Acute Febrile Disease Research Articles

To Evaluate the Different Rapid Screening Tests for Diagnosis of Leptospirosis

Leptospirosis is an acute febrile disease, in tropical and sub-tropical regions of world. It has been under-reported in India, due to presence of non-specific symptoms and unavailability of appropriate laboratory diagnostic facilities in most part of the country. The diagnosis of leptospirosis is usually based on demonstration of antibodies by different serological tests. The present study aims to evaluate and compare commercially available rapid test. Case control study. Three screening tests (Leptocheck WB, Latex agglutination test and SD leptospira) were compared by using 100 serum samples randomly obtained from clinical cases of Leptospirosis admitted in new civil hospital, Surat, Gujarat. All the patients with acute Leptospirosis were included in this 4-months pilot study from July 2011 to October 2011. All the results were compared with IgM ELISA and MAT for confirmation of diagnosis. Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 84.8%, 84.8% and 72.7% & specificities of 37.3%, 71.2% and 71.2% respectively as compared to MAT. Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 90.7%, 89.7% and 53.7% & specificities of 93.4%, 90.9% and 60% respectively as compared to IgM ELISA. Latex agglutination test kit and Leptocheck WB were found to be highly sensitive and specific. Neither of these tests require specialized equipment, and could be performed in peripheral laboratories with relatively little expertise.

Early Detection of Kawasaki Disease in Infants.

Background and ObjectivesThis study aimed to investigate the clinical characteristics of infantile Kawasaki disease (KD), and to evaluate early diagnostic features of KD in febrile infants.Subjects and MethodsWe retrospectively reviewed the medical records of 64 KD patients from January 2010 to October 2014. There was an analysis of the clinical, laboratory data of the infants versus children groups. Furthermore, the clinical and laboratory data of infantile KD patients were compared with 16 infants who were admitted for other acute febrile diseases.ResultsA total of 64 patients with KD were identified; 20 (31.3%) were infants; 44 (68.8%) were >1 year old children. Incomplete KD was much more common in infants (n=13, 65.0%) than in children group (n=14, 31.8%) (p=0.013). The infants were characterized by significantly higher rates of inflammatory changes at the Bacille Calmett-Guérin (BCG) inoculation site (p<0.001), but lower rates of changes in the extremities (p=0.029) and cervical lymphadenopathy (p=0.006). The serum levels of platelet after 1 week (p=0.005), C-reactive protein (p=0.038), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0.026) were all significantly higher in the infants group. Comparing the infants with KD versus the other acute febrile diseases, there were significantly higher serum levels of erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.046) and NT-proBNP (p=0.001) for the infants with KD group.ConclusionBCGitis and higher levels of NT-proBNP can be helpful for early diagnosis of the incomplete KD in infants, and may be a good predictor of KD in acute febrile infants, when combined with other acute phase reactants.

Human Anaplasmosis in Acute Febrile Patients during Scrub Typhus Season in Korea.

Dear Editor, Scrub typhus is an infectious disease caused by Orientia tsutsugamushi, and has become one of the most prevalent human diseases in Korea; since 2004, the disease has spread widely in the southwestern provinces of the country and is becoming endemic [1]. Anaplasmosis is caused by the bacterium Anaplasma phagocytophilum, and leads to human granulocytic ehrlichiosis (HGE) (human granulocytic anaplasmosis). A. phagocytophilum has been detected in Haemaphysalis longicornis, Ixodes nipponensis and I. persulcatus ticks in Korea [2]. The clinical presentations of scrub typhus/anaplasmosis are similar; symptoms that typically develop within 1-2 weeks of infection include fever, headache and malaise. Evidence has been suggesting the presence of A. phagocytophilum infections in South Korea [3]. Although scrub typhus is very common, to date, there has been only one confirmed report of anaplasmosis in Korea [4]. Serum specimens from 100 patients (≥ 18 years old) with acute febrile disease were studied using indirect immunofluorescence assay against O. tsutsugamushi for scrub typhus and real-time PCR for human anaplasmosis. The serum enrolled in this study was collected during the scrub typhus season in Korea from September 2011 to December 2012. The mean age of patients with febrile disease was 57.3 years. Forty-one acute febrile illness patients were positive for O. tsutsugamushi (41%), but none tested positive for A. phagocytophilum. HGA was first identified in the United States in 1994 [5] and subsequently in countries in Europe and Asia. A high percentage of Korean water deer (63.6%) were found to host A. phagocytophilum [6]. In a previous study, 1.8% of serum samples from patients with acute fever were positive for A. phagocytophilum on immunofluorescence antibody test [7]. The number of anaplasmosis cases reported to the CDC has increased steadily since the disease became reportable, from 348 cases in 2000, to 1,761 cases in 2010. The incidence of anaplasmosis has also increased, from 1.4 cases per million persons in 2000 to 6.1 cases per million persons in 2010 [8]. Since the presence of human anaplasmosis has been confirmed in Korea, this information provides a basis for treating and monitoring febrile patients with a history of contact with ticks. As both scrub typhus and anaplasmosis are potentially serious illnesses, urgent medical attention is required on suspicion of infection. In this study, we found acute febrile illness patients in Korea to have scrub typhus, with no evidence of anaplasmosis. Detailed studies are needed to isolate and identify Anaplasma spp. from humans, animals and vector ticks/mites in Korea from different regions to confirm their presence and capacity to cause disease.

Distribution and Seroprevalence of PPR Virus in Chad During 2004 - 2014

Peste des petits ruminants (PPR) is an acute febrile viral disease of goats and sheep characterized by mucopurulent nasal and ocular discharge, erosive and necrotizing stomatitis, enteritis and pneumonia. It is widespread, virulent and devastating causing significant impacts to the economy, food security and livelihoods of poor marginalized farmers. This study focused on clinical observations of 233 suspected cases of PPR and provided detailed information on the prevalence of antibodies against the PPR virus in sera from 986 small ruminants and 31 from camels. Most of specimens for this study were obtained from the slaughterhouse in N'Djamena. Sera for the detection of antibodies against the PPR virus were not necessarily representative of the target population, even if they were from a larger number of regions. According to information provided by the epidemiological surveillance field agents, the foci of the disease were more severe in goats than in sheep and the outbreaks frequency was higher during the Cold dry season (December to June) than during the other months of the year. Analysis of 1017 sera collected in small ruminants and camels revealed that the prevalence of antibodies against the PPR virus was 34.48%. The prevalence of antibodies against the PPR virus varied by species (goats, 15.21%, sheep, 19.25% and camels, 0%), age groups and geographic areas. The rate of infection by the PPR virus was higher in the sheep population (34. 67%) than in goats (27.37%). The study showed seroprevalence higher in sheep than in goats. In contrast, no serum from camels revealed positive vis-à-vis the PPR virus. Another serological survey would need to be undertaken in the population of camels in order to clarify their role in the epidemiology of PPR.

Isolation and characterization of Mayaro virus from a human in Acre, Brazil.

Mayaro virus (MAYV) is widely distributed throughout South America and is the etiologic agent of Mayaro fever, an acute febrile illness often presenting with arthralgic manifestations. The true incidence of MAYV infection is likely grossly underestimated because the symptomatic presentation is very similar to that of dengue fever and other acute febrile tropical diseases. We report the complete genome sequence of a MAYV isolate detected from an Acrelândia patient presenting with fever, chills, and sweating, but with no arthralgia. Results show that this isolate belongs to genotype D and is closely related to Bolivian strains. Our results suggest that the Acre/Mayaro strain is closely related to the progenitor of these Bolivian strains that were isolated between 2002 and 2006.

Impact of Daily Average Temperature on Annual Incidence of Scrub Typhus for Predicting

Background: Scrub typhus is an acute febrile infectious disease. It is one of the most prevalent vector borne disease and occurs most frequently from October to December in Korea. The incidence of scrub typhus in Korea has shown rapidly increasing trend last decades and over 10,000 cases were reported in 2013. Weather variables are potential predictors of scrub typhus incidence. Predicting annual incidence of scrub typhus before autumn facilitates early public health responses to minimize morbidity. This study explored the impact of daily average temperature on the outbreak of scrub typhus in Korea. Methods: Analysis was performed using data on monthly weather variables and notified annual cases of scrub typhus in 68 cities, Korea from 2001 to 2008. Cities are categorized according to average annual incidence from 2001 to 2008 (High incidence area: average annual incidence &gt;30 cases/100,000 persons, medium incidence area: 10-30 cases/100,000 persons, low incidence area: 0-10 cases/100,000 persons). A Poisson generalized estimating equations (GEE) model was used to estimate the impact of daily average temperature in the summer season on annual incidence of scrub typhus. Results: For high incidence area, medium incidence area and low incidence area, the average incidence per year was increased by 31% [95% confidence interval (CI): 15, 49%], 37% [95% CI: 22, 54%] and 28% [95% CI: 11, 48%] for a 1 degrees C increase in daily average temperature in August after controlling for potential confounding effects of precipitation and humidity. Daily average temperature, precipitation and humidity of other months like June, July in summer season did not impact on annual incidence for predicting. Conclusions: These findings suggest that daily average temperature in August have a considerable impact on annual incidence of scrub typhus in Korea for predicting before coming of autumn as outbreak season.

DIAGNÓSTICO DIFERENCIAL ENTRE A FEBRE MACULOSA BRASILEIRA E O DENGUE NO CONTEXTO DAS DOENÇAS FEBRIS AGUDAS

Acute febrile diseases are common and often associated with infectious agents in tropical countries such as Brazil. With nonspecific clinical manifestations and hard to differentiate with a number of endemic diseases such as dengue, leptospirosis, and other fatal diseases, Brazilian spotted fever has rarely been considered in the diagnosis, fact that with the consequent delay in the specific antimicrobial treatment, has determined high lethality often observed in our country. In this article the authors discuss the difficulty of the differential diagnosis of FMB with dengue, one of the most important and frequent infectious diseases in Brazil, where epidemics are reported regularly and the possibility of errors in diagnosis due to clinical similarity is a reality.

Evaluation of four commercial real-time RT-PCR kits for the detection of dengue viruses in clinical samples.

BackgroundDengue is the most frequent arthropod-borne viral disease worldwide. Because dengue manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for the differential diagnosis. Timely and accurate diagnosis of dengue virus (DENV) infection is important for appropriate management of complications, pathophysiological studies, epidemiological investigations and optimization of vector-control measures. Several “in-house” reverse transcriptase-polymerase chain reaction (RT-PCR) methods have been developed to detect, type and/or quantify DENV. Standardized dengue RT-PCR kits with internal controls have been recently introduced, but need clinical evaluation. We assessed the performances of 4 commercial DENV real-time RT-PCR kits.FindingsThe 4 kits were evaluated using a panel of 162 samples positive with an existing in-place hemi-nested RT-PCR used for routine DENV-infection diagnosis in patients with acute-febrile disease. The panel included 46 DENV-1, 37 DENV-2, 33 DENV-3, and 46 DENV-4. Also, 70 negative serum specimens were used to determine specificity. Geno-Sen’s Dengue 1–4 Real-Time RT-PCR kit was the only assay to provide quantification using standards, but lacked sensitivity for DENV-4 detection. The SimplexaTM Dengue RT-PCR assay, with 151 (93.2% [95% confidence interval, 89.3–97.1]) positive samples, had significantly higher sensitivity than the other 3 kits; in a complementary evaluation of 111 consecutive patients’ samples, its performance and genotyping agreed with the hemi-nested gold-standard assay.ConclusionsThe SimplexaTM Dengue RT-PCR’s good performance to detect and genotype DENV1–4 requires further evaluation in multicenter and prospective studies, particularly in settings of clinical diagnosis during dengue outbreaks.

The Need for More Research and Public Health Interventions on Dengue Fever in Burkina Faso

The Need for More Research and Public Health Interventions on Dengue Fever in Burkina Faso

Biochemical and immunological characterization of anthrax spore vaccine in goat

Anthrax is caused by Bacillus anthracis bacterium and an acute infectious febrile septicemic disease of all warm-blooded animals including human. It is a disease of major economic importance in ruminant specially in goat characterized principally by a rapid fatal course followed by sudden death. The present investigation was under taken to determine the biochemical characterization of anthrax spore vaccine bacteria and to determine the immunological response in goat after anthrax vaccination. Anthrax vaccine was collected from local government veterinary hospital, Mymensingh which was prepared by LRI. The goats were selected from different regions of Bangladesh. The used methods were culture of vaccine bacterial sediment in different media, staining of bacteria with Gram’s stain, and sugar fermentation tests for biochemical characterization of anthrax vaccine bacteria. Slide agglutination test and indirect ELISA tests were performed for immunological response after vaccination. Morphologically anthrax vaccine bacteria was gram positive rod shaped or short chain in anthrax vaccine sediment, culture in nutrient agar and nutrient broth. The anthrax vaccine bacteria fermented three sugars (dextrose, maltose and sucrose) and produced only acid but did not ferment two sugars (lactose and mannitol). Immunuglobulin of collected serum (Day0, Day30 and Day90) also agglutinated anthrax antigen on Day 30 and Day 90 of post immunization and onwards. Indirect ELISA provided evidence that immunization of captive and free range goat generated level of anti anthrax 1gG antibody response at Day 0 (OD Value 0.5474±0.0466) of immunization and reached its peak at Day 30 (OD Value 0.9604±0.0936) and maintained that level up to the end of the study (Day 90, OD Value 1.217±0.1129). After vaccination, immunological response was found in goat. However whether this immune response can protect natural anthrax infection need to be evaluated through challenge dose of fields isolates of Bacillus anthracis in future.DOI: http://dx.doi.org/10.3329/bjvm.v11i2.19140Bangl. J. Vet. Med. (2013).11(2): 151-157

Dysregulated host inflammatory response in rats with fatal encephalitic Rift Valley Fever (VIR5P.1021)

Abstract Rift Valley Fever virus (RVFV) is a zoonotic arbovirus capable of causing widespread outbreaks with severe morbidity, mortality, and socioeconomic consequences. Most patients develop an acute febrile disease but recover, while a small subset of infected humans develop more severe disease including hemorrhagic manifestations, meningoencephilitis, or retinitis resulting in blindness. Inbred rats have been shown to be a good model of severe human RVF. Lewis rats are highly resistant to subcutaneous inoculation with RVFV, but develop uniformly fatal encephalitis after exposure to low doses of RVFV by inhalation. Elevated levels of M-CSF and MCP-1 are seen in the blood on day 4 post-exposure concurrent with granulocytosis and thrombocytopenia that continues until death. IL-1β and GRO/KC, the rat homolog of IL-8, peaked slightly on day 4 p.i., decreased briefly, and were highly elevated in the blood of moribund rats. In the brain, many pro-inflammatory cytokine levels, including IL-1α, IFN-γ, and IL-18, were found to be greatly elevated at day 5 post-exposure, which coincides with the earliest detection of virus in the brain. Pathological evaluation of brain tissue indicates an influx of lymphocytes and neutrophils that corresponds with the onset of neurological signs and severe disease in the Lewis rats. These data suggest that the host immunological response may be contributing to the pathogenesis of RVFV in the brain and the outcome of infection.

West Nile Fever in the Tula region, Russian Federation

As a result of serological testing (MAC-ELISA, ELISA-IgG and neutralization test) 143 sera from 132 patients with acute febrile disease of unknown etiology hospitalized in summer 2012 in the hospitals of Tula, the first time in Tula and the Tula region were diagnosed 4 cases of West Nile fever. The age ofpatients was 42, 60, 62 and 64. They all got sick in August 2012. The temperature reached 39-40°C. Duration of disease from 13 to 20 days, the duration of hospitalization from 8 to17 days. Neurological symptoms were observed in two patients in the form of meningeal syndrome and encephalopathy with asthenic symptoms (in one case) and faint meningeal syndrome (in another).

Diagnosis of extrapulmonary TB: Experience with the Xpert MTB/Rif assay

Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls. Methods & Materials: In the present study, we evaluated the performance of three commercialdengue real-time PCR kits (SimplexaTM Dengue PCR assay: Focus Diagnostic, RealStar® Dengue RT-PCR kit 1.0: Altona Diagnostics, Geno-Sen’s Dengue 1-4 Real-time PCR kit: Genome Diagnostics Pvt) using 162 samples positive with the hemi-nested RT-PCR (46 DENV-1, 37 DENV-2, 33 DENV-3, and 46 DENV-4). In addition, 70 negative serum specimens were used to evaluate specificity. All three kits included an internal control. RNA extraction was performed using the NucliSens easyMAG® (BioMerieux). Results: Geno-Sen’s, RealStar®, and SimplexaTM tests were positive in 138 (85.1%), 135 (83.3%), and 151 (93.2%) samples, respectively. The sensitivity of SimplexaTM was significantly higher than Geno-Sen’s (Chi 2, p =0.009) and RealStar® (p =0.005). Compared to the in-place reference RT-PCR, the specificity was 100% for Geno-Sen’s and SimplexaTM and 98% for Real Star.According to dengue genotypes, the sensitivity was for DENV-1 (91%, 78% and 96%), for DENV-2 (89%, 87%, and 92%) for DENV-3 (91%, 91%, 91%), for DENV-4 (72%, 80% and 94%) by Geno-Sen’s, Real Star® and SimplexaTM kits respectively. Simplexa is the only kit providing genotyping of virus. Conclusion: The good performance of the SimplexaTM Dengue PCR assay at the detection and genotyping level in combination with an automated extraction is suitable for diagnosis during dengue outbreaks in tropical areas.

Evaluation of three commercial real-time PCR kits for dengue diagnosis

Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls. Methods & Materials: In the present study, we evaluated the performance of three commercialdengue real-time PCR kits (SimplexaTM Dengue PCR assay: Focus Diagnostic, RealStar® Dengue RT-PCR kit 1.0: Altona Diagnostics, Geno-Sen's Dengue 1-4 Real-time PCR kit: Genome Diagnostics Pvt) using 162 samples positive with the hemi-nested RT-PCR (46 DENV-1, 37 DENV-2, 33 DENV-3, and 46 DENV-4). In addition, 70 negative serum specimens were used to evaluate specificity. All three kits included an internal control. RNA extraction was performed using the NucliSens easyMAG® (BioMérieux). Results: Geno-Sen's, RealStar®, and Simplexa™ tests were positive in 138 (85.1%), 135 (83.3%), and 151 (93.2%) samples, respectively. The sensitivity of Simplexa™ was significantly higher than Geno-Sen's (Chi 2, p = 0.009) and RealStar® (p = 0.005). Compared to the in-place reference RT-PCR, the specificity was 100% for Geno-Sen's and Simplexa™ and 98% for Real Star.According to dengue genotypes, the sensitivity was for DENV-1 (91%, 78% and 96%), for DENV-2 (89%, 87%, and 92%) for DENV-3 (91%, 91%, 91%), for DENV-4 (72%, 80% and 94%) by Geno-Sen's, Real Star® and Simplexa™ kits respectively. Simplexa is the only kit providing genotyping of virus. Conclusion: The good performance of the SimplexaTM Dengue PCR assay at the detection and genotyping level in combination with an automated extraction is suitable for diagnosis during dengue outbreaks in tropical areas.

Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012

In 2012, a female wildlife biologist experienced fever, malaise, headache, generalized myalgia and arthralgia, neck stiffness, and a sore throat shortly after returning to the United States from a 6-week field expedition to South Sudan and Uganda. She was hospitalized, after which a maculopapular rash developed and became confluent. When the patient was discharged from the hospital on day 14, arthralgia and myalgia had improved, oropharynx ulcerations had healed, the rash had resolved without desquamation, and blood counts and hepatic enzyme levels were returning to reference levels. After several known suspect pathogens were ruled out as the cause of her illness, deep sequencing and metagenomics analysis revealed a novel paramyxovirus related to rubula-like viruses isolated from fruit bats.

Molecular investigation of 2013 dengue Fever outbreak from delhi, India.

Dengue fever is a self-limiting, acute febrile disease which may aggravate to haemorrhage, plasma leakage and organ impairment in small number of cases. An outbreak of dengue fever occurred in Delhi, India after rainy season in the year 2013. Dengue virus specific RT-PCR was carried out on 378 suspected blood samples that were collected during the outbreak. Dengue virus was detected in 71% samples with highest number of patients infected by DENV-2 (86%) followed by DENV-1 (19 %) and DENV-3 (8%). Co-infection with more than one DENV serotype was detected in 14% samples. Twenty nine DENV strains (10 DENV-1, 12 DENV-2 and 7 DENV-3) were sequenced for partial envelope protein gene. Phylogenetic analysis grouped DENV-1 strains in the American African genotype, DENV-2 strains in the Cosmopolitan genotype and DENV-3 in Genotype III. We report the serotype distribution, circulating genotypes and partial envelope protein gene sequence of 29 DENV strains detected during 2013 outbreak in Delhi, India.

川崎病的研究进展

川崎病是一种以全身血管炎为主要病变的急性发热性出疹疾病，也是儿童后天性心脏病的诱因之一，严重者导致冠状动脉损伤，甚至引起心肌梗死及猝死。IVIG是公认的治疗川崎病的有效药物，本文就川崎病发病机制及IVIG对川崎病的治疗做一综述。Kawasaki disease is an acute febrile rash disease of systemin vasculitis and has become one cause of acquired pediatric heart disease in child. It will result in coronary artery damage and even lead to myocardial infarction and sudden death. IVIG is recognized as an effective drug treatment of Kawasaki disease. This review covers for mechanism and IVIG treatment of Kawasaki disease.

Coxsackievirus A6–Induced Hand-Foot-Mouth Disease

Hand-foot-mouth disease (HFMD) is an acute, self-limited, highly contagious viral illness that commonly affects children younger than 5 years. It is most typically caused by enterovirus 71 or coxsackievirus A16 and results in asymptomatic infection or mild disease. Immunocompetent adults are rarely affected. Recently, there have been increasing reports of a more severe form of HFMD associated with fevers, joint pains, and widespread painful eruptions. Some of these patients required hospitalization for supportive care. These severe cases were most commonly caused by coxsackievirus A6. We describe a 37-year-old white man with widespread, crusted, pruritic papules on the scalp, ears, and face and a purpuric and targetoid painful vesicular eruption on his hands and feet, with associated fevers, neurologic symptoms, and arthritis, who required hospitalization for supportive care. His infection with coxsackievirus A6 was confirmed based on polymerase chain reaction from his oral mucosa and cutaneous vesicle fluid. Dermatologists should be familiar with the severe variant of HFMD caused by coxsackievirus A6, include it in their differential diagnosis of acute febrile blistering diseases, and be aware that certain patients may require hospitalization.

Anaplasma phagocytophilum strains from voles and shrews exhibit specific ankA gene sequences

BackgroundAnaplasma phagocytophilum is a Gram-negative bacterium that replicates obligate intracellularly in neutrophils. It is transmitted by Ixodes spp. ticks and causes acute febrile disease in humans, dogs, horses, cats, and livestock. Because A. phagocytophilum is not transmitted transovarially in Ixodes spp., it is thought to depend on reservoir hosts to complete its life cycle. In Europe, A. phagocytophilum was detected in roe deer, red deer, wild boars, and small mammals. In contrast to roe deer, red deer and wild boars have been considered as reservoir hosts for granulocytic anaplasmosis in humans, dogs, and horses according to groESL- and ankA-based genotyping. A. phagocytophilum variants infecting small mammals in Europe have not been characterized extensively to date.ResultsWe amplified the total ankA open reading frames of 27 strains from voles and shrews. The analysis revealed that they harboured A. phagocytophilum strains that belonged to a distinct newly described ankA gene cluster. Further, we provide evidence that the heterogeneity of ankA gene sequences might have arisen via recombination.ConclusionsBased on ankA-based genotyping voles and shrews are unlikely reservoir hosts for granulocytic anaplasmosis in humans, dogs, horses, and livestock in Europe.

Outbreak of herpangina in the Brazilian Amazon in 2009 caused by Enterovirus B

In October 2009, our laboratory was contacted by a Brazilian Public Health organization regarding a severe community outbreak of an acute exanthematic and febrile disease in the Brazilian Amazon that primarily affected children. A total of 44 patients with febrile disease were identified by the local public health system, 37 of whom were children between 1 and 9 years of age. Molecular virological and phylogenetic characterization revealed that enterovirus B was the etiological agent of this outbreak, which was characterized by a clinical presentation known as herpangina.