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Barathan M. From fever to action: diagnosis, treatment, and prevention of acute undifferentiated febrile illnesses. Pathog Dis 2024; 82:ftae006. [PMID: 38614961 PMCID: PMC11067964 DOI: 10.1093/femspd/ftae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 04/15/2024] Open
Abstract
Acute Undifferentiated Febrile Illness (AUFI) presents a clinical challenge, often characterized by sudden fever, non-specific symptoms, and potential life-threatening implications. This review highlights the global prevalence, types, challenges, and implications of AUFI, especially in tropical and subtropical regions where infectious diseases thrive. It delves into the difficulties in diagnosis, prevalence rates, regional variations, and potential causes, ranging from bacterial and viral infections to zoonotic diseases. Furthermore, it explores treatment strategies, preventive measures, and the critical role of the One Health approach in addressing AUFI. The paper also addresses the emerging zoonotic risks and ongoing outbreaks, including COVID-19, Rickettsia spp., and other novel pathogens, emphasizing their impact on AUFI diagnosis and management. Challenges in resource-limited settings are analyzed, highlighting the need for bolstered healthcare infrastructure, enhanced diagnostics, and collaborative One Health strategies. Amidst the complexity of emerging zoonotic threats, this review underscores the urgency for a multifaceted approach to mitigate the growing burden of AUFI, ensuring early diagnosis, appropriate treatment, and effective prevention strategies.
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Affiliation(s)
- Muttiah Barathan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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Rodarte KA, Fair JM, Bett BK, Kerfua SD, Fasina FO, Bartlow AW. A scoping review of zoonotic parasites and pathogens associated with abattoirs in Eastern Africa and recommendations for abattoirs as disease surveillance sites. Front Public Health 2023; 11:1194964. [PMID: 37529427 PMCID: PMC10387540 DOI: 10.3389/fpubh.2023.1194964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Abattoirs are facilities where livestock are slaughtered and are an important aspect in the food production chain. There are several types of abattoirs, which differ in infrastructure and facilities, sanitation and PPE practices, and adherence to regulations. In each abattoir facility, worker exposure to animals and animal products increases their risk of infection from zoonotic pathogens. Backyard abattoirs and slaughter slabs have the highest risk of pathogen transmission because of substandard hygiene practices and minimal infrastructure. These abattoir conditions can often contribute to environmental contamination and may play a significant role in disease outbreaks within communities. To assess further the risk of disease, we conducted a scoping review of parasites and pathogens among livestock and human workers in abattoirs across 13 Eastern African countries, which are hotspots for zoonoses. Our search results (n = 104 articles) showed the presence of bacteria, viruses, fungi, and macroparasites (nematodes, cestodes, etc.) in cattle, goats, sheep, pigs, camels, and poultry. Most articles reported results from cattle, and the most frequent pathogen detected was Mycobacterium bovis, which causes bovine tuberculosis. Some articles included worker survey and questionnaires that suggested how the use of PPE along with proper worker training and safe animal handling practices could reduce disease risk. Based on these findings, we discuss ways to improve abattoir biosafety and increase biosurveillance for disease control and mitigation. Abattoirs are a 'catch all' for pathogens, and by surveying animals at abattoirs, health officials can determine which diseases are prevalent in different regions and which pathogens are most likely transmitted from wildlife to livestock. We suggest a regional approach to biosurveillance, which will improve testing and data gathering for enhanced disease risk mapping and forecasting. Next generation sequencing will be key in identifying a wide range of pathogens, rather than a targeted approach.
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Affiliation(s)
- Katie A. Rodarte
- Genomics and Bioanalytics, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Jeanne M. Fair
- Genomics and Bioanalytics, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Bernard K. Bett
- International Livestock Research Institute and ILRI/BMZ One Health Research, Education, Outreach and Awareness Centre, Nairobi, Kenya
| | - Susan D. Kerfua
- National Livestock Resources Research Institute, National Agricultural Research Organization, Kampala, Uganda
| | - Folorunso O. Fasina
- Emergency Centre for Transboundary Animal Diseases, Food and Agriculture Organization of the United Nations, Nairobi, Kenya
- Department of Veterinary Tropical Diseases, University of Pretoria, Onderstepoort, South Africa
| | - Andrew W. Bartlow
- Genomics and Bioanalytics, Los Alamos National Laboratory, Los Alamos, NM, United States
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Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar. Pathogens 2021; 10:pathogens10111482. [PMID: 34832637 PMCID: PMC8621948 DOI: 10.3390/pathogens10111482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Rickettsiae may cause febrile infections in humans in tropical and subtropical regions. From Madagascar, no molecular data on the role of rickettsioses in febrile patients are available. Blood samples from patients presenting with fever in the area of the capital Antananarivo were screened for the presence of rickettsial DNA. EDTA (ethylenediaminetetraacetic acid) blood from 1020 patients presenting with pyrexia > 38.5 °C was analyzed by gltA-specific qPCR. Positive samples were confirmed by ompB-specific qPCR. From confirmed samples, the gltA amplicons were sequenced and subjected to phylogenetic analysis. From five gltA-reactive samples, two were confirmed by ompB-specific qPCR. The gltA sequence in the sample taken from a 38-year-old female showed 100% homology with R. typhi. The other sample taken from a 1.5-year-old infant was 100% homologous to R. felis. Tick-borne rickettsiae were not identified. The overall rate of febrile patients with molecular evidence for a rickettsial infection from the Madagascan study site was 0.2% (2/1020 patients). Flea-borne rickettsiosis is a rare but neglected cause of infection in Madagascar. Accurate diagnosis may prompt adequate antimicrobial treatment.
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Schafbauer T, Dreyfus A, Hogan B, Rakotozandrindrainy R, Poppert S, Straubinger RK. Seroprevalence of Leptospira spp. Infection in Cattle from Central and Northern Madagascar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112014. [PMID: 31174244 PMCID: PMC6603958 DOI: 10.3390/ijerph16112014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022]
Abstract
Leptospirosis is a zoonotic disease of global importance, especially in tropical countries. The current Leptospira spp. seroprevalence in cattle from central and northern Madagascar is unknown. Thus, the aim of this study was to determine the seroprevalence resulting from infections with pathogenic Leptospira spp. in zebu cattle from these areas. Serum samples from 194 animals were tested by microscopic agglutination test (MAT) using a panel of 12 serovars as antigens. Samples with a titer of ≥1:100 were considered positive. The overall seroprevalence was 59.3% (95% CI; 52.0–66.2%) with titers ranging from 1:100 to 1:1600. Among the seropositive animals, the most frequent antibody reactions were against serovar L. Tarassovi (serogroup L. Tarassovi) with 40.2% (33.3–47.5%), followed by L. Hardjo (L. Sejroe) with 13.9% (9.5–19.8%), L. Grippotyphosa (L. Grippotyphosa) with 9.8% (6.2–15.1%), L. Pomona (L. Pomona) with 7.7% (4.5–12.7%) and L. Autumnalis (L. Autumnalis) with 5.2% (2.6–9.5%). Less than 5% of the samples reacted positively against the remaining serovars. These results indicate a very high exposure of Malagasy cattle to Leptospira spp. which, consequently, poses a definite risk for people working with cattle acquiring this zoonotic infection.
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Affiliation(s)
- Theresa Schafbauer
- Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Department of Veterinary Sciences, Faculty of Veterinary Medicine, LMU Munich, Veterinaerstr. 13, 80539 Munich, Germany.
| | - Anou Dreyfus
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Faculty of Medicine, University Basel, 4056 Basel, Switzerland.
| | - Benedikt Hogan
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany.
| | - Raphael Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, BP 566, Antananarivo 101, Madagascar.
| | - Sven Poppert
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Faculty of Medicine, University Basel, 4056 Basel, Switzerland.
| | - Reinhard K Straubinger
- Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Department of Veterinary Sciences, Faculty of Veterinary Medicine, LMU Munich, Veterinaerstr. 13, 80539 Munich, Germany.
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Systematic Review of Important Bacterial Zoonoses in Africa in the Last Decade in Light of the 'One Health' Concept. Pathogens 2019; 8:pathogens8020050. [PMID: 30995815 PMCID: PMC6631375 DOI: 10.3390/pathogens8020050] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023] Open
Abstract
Zoonoses present a major public health threat and are estimated to account for a substantial part of the infectious disease burden in low-income countries. The severity of zoonotic diseases is compounded by factors such as poverty, living in close contact with livestock and wildlife, immunosuppression as well as coinfection with other diseases. The interconnections between humans, animals and the environment are essential to understand the spread and subsequent containment of zoonoses. We searched three scientific databases for articles relevant to the epidemiology of bacterial zoonoses/zoonotic bacterial pathogens, including disease prevalence and control measures in humans and multiple animal species, in various African countries within the period from 2008 to 2018. The review identified 1966 articles, of which 58 studies in 29 countries met the quality criteria for data extraction. The prevalence of brucellosis, leptospirosis, Q fever ranged from 0–40%, 1.1–24% and 0.9–28.2%, respectively, depending on geographical location and even higher in suspected outbreak cases. Risk factors for human zoonotic infection included exposure to livestock and animal slaughters. Dietary factors linked with seropositivity were found to include consumption of raw milk and locally fermented milk products. It was found that zoonoses such as leptospirosis, brucellosis, Q fever and rickettsiosis among others are frequently under/misdiagnosed in febrile patients seeking treatment at healthcare centres, leading to overdiagnoses of more familiar febrile conditions such as malaria and typhoid fever. The interactions at the human–animal interface contribute substantially to zoonotic infections. Seroprevalence of the various zoonoses varies by geographic location and species. There is a need to build laboratory capacity and effective surveillance processes for timely and effective detection and control of zoonoses in Africa. A multifaceted ‘One Health’ approach to tackle zoonoses is critical in the fight against zoonotic diseases. The impacts of zoonoses include: (1) Humans are always in contact with animals including livestock and zoonoses are causing serious life-threatening infections in humans. Almost 75% of the recent major global disease outbreaks have a zoonotic origin. (2) Zoonoses are a global health challenge represented either by well-known or newly emerging zoonotic diseases. (3) Zoonoses are caused by all-known cellular (bacteria, fungi and parasites) and noncellular (viruses or prions) pathogens. (4) There are limited data on zoonotic diseases from Africa. The fact that human health and animal health are inextricably linked, global coordinated and well-established interdisciplinary research efforts are essential to successfully fight and reduce the health burden due to zoonoses. This critically requires integrated data from both humans and animals on zoonotic diseases.
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Cappelli A, Capone A, Valzano M, Bozic J, Preziuso S, Mensah P, Varotto Boccazzi I, Rinaldi L, Favia G, Ricci I. Denaturing Gradient Gel Electrophoresis Analysis of Bacteria in Italian Ticks and First Detection of Streptococcus equi in Rhipicephalus bursa from the Lazio Region. Vector Borne Zoonotic Dis 2018; 19:328-332. [PMID: 30418103 DOI: 10.1089/vbz.2018.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tick-borne diseases are an increasing problem for the community. Ticks harbor a complex microbial population acquired while feeding on a variety of animals. Profiling the bacterial population by 16S rDNA amplification and denaturing gradient gel electrophoresis enables detection of the broad spectrum of bacteria that settles in the ticks. This study identified known and unknown tick-infecting bacteria in samples from Italy. Seven adult ticks from different hosts and origins were analyzed: two Rhipicephalus sanguineus ticks from dogs (Lombardia), two Rhipicephalus bursa ticks from bovines (Lazio), and three Ixodes ricinus ticks from humans (Marche). The major result was the first report of the zoonotic agent Streptococcus equi in ticks. S. equi is a species complex of highly contagious pathogens. Subsequent to S. equi detection in a R. bursa tick removed from a bovine of Lazio in 2012, we studied 95 R. bursa samples collected from 3 bovines, 3 ponies, and 1 sheep grazing in the same area in 2012 and from 6 ponies grazing there in 2017. The results of a specific PCR assay indicated a not sporadic occurrence of S. equi in ticks. This finding provides a basis for assessing the potential of ticks to harbor and disperse S. equi.
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Affiliation(s)
- Alessia Cappelli
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Aida Capone
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Matteo Valzano
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Jovana Bozic
- 2 Medical Entomology Lab/IFAS Vero Beach, University of Florida, Vero Beach, Florida.,3 Emerging Pathogens Institute Gainesville, University of Florida, Gainesville, Florida
| | - Silvia Preziuso
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Priscilla Mensah
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | | | - Laura Rinaldi
- 5 Department of Veterinary Medicine and Animal Production, University of Naples, Naples, Italy
| | - Guido Favia
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Irene Ricci
- 1 School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
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Guillebaud J, Bernardson B, Randriambolamanantsoa TH, Randrianasolo L, Randriamampionona JL, Marino CA, Rasolofo V, Randrianarivelojosia M, Vigan-Womas I, Stivaktas V, Venter M, Piola P, Héraud JM. Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar. PLoS Negl Trop Dis 2018; 12:e0006642. [PMID: 30011274 PMCID: PMC6062140 DOI: 10.1371/journal.pntd.0006642] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/26/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases. METHODOLOGY Consenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status. PRINCIPAL FINDINGS A total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections. CONCLUSIONS These results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar.
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Affiliation(s)
- Julia Guillebaud
- Virology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
| | - Barivola Bernardson
- Virology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
- Epidemiology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
| | | | | | - Jane Léa Randriamampionona
- Epidemiology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
- Direction de la Veille Sanitaire et de la Surveillance Epidémiologique, Ministry of Public Health 101, Antananarivo, Madagascar
| | | | - Voahangy Rasolofo
- Mycobacterial Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
| | | | - Ines Vigan-Womas
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
| | - Voula Stivaktas
- Emerging and Respiratory Virus Program, Centre for Viral Zoonoses, University of Pretoria, Pretoria, South Africa
| | - Marietjie Venter
- Emerging and Respiratory Virus Program, Centre for Viral Zoonoses, University of Pretoria, Pretoria, South Africa
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
| | - Jean-Michel Héraud
- Virology Unit, Institut Pasteur de Madagascar 101, Antananarivo, Madagascar
- * E-mail:
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Presence of Borrelia spp. DNA in ticks, but absence of Borrelia spp. and of Leptospira spp. DNA in blood of fever patients in Madagascar. Acta Trop 2018; 177:127-134. [PMID: 28986249 DOI: 10.1016/j.actatropica.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
The occurrence of tick-borne relapsing fever and leptospirosis in humans in Madagascar remains unclear despite the presence of their potential vectors and reservoir hosts. We screened 255 Amblyomma variegatum ticks and 148 Rhipicephalus microplus ticks from Zebu cattle in Madagascar for Borrelia-specific DNA. Borrelia spp. DNA was detected in 21 Amblyomma variegatum ticks and 2 Rhipicephalus microplus ticks. One Borrelia found in one Rhipicephalus microplus showed close relationship to Borrelia theileri based on genetic distance and phylogenetic analyses on 16S rRNA and flaB sequences. The borreliae from Amblyomma variegatum could not be identified due to very low quantities of present DNA reflected by high cycle threshold values in real-time-PCR. It is uncertain whether these low numbers of Borrelia spp. are sufficient for transmission of infection from ticks to humans. In order to determine whether spirochaete infections are relevant in humans, blood samples of 1009 patients from the highlands of Madagascar with fever of unknown origin were screened for Borrelia spp. - and in addition for Leptospira spp. - by real-time PCR. No target DNA was detected, indicating a limited relevance of these pathogens for humans in the highlands of Madagascar.
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