Zoonotic infections in adults in the Bushbuckridge District of Mpumalanga Province

Abstract

Background: The Mnisi area of Bushbuckridge, Mpumalanga, SouthAfricahasapopulationof approximately80000,mainlyagropastoralists. The area is bordered by the Kruger National Park and contact between wildlife, livestock and humans is frequent. Cattle are brought to community diptanks weekly for tick control and active veterinary surveillance. Methods & Materials: Between October 2012 through June 2013, consentingmalaria-negative adult patientswith acute febrile illness (AFI) were enrolled if they matched the study criteria. A nurse interviewed the patients and acute blood samples were taken,with patients requested to return in 2weeks for re-sampling. Additionally, we enrolled healthy herders and veterinary staff at 5 dip tanks. Testing was done for brucellosis, bartonella, leptospirosis, Q-fever, tick bite fever (TBF), and West Nile virus, Sindbis, Rift Valley fever and chikungunya virus infections. Results: Of 119 eligible patients, 74 (62%) were enrolled; median age was 34 years; 46/74 (62%) were females (2 pregnant). Median illness duration was 3 days and median body temperature was 37.55 ◦C. Recent TBF was present in 13/65 (20%) patients and past infection in 33/58 (57%); 22/52 (42%) hadQ-fever antibodies, 7/74 (9.5%) had acute bartonellosis, 5 (6.8%) had leptospirosis, 2/71 (2.8%) had previousWestNile, 1/71 (1.4%) had recent Sindbis, 1/74 (1.35%) had recent brucellosis. 64 healthy adult herders/veterinary staff were recruited; 46/64 (72%) were male, median age 55 years. The median duration of diptank attendance was 15 years. 63/64 (98%) were positive for exposure to at least one of the 9 zoonoses tested. 14/64 (22%) had previous leptospirosis, 38/64 (59%)Q-fever, 2/64 (3%) chikungunya, 2/64 (3%) Sindbis and 59/64 (92%) TBF. Conclusion: There was a high background exposure to TBF, Q fever and leptospirosis in the community. A surprising finding was thenumberofbartonella infections, notpreviouslydescribed in this population. There is a need to re-look at AFI treatment algorithms in the clinic setting; also to educate the population about reducing tick and surfacewater contact. Zoonosis surveillance is to continue.