Etiology of tick-borne febrile illnesses in adult residents of north-eastern Poland: Report from a prospective clinical study

Global status of Anaplasma phagocytophilum infections in human population: A 50-year (1970-2020) meta-analysis

BACKGROUND & OBJECTIVES

Anaplasma phagocytophilum causes human granulocytic anaplasmosis; a febrile tick-borne bacterial zoonosis of increasing public health importance in many parts of the world which is life threatening in undiagnosed, misdiagnosed and untreated cases. In this study we determined and reported the global status of the pathogen in man.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used to perform a systematic review and meta-analysis of data published in six electronic databases between 1970 and 2020. We pooled data using the random-effects model, performed sensitivity analysis by the single study deletion method and assess across study bias by the funnel plot and its statistical significance by the Egger's regression test.

RESULTS

A total of 7018 cases of A. phagocytophilum were reported from 48,619 individuals examined across 22 countries in three continents. Overall pooled estimate was 8.13% (95% CI: 5.70 - 11.47) with a range of 4.64 (95% CI: 1.78 - 11.54) to 12.18% (95% CI: 7.66 - 18.83) across sub-groups. Regional prevalence was highest in North America 11.07% (95% CI: 3.13 - 32.38), while that in relation to study population was highest among occupationally exposed population 11.41% (95% CI: 5.69 - 21.56).

INTERPRETATION & CONCLUSION

The study revealed a significant variation in the prevalence of A. phagocytophilum across Asia, Europe and North America, with the highest prevalence in North America and among occupationally exposed population. To curtail the menace of this growing public health crisis, we recommend integrated control programmes involving tick control, the use of appropriate clothing by occupationally exposed population and health education.

The fauna and perspective of rodentia ectoparasites in Iran relying on their roles within public health and veterinary characteristics

Historically, rodents-ectoparasites are responsible for many diseases in human and domestic animal communities because they are well-adapted to the environment and nutritional resources. In addition, ectoparasites can affect the reproductive rates, ecological fitness and the dispersal pattern of their hosts. Data was compiled through all publications relating to ectoparasites fauna from Iranian rodents. Host specificity, rodent-parasites interaction, geographical distribution, ecological trends as well as the medical or veterinary importance of ectoparasites are considered in this review. Also, results compared with other equal global findings. According to the obtained information, the genus Hyalomma considered being the major vector of Crimean-Congo hemorrhagic fever. Sistan-Balouchistan, Isfahan, Fars and Khuzestan are endemic provinces of this disease in Iran. Ixodes ticks (especially Hyalomma spp.) commonly existed throughout the months but had high activity in spring and late autumn seasons. Muridae as the most diversified rodent family was more reiterated exploited host by all parasites in this knowledge. Tatera indica confirmed as a positive host for Francisella tularensis by serological test but the definitive reservoir is still unclear in Iran. Meriones persicus as a nocturnal jird has been permanently presented in semi-desert areas except Dasht-e Kavir desert. This rodent was the frequent host for Pulicid fleas followed by Mus musculus and Cricetulus migratorius (Cricetidae). Rattus norvegicus was specialized host for Polyplax spinulosa (spiny rat louse). Pulex irritans from Pulicidae was spread in particularly west of Iran which known as an endemic focus of plague. Mites were high diversity than other taxa. The domestic vertebrates (sheep, goat and cattle) were primitive hosts and rodents were discovered as auxiliary hosts for ticks in Iran apparently. The available data suggested that lice had a type of model of host specificity due to their morphological traits. Meanwhile, Alborz and Zagros mountains ranges provided the specialized habitats for animals which have been surrounded by northern and western regions. Perhaps these mountainous areas can prevent gene flow between local mammalian populations. Notably, the genealogy of parasite genome can orient toward the evolutionary process into speciation point. In general, more researches are needed to decipher the whole sights of host-parasite association and the role of ectoparasites within zoonosis diseases.

Comparison of clinical and laboratory characteristics of patients fulfilling criteria for proven and probable human granulocytic anaplasmosis

To assess the value of clinical definitions for human granulocytic anaplasmosis (HGA) epidemiological, clinical and laboratory findings in 50 adult patients with proven HGA (Anaplasma phagocytophilum isolated from blood, and/or positive PCR result, and/or seroconversion or ≥4-fold change in serum IFA antibody titres to A. phagocytophilum) and 46 patients with probable HGA (demonstration of serum antibodies to A. phagocytophilum in titres ≥1:256) were compared. Patients with proven HGA were older (55 versus 43.5 years; p = 0.001), were more often treated with doxycycline (31/50, 62% versus 11/46, 23.9%; p < 0.001), more frequently reported chills (40/50, 80% versus 17/46, 36.9%; p < 0.001), myalgia (37/50, 74% versus 21/46, 45.7%; p = 0.005) and cough (10/50, 20% versus 2/46, 4.4%; p = 0.02), and had more often abnormal laboratory findings such as thrombocytopenia (45/50, 90% versus 22/46, 47.8%; p < 0.001), abnormal liver function test results (45/50, 87% versus 22/46, 47.8%; p < 0.001), leukopenia (38/50, 76% versus 21/46, 45.7%; p = 0.002) and elevated serum CRP concentration (48/50, 96% versus 31/46, 67.4%; p < 0.001). The dissimilarities imply that in some patients fulfilling criteria for probable HGA the signs and symptoms most likely are not the result of a recent infection with A. phagocytophilum and indicate that clinical definitions used in the present study have a distinctive value.

Detection and quantification of Anaplasma phagocytophilum and Babesia spp. in Ixodes ricinus ticks from urban and rural environment, northern Poland, by real-time polymerase chain reaction

Anaplasma phagocytophilum and Babesia spp. are emerging tick-borne pathogens which can threaten human health. A duplex real-time PCR and qPCRs with primers and probes targeting 97 and 116 bp fragments of 16S rRNA and 18S rRNA genes, respectively, were used for qualitative and quantitative detection of both pathogens in Ixodes ricinus ticks. Altogether 1875 ticks (1084 adults and 791 nymphs) were collected from rural and urban habitats in northern Poland. Of them, at least 0.9% were found to be infected with A. phagocytophilum while 2.5% with Babesia spp. A comparison of the infection rates by the tick stage, the type of area, the collection site, habitats of different tick density and by the month of collection was done. The prevalence of pathogens was significantly lower in nymphs than in adult ticks (p = 0.02) and in rural areas than in urban areas (p = 0.007). Four different 16S rRNA gene variants of A. phagocytophilum were determine, however none of them showed 100% identity with compared sequences isolated from human patients. The dominant Babesia species was B. venatorum. Results of qPCRs with circular and linearized forms of plasmids used as the standards showed significant difference in the pathogen loads (p = 0.001). The copy numbers of A. phagocytophilum and Babesia spp. estimated from the linear plasmids were 28.7 and 5.1 times lower, respectively, when compared with their circular forms, and were accepted as more reliable. The average number of copies of 16S rRNA gene of A. phagocytophilum in the positive I. ricinus samples were 3.39 × 10(5) ± 6.09 × 10(5). The mean copy number of 18S rRNA gene of Babesia spp. was ~2.55 × 10(5) ± 1.04 × 10(6). We confirmed the presence of A. phagocytophilum and Babesia spp. in I. ricinus in both rural and urban environments. The determined low infection rates suggests, however, that the risk for local population and tourists to acquire infection is also low. Moreover, we confirmed recent findings that serious overestimation by circular plasmid DNA makes it less suitable as a standard and that the linear standards should be recommended for qPCR.

Monitoring human tick-borne disease risk and tick bite exposure in Europe: available tools and promising future methods

Ticks are the main vector for infectious disease pathogens in both humans and animals, and tick-borne diseases are currently spreading throughout Europe. Various surveillance methods have been developed to estimate the burden and risk of tick-borne diseases and host exposure to tick bites. The ultimate aims of these approaches are to determine the risk level of a tick-borne disease in a given area, determine its health priority, identify the at-risk population and propose specific countermeasures or complementary studies as needed. The purpose of this review is to present the current methods for monitoring the circulation of tick-borne diseases and to highlight the use of salivary antigens as original and recently developed serological tools that could be useful for tick bite risk assessment and could improve the current surveillance methods.

Are patients with erythema migrans who have leukopenia and/or thrombocytopenia coinfected with Anaplasma phagocytophilum or tick-borne encephalitis virus?

Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA) are endemic in central part of Slovenia. We tested the hypothesis that patients with erythema migrans (EM) from this region, who have leukopenia and/or thrombocytopenia (typical findings in HGA and in the initial phase of TBE but not in patients with LB) are coinfected with Anaplasma phagocytophilum and/or with TBE virus, i.e. that cytopenia is a result of concomitant HGA or the initial phase of TBE. Comparison of clinical and laboratory findings for 67 patients with EM who disclosed leukopenia/thrombocytopenia with the corresponding results in sex- and age-matched patients with EM and normal blood cell counts revealed no differences. In addition, patients with typical EM and leukopenia and/or thrombocytopenia tested negative for the presence of IgM and IgG antibodies to TBE virus by ELISA as well as for the presence of specific IgG antibodies to A. phagocytophilum antigens by IFA in acute and convalescent serum samples. Thus, none of 67 patients (95% CI: 0 to 5.3%) with typical EM (the presence of this skin lesion attests for early Lyme borreliosis and is the evidence for a recent tick bite) was found to be coinfected with A. phagocytophilum or had a recent primary infection with TBE virus. The findings in the present study indicate that in Slovenia, and probably in other European countries endemic for LB, TBE and HGA, patients with early LB are rarely coinfected with the other tick-transmitted agents.

Co-infection and genetic diversity of tick-borne pathogens in roe deer from Poland

Wild species are essential hosts for maintaining Ixodes ticks and the tick-borne diseases. The aim of our study was to estimate the prevalence, the rate of co-infection with Babesia, Bartonella, and Anaplasma phagocytophilum, and the molecular diversity of tick-borne pathogens in roe deer in Poland. Almost half of the tested samples provided evidence of infection with at least 1 species. A. phagocytophilum (37.3%) was the most common and Bartonella (13.4%) the rarest infection. A total of 18.3% of all positive samples from roe deer were infected with at least 2 pathogens, and one-third of those were co-infected with A. phagocytophilum, Bartonella, and Babesia species. On the basis of multilocus molecular studies we conclude that: (1) Two different genetic variants of A. phagocytophilum, zoonotic and nonzoonotic, are widely distributed in Polish roe deer population; (2) the roe deer is the host for zoonotic Babesia (Bab. venatorum, Bab. divergens), closely related or identical with strains/species found in humans; (3) our Bab. capreoli and Bab. divergens isolates differed from reported genotypes at 2 conserved base positions, i.e., positions 631 and 663; and (4) this is the first description of Bart. schoenbuchensis infections in roe deer in Poland. We present 1 of the first complex epidemiological studies on the prevalence of Babesia, Bartonella, and A. phagocytophilum in naturally infected populations of roe deer. These game animals clearly have an important role as reservoir hosts of tick-borne pathogens, but the pathogenicity and zoonotic potential of the parasite genotypes hosted by roe deer requires further detailed investigation.

Detection of tick-borne pathogens in ticks from migratory birds in the Baltic region of Russia

We report the finding of tick-borne encephalitis (TBE)-virus in indigenous Ixodes ricinus (L.), 'Candidatus Neoehrlichia mikurensis' in exotic Ixodes frontalis (Panzer) and Rickettsia aeshlimannii in exotic Hyalomma marginatum Koch subadult ticks detached from 18.5% (107/577) infested migratory birds in the Baltic region of Russia. This is the first record of human pathogenic 'Candidatus N. mikurensis' in I. frontalis ticks. Moreover, seven other pathogens were identified in I. ricinus ticks. Spotted Fever Group rickettsiae were the predominant pathogen group and were detected only in nymphs. Future investigations are warranted to further characterize the role of birds in the epizootiology of tick-borne pathogens in this region.

The current perspective on tick-borne encephalitis awareness and prevention in six Central and Eastern European countries: report from a meeting of experts convened to discuss TBE in their region

Tick-borne encephalitis (TBE) is a potentially life-threatening disease in humans and is caused by a flavivirus spread by infected ticks (Ixodes ricinus and Ixodes persulcatus). TBE is endemic across much of Central and Eastern Europe and the incidence is increasing, with numbers estimated to be as many as 8755 cases per year. The reasons for this increase are multi-faceted and may involve improvements in diagnosis and reporting of TBE cases, increases in recreational activities in areas inhabited by infected ticks and changes in climatic conditions affecting tick habitats. Vaccination is the most effective method of preventing TBE; following a successful nationwide vaccination campaign in Austria, the annual number of TBE cases fell to about 10% of those reported in the pre-vaccination era. This report describes the findings of a group of leading experts from six Central and Eastern European countries who convened to discuss TBE in their region during the 28th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID) Nice, France, 4-8 May 2010.

Anaplasma phagocytophilum infection in a child

This is the first case of Anaplasma phagocytophilum infection described in Cyprus. A 9-year-old girl was infected after a tick-bite. The infection was diagnosed by molecular-based detection of the bacterium in 2 blood samples. The polymerase chain reaction product was sequenced, revealing a novel strain of Anaplasma phagocytophilum.

The Root-VoleMicrotus oeconomus(Pallas, 1776): A New Potential Reservoir ofAnaplasma phagocytophilum

Anaplasma phagocytophilum infection is a recently emerged tick-borne zoonosis. The bacterium's reservoirs likely comprise cervids, some ruminants, rodents, and perhaps other small and intermediate-size mammals; the main vector in Europe is the Ixodes ricinus tick. The Białowieza Primeval Forest is an ecosystem with a known prevalence of tick-borne pathogens. We studied the root-vole Microtus oeconomus to evaluate the natural infection of A. phagocytophilum. Intragranulocytic bacterial clusters (morulae) were not seen, but the A. phagocytophilum-specific nested polymerase chain reaction (PCR) product, targeting the rrs gene, was detected in two out of 30 rodent samples (GenBank accession nos. DQ361024 and DQ361025). Twenty-six root vole (86.6%) hosted ticks, mainly Dermacentor reticulatus larvae and nymphs. Only two rodents were parasitazed by I. ricinus single larvae. These data show the presence of natural infection of A. phagocytophilum among the root-vole M. oeconomus in the Białowieza Primeval Forest ecosystem.