresponding to the traveler's specific itinerary, accommodations, and planned activities, and devise a rational strategy to reduce risk.

Prevention of arthropod-related disease

Arthropods of medical importance include vespids, ticks, mosquitoes, mites, flies, and fleas. They spread illness as disease vectors, are associated with lethal allergic reactions, and produce potentially deadly toxins. Strategies for prevention of illness include avoidance, vector reduction programs, chemoprophylaxis, and repellents. Strategies must be tailored to regional risks.

Scrub typhus during pregnancy: a case report and review of the literature

Scrub typhus is a rickettsial disease that is uncommon during pregnancy. We report a case of a 33-year-old woman, G1P0, 29 weeks pregnancy who presented to hospital with high fever, chill and headache for two weeks. Her diagnosis of scrub typhus was confirmed by serum immunofluorescent assay. She was successfully treated with chloramphenicol, but preterm delivery occurred. Her infant died from respiratory distress syndrome. No vertical transmission was demonstrated in this case. Scrub typhus should be listed in the differential diagnosis of acute febrile illness in pregnant women, who either live in, or return from, endemic areas. Chloramphenicol can be used safely during pregnancy if it is not circulating at the time of delivery.

Characterization of Orientia tsutsugamushi strains isolated in Shandong Province, China by immunofluorescence and restriction fragment length polymorphism (RFLP) analyses

In order to identify the characteristics of the Sta56 gene of the 23 isolates of Orientia (O.) tsutsugamushi isolated in Shandong Province, indirect immunofluorescence assay (IFA) was used to identify the gene type of 23 strains O. tsutsugamushi isolated from scrub typhus patients, chigger mites, and rodents. Restriction fragment length polymorphism (RFLP) analysis was also used to analyze the restriction profiles of the Sta56 gene PCR amplification products of the 23 isolated strains of the O. tsutsugamushi; the results were compared with those acquired by nested PCR. By IFA, 21 of the 23 isolates belonged to the Gilliam type, and 2 to the Karp type. Using RFLP analysis, 21 strains had similar restriction profiles to the Japan Kawasaki strain, but they had no restriction site Hha I, and thus had some difference in gene sequence compared with the Japan Kawasaki strain. The other 2 strains had similar restriction profiles to Karp. These results were identical to that acquired by nested-PCR. In Shandong Province, the gene types of epidemic O. tsutsugamushi strains were similar to the Japan Kawasaki type, but had some differences in gene sequence. In addition, Karp also existed.

A survey of the relationships among the viruses not considered arboviruses, vertebrates, and arthropods

No single group of organisms demonstrates more extensive and diverse associations with animal viruses than the phylum Arthropoda. Compared with the well-recognized relationship found in arboviruses, however, most of the atypical arthropod-vertebrate relationships of the viruses normally not considered arboviruses have received much less attention, as they remain in the marginal areas of interest for most researchers in animal virology, veterinary medicine, medical entomology, and invertebrate pathology. However, this comprehensive review of the information gathered from several branches of virology by profession reveals highly valuable information potentially useful in the fields of research ranging from investigations of the mode of transmission of poorly understood or emerging viral diseases to studies of the evolution of biological transmission of animal viruses by arthropod vectors. The observations and data obtained for the animal virus relationships with arthropods and vertebrates outside the boundaries of arboviruses, in turn, can be used to reexamine more closely the definition of arboviruses. With increasing number of reports challenging one of the basic tenets of the definition of arbovirus (requirement of viremia in vertebrate host) and others describing virus-host relationships that complicate the definition of arbovirus, the accumulated information clearly demonstrates the difficulty of defining the boundaries of arboviruses.

PRESIDENTIAL ADDRESS:*FLAVOR BUDS AND OTHER DELIGHTS

Using good sense and some biological information, one can enjoy a delightful morsel or enhanced meal from a variety of parasites, either raw or cooked. Bon Appétit!

A climate-based model predicts the spatial distribution of the Lyme disease vector Ixodes scapularis in the United States

An understanding of the spatial distribution of the black-legged tick, Ixodes scapularis, is a fundamental component in assessing human risk for Lyme disease in much of the United States. Although a county-level vector distribution map exists for the United States, its accuracy is limited by arbitrary categories of its reported presence. It is unknown whether reported positive areas can support established populations and whether negative areas are suitable for established populations. The steadily increasing range of I. scapularis in the United States suggests that all suitable habitats are not currently occupied. Therefore, we developed a spatially predictive logistic model for I. scapularis in the 48 conterminous states to improve the previous vector distribution map. We used ground-observed environmental data to predict the probability of established I. scapularis populations. The autologistic analysis showed that maximum, minimum, and mean temperatures as well as vapor pressure significantly contribute to population maintenance with an accuracy of 95% (p < 0.0001). A cutoff probability for habitat suitability was assessed by sensitivity analysis and was used to reclassify the previous distribution map. The spatially modeled relationship between I. scapularis presence and large-scale environmental data provides a robust suitability model that reveals essential environmental determinants of habitat suitability, predicts emerging areas of Lyme disease risk, and generates the future pattern of I. scapularis across the United States.

[Long-term morbidity and spatial distribution of tick-borne encephalitis and ixodes tick-borne borreliosis in Udmurtia]

The paper considers the trends of morbidity due to tick-borne encephalities (TBE) and lxodes tick-borne borrelioses (lTBB) in Udmurtia during 35 years (1965-2000) and evaluates the long-term influence of measures aimed at suppressing natural foci by eliminating the basic vector on this process. For this, data on 1062 cases of fevers occurring after the bite of a tick in Udmurtia in 1965-1968, the similar data on 1509 cases in 1983-1987, and the official data on the incidence of these infections in 1996-2000 have been retrospectively analyzed. It has been shown that in Udmurtia the natural foci of lTBB coexisted with those of TBE long before the pathogens of borrelioses were described and notification of the infection of this group was initiated. In the 1990s, there was a drastic rise in the incidence of TBE and lTBB as compared with the 1960s and 1980s, which was due to an increase in the rate of contacts of the population with natural foci and to the better diagnosis of these infections. The prevalence of lTBB coincides with that of TBE. There is a long (more than 30 years) epidemiological effect in eliminating the vector Ixodes persulcatus.

Could ectoparasites act as vectors for prion diseases?

Prion diseases are rare neurodegenerative diseases of humans and animals with a lethal evolution. Several cell types found on the human skin, including keratinocytes, fibroblasts and lymphocytes, are susceptible to the abnormal infective isoform of the prion protein, which transforms the skin to produce a potential target for prion infection. Iatrogenic transmission of Creutzfeldt-Jakob disease was also recognized after corneal transplants in humans, and scrapie was successfully transmitted to mice after ocular instillation of infected brain tissue, confirming that these new routes, as well as cerebral inoculation and oral ingestion, could be important in prion infections. Animal prion infections, such as scrapie (sheep) and "mad cow disease" (cattle), have shown a pattern of horizontal transmission in farm conditions and several ectoparasites have been shown to harbor prion rods in laboratory experiments. Fly larvae and mites were exposed to brain-infected material and were readily able to transmit scrapie to hamsters. New lines of evidence have confirmed that adult flies are also able to express prion proteins. Because ocular and cerebral myiases and mite infestation are not rare worldwide, and most cases are caused by fly larvae or hay mites that usually affect sheep and cattle, it is important to discuss the possibility that these ectoparasites could eventually act as reservoirs and/or vectors for prion diseases.

'Lyme disease': ancient engine of an unrecognized borreliosis pandemic?

Unexpectedly we have found large numbers of chronically ill Borrelia burgdorferi PCR- and seropositive patients in Houston, Texas, a zoonotically 'non-endemic' area. In order to understand this finding prior to sufficient data availability, we chose to examine critically currently accepted but troublesome 'Lyme disease' concepts. Our method was to analyze each foundation 'Lyme disease' premise within the context of available medical and veterinary literature, then to reconstruct the disease model consistent with the preponderance of that data. We find the present conceptualization of the illness seriously truncated, with a high likelihood of two distinct but connected forms of human B. burgdorferi infection. The yet-unrecognized form appears to have a broader clinical presentation, wider geographic distribution, and vastly greater prevalence. We conclude that 'Lyme disease' currently acknowledges only its zoonosis arm and is a limited conceptualization of a far more pervasive and unrecognized infection state that must be considered a global epidemic.

Tick salivary gland extract-activated transmission of Borrelia afzelii spirochaetes

Saliva-activated transmission of Borrelia afzelii Canica, Nato, du Merle, Mazie, Baranton et Postic, 1993 was demonstrated using salivary gland extract (SGE) from Ixodes ricinus (L., 1758) ticks and C3H mice. Injection of Borrelia spirochaetes together with SGE increased the level of bacteraemia and accelerated the appearance of bacteria in the urinary bladder, compared with the injection of spirochaetes alone. More I. ricinus nymphs became infected when feeding on mice inoculated with B. afzelii plus SGE. Analysis of cytokines produced by cells of draining lymph nodes from SGE-treated mice showed a suppression of proinflammatory cytokines IFN-gamma, IL-6 and GM-CSF following a transient upregulation in comparison with the control mice infected without SGE.

Development of an in vitro method for the evaluation of candidate repellents against Leptotrombidium (Acari: Trombiculidae) chiggers

We developed a rapid and economical in vitro procedure with which to evaluate the efficacy of candidate repellents against chiggers. The procedure requires only 5 min and a small number of chiggers to obtain a valid estimate of the median effective dose. We used this procedure to evaluate the repellent activity of 11 compounds against the chigger, Leptotrombidium imphalum Vercammen-Grandjean and Langston. Median effective doses were determined for 10 of the 11 compounds. DM-165-2 (N,N-diethyl-3-flurobenzamide) was the only compound that was significantly more effective than deet.

Human granulocytic ehrlichiosis as a common cause of tick-associated fever in Southeast Sweden: report from a prospective clinical study

Between May and December 1998, tick-associated febrile illness was prospectively studied in Southeast Sweden in order to assess the occurrence of human granulocytic ehrlichiosis (HGE). Inclusion criteria were fever (> or = 38.0 degrees C), with or without headache, myalgia or arthralgia in patients with an observed tick bite or tick exposure within 1 month prior to onset of symptoms. Patients with clinical signs of Lyme borreliosis were included. Of the 27 patients included, we identified 4 cases of HGE. Three of the patients had coinfection with Lyme borreliosis, which presented as erythema migrans. All 27 patients presented with a 2-5 d history of fever. None of the clinical signs or laboratory parameters monitored was helpful in predicting ehrlichiosis in this group with tick-associated fever conditions. Within the HGE-negative group (n = 23), 12 patients had clinical or laboratory signs of Lyme borreliosis. For 11 patients, the aetiology of the fever remained unclear. Our results suggest that HGE is common in tick-infested areas of Southeast Sweden, and may occur as a coinfection of Lyme borreliosis. Granulocytic ehrlichiosis should be suspected in patients who present with tick-associated fever, with or without erythema migrans. Ehrlichia serology and PCR should be employed to confirm the diagnosis.

Population dynamics of Frankliniella spp. and tomato spotted wilt incidence as influenced by cultural management tactics in tomato

We investigated the effects of ultraviolet (UV)-reflective mulch and two rates of nitrogen fertilization on populations of Frankliniella spp. thrips and on the incidence of tomato spotted wilt in field-grown tomato in northern Florida. The higher of the two soil nitrogen fertilizer treatments significantly increased populations of Frankliniella occidentalis (Pergande), whereas mulch reflectance significantly decreased populations of F. occidentalis. Populations of Frankliniella tritici (Fitch) were decreased only by UV-reflective mulch. Decreased thrips populations in UV-reflective mulch plots were probably due to disruptions in host-finding behavior. Increased thrips populations in tomatoes treated with the higher nitrogen fertilization rate were probably due in part to increased nutrients available in flowers. Incidence of tomato spotted wilt was significantly decreased in tomatoes grown on UV-reflective mulch, whereas disease incidence was significantly greater in increased nitrogen-fertilized plots. This research reveals that cultural practices resulted in up to 45% reduction in the numbers of vector and nonvector species of flower thrips and up to 50% reduction in tomato spotted wilt.

Akabane and bovine ephemeral fever virus infections

Akabane and bovine ephemeral fever viruses are exotic to the American continent. Both viruses are spread by insect vectors, and each causes disease of varying severity in food-producing animals. However, there are few other similarities between the agents and the diseases that they cause. They do not share the same insect vectors, the mammalian host range is different, and the clinical manifestations of virus infection vary markedly. Akabane virus is a cause of severe congenital defects, but adult animals show no signs of infection. In contrast, bovine ephemeral fever virus causes a febrile illness affecting mainly mature animals. If introduced to North America, it is probable that there would be significant economic losses, at least until endemic virus transmission patterns were established. Subsequently, it is likely that there would be patterns of alternate disease outbreaks followed by interepidemic periods in which there is a minor clinical effect.

Blue Ribbon Committee on Bloodborne Parasitic Diseases

In summary, the A1 recommendations are related to: developing a network (epidemiologic and demographic aspects); undertaking activities within the network; providing support for parasite research testing; developing new policies, and; preparing a Memorandum to Cabinet for submission by September 1, 2001, for funding from April 2002 over 5 years. The A recommendations deal with sustaining the network and addressing existing needs, including Public and professional education Review of current policies Business plan Development of a contribution program to meet operational needs. The B recommendation(s) will be dealt with by the future Treasury Board submission. The group identified no C recommendations.