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Yoshinari NH, Bonoldi VLN, Bonin S, Falkingham E, Trevisan G. The Current State of Knowledge on Baggio–Yoshinari Syndrome (Brazilian Lyme Disease-like Illness): Chronological Presentation of Historical and Scientific Events Observed over the Last 30 Years. Pathogens 2022; 11:pathogens11080889. [PMID: 36015013 PMCID: PMC9415174 DOI: 10.3390/pathogens11080889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022] Open
Abstract
Baggio–Yoshinari Syndrome (BYS) is an emerging Brazilian tick-borne infectious disease that clinically mimics Lyme Disease (LD) present in the Northern Hemisphere. LD is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex and transmitted by Ixodid ticks of complex Ixodes rticinus. On the contrary, BYS is transmitted by hard Ixodid ticks of the genera Amblyomma, Rhipicephalus and Dermacentor. In 1992, the first cases of BYS were described in patients that developed EM rash, flu-like symptoms and arthritis after tick bite episodes. Since these findings, research in BYS has been developing for more than 30 years and shows that its epidemiological, clinical and laboratorial features are different from LD. Borrelia burgdorferi was never isolated in Brazil. In addition, specific serologic tests have shown little positivity. Furthermore, peripheral blood analysis of patients using electron microscopy exhibited structures resembling spirochete-like microorganisms or the latent forms of spirochetes (L form or cell wall deficient bacteria). For these reasons, Brazilian zoonosis was defined as an exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes belonging to the B. burgdorferi sensu lato complex with atypical morphology. The Brazilian ecosystem, combined with its ticks and reservoir biodiversity, possibly contributed to the origin of this new zoonosis, which emerged as a result of the passage of B. burgdorferi through exotic vectors and reservoirs.
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Affiliation(s)
- Natalino Hajime Yoshinari
- Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05508-220, Brazil
| | - Virginia Lucia Nazario Bonoldi
- Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05508-220, Brazil
| | - Serena Bonin
- DSM—Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-3993266
| | - Erica Falkingham
- DSM—Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Giusto Trevisan
- DSM—Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
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Cordeiro MD, Silva CBD, Navarrete MG, Roque E, Fonseca AHD. First serological detection of Borrelia spp. in dogs in western Cuba. ACTA ACUST UNITED AC 2020; 29:e014020. [PMID: 33295375 DOI: 10.1590/s1984-29612020104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022]
Abstract
This study aimed to verify the presence of IgG antibodies against Borrelia burgdorferi sensu lato (s.l) in domestic dogs in western Cuba. Serum samples were analyzed by indirect enzyme-linked immunosorbent assay (ELISA), using crude antigens of a B. burgdorferi strain of North American origin. To verify the presence of Borrelia spp., deoxyribonucleic acid (DNA) extracted from individual blood samples was analyzed by nested-PCR, with markers targeted for amplification of portions of the flagellin B gene (flaB) present in Borrelia spirochetes. Ticks were also collected through inspection of the animals. Sera from 93 of 176 (52.84%) dogs were reactive to the indirect ELISA. Geographic prevalence varied from 54.35% (25/46) in Boyeros, 44.44% (20/45) in Cotorro, 66.67% (22/33) in Habana del Este, and 50% (26/52) in San José de las Lajas. There was no statistical difference between these tested variables. No blood samples analyzed were positive for the Borrelia flaB gene.
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Affiliation(s)
- Matheus Dias Cordeiro
- Departamento de Epidemiologia e Saúde Pública, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro - UFRRJ, Seropédica, RJ, Brasil
| | - Claudia Bezerra da Silva
- Departamento de Epidemiologia e Saúde Pública, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro - UFRRJ, Seropédica, RJ, Brasil
| | - Maylin Gonzalez Navarrete
- Departamento de Prevención, Facultad de Medicina Veterinaria, Universidad Agraria de La Habana - UNAH, Mayabeque, Cuba
| | - Eugênio Roque
- Departamento de Prevención, Facultad de Medicina Veterinaria, Universidad Agraria de La Habana - UNAH, Mayabeque, Cuba
| | - Adivaldo Henrique da Fonseca
- Departamento de Epidemiologia e Saúde Pública, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro - UFRRJ, Seropédica, RJ, Brasil
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Higa LDOS, Csordas BG, Garcia MV, Oshiro LM, Duarte PO, Barros JC, Andreotti R. Spotted fever group Rickettsia and Borrelia sp. cooccurrence in Amblyomma sculptum in the Midwest region of Brazil. EXPERIMENTAL & APPLIED ACAROLOGY 2020; 81:441-455. [PMID: 32572671 DOI: 10.1007/s10493-020-00513-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
More than 70 tick species are found in Brazil, distributed over five genera and including main vectors of infectious disease agents affecting both animals and humans. The genus Amblyomma is the most relevant for public health in Brazil, wherein Amblyomma aureolatum, Amblyomma ovale and Amblyomma sculptum have been incriminated as vectors of Rickettsia and Borrelia pathogens. The objective of this study was to investigate the presence of Rickettsia spp. and Borrelia spp. in ticks in the Brazilian mid-western savannah. DNA extraction, PCR for Borrelia spp. (flgE gene) and Rickettsia spp. (ompA and gltA genes) and subsequent sequencing were performed. A total of 1875 ticks were collected and identified as A. sculptum except for two Amblyomma coelebs ticks. Molecular evidence for Borrelia spp. and Rickettsia parkeri was found in A. sculptum. This is the first molecular evidence for R. parkeri in A. sculptum ticks in the Midwest region and Borrelia spp. circulating in a tick of the Amblyomma genus in Brazil.
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Affiliation(s)
- Leandro de Oliveira Souza Higa
- Pós-Graduação em Doenças Infecciosas e Parasitárias-Faculdade de Medicina, UFMS - Univ. Federal de Mato Grosso do Sul, Laboratório de Biologia do carrapato, Embrapa Gado de Corte, Campo Grande, MS, Brazil
| | - Bárbara Guimarães Csordas
- Laboratório de Biologia do Carrapato, Empresa Brasileira de Pesquisa Agropecuária, Embrapa Gado de Corte, Bolsista FUNDAPAM, Campo Grande, MS, Brazil
| | - Marcos Valério Garcia
- Laboratório de Biologia do Carrapato, Empresa Brasileira de Pesquisa Agropecuária, Embrapa Gado de Corte, Bolsista FUNDAPAM, Campo Grande, MS, Brazil
| | - Leandra Marla Oshiro
- Laboratório de Biologia do Carrapato, Empresa Brasileira de Pesquisa Agropecuária, Embrapa Gado de Corte, Bolsista FUNDAPAM, Campo Grande, MS, Brazil
| | - Pâmella Oliveira Duarte
- Pós-Graduação em Doenças Infecciosas e Parasitárias-Faculdade de Medicina, UFMS - Univ. Federal de Mato Grosso do Sul, Laboratório de Biologia do carrapato, Embrapa Gado de Corte, Campo Grande, MS, Brazil
| | | | - Renato Andreotti
- Empresa Brasileira de Pesquisa Agropecuária, Embrapa Gado de Corte, Campo Grande, MS, Brazil.
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Day MJ, Crawford C, Marcondes M, Squires RA. Recommendations on vaccination for Latin American small animal practitioners: a report of the WSAVA Vaccination Guidelines Group. J Small Anim Pract 2020; 61:E1-E35. [PMID: 32227347 PMCID: PMC7228315 DOI: 10.1111/jsap.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The World Small Animal Veterinary Association Vaccination Guidelines Group has produced global guidelines for small companion animal practitioners on best practice in canine and feline vaccination. Recognising that there are unique aspects of veterinary practice in certain geographical regions of the world, the Vaccination Guidelines Group undertook a regional project in Latin America between 2016 and 2019, culminating in the present document. The Vaccination Guidelines Group gathered scientific and demographic data during visits to Argentina, Brazil and Mexico, by discussion with national key opinion leaders, visiting veterinary practices and review of the scientific literature. A questionnaire survey was completed by 1390 veterinarians in five Latin American countries and the Vaccination Guidelines Group delivered continuing education at seven events attended by over 3500 veterinarians. The Vaccination Guidelines Group recognised numerous challenges in Latin America, for example: (1) lack of national oversight of the veterinary profession, (2) extraordinary growth in private veterinary schools of undetermined quality, (3) socioeconomic constraints on client engagement with preventive health care, (4) high regional prevalence of some key infectious diseases (e.g. feline leukaemia virus infection, canine visceral leishmaniosis), (5) almost complete lack of minimal antigen vaccine products as available in other markets, (6) relative lack of vaccine products with extended duration of immunity as available in other markets, (7) availability of vaccine products withdrawn from other markets (e.g. Giardia vaccine) or unique to Latin America (e.g. some Leishmania vaccines), (8) accessibility of vaccines directly by pet owners or breeders such that vaccination is not delivered under veterinary supervision, (9) limited availability of continuing education in veterinary vaccinology and lack of compulsion for continuing professional development and (10) limited peer‐reviewed published scientific data on small companion animal infectious diseases (with the exception of leishmaniosis) and lack of support for such academic research. In this document, the Vaccination Guidelines Group summarises the findings of this project and assesses in evidence‐based fashion the scientific literature pertaining to companion animal vaccine‐preventable diseases in Latin America. The Vaccination Guidelines Group makes some recommendations on undergraduate and postgraduate education and academic research. Recognising that current product availability in Latin America does not permit veterinarians in these countries to vaccinate according to the global World Small Animal Veterinary Association guidelines, the Vaccination Guidelines Group makes a series of “pragmatic” recommendations as to what might be currently achievable, and a series of “aspirational” recommendations as to what might be desirable for the future. The concept of “vaccine husbandry” is addressed via some simple guidelines for the management of vaccine products in the practice. Finally, the Vaccination Guidelines Group emphasises the global trend towards delivery of vaccination as one part of an “annual health check” or “health care plan” that reviews holistically the preventive health care needs of the individual pet animal. Latin American practitioners should transition towards these important new practices that are now well embedded in more developed veterinary markets. The document also includes 70 frequently asked questions and their answers; these were posed to the Vaccination Guidelines Group during our continuing education events and small group discussions and should address many of the issues surrounding delivery of vaccination in the Latin American countries. Spanish and Portuguese translations of this document will be made freely available from the on‐line resource pages of the Vaccination Guidelines Group.
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Affiliation(s)
- M J Day
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, 6150, Australia
| | - C Crawford
- University of Florida School of Veterinary Medicine, Gainesville, FL, USA
| | - M Marcondes
- School of Veterinary Medicine, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - R A Squires
- Discipline of Veterinary Science, James Cook University, Townsville, QLD, Australia
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Cai YC, Wu F, Hu W, Chen J, Chen SH, Xu B, Lu Y, Ai L, Yang CL, Zhao S. Molecular characterization of Babesia microti seroreactive antigen 5-1-1 and development of rapid detection methods for anti-B. microti antibodies in serum. Acta Trop 2018; 185:371-379. [PMID: 29559329 DOI: 10.1016/j.actatropica.2018.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 01/17/2023]
Abstract
Babesiosis has become a new global threat impacting human health, and most human babesiosis cases are caused by Babesia microti. Until now few antigens of B. microti have been described which can be used for the diagnosis of human babesiosis. In the present study, we report on the bioinformatic analysis, cloning and expression of the sequence encoding the B. microti seroreactive antigen 5-1-1 to investigate its potential incorporation in serologic diagnostic tools for babesiosis. Bioinformatic analysis and recombinant gene expression were performed to molecularly characterize seroreactive antigen 5-1-1. Enhanced chemiluminescence (ECL)-Western blot methods were used to detect specific antibodies in infected mice. Immunofluorescence antibody assays (IFA) were performed to detect the localization of BmSA5-1-1 in B. microti parasites. ELISA and immunochromatographic (ICT) tests were developed using recombinant BmSA5-1-1 to evaluate its potential use in rapid detection methods for B. microti antibodies and for the diagnosis of babesiosis. A recombinant expression plasmid was constructed by inserting the target gene fragment in the pET28a vector after double digestion with BamHI and XhoI restriction enzymes. The recombinant BmSA5-1-1 protein was expressed in Escherichia coli (rBmSA5-1-1) and purified by means of Ni-nitrilotriacetic acid (NTA) agarose columns. Polyclonal antibodies were generated against rBmSA5-1-1. Based on indirect immunofluorescence assay results, BmSA5-1-1 appeared to localize on the surface of B. microti. ELISA tests using the rBmSA5-1-1 antigen detected specific antibodies from infected mice as early as 4 days post-infection. Our results indicate that the two methods we developed can detect specific antibodies in mice at different stages of infection with sensitivities of 100% (rBmSA5-1-1 ELISA) and 90% (ICT). The specificity of the two methods was 100%. Sera of patients suffering from other closely related parasitic diseases, such as malaria and toxoplasmosis, produced negative results. In conclusion, seroreactive antigen 5-1-1, a member of the BMN1 protein family, is expressed on the outer surface of B. microti and is a promising candidate antigen for the early diagnosis of babesiosis. rBmSA5-1-1 ELISA and ICT methods show good potential for detecting specific antibodies in mice at different stages of infection.
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Djokic V, Akoolo L, Parveen N. Babesia microti Infection Changes Host Spleen Architecture and Is Cleared by a Th1 Immune Response. Front Microbiol 2018; 9:85. [PMID: 29445365 PMCID: PMC5797759 DOI: 10.3389/fmicb.2018.00085] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/12/2018] [Indexed: 12/11/2022] Open
Abstract
Babesia microti is a malaria-like parasite, which infects ∼2000 people annually, such that babesiosis is now a notifiable disease in the United States. Immunocompetent individuals often remain asymptomatic and are tested only after they feel ill. Susceptible C3H/HeJ mice show several human-like disease manifestations and are ideal to study pathogenesis of Babesia species. In this study, we examined parasitemia of B. microti at different time points and assessed its impact on hemoglobin levels in blood, on spleen pathology and overall immune response in C3H/HeJ mice. Peak parasitemia of 42.5% was immediately followed by diminished hemoglobin level. Parasitemia at 21 days of infection was barely detectable by microscopy presented 5.7 × 108 to 5.9 × 109B. microti DNA copies confirming the sensitivity of our qPCR. We hypothesize that qPCR detects DNA released from recently lysed parasites or from extracellular B. microti in blood, which are not easily detected in blood smears and might result in under-diagnosis of babesiosis in patients. Splenectomized patients have been reported to show increased babesiosis severity and result in high morbidity and mortality. These results emphasize the importance of splenic immunity in resolution of B. microti infection. Splenomegaly in infected mice associated with destruction of marginal zone with lysed erythrocytes and released B. microti life forms in our experiments support this premise. At conclusion of the experiment at 21 days post-infection, significant splenic B and T cells depletion and increase in macrophages levels were observed in B. microti infected mice suggesting a role of macrophage in disease resolution. Infected mice also showed significantly higher plasmatic concentration of CD4 Th1 cells secreted cytokines such as IL-2 and IFN-γ while cytokines such as IL-4, IL-5, and IL-13 secreted by Th2 cells increase was not always significant. Thus, Th1 cells-mediated immunity appears to be important in clearance of this intracellular pathogen. Significant increase in IL-6 that promotes differentiation of Th17 cells was observed but it resulted in only moderate change in IL-17A, IL-17F, IL-21, and IL-22, all secreted by Th17 cells. A similar immune response to Trypanosoma infection has been reported to influence the clearance of this protozoan, and co-infecting pathogen(s).
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Affiliation(s)
- Vitomir Djokic
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Lavoisier Akoolo
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Nikhat Parveen
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ, United States
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Primus S, Akoolo L, Schlachter S, Parveen N. Screening of patient blood samples for babesiosis using enzymatic assays. Ticks Tick Borne Dis 2017; 9:302-306. [PMID: 29150323 DOI: 10.1016/j.ttbdis.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/30/2017] [Accepted: 11/09/2017] [Indexed: 01/17/2023]
Abstract
Human babesiosis is an emerging tick-borne disease in the United States and Europe. Transmitted by Ixodes ticks, the causative agent Babesia microti is an intraerythrocytic parasite that causes mild to deadly disease. Transmission of B. microti can also occur by transfusion of infected blood and blood products resulting in transfusion-transmitted babesiosis (TTB), which carries a high risk of fatality. To effectively manage this rise in B. microti infections, better screening tools are needed, which require minimal manipulation of the samples before testing. To this end, we tested two enzymatic assays, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), for efficacy in diagnosis of babesiosis. The results show that AST and ALT activity is significantly higher in the plasma of B. microti-infected patients. Moreover, statistical analysis revealed that these assays have high sensitivity and positive predictive values, which highlights their usefulness as diagnostics for babesiosis. These standardized enzymatic assays can be used to perform high-throughput, large-scale screens of blood and blood products before they are certified safe for transfusion.
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Affiliation(s)
- Shekerah Primus
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ 07013, USA
| | - Lavoisier Akoolo
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ 07013, USA
| | - Samantha Schlachter
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ 07013, USA
| | - Nikhat Parveen
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ 07013, USA.
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Cursino-Santos JR, Singh M, Pham P, Lobo CA. A novel flow cytometric application discriminates among the effects of chemical inhibitors on various phases ofBabesia divergensintraerythrocytic cycle. Cytometry A 2017; 91:216-231. [DOI: 10.1002/cyto.a.23062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/09/2016] [Accepted: 12/28/2016] [Indexed: 12/21/2022]
Affiliation(s)
| | - Manpreet Singh
- Department of Blood Borne Parasites; New York Blood Center; New York New York
| | - Petra Pham
- Flow Cytometry Core Facility; New York Blood Center; New York New York
| | - Cheryl A. Lobo
- Department of Blood Borne Parasites; New York Blood Center; New York New York
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Akoolo L, Schlachter S, Khan R, Alter L, Rojtman AD, Gedroic K, Bhanot P, Parveen N. A novel quantitative PCR detects Babesia infection in patients not identified by currently available non-nucleic acid amplification tests. BMC Microbiol 2017; 17:16. [PMID: 28088177 PMCID: PMC5237571 DOI: 10.1186/s12866-017-0929-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022] Open
Abstract
Background Ticks transmit Babesia microti, the causative agents of babesiosis in North America and Europe. Babesiosis is now endemic in Northeastern USA and affects people of all ages. Babesia species infect erythrocytes and can be transmitted through blood transfusion. Whole blood and blood products, which are not tested for Babesia, can cause transfusion-transmitted babesiosis (TTB) resulting in severe consequences in the immuno-compromised patients. The purpose of this study was epidemiological evaluation of babesiosis in a tick-infested state. Results We examined blood samples from 192 patients who visited clinics during the active tick-borne diseases season, using a newly developed qPCR assay that uses the specific molecular beacon probe. Due to the absence of clear symptomology, clinical laboratories did not test 131 samples by IFA, FISH or microscopic examination of Giemsa-stained blood smears. Babesia infection was detected in all age groups by FISH and microscopy; notably patients >40 years of age represented 64% of tested samples and 13% were younger patients. We tested all samples using qPCR and found that 38% were positive for Babesia. Of 28 samples that were positive by FISH, 27 (96%) were also positive by qPCR indicating high congruency between nucleic acid based tests. Interestingly, of 78 asymptomatic samples not tested by FISH, 22 were positive by our qPCR. Direct detection of Babesia relies upon microscopic examination of patient blood smears, which is labor intensive, difficult to scale up, requires specific expertise and is hence, often not performed. In fact, a clinical laboratory examined only 23 of 86 blood samples obtained from two different counties by microscopy. By considering individuals positive for Babesia infection when results from currently available microscopy, FISH or serological tests were positive, we found that our qPCR is highly sensitive (96.2%) and showed a specificity of 70.5% for Babesia. Conclusion Robust qPCR using specific probes can be highly useful for efficient and appropriate diagnosis of babesiosis in patients in conjunction with conventional diagnostics, or as a stand-alone test, especially for donated blood screening. The use of a nucleic acid amplification test based screening of blood and blood products could prevent TTB. Electronic supplementary material The online version of this article (doi:10.1186/s12866-017-0929-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Rasel Khan
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Laura Alter
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Albert D Rojtman
- Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA
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Nascimento DAG, Vieira RFDC, Vieira TSWJ, Toledo RDS, Tamekuni K, Santos NJRD, Gonçalves DD, Vieira ML, Biondo AW, Vidotto O. Serosurvey of Borrelia in dogs, horses, and humans exposed to ticks in a rural settlement of southern Brazil. ACTA ACUST UNITED AC 2016; 25:418-422. [PMID: 27982299 DOI: 10.1590/s1984-29612016085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/23/2016] [Indexed: 11/21/2022]
Abstract
The aims of the present study were to serosurvey dogs, horses, and humans highly exposed to tick bites for anti-Borrelia burgdorferi s.l. antibodies, identify tick species present, and determine risk factors associated with seropositivity in a rural settlement of Paraná State, southern Brazil. Eighty-seven residents were sampled, along with their 83 dogs and 18 horses, and individual questionnaires were administered. Immunofluorescence antibody test (IFAT) was performed on serum samples and positive samples were subjected to western blot (WB) analysis. Anti-B. burgdorferi antibodies were found in 4/87 (4.6%) humans, 26/83 (31.3%) dogs, and 7/18 (38.9%) horses by IFAT, with 4/4 humans also positive by WB. Ticks identified were mostly from dogs and included 45/67 Rhipicephalus sanguineus, 21/67 Amblyomma ovale, and 1/67 A. cajennense sensu lato. All (34/34) horse ticks were identified as A. cajennense s.l.. No significant association was found when age, gender, or presence of ticks was correlated to seropositivity to Borrelia sp. In conclusion, although anti-Borrelia antibodies have been found in dogs, horses and their owners from the rural settlement, the lack of isolation, molecular characterization, absence of competent vectors and the low specificity of the commercial WB kit used herein may have impaired risk factor analysis.
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Affiliation(s)
| | | | | | - Roberta Dos Santos Toledo
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina - UEL, Londrina, PR, Brasil
| | - Katia Tamekuni
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina - UEL, Londrina, PR, Brasil
| | | | - Daniela Dibb Gonçalves
- Departamento de Medicina Veterinária e Saúde Pública, Universidade Paranaense - UNIPAR, Umuarama, PR, Brasil
| | - Maria Luísa Vieira
- Grupo de Leptospirose e Doença de Lyme, Unidade de Microbiologia Médica, Institute of Hygiene and Tropical Medicine - IHMT, Universidade Nova de Lisboa - UNL, Lisboa, Portugal
| | - Alexander Welker Biondo
- Departamento de Medicina Veterinária, Universidade Federal do Paraná - UFPR, Curitiba, PR, Brasil
| | - Odilon Vidotto
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina - UEL, Londrina, PR, Brasil
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Gonçalves DD, Moura RA, Nunes M, Carreira T, Vidotto O, Freitas JC, Vieira ML. Borrelia burgdorferi sensu lato in humans in a rural area of Paraná State, Brazil. Braz J Microbiol 2015; 46:571-5. [PMID: 26273276 PMCID: PMC4507553 DOI: 10.1590/s1517-838246220140097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/07/2014] [Indexed: 05/28/2023] Open
Abstract
This study describes the detection of Borrelia garinii and Borrelia
burgdorferi sensu stricto (s.s.) in Brazilian individuals using PCR
and DNA sequencing. Our results suggest that these species are emerging
pathogens in this country, and additional studies are necessary to determine the
epidemiological characteristics of this disease in Brazil.
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Affiliation(s)
- Daniela Dib Gonçalves
- Universidade Estadual de Londrina, Programa de Pós-gradução em Ciência Animal, Universidade Estadual de Londrina, Londrina, PR, Brasil, Programa de Pós-gradução em Ciência Animal, Universidade Estadual de Londrina, Londrina, PR, Brazil. ; Universidade Paranaense, Medicina Veterinária Preventiva, Universidade Paranaense, Umuarama, PR, Brasil, Medicina Veterinária Preventiva, Universidade Paranaense, Umuarama, PR, Brazil
| | - Rodrigo Assunção Moura
- Universidade Paranaense, Medicina Veterinária Preventiva, Universidade Paranaense, Umuarama, PR, Brasil, Medicina Veterinária Preventiva, Universidade Paranaense, Umuarama, PR, Brazil
| | - Mônica Nunes
- Universidade Nova de Lisboa, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal, Leptospirosis and Lyme Borreliosis Group, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teresa Carreira
- Universidade Nova de Lisboa, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal, Leptospirosis and Lyme Borreliosis Group, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Odilon Vidotto
- Universidade Estadual de Londrina, Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, PR, Brasil, Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Julio Cesar Freitas
- Universidade Estadual de Londrina, Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, PR, Brasil, Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Maria Luísa Vieira
- Universidade Nova de Lisboa, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal, Leptospirosis and Lyme Borreliosis Group, Medical Microbiology Unit, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
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12
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Vieira TSWJ, Vieira RFDC, Nascimento DAGD, Tamekuni K, Toledo RDS, Chandrashekar R, Marcondes M, Biondo AW, Vidotto O. Serosurvey of tick-borne pathogens in dogs from urban and rural areas from Parana State, Brazil. ACTA ACUST UNITED AC 2015; 22:104-9. [PMID: 24252955 DOI: 10.1590/s1984-29612013000100019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/12/2012] [Indexed: 11/22/2022]
Abstract
Considering the zoonotic potential of tick-borne disease (TBD) agents and the fact that dogs may act as sentinels for human infection, the aim of the present study was to determine the seroprevalence of TBD agents and risk factors for exposure in two different canine populations from Parana State, Southern Brazil. A total of 138 dog serum samples from urban (UA) (n=68) and rural (RA) (n=70) areas were tested with commercial ELISA rapid test for Anaplasma phagocytophilum, Ehrlichia canis and Borrelia burgdorferi antibodies and indirect immunofluorescence assay (IFAT) for Babesia vogeli. An overall of 92∕138 (66.7%) dogs, being 62∕68 (91.2%) from UA and 30∕70 (42.9%) from RA, were seropositive for at least one TBD agent. From the total number of dogs, sixty-two were positive for E. canis (44.9%), 19 (13.8%) for A. phagocytophilum, and 64 (46.4%) for B. vogeli. Anti-B. burgdorferi antibodies were not detected. Dogs from UA showed a higher percentage of tick infestation (p = 0.0135) and were highly associated with seropositivity to E. canis (p = 0.000005), A. phagocytophilum (p = 0.0001), and B. vogeli (p = 0.0012). In summary, the findings indicate that dogs from urban areas present higher potential risk exposure to TBD pathogens than those from rural areas.
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13
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Yabsley MJ, Shock BC. Natural history of Zoonotic Babesia: Role of wildlife reservoirs. Int J Parasitol Parasites Wildl 2013; 2:18-31. [PMID: 24533312 PMCID: PMC3862492 DOI: 10.1016/j.ijppaw.2012.11.003] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/25/2012] [Accepted: 11/06/2012] [Indexed: 11/02/2022]
Abstract
Babesiosis is an emerging zoonotic disease on all inhabited continents and various wildlife species are the principal reservoir hosts for zoonotic Babesia species. The primary vectors of Babesia are Ixodid ticks, with the majority of zoonotic species being transmitted by species in the genus Ixodes. Species of Babesia vary in their infectivity, virulence and pathogenicity for people. Various factors (e.g., increased interactions between people and the environment, increased immunosuppression, changes in landscape and climate, and shifts in host and vector species abundance and community structures) have led to an increase in tick-borne diseases in people, including babesiosis. Furthermore, because babesiosis is now a reportable disease in several states in the United States, and it is the most common blood transfusion-associated parasite, recognized infections are expected to increase. Because of the zoonotic nature of these parasites, it is essential that we understand the natural history (especially reservoirs and vectors) so that appropriate control and prevention measures can be implemented. Considerable work has been conducted on the ecology of Babesia microti and Babesia divergens, the two most common causes of babesiosis in the United States and Europe, respectively. However, unfortunately, for many of the zoonotic Babesia species, the reservoir(s) and/or tick vector(s) are unknown. We review the current knowledge regarding the ecology of Babesia among their reservoir and tick hosts with an emphasis of the role on wildlife as reservoirs. We hope to encourage the molecular characterization of Babesia from potential reservoirs and vectors as well from people. These data are necessary so that informed decisions can be made regarding potential vectors and the potential role of wildlife in the ecology of a novel Babesia when it is detected in a human patient.
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Affiliation(s)
- Michael J. Yabsley
- Corresponding author. Address: The Southeastern Cooperative Wildlife Disease Study, Department of Population Health, 589 DW Brooks Drive, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA. Tel.: +1 706 542 1741; fax: +1 706 542 5865.
| | - Barbara C. Shock
- Daniel B. Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA 30602, USA
- The Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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14
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Rezende J, Rangel CP, Cunha NC, Fonseca AH. Primary embryonic cells of Rhipicephalus microplus and Amblyomma cajennense ticks as a substrate for the development of Borrelia burgdorferi (strain G39/40). BRAZ J BIOL 2012; 72:577-82. [PMID: 22990829 DOI: 10.1590/s1519-69842012000300021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/31/2012] [Indexed: 11/22/2022] Open
Abstract
Borrelia burgdorferi, the agent of Lyme borreliosis, is a spirochetes transmitted by ticks to humans and animals. Its cultivation in vitro in tick cells allows studies of its biology and provides methodology for future research in Brazil, and for the isolation of Borrelia spp. We examined in vitro the characteristics of embryonic cells of Rhipicephalus microplus and Amblyomma cajennense in cell culture and investigated the suitability of embryonic cells as a substrate for cultivation of B. burgdorferi. Subcultures were prepared from primary cultures of embrionary cells of R. microplus and A. cajennense maintained in Leibovitz's (L-15) complete medium at 28 ºC and 31 ºC, respectively. When a monolayer had formed, the L-15 was replaced with Barbour-Stoener-Kelly medium for experiments to infect cell cultures with B. burgdorferi. After 72 hours of cultivation, the spirochetes were counted using an inverted phase contrast microscope and dark-field illumination (400×). Survival, multiplication and the adherence of B. burgdorferi for embryonic cells of R. microplus and A. cajennense were observed. B. burgdorferi cultured with embryonic cells of R. microplus grew on average to a density (final count) of 2.4 × 10(7) spirochetes/mL, whereas in cell-free culture, an average of 2.5 × 10(7) spirochetes/mL were counted. When cultivated with A. cajennense cells, the final count of spirochetes was on average 1.7 × 10(7) spirochetes/mL, while spirochetes cultured under cell-free conditions replicated on average of 2.2 × 10(7) spirochetes/mL. Similar results were observed in the final count of Spirochetes cultivated in cells of R. microplus and A. cajennense, when compared with cell-free control. These results demonstrated that cells of R. microplus and A. cajennense have the potential to be used as growth substrate for B. burgdorferi in the study of its interaction with host cells.
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Affiliation(s)
- J Rezende
- Departamento de Epidemiologia e Saúde Pública, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil.
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15
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Carranza-Tamayo CO, Costa JNGD, Bastos WM. Lyme disease in the state of Tocantins, Brazil: report of the first cases. Braz J Infect Dis 2012; 16:586-9. [PMID: 23141972 DOI: 10.1016/j.bjid.2012.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022] Open
Abstract
Lyme disease is an underdiagnosed zoonosis in Brazil. There are no cases registered in the state of Tocantins, the newest Brazilian state. The cases of three patients in contact with rural areas in three Tocantins' districts are herein described, and the Brazilian literature is reviewed.
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Affiliation(s)
- César Omar Carranza-Tamayo
- Superintendence of Surveillance and Health Protection, Department of Health of the State of Tocantins, Palmas, TO, Brazil.
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16
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Gouveia EA, Alves MF, Mantovani E, Oyafuso LK, Bonoldi VLN, Yoshinari NH. Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas". Rev Inst Med Trop Sao Paulo 2010; 52:297-303. [DOI: 10.1590/s0036-46652010000600003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 09/03/2010] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the epidemiological, clinical and laboratorial profile of patients with Baggio-Yoshinari Syndrome (BYS), who underwent internment at the Instituto de Infectologia Emilio Ribas in São Paulo, Brazil, during the period from July 1990 to July 2006. BYS is a new Brazilian tick-borne disease caused by Borrelia burgdorferi sensu lato microorganisms that resembles features of Lyme disease (LD), except for its epidemiological, clinical and laboratorial particularities. From 60 patients' records with positive serology to B. burgdorferi done by ELISA and Western-blotting methods, 19 cases were diagnosed as having BYS, according to criteria adopted at LIM-17 HCFMUSP, the Brazilian Reference Laboratory for the research of BYS. The other 41 remaining patients displayed miscellaneous infections or auto-immune processes. The beginning of symptoms in BYS group varied from one day to six years, from the onset of the disease. Four of 19 patients were included in acute disease stage, and 15 in latent. General unspecific symptoms were identified in almost all cases, with high frequencies of fever (78.9%) and lymphadenomegaly (36.8%). Six patients had skin lesions (31.5%); six arthralgia or arthritis (31.5%) and eight neurological symptoms (42%). Interestingly, two patients showed antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid. Since BYS is a new emergent Brazilian zoonosis and its diagnosis is sometimes complex, all the new knowledge about BYS must be scattered to Brazilian Medical specialists, aiming to teach them how to diagnose this amazing tick-borne disease and to avoid its progression to chronic irreversible sequels
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17
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Santos M, Ribeiro-Rodrigues R, Lobo R, Talhari S. Antibody reactivity to Borrelia burgdorferi sensu stricto antigens in patients from the Brazilian Amazon region with skin diseases not related to Lyme disease. Int J Dermatol 2010; 49:552-6. [PMID: 20534091 DOI: 10.1111/j.1365-4632.2010.04393.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the present study, we report the occurrence of borreliosis in patients from the Brazilian Amazonic region. Nineteen (7.2%) out of 270 dermatological patients with different skin diseases (no one with clinical Lyme disease), tested positive by ELISA for Borrelia burgdorferi. Serum samples from 15 out of the 19 ELISA-positive patients were further evaluated by Western blot. Presence of Borrelia burgdorferi specific IgG was confirmed in eight (53.3%) out of the 15 patients. All eight patients with ELISA and Western blot positive reactions were treated with doxycycline, according to the Centers for Disease Control and Prevention guidelines. One of them had clinical manifestations of colagenosis and was sent to the Department of Internal Medicine for further investigation. Data presented here suggested that borreliosis "lato sensu" is in the Brazilian Amazon region.
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Affiliation(s)
- Mônica Santos
- Dermatology Division, Fundação de Medicina Tropical do Amazonas (FMT-AM), Manaus, Amazonas State, Brazil
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18
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Talhari S, de Souza Santos MN, Talhari C, de Lima Ferreira LC, Silva RM, Zelger B, Massone C, Ribeiro-Rodrigues R. Borrelia Burgdorferi "sensu lato" in Brazil: Occurrence confirmed by immunohistochemistry and focus floating microscopy. Acta Trop 2010; 115:200-4. [PMID: 20211144 DOI: 10.1016/j.actatropica.2010.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/19/2010] [Accepted: 02/28/2010] [Indexed: 11/26/2022]
Abstract
In the present study, we report the occurrence of Lyme's borreliosis in patients from the Brazilian Amazon Region. Borreliosis was investigated by immunohistochemistry and focus floating microscopy for Borrelia burgdorferi in skin biopsy samples from 22 patients with both clinical and histopathology evidences compatible with Erythema Migrans. Spirochetes were detected by specific immunohistochemistry and focus floating microscopy for B. burgdorferi in samples from five patients. Clinical cure of the cutaneous lesions was observed in all the patients after treatment with doxycycline regimen as proposed by the Center Disease Control guidelines. A limitation of our study was the fact that we were not able to isolate and culture these organisms. These are the first known Brazilian cases of borreliosis to have Focus Floating Microscopy confirmation.
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Spolidorio MG, Labruna MB, Machado RZ, Moraes-Filho J, Zago AM, Donatele DM, Pinheiro SR, Silveira I, Caliari KM, Yoshinari NH. Survey for tick-borne zoonoses in the state of Espirito Santo, southeastern Brazil. Am J Trop Med Hyg 2010; 83:201-6. [PMID: 20595502 DOI: 10.4269/ajtmh.2010.09-0595] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Blood samples collected from 201 humans, 92 dogs, and 27 horses in the state of Espirito Santo, Brazil, were tested by polymerase chain reaction, indirect immunofluorescence assays, and indirect enzyme-linked immunosorbent assay for tick-borne diseases (rickettsiosis, ehrlichiosis, anaplasmosis, borreliosis, babesiosis). Our results indicated that the surveyed counties are endemic for spotted fever group rickettsiosis because sera from 70 (34.8%) humans, 7 (7.6%) dogs, and 7 (25.9%) horses were reactive to at least one of the six Rickettsia species tested. Although there was evidence of ehrlichiosis (Ehrlichia canis) and babesiosis (Babesia canis vogeli, Theileria equi) in domestic animals, no human was positive for babesiosis and only four individuals were serologically positive for E. canis. Borrelia burgdorferi-serologic reactive sera were rare among humans and horses, but encompassed 51% of the canine samples, suggesting that dogs and their ticks can be part of the epidemiological cycle of the causative agent of the Brazilian zoonosis, named Baggio-Yoshinari Syndrome.
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Affiliation(s)
- Mariana G Spolidorio
- Laboratório de Investigação Médica 17 (LIM17), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Dantas-Torres F. Canine vector-borne diseases in Brazil. Parasit Vectors 2008; 1:25. [PMID: 18691408 PMCID: PMC2533296 DOI: 10.1186/1756-3305-1-25] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 08/08/2008] [Indexed: 11/24/2022] Open
Abstract
Canine vector-borne diseases (CVBDs) are highly prevalent in Brazil and represent a challenge to veterinarians and public health workers, since some diseases are of great zoonotic potential. Dogs are affected by many protozoa (e.g., Babesia vogeli, Leishmania infantum, and Trypanosoma cruzi), bacteria (e.g., Anaplasma platys and Ehrlichia canis), and helminths (e.g., Dirofilaria immitis and Dipylidium caninum) that are transmitted by a diverse range of arthropod vectors, including ticks, fleas, lice, triatomines, mosquitoes, tabanids, and phlebotomine sand flies. This article focuses on several aspects (etiology, transmission, distribution, prevalence, risk factors, diagnosis, control, prevention, and public health significance) of CVBDs in Brazil and discusses research gaps to be addressed in future studies.
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Affiliation(s)
- Filipe Dantas-Torres
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, PO Box 7472, Recife, 50670420, Pernambuco, Brazil.
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21
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Fonseca AHD, Salles RDS, Salles SDAN, Madureira RC, Yoshinari NH. Borreliose de Lyme simile: uma doença emergente e relevante para a dermatologia no Brasil. An Bras Dermatol 2005. [DOI: 10.1590/s0365-05962005000200008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho de revisão são apresentadas doenças relacionadas com espiroquetas do gênero Borrelia, agentes etiológicos de diferentes enfermidades comuns ao homem e a animais. Enfatizou-se a Borrelia burgdorferi lato sensu, que inclui diferentes espécies causadoras de doenças e com envolvimento sistêmico, com interesse em várias especialidades médicas, como dermatologia, reumatologia, cardiologia e neurologia. Considerando que existem diferenças quanto ao agente etiológico, além dos aspectos clínicos e laboratoriais, quando comparada com a borreliose de Lyme causada pelas Borrelia burgdorferi, B. garinii e B. afzelli, a infecção no Brasil deve ser referida como borreliose de Lyme simile. O eritema migratório recidivante é a principal manifestação clínica da borreliose existente tanto no Brasil como nos demais países. Essa lesão clássica está relacionada com a picada do carrapato vetor e inicia-se como uma mácula ou pápula cutânea avermelhada, de caráter expansivo, eventualmente surgem lesões semelhantes múltiplas a distância. A manifestação clínica da enfermidade, em especial o envolvimento cutâneo, é o parâmetro diagnóstico mais relevante, e os exames complementares sorológicos confirmam a suspeita clínica.
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