First Urban Case of Rickettsia parkeri (Atlantic Rainforest Strain) Rickettsiosis in Mérida, Mexico

Infectious Diseases Associated with Caves

Tickborne Meningoencephalitis, First Case after 19 Years in Northeastern Germany

Ticks biting humans in the Brazilian savannah: Attachment sites and exposure risk in relation to species, life stage and season

Human cases of relapsing fever (RF) in North America are caused primarily by Borrelia hermsii and Borrelia turicatae, which are spread by argasid (soft) ticks, and by Borrelia miyamotoi, which is transmitted by ixodid (hard) ticks. In some regions of the United States, the ranges of the hard and soft tick RF species are known to overlap; in many areas, recorded ranges of RF spirochetes overlap with Lyme disease (LD) group Borrelia spirochetes. Identification of RF clusters or cases detected in unusual geographic localities might prompt public health agencies to investigate environmental exposures, enabling prevention of additional cases through locally targeted mitigation. However, exposure risks and mitigation strategies differ among hard and soft tick RF, prompting a need for additional diagnostic strategies that differentiate hard tick from soft tick RF. We evaluated the ability of new and previously described recombinant antigens in serological assays to differentiate among prior exposures in mice to LD, soft or hard tick RF spirochetes. We extracted whole-cell protein lysates from RF Borrelia cultures and synthesized six recombinant RF antigens (Borrelia immunogenic protein A (BipA) derived from four species of RF Borrelia, glycerophosphodiester phosphodiesterase (GlpQ), and Borrelia miyamotoi membrane antigen A (BmaA)) to detect reactivity in laboratory derived (Peromyscus sp. and Mus sp.) mouse serum infected with RF and LD Borrelia species. Among 44 Borrelia exposed mouse samples tested, all five mice exposed to LD spirochetes were correctly differentiated from the 39 mice exposed to RF Borrelia using the recombinant targets. Of the 39 mice exposed to RF spirochetes, 28 were accurately categorized to species of exposure (71%). Segregation among soft tick RF species (Borrelia hermsii, Borrelia parkeri and Borrelia turicatae) was inadequate (58%) owing to observed cross-reactivity among recombinant BipA protein targets. However, among the 28 samples accurately separated to species, all were accurately assigned to soft tick or hard tick RF type. Although not adequately specific to accurately categorize exposure to soft tick RF species, the recombinant BipA protein targets from soft and hard tick RF species show utility in accurately discriminating mouse exposures to LD or RF Borrelia, and accurately segregate hard tick from soft tick RF Borrelia exposure.

To the Editor: Francisella tularensis, the etiologic agent of tularemia, is a highly infectious zoonotic agent. F. tularensis subsp. holarctica (type B) is found throughout the Northern Hemisphere and is the only subspecies found in Europe (1). Lagomorphs and rodents probably serve as the primary mammalian reservoir hosts, and hematophagous arthropods, such as ticks, play a role as vectors and hosts (2,3). Although F. tularensis is a potential agent of biological warfare and several emergences and reemergences of tularemia have been reported around the world (1,4), the epizootiology of the disease is only partially understood. The aim of our study was to analyze factors that influence the emergence of tularemia in Hungary. The study area (15,475 km2) included 3 counties in eastern Hungary. The analyzed data represented a period of 25 years, March 1984–February 2010. Annual F. tularensis–specific seroprevalence data for the European brown hare (Lepus europaeus) population were obtained by slide agglutination testing during the winter (December and January) screening of 2,500–25,000 animals (Technical Appendix). Population density data (animals/km2) for hares were based on February line transect counts and were obtained from the Hungarian Game Management database (www.vvt.gau.hu/vadgazdalkodasi_statisztikak.htm). Common vole (Microtus arvalis) densities (calculated from the number of active burrows/hectare during November) for 1996–2010 were obtained from the Central Agriculture Office, Budapest, Hungary. Vole density was scaled from 0 (absent) to 10 (peak population). The annual number of tularemia cases in humans (based on clinical history and tube agglutination test results) was obtained from the National Center for Epidemiology, Budapest. The data were regrouped according to the yearly biologic cycle (March–February) for hares and voles (Figure), and relationships between these yearly data were quantified by using the Spearman rank correlation coefficient (5) at county and regional levels. A 2–3 year cycle was characteristic for the analyzed data. A significant positive correlation was found among the number of tularemia cases in humans and the seroprevalence of F. tularensis among European brown hares (Spearman ρ = 0.73; p<0.0001) and the population density of common voles (Spearman ρ = 0.77; p = 0.0081). A significant negative correlation was found between the population density of hares and the seroprevalence of F. tularensis in hares (Spearman ρ = −0.41; p = 0.0365). Figure Correlation between the seroprevalence of Francisella tularensis in the European brown hare (Lepus europaeus) population, the population density of European brown hares and common voles (Microtus arvalis), and the number of tularemia cases in humans eastern ... The comprehensive and long-term annual data used in this study provide clues regarding the factors shaping the intraannual epizootiology and emergence or reemergence of tularemia. The European brown hare is moderately sensitive to F. tularensis subsp. holarctica. The hares produce a heterogeneous response to infection, which means that some die of overwhelming bacteremia and others survive with a protracted course of infection, thereby contributing to the maintenance of tularemia over longer periods and serving as useful sentinels of disease activity. Other studies have concluded that hares, together with infected ticks, may serve as disease reservoirs between epizootics (2,3,6,7). However, we instead hypothesize that the 2–3 year cycling feature of the population dynamics for the common vole (2) determines the ecology of F. tularensis subsp. holarctica in eastern Hungary. The common vole is highly susceptible to F. tularensis subsp. holarctica (3,8). When population densities among voles are high, F. tularensis disease transmission and spillover to hares may be facilitated by stress-related aggression, cannibalism, and F. tularensis contamination of the environment by infectious body discharges (2). Enhanced transmission and spillover can expand local outbreaks to epizootic proportions, and infected hares may, in turn, further enhance the spread of disease through bacterial shedding in urine (6,7). The disease in hares often results in septicemia and death (7), thus decreasing the population density of these animals. Hares and especially voles are also hosts for different stages of several tick species (2,6), so it can be expected, that higher numbers of infected rodents and lagomorphs result in an increased proportion of infected ticks and, thus, increased transmission of F. tularensis subsp. holarctica. It can be concluded that a higher number of infection sources in the environment results in elevated numbers of cases in humans, mainly through the handling and skinning of hares, but also through tick bites and, potentially, the inhalation of infectious aerosols originating from, for example, hay or grain. Technical Appendix: Detailed data of the annual Francisella tularensis–specific seroprevalence in the European brown hare (Lepus europaeus) population, the annual population density of European brown hares and common voles (Microtus arvalis), and the annual number of tularemia cases in humans, Hungary, 1984–2010. Data are for 3 counties in eastern Hungary: Bekes, Csongrad, and Jasz-Nagykun-Szolnok)*. Click here to view.(47K, xls)

Specimens of the hard tick Amblyomma triste were found infected with Rickettsia parkeri in an area of Argentina (General Lavalle, Buenos Aires Province) where cases of human illness attributed to this microorganism have been reported. Molecular detection of R. parkeri was based on polymerase chain reactions that amplify a ca. 400-bp fragment of the 23S-5S intergenic spacer and a ca. 500-bp fragment of the gene encoding a 190-kDa outer membrane protein. Three (6.97%) of 43 A. triste ticks were determined to be positive for R. parkeri. These results provide strong evidence that A. triste is the vector of R. parkeri in the study area. The findings of this work have epidemiological relevance because human parasitism by A. triste ticks has been frequently recorded in some riparian areas of Argentina and Uruguay and new cases of R. parkeri rickettsiosis might arise in the South American localities where humans are exposed to the bites of this tick species.

An atypical presentation of monkeypox associated with scrotal and penile shaft edema

The objective of this study was to determine the level of organochlorine pesticides in maternal milk of women living in urban and rural areas in central Mexico. High levels of the DDT (1,1,1,-trichloro-2,2-bis (p-chlorophenyl) ethane) and metabolites, p,p'-DDT (1.83, 0.66 and 3.13 mg/kg) and p,p'-DDE (2.49, 4.28 and 13.32 mg/kg), were encountered for Mexico City, Cuemavaca and rural Morelos, respectively. As was expected, the highest levels of exposure to these pesticides were found in the rural areas of the State of Morelos.

In selected localities of Ceské Budĕjovice and Ceský, Krumlov districts, well known by stable high incidence of tick-borne encephalitis (TBE) human cases but with low incidence of Lyme borreliosis, monitoring of Borrelia burgdorferi sensu lato (s.l.) in Ixodes ricinus ticks was performed. Research was also aimed at the spread of I. ricinus to mountain areas of this region (National Park Sumava), as well as at investigating this tick for B. burgdorferi s.l. genospecies and TBE virus infection. Altogether 498 nymphs, 88 females and 11 males of I. ricinus from lower locations and 58 nymphs from mountain locations (760-1080 m above sea level) were tested by polymerase chain reaction. In lower locations total prevalence of Borrelia burgdorferi s.l. in Ixodes ricinus ticks was 35%. Single infection of Borrelia afzelii, B. garinii and B. burgdorferi sensu stricto (s.s.) was found in 59, 50 and 63 ticks, respectively (i.e. in 12.8, 11.2 and 14.1%). Double infection was found in 42 ticks (6.0%) and triple infection in three ticks (0.4%). The high frequency of B. burgdorferi s.s. exceeds the as yet reported occurrence in Central Europe. These circumstances are discussed. In mountain locations B. afzelii was found in five ticks, that including two co-infection with B. garinii, in elevations of 762 m and 1024 m above sea level, respectively. This fact signals a real danger of human infections in a region that was previously deemed to be without risk. Moreover, this region is more and more the target destination of tourist activities. The results also suggest that the penetration of infection can be rapid and formation and establishment of natural focus of Lyme borreliosis might be rather quick.

On the cause and consequences of IgE to galactose-α-1,3-galactose: A report from the National Institute of Allergy and Infectious Diseases Workshop on Understanding IgE-Mediated Mammalian Meat Allergy

Of goats and men: rethinking anaplasmoses as zoonotic infections

IntroductionPerthes’ disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as...

Since the first report of a human tick infestation in 1982 1 , about 40 human cases have been reported in the Korean literature.The causative ticks reported in Korea were 7 species, and tick bites from Amblyomma testudinarium has been reported once in Korea 2 .Dermoscopy is a useful

Introduction: Lyme disease is the most common vector borne infection in the united state, There have been multiple cases of borreliosis reported across the world especially in North America and Europe in which the course of disease was characterized by long standing high fever, enlargement of liver and spleen, pancreatitis, pneumonia and anemia. Many GI manifestation of borreliosis have been reported in literature but involvement of the pancreas has so far not been reported. We describe a case of pancreatitis in a patient with serology-proven lyme disease (Borreliosis). Case Description: This is the case of 20 year old Caucasian female presented to ED with complaint of abdominal pain and generalized body aches. In late June she went camping in upstate, New York. She stayed there for the entire month, she had a tick bite during camping and tick was removed immediately; no symptoms reported at that time. Week later, she developed abdominal pain, nausea, vomiting and fever and was admitted in the hospital New York and was found to have pancreatitis. Lipase was elevated at 1250. Discussion: History of tick bite, rash with central clearing with bull's eye appearance is Erythema Migrans, the characteristic rash of early course of lyme disease. Abdominal pain, nausea, vomiting, with elevated lipase is characteristic symptoms of pancreatitis. Diagnosis of acute pancreatitis is established on clinical symptoms and laboratory testing. According to American College of Gastroenterology guidelines, the presence of two of the following three characteristics is sufficient for the diagnosis acute pancreatitis: Abdominal pain, serum lipase higher than three times the upper limit, and radiographic evidence of acute pancreatitis. The patient had 2 of these three characteristics. There has been no case reported associated with Lyme pancreatitis till today, the reason of reporting this case is to highlight the difficulty in diagnosing borreliosis. As borreliosis is multisystem disease and there have been reported cases where diagnosis was difficult to reach we suggest exploring other manifestation of this disease.

ABSTRACT.Crimean–Congo hemorrhagic fever (CCHF) is a lethal zoonotic disease transmitted through tick bites and contact with infected animals or humans. As CCHF continues to expand worldwide, we report on the first severe outbreak in Senegal (Podor, Saint-Louis region) in 2022. We conducted a comprehensive outbreak investigation after a confirmed CCHF human case in Podor. This included sample collections from humans, animals, and ticks from the household and surrounding area. Human and animal samples were tested by ELISA for antibodies to CCHF virus and by reverse transcription polymerase chain reaction (RT-PCR) for CCHF virus RNA, whereas tick samples underwent CCHF RT-PCR only. Positive RT-PCR samples underwent viral genome sequencing for genetic characterization. We determined three CCHF human cases, with two deaths, as well as virus circulation in 11 ticks and in livestock, with an overall seroprevalence of 42.5%. CCHF IgG antibodies were detected in human contact cases, showing its prior prevalence in the area. Phylogenetic analyses revealed high genetic diversity within CCHF genotypes, with existence of reassortants and cocirculation of two different isolates from various origins in Mboyo and Nenette villages, where human cases were detected. The data showed a correlation between the strains identified in humans and ticks in each village, showing two independent emergences in Podor. The outbreak in Podor was probably because of the high abundance of animal hosts in this sylvopastoral area, the diversity of tick populations with the presence of the main CCHF vectors, and the increasing prevalence of CCHF virus. The surveillance in this area needs to be strengthened.