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Norte AC, Araújo PM, Augusto L, Guímaro H, Santos S, Lopes RJ, Núncio MS, Ramos JA, Lopes de Carvalho I. Effects of stress exposure in captivity on physiology and infection in avian hosts: no evidence of increased Borrelia burgdorferi s.l. infectivity to vector ticks. Microb Ecol 2022; 83:202-215. [PMID: 33758979 DOI: 10.1007/s00248-021-01738-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Exposure to environmental stressors, an increasingly recurring event in natural communities due to anthropogenic-induced environmental change, profoundly impacts disease emergence and spread. One mechanism through which this occurs is through stress-induced immunosuppression increasing disease susceptibility, prevalence, intensity and reactivation in hosts. We experimentally evaluated how exposure to stressors affected both the physiology of avian hosts and the prevalence of the zoonotic bacteria Borrelia burgdorferi sensu lato (s.l.), in two model species-the blackbird Turdus merula and the robin Erithacus rubecula captured in the wild, using xenodiagnoses and analysis of skin biopsies and blood. Although exposure to stressors in captivity induced physiological stress in birds (increased the number of circulating heterophils), there was no evidence of increased infectivity to xenodiagnostic ticks. However, Borrelia detection in the blood for both experimental groups of blackbirds was higher by the end of the captivity period. The infectivity and efficiency of transmission were higher for blackbirds than robins. When comparing different methodologies to determine infection status, xenodiagnosis was a more sensitive method than skin biopsies and blood samples, which could be attributed to mild levels of infection in these avian hosts and/or dynamics and timing of Borrelia infection relapses and redistribution in tissues.
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Affiliation(s)
- A C Norte
- Department of Life Sciences, MARE-Marine and Environmental Sciences Centre, Calçada Martim de Freitas, Faculty of Sciences and Technology, University of Coimbra, 3000-456, Coimbra, Portugal.
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
| | - P M Araújo
- Department of Life Sciences, MARE-Marine and Environmental Sciences Centre, Calçada Martim de Freitas, Faculty of Sciences and Technology, University of Coimbra, 3000-456, Coimbra, Portugal
- Centro de Investigação em Biodiversidade e Recursos Genéticos, CIBIO-InBIO, Universidade do Porto, Porto, Portugal
| | - L Augusto
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- Department of Veterinary Sciences, University of Évora, Évora, Portugal
| | - H Guímaro
- Department of Life Sciences, MARE-Marine and Environmental Sciences Centre, Calçada Martim de Freitas, Faculty of Sciences and Technology, University of Coimbra, 3000-456, Coimbra, Portugal
| | - S Santos
- Department of Life Sciences, MARE-Marine and Environmental Sciences Centre, Calçada Martim de Freitas, Faculty of Sciences and Technology, University of Coimbra, 3000-456, Coimbra, Portugal
| | - R J Lopes
- Centro de Investigação em Biodiversidade e Recursos Genéticos, CIBIO-InBIO, Universidade do Porto, Porto, Portugal
| | - M S Núncio
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - J A Ramos
- Department of Life Sciences, MARE-Marine and Environmental Sciences Centre, Calçada Martim de Freitas, Faculty of Sciences and Technology, University of Coimbra, 3000-456, Coimbra, Portugal
| | - I Lopes de Carvalho
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
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Cordeiro R, Jordao L, Pelerito A, de Carvalho IL, Nuncio MS. Implementation of bioterrorism agents diagnosis by electron microscopy in Portuguese reference laboratory. Ultrastruct Pathol 2017. [DOI: 10.1080/01913123.2016.1272645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Cordeiro
- Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - L. Jordao
- Electron Microscopy Laboratory, Research and Development Unit, Environmental Health Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - A. Pelerito
- Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - I. Lopes de Carvalho
- Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - M. S. Nuncio
- Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
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Lopes de Carvalho I, Toledo A, Carvalho CL, Barandika JF, Respicio-Kingry LB, Garcia-Amil C, García-Pérez AL, Olmeda AS, Zé-Zé L, Petersen JM, Anda P, Núncio MS, Escudero R. Francisella species in ticks and animals, Iberian Peninsula. Ticks Tick Borne Dis 2015; 7:159-165. [PMID: 26520052 DOI: 10.1016/j.ttbdis.2015.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
The presence of Francisella species in 2134 ticks, 93 lagomorphs and 280 small mammals from the Iberian Peninsula was studied. Overall, 19 ticks and 6 lagomorphs were positive for Francisella tularensis subsp. holarctica, suggesting, as described for other regions, that lagomorphs may have an important role in the maintenance of F. tularensis in nature. Of the 6 positive lagomorphs, 4 were identified as the European rabbit, Oryctogalus cuniculus. Additionally, 353 ticks and 3 small mammals were PCR positive for Francisella-like endosymbionts (FLEs) and one small mammal was also positive for Francisella hispaniensis-like DNA sequences. Among FLE positive specimens, a variety of sequence types were detected: ticks were associated with 5 lpnA sequence types, with only one type identified per tick, in contrast to 2 lpnA sequence types detected in a single wood mouse (Apodemus sylvaticus). To our knowledge, this is the first report of FLEs in free-living small mammals as well as the first detection of F. hispaniensis-like sequences in a natural setting.
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Affiliation(s)
| | - A Toledo
- Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - C L Carvalho
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Águas de Moura, Portugal; University of Évora, Évora, Portugal
| | - J F Barandika
- NEIKER - Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Biscay, Spain
| | | | - C Garcia-Amil
- Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - A L García-Pérez
- NEIKER - Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Biscay, Spain
| | - A S Olmeda
- Universidad Complutense de Madrid, Madrid, Spain
| | - L Zé-Zé
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Águas de Moura, Portugal
| | - J M Petersen
- Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - P Anda
- Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M S Núncio
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal; Instituto Nacional de Saúde Dr. Ricardo Jorge, Águas de Moura, Portugal
| | - R Escudero
- Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Norte AC, da Silva LP, Tenreiro PJQ, Felgueiras MS, Araújo PM, Lopes PB, Matos C, Rosa A, Ferreira PJSG, Encarnação P, Rocha A, Escudero R, Anda P, Núncio MS, Lopes de Carvalho I. Patterns of tick infestation and their Borrelia burgdorferi s.l. infection in wild birds in Portugal. Ticks Tick Borne Dis 2015; 6:743-50. [PMID: 26159798 DOI: 10.1016/j.ttbdis.2015.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
Wild birds may act as reservoirs for zoonotic pathogens and may be mechanical carriers of pathogen infected vector ticks through long distances during migration. The aim of this study was to assess tick infestation patterns in birds in Portugal and the prevalence of tick infection by Borrelia burgdorferi s.l. using PCR techniques. Seven tick species were collected from birds including Haemaphysalis punctata, Hyalomma spp., Ixodes acuminatus, Ixodes arboricola, Ixodes frontalis, Ixodes ricinus and Ixodes ventalloi. We found that I. frontalis and Hyalomma spp. were the most common ticks infesting birds of several species and that they were widespread in Portugal. Turdus merula was the bird species that presented the highest diversity of infesting ticks and had one of the highest infestation intensities. B. burgdorferi s.l. was detected in 7.3% (37/505) of Ixodidae ticks derived from birds. The most common genospecies was Borrelia turdi (6.9%), detected in ticks collected from Parus major, T. merula and Turdus philomelos, but Borrelia valaisiana (0.2%) and one Borrelia sp. (0.2%) similar to Borrelia bissettii (96% of similarity of the flaB gene in Blastn) were also detected. This study contributed to a better knowledge of the Ixodidae tick fauna parasitizing birds in Western Europe and to the assessment of the prevalence of B. burgdorferi s.l. associated with birds and their ticks.
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Affiliation(s)
- A C Norte
- MARE - Marine and Environmental Sciences Centre, Department of Life Sciences, Largo Marquês de Pombal, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra, Portugal; Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, Portugal.
| | - L P da Silva
- MARE - Marine and Environmental Sciences Centre, Department of Life Sciences, Largo Marquês de Pombal, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra, Portugal; CFE - Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - P J Q Tenreiro
- Instituto da Conservação da Natureza e das Florestas, IP, DCNFC-DGOV, Mata Nacional do Choupal, 3000-611 Coimbra, Portugal
| | - M S Felgueiras
- A ROCHA - Associação Cristã de Estudo e Defesa do Ambiente, Apartado 41, 8501-903 Mexilhoeira Grande, Portugal
| | - P M Araújo
- MARE - Marine and Environmental Sciences Centre, Department of Life Sciences, Largo Marquês de Pombal, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - P B Lopes
- MARE - Marine and Environmental Sciences Centre, Department of Life Sciences, Largo Marquês de Pombal, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - C Matos
- Rua da capela, n°13, 7630-711 Bicos, Odemira, Portugal
| | - A Rosa
- Casais da Estrada, 2000-335 Achete, Santarém, Portugal
| | | | - P Encarnação
- Instituto da Conservação da Natureza e das Florestas, IP, Estação Ornitológica do Monte do Outeirão - Apartado 139, 7500-999 Vila Nova Santo André, Portugal
| | - A Rocha
- MARE - Marine and Environmental Sciences Centre, Department of Life Sciences, Largo Marquês de Pombal, Faculty of Sciences and Technology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - R Escudero
- Laboratorio de Espiroquetas y Patógenos Especiales, Servicio de Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - P Anda
- Laboratorio de Espiroquetas y Patógenos Especiales, Servicio de Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - M S Núncio
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, Portugal
| | - I Lopes de Carvalho
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, Portugal; Emergence Response and Biopreparadness Unit, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
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Carvalho CL, Lopes de Carvalho I, Zé-Zé L, Núncio MS, Duarte EL. Tularaemia: a challenging zoonosis. Comp Immunol Microbiol Infect Dis 2014; 37:85-96. [PMID: 24480622 PMCID: PMC7124367 DOI: 10.1016/j.cimid.2014.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/28/2013] [Accepted: 01/04/2014] [Indexed: 01/21/2023]
Abstract
In recent years, several emerging zoonotic vector-borne infections with potential impact on human health have been identified in Europe, including tularaemia, caused by Francisella tularensis. This remarkable pathogen, one of the most virulent microorganisms currently known, has been detected in increasingly new settings and in a wide range of wild species, including lagomorphs, rodents, carnivores, fish and invertebrate arthropods. Also, a renewed concern has arisen with regard to F. tularensis: its potential use by bioterrorists. Based on the information published concerning the latest outbreaks, the aim of this paper is to review the main features of the agent, its biology, immunology and epidemiology. Moreover, special focus will be given to zoonotic aspects of the disease, as tularaemia outbreaks in human populations have been frequently associated with disease in animals.
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Affiliation(s)
- C L Carvalho
- Institute of Mediterranean Agricultural and Environmental Science (ICAAM), School of Science and Technology ECT, University of Évora, Portugal; Centre for Vectors and Infectious Diseases Research, National Health Institute Doutor Ricardo Jorge, Águas de Moura, Portugal
| | - I Lopes de Carvalho
- Emergency Response and Bio-preparedness Unit, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - L Zé-Zé
- Centre for Vectors and Infectious Diseases Research, National Health Institute Doutor Ricardo Jorge, Águas de Moura, Portugal
| | - M S Núncio
- Centre for Vectors and Infectious Diseases Research, National Health Institute Doutor Ricardo Jorge, Águas de Moura, Portugal
| | - E L Duarte
- Institute of Mediterranean Agricultural and Environmental Science (ICAAM), School of Science and Technology ECT, University of Évora, Portugal.
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Norte AC, de Carvalho IL, Ramos JA, Gonçalves M, Gern L, Núncio MS. Diversity and seasonal patterns of ticks parasitizing wild birds in western Portugal. Exp Appl Acarol 2012; 58:327-339. [PMID: 22669280 DOI: 10.1007/s10493-012-9583-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 05/22/2012] [Indexed: 05/28/2023]
Abstract
The diversity and abundance of questing ticks and ticks parasitizing birds was assessed during 1 year in two recreational forests in western Portugal, a suburban forest and an enclosed game area. The aim of this study was to assess the distribution and seasonality of tick species and to understand the role of bird species as hosts for ticks. Ixodes ricinus was the most abundant questing tick collected in the enclosed game area, whereas in the suburban forest, only three ticks were collected by blanket dragging. Tick species parasitizing birds included I. ricinus, I. frontalis, I. arboricola, I. acuminatus, Haemaphysalis punctata, Hyalomma marginatum and H. lusitanicum. This is the first record of I. arboricola in Portugal. Tick prevalence and intensity of infestation differed between study areas and was higher in birds from the game area where a large population of deer and wild boar may support tick populations. Ground and shrub dwelling bird species such as Turdus merula, Erithacus rubecula and Sylvia melanocephala were the most heavily parasitized by ticks, but the importance of different bird species as hosts of larvae and nymphs of I. ricinus and I. frontalis differed. Therefore, different bird species may contribute differently for tick population maintenance.
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Affiliation(s)
- A C Norte
- Department of Life Sciences, Institute of Marine Research IMAR/CMA, University of Coimbra, Apartado 3046, 3001-401 Coimbra, Portugal.
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Norte AC, Ramos JA, Gern L, Núncio MS, Lopes de Carvalho I. Birds as reservoirs forBorrelia burgdorferis.l. in Western Europe: circulation ofB. turdiand other genospecies in bird-tick cycles in Portugal. Environ Microbiol 2012; 15:386-97. [DOI: 10.1111/j.1462-2920.2012.02834.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palma M, Lopes de Carvalho I, Figueiredo M, Amaro F, Boinas F, Cutler S, Núncio M. Borrelia hispanica in Ornithodoros erraticus, Portugal. Clin Microbiol Infect 2012; 18:696-701. [DOI: 10.1111/j.1469-0691.2011.03623.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lopes de Carvalho I, Núncio MS, David de Morais J. [Tularemia]. ACTA MEDICA PORT 2009; 22:281-290. [PMID: 19686629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 12/12/2008] [Indexed: 05/28/2023]
Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis. The etiological agent is transmitted to man by direct contact with infected animals, air, water or contaminated food, or through hematophagous vectors. In Portugal, in 1998, after an outbreak in Spain, the Direcção Geral de Saúde issued a warning, alerting the clinicians to the possibility of the disease spreading throughout the national territory. In this work, an epidemiological review of tularemia is made in order to contribute to the better knowledge of this disease.
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Affiliation(s)
- I Lopes de Carvalho
- Centro de Estudos de Vectores e Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa
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Lopes de Carvalho I, Fonseca JE, Marques JG, Ullmann A, Hojgaard A, Zeidner N, Núncio MS. Vasculitis-like syndrome associated with Borrelia lusitaniae infection. Clin Rheumatol 2008; 27:1587-91. [DOI: 10.1007/s10067-008-1012-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 09/03/2008] [Indexed: 11/24/2022]
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Abstract
Lyme borreliosis is considered to be an emerging infection in some regions of the world, including Portugal. The first Portuguese human case of Lyme borreliosis was identified in 1989. Since 1999, this disease is considered a notifiable disease (DDO) in Portugal, but only a few cases are reported each year, which does not allow consistent analysis of risk factors and the impact on public health. In this study the authors analyse the data available at the Centre for Vectors and Infectious Diseases Research (CEVDI) laboratory, at the Instituto Nacional de Saúde Dr. Ricardo Jorge (National Institute of Health, INSA) during the past 15 years (1990-2004) and evaluate them against the registry of national reported cases (1999-2004). Serological tests were the basis for laboratory diagnosis. Data on year of diagnosis, sex, age, geographical origin and clinical signs are available for 628 well documented Portuguese positive cases. The number of cases per year varied between 2 and 78, with the highest number of cases reported in 1997. Of the positive cases, 53.5% were female and the age group most affected was 35-44 years old. Neuroborreliosis was the most common clinical manifestation (37.3%). Human cases were detected in 17 of the 20 regions of Portugal, and the highest number of laboratory confirmed cases were from the Lisbon district. The comparison of the number of notified cases and the number of positive cases confirmed by our laboratory show that Lyme borreliosis is clearly an underreported disease. Due to the scattered distribution of the positive cases and the low prevalence of the tick species Ixodes ricinus, the most effective prevention measure for Lyme borreliosis in Portugal is education of the risk groups on how to prevent tick bites.
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Affiliation(s)
- I Lopes de Carvalho
- Centre for Vectors and Infectious Diseases Research, Instituto Nacional de Saúde Dr. Ricardo Jorge (National Institute of Health), Águas de Moura, Portugal
| | - M S Núncio
- Centre for Vectors and Infectious Diseases Research, Instituto Nacional de Saúde Dr. Ricardo Jorge (National Institute of Health), Águas de Moura, Portugal
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Lopes de Carvalho I, Núncio MS. Laboratory diagnosis of Lyme borreliosis at the Portuguese National Institute of Health (1990-2004). Euro Surveill 2006; 11:257-60. [PMID: 17130658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Lyme borreliosis is considered to be an emerging infection in some regions of the world, including Portugal. The first Portuguese human case of Lyme borreliosis was identified in 1989. Since 1999, this disease is considered a notifiable disease (DDO) in Portugal, but only a few cases are reported each year, which does not allow consistent analysis of risk factors and the impact on public health. In this study the authors analyse the data available at the Centre for Vectors and Infectious Diseases Research (CEVDI) laboratory, at the Instituto Nacional de Saude Dr. Ricardo Jorge (National Institute of Health, INSA) during the past 15 years (1990-2004) and evaluate them against the registry of national reported cases (1999-2004). Serological tests were the basis for laboratory diagnosis. Data on year of diagnosis, sex, age, geographical origin and clinical signs are available for 628 well documented Portuguese positive cases. The number of cases per year varied between 2 and 78, with the highest number of cases reported in 1997. Of the positive cases, 53.5% were female and the age group most affected was 35-44 years old. Neuroborreliosis was the most common clinical manifestation (37.3%). Human cases were detected in 17 of the 20 regions of Portugal, and the highest number of laboratory confirmed cases were from the Lisbon district. The comparison of the number of notified cases and the number of positive cases confirmed by our laboratory show that Lyme borreliosis is clearly an underreported disease. Due to the scattered distribution of the positive cases and the low prevalence of the tick species Ixodes ricinus, the most effective prevention measure for Lyme borreliosis in Portugal is education of the risk groups on how to prevent tick bites.
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Affiliation(s)
- I Lopes de Carvalho
- Centre for Vectors and Infectious Diseases Research, Instituto Nacional de Saude Dr. Ricardo Jorge (National Institute of Health), Aguas de Moura, Portugal
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