A review on the eco-epidemiology and clinical management of human granulocytic anaplasmosis and its agent in Europe

Anaplasma phagocytophilum is the agent of tick-borne fever, equine, canine and human granulocytic anaplasmosis. The common route of A. phagocytophilum transmission is through a tick bite, the main vector in Europe being Ixodes ricinus. Despite the apparently ubiquitous presence of the pathogen A. phagocytophilum in ticks and various wild and domestic animals from Europe, up to date published clinical cases of human granulocytic anaplasmosis (HGA) remain rare compared to the worldwide status. It is unclear if this reflects the epidemiological dynamics of the human infection in Europe or if the disease is underdiagnosed or underreported. Epidemiologic studies in Europe have suggested an increased occupational risk of infection for forestry workers, hunters, veterinarians, and farmers with a tick-bite history and living in endemic areas. Although the overall genetic diversity of A. phagocytophilum in Europe is higher than in the USA, the strains responsible for the human infections are related on both continents. However, the study of the genetic variability and assessment of the difference of pathogenicity and infectivity between strains to various hosts has been insufficiently explored to date. Most of the European HGA cases presented as a mild infection, common clinical signs being pyrexia, headache, myalgia and arthralgia. The diagnosis of HGA in the USA was recommended to be based on clinical signs and the patient’s history and later confirmed using specialized laboratory tests. However, in Europe since the majority of cases are presenting as mild infection, laboratory tests may be performed before the treatment in order to avoid antibiotic overuse. The drug of choice for HGA is doxycycline and because of potential for serious complication the treatment should be instituted on clinical suspicion alone

Antinuclear antibodies are not increased in the early phase of Borrelia infection.

In the literature, there are case reports suggesting that Borrelia burgdorferi infection may induce autoimmune diseases dependent on antinuclear antibodies (ANA). The present study was undertaken in order to verify this possibility in a prospective manner. The study group comprised 78 consecutive patients (51 women and 27 men, median age 41.5 years) referred to our Department for the serologic diagnosis of Borrelia infection. The patients' sera were tested for Borrelia-specific IgM and IgG (Recombinant Antigen Enzyme Immunoassays, Biomedica). Antibodies against Borrelia were detected in 31 (39.7 %) persons. 15 persons (19.2 %) had positive IgM, another 15 (19.2 %)--positive IgG, and 1 person (3.2 %)--both IgM and IgG. Frequent positivity of IgM antibodies suggests that persons in the early phase of infection prevailed in the group. Tests for anti-dsDNA, anti-RNP, anti-Sm antibodies, and a screening test for systemic rheumatic diseases (ANA Rheuma Screen) were carried out using Varelisa Enzyme Immunoassays (Pharmacia and Upjohn). The spectrum of autoimmune diseases covered by these tests included SLE, MCTD, Sjogren's syndrome, scleroderma, polymyositis, and dermatomyositis. ANA were detected in 15 persons (19.2 %): anti-dsDNA in 7 (9.0 %), anti-RNP in 1 (1.3 %), anti-Sm in 2 (2.6 %), and ANA Rheuma Screen was positive in 6 persons (7.7 %). Statistical analysis of differences in the ANA frequency between Borrelia-positive and -negative groups was carried out using Fisher's exact chi-square test (both without and with gender and age matching). No significant differences were found between the groups. Based on the above results, we conclude that there is no increase in the frequency of antinuclear antibodies in the early phase of Borrelia infection

Preliminary results of seroepidemiological and clinical examinations for Q fever among an occupationally-exposed population – preliminary report

Gorączka Q (febris Q, coxiellosis) jest występującą globalnie chorobą ludzi i wielu gatunków zwierząt. Wywołuje ją, namnażająca się wewnątrzkomórkowo, bakteria Coxiella burnetii (rząd Legionellales), wytwarzająca spory – wyjątkowo wytrzymałe na działanie czynników fi zyko-chemicznych. W Polsce, jako choroba ludzi, znana jest od 1956 roku, zaś najczęstszym źródłem zakażenia dla ludzi są: zakażone bydło i owce oraz skażone środowisko bytowania tych zwierząt. Wycinkowo jedynie rozpoznana epidemiologicznie i sporadycznie diagnozowana u ludzi, występuje niewątpliwie na terenie całego kraju. Ofi cjalnie zgłaszane przypadki u ludzi, odzwierciedlają (według szacunku jednego z nas, jedynie około 1% przypadków klinicznych u ludzi w Polsce). Motywem przedstawionych poniżej badań, były 3 ogniska epizootyczno-epidemiczne, które pojawiły się latem i wczesną jesienią 2008 roku, na pograniczu województw lubelskiego i podkarpackiego, zrazu u krów mlecznych i wtórnie, u ludzi z grup narażenia zawodowego. W pracy przedstawiono wstępne wyniki badań w kierunku gorączki Q u osób zawodowo narażonych. Przebadano serologicznie grupę 135 osób. W celu wykazania obecności przeciwciał IgG zastosowano metodę immunofl uorescencji pośredniej (IFA) w fazie I i II oraz metodę odczynu wiązania dopełniacza (OWD) w fazie II. Przedstawione wyniki traktujemy jako wstępne, zaś badania kontynuujemy wespół z Laboratorium Diagnostyki Serologicznej Państwowego Instytutu Weterynaryjnego – Państwowego Instytutu Badawczego w Puławach, której kierownikiem jest dr wet. Krzysztof Niemczuk, uczestnik wspólnego Grantu, oraz z oddziałami obserwacyjno-zakaźnymi w Biłgoraju i Dębicy i Narodowym Instytutem Zdrowia Publicznego-Państwowym Zakładem Higien

RISK OF TISK-BORNE ENCEPHALITIS (TBE) VIRUS INFECTION AMONG PEOPLE OCCUPATIONALLY EXPOSED TO TICK BITES.

The paper presents the results of seroepidemiologic studies concerning tick-borne encephalitis (TBE) in 1583 persons (1261 forestry workers and 233 farmers) from the Lublin region (eastern Poland) occupationally exposed to ticks and in 130 healthy blond donors (a control group). The mean percentage of seropositive reactions in forestry workers amounted 19.8% and in farmers 32.0%. Based on 5-year research (1994-1998) conducted in 5 districts of the Lublin region, an existence of endemic foci of TBE was detected in the district of Biała Podlaska. on the areas of Radzyń Podlaski and Parczew, where the percentage of seropositive reactions in forestry workers exceeded 50%. Statistical analysis showed that the frequency of seropositive reactions in forestry workers and farmers was significantly greater compated to control group (p<0.001 and p<0.05, respectively). It indicates that these groups are occupationally exposed to TBE wirus. Totally, in the years 1994-98 nine clinical cases of TBE (acute neuroinfection) in forestry workers and fourteen clinical cases in farmers were confirmed serologically. The effectiveness of specific immunization againstTBE was proved on the brie of 100% seroconversion in 56 earlier seronegative forestry workers. The obtained results proved that forestry workers and farmers in Poland are under increased risk of infection with TBE virus

Ocena występowania krętków Borrelia burgdorferi sensu lato w kleszczach Ixodes ricinus na terenie wybranych rejonów Lubelszczyzny przy zastosowaniu metody łańcuchowej reakcji polimerazy [PCR]

Evaluation of occurrence of spirochetes Borrelia burgdorferi sensu lato in Ixodes ricinus ticks in selected areas of the Lublin Region by polimerase chain reaction method (PCR). During the period 2001-2002, 1098 Ixodes ricinus ticks were collected at forest sampling sites and the degree of their infection with Borrelia burgdorferi spirochetes was determined by means of polimerase chain reaction (PCR). The presence of Borrelia burgdorferi genetic material was noted in 69 cases (6.3%). lt was confirmed that the frequency of infection of adult forms of ticks (males and females) was nearly twice as high as nymphs. The highest degree of infection was observed in females – 9.5%. The degree of infection among males and nymphs was smaller - 5.9% and 4.4% respectively in individual provinces. The percentage of infected females ranged from 7.9% in the Zamość Province to 13.6% in the Włodawa Province. In males, the percentage of infected ticks remained within the range from 3.1% in the Lublin Province to 13.3% in the Lubartów Province

Ocena wystepowania kretkow Borrelia burgdorferi sensu lato w kleszczach Ixodes ricinus na terenie wybranych rejonow Lubelszczyzny przy zastosowaniu metody lancuchowej reakcji polimerazy [PCR]

Evaluation of occurrence of spirochetes Borrelia burgdorferi sensu lato in Ixodes ricinus ticks in selected areas of the Lublin Region by polimerase chain reaction method (PCR). During the period 2001-2002, 1098 Ixodes ricinus ticks were collected at forest sampling sites and the degree of their infection with Borrelia burgdorferi spirochetes was determined by means of polimerase chain reaction (PCR). The presence of Borrelia burgdorferi genetic material was noted in 69 cases (6.3%). lt was confirmed that the frequency of infection of adult forms of ticks (males and females) was nearly twice as high as nymphs. The highest degree of infection was observed in females – 9.5%. The degree of infection among males and nymphs was smaller - 5.9% and 4.4% respectively in individual provinces. The percentage of infected females ranged from 7.9% in the Zamość Province to 13.6% in the Włodawa Province. In males, the percentage of infected ticks remained within the range from 3.1% in the Lublin Province to 13.3% in the Lubartów Province

Ocena narazenia na zakazenie wirusem kleszczowego zapalenia mozgu osob zawodowo eksponowanych na kontakt z kleszczami

The paper presents the results of seroepidemiologic studies concerning tick-borne encephalitis (TBE) in 1583 persons (1261 forestry workers and 233 farmers) from the Lublin region (eastern Poland) occupationally exposed to ticks and in 130 healthy blond donors (a control group). The mean percentage of seropositive reactions in forestry workers amounted 19.8% and in farmers 32.0%. Based on 5-year research (1994-1998) conducted in 5 districts of the Lublin region, an existence of endemic foci of TBE was detected in the district of Biała Podlaska. on the areas of Radzyń Podlaski and Parczew, where the percentage of seropositive reactions in forestry workers exceeded 50%. Statistical analysis showed that the frequency of seropositive reactions in forestry workers and farmers was significantly greater compated to control group (p<0.001 and p<0.05, respectively). It indicates that these groups are occupationally exposed to TBE wirus. Totally, in the years 1994-98 nine clinical cases of TBE (acute neuroinfection) in forestry workers and fourteen clinical cases in farmers were confirmed serologically. The effectiveness of specific immunization againstTBE was proved on the brie of 100% seroconversion in 56 earlier seronegative forestry workers. The obtained results proved that forestry workers and farmers in Poland are under increased risk of infection with TBE virus