Pasożytnicze pierwotniaki krwi potencjalnym zagrożeniem bezpieczeństwa krwiodawstwa w świetle doniesień prezentowanych na konferencji „Aktualne problemy dotyczące czynników zakaźnych przenoszonych przez krew” (10 marca 2017 r., Warszawa)

The study objective was evaluation of the protozoal parasite infection risk (malaria, Chagas disease, leishmaniosis and babesiosis) in relation to blood transfusion safety. These protozoal parasitic diseases are mostly transmitted by arthropod vectors, but also vertically through transfusion of blood and blood components. All with the exception of babesiosis, are endemic mostly in tropical countries and effect millions of people, both inhabitants of endemic regions, travelers to such endemic areas as well as autochthons migrating from these areas. In most European countries prevention of disease transmission through blood transfusion relies mainly on restrictive donor selection (questionnaires, serological and molecular biology tests) and deferral of infected or seropositive donors. In transfusion medicine the overall loss of blood due to these diseases is substantial. In Poland “imported” diseases such as malaria, Chagas disease and leishmaniosis are very rare and are no serious threat to blood safety. However, blood donors should be screened for Babesia infections, especially in some north-eastern regions of the country where human babesiosis is already documented. This could have relevant impact on blood safety but as yet no adequate procedures have been implemented.  Celem pracy jest ocena zagrożenia bezpieczeństwa krwiodawstwa przez pasożytnicze pierwotniaki w takich chorobach, jak: malaria, choroba Chagasa, leiszmanioza i babeszjoza. Choroby te przenoszone są głównie przez krwiopijne stawonogi oraz wertykalnie, między innymi drogą przetoczenia krwi i jej składników. Choroby te występują — z wyjątkiem babeszjozy — w krajach tropikalnych, dotyczą milionów ludzi, stanowią ważny problem zdrowotny nie tylko w endemicznych obszarach ich występowania, ale również dla osób podróżujących w te regiony oraz dla imigrantów z tych krajów. W Europie zapobieganie tym chorobom związane jest m.in. z restrykcyjną kwalifikacją dawców krwi (kwestionariusze, testy serologiczne i molekularne) oraz ewentualnym eliminowaniem zarażonych lub seropozytywnych dawców. W skali globalnej straty krwi z powodu zarażonych dawców mają istotne znaczenie dla medycyny transfuzyjnej. W Polsce malaria, choroba Chagasa i leiszmanioza są rzadkimi, „importowanymi” chorobami i nie stanowią problemu dla bezpieczeństwa krwiodawstwa. Natomiast monitorowanie zarażenia dawców przez pasożyty Babesia powinno istnieć szczególnie w północno-wschodnich regionach kraju, ostatnio bowiem udokumentowano babeszjozę u ludzi, co może mieć istotne znaczenie dla krwiodawstwa. W tym zakresie ciągle brak stosownych procedur

Tick borne diseases in the context of blood safety

Obserwowany w Polsce znaczny wzrost częstości zachorowań na przenoszoną przez kleszcze boreliozę z Lyme (BL), a także możliwość przeniesienia z krwią tej i innych chorób odkleszczowych (TBD) budzą obawy transfuzjologów o bezpieczeństwo krwi i jej składników. Wątpliwości dotyczą kwalifikacji do oddania krwi zarówno dawców ukąszonych przez kleszcze, jak i osób, które przebyły poszczególne TBD. Ryzyko przeniesienia z krwią czynników zakaźnych wywołujących TBD jest zróżnicowane. Przepisy krwiodawstwa w Polsce normują postępowanie z dawcami tylko w przypadku niektórych TBD. W pracy przedstawiono aktualny stan wiedzy głównie na temat BL, w mniejszym zaś zakresie babeszjozy, anaplazmozy i kleszczowego zapalenia mózgu, przy uwzględnieniu zarówno ryzyka ich przeniesienia z krwią, jak i szerszego kontekstu diagnostyczno-klinicznego. Uwzględniono także znaczenie zakażeń wielogatunkowych. Podkreślono zarówno znaczenie realnej oceny ryzyka przeniesienia choroby drogą transfuzji, jak i potrzebę unikania w miarę możliwości zachowań nadmiernie restrykcyjnych, prowadzących do nieuzasadnionej eliminacji krwiodawców. J. Transf. Med. 2011; 1: 4–22A significant increase in the Lyme disease (BL) incidence in our country and the possibility of BL and other tick borne diseases (TBDs) transmission with blood has raised concern about the safety of blood and its components. They cover both the qualification for blood donation after a tick bite and after any TBD. The risk of any TBD transmission with blood is varied. The rules regulating blood donations in Poland apply only to donors with some TBDs. Our paper presents the current state of knowledge mainly on BL and, to a lesser extent, on three other TBDs i.e. babesiosis, anaplasmosis as well as tick-borne encephalitis, not only in terms of transmission risk with blood but also in a broader context of diagnosis and clinical disease course. The importance of multispecies infections (coinfections) is also taken into account. There is the need to maintain a balance between excessively restrictive approach that eliminates blood donors and consideration of the real risk of disease transmission with blood. J. Transf. Med. 2011; 1: 4–2

Rickettsiaceae and Anaplasmataceae infections in Ixodes ricinus ticks from urban and natural forested areas of Poland

BACKGROUND: Ixodes ricinus is a major vector for a range of microbial pathogens and the most prevalent and widely distributed tick species on the European continent, occurring in both natural and urban habitats. Nevertheless, little is known about the relative density of ticks in these two ecologically distinct habitats and the diversity of tick-borne pathogens that they carry. METHODS: We compared densities of questing I. ricinus nymphs and adults in urban and natural habitats in Central and Northeastern Poland, assessed the prevalence and rate of co-infection with A. phagocytophilum, Rickettsia, Ehrlichia and ‘Ca. Neoehrlichia spp.’ in ticks, and compared the diversity of tick-borne pathogens using molecular assays (PCR). RESULTS: Of the 1325 adults and nymphs, 6.2% were infected with at least one pathogen, with 4.4%, 1.7% and less than 0.5% being positive for the DNA of Rickettsia spp., A. phagocytophilum, Ehrlichia spp. and Ca. N. mikurensis, respectively. Although tick abundance was higher in natural habitats, the prevalence of the majority of pathogens was higher in urban forested areas. CONCLUSION: We conclude that: (i) zoonotic genetic variants of A. phagocytophilum are widely distributed in the Polish tick population, (ii) although the diversity of tick borne pathogens was higher in natural habitats, zoonotic species/strains were detected only in urban forests, (iii) and we provide the first description of Ca. N. mikurensis infections in ticks in Poland

Clinical and molecular features of one case of human infection with <i>Anaplasma phagocytophilum</i> from Podlaskie Province in eastern Poland

The article focuses on the clinical and laboratory diagnosis of human granulocytic anaplasmosis (HGA) caused by Anaplasma phagocytophilum infection in one of 28 patients (3.6%; n=1/28 tested samples) with early Lyme borreliosis. The clinical and laboratory results of a 42-year-old patient fulfilled criteria of confirm anaplasmosis and suggest an acute stage of illness. The described case provides strong presumptive evidence that infection in this patient was acquired with a pathogenic strain of A. phagocytophilum through a tick bite. A positive DNA with PCR for A. phagocytophilum infection was sequenced and analyzed phylogenetically. Physicians should consider the possibility of anaplasmosis in patients with early Lyme borreliosis, and A. phagocytophilum should be considered as a differential diagnosis in all patients from an endemic region of potential high risk factors for tick-borne diseases

Ticks and the city - are there any differences between city parks and natural forests in terms of tick abundance and prevalence of spirochaetes?

Abstract Background Ixodes ricinus ticks are commonly encountered in either natural or urban areas, contributing to Lyme disease agents Borreliella [(Borrelia burgdorferi (sensu lato)] spp. and Borrelia miyamotoi enzootic cycles in cities. It is an actual problem whether urbanization affects pathogen circulation and therefore risk of infection. The aim of the study was to evaluate main tick-borne disease risk factors in natural, endemic areas of north-east (NE) Poland (Białowieża) and urban areas of central Poland (Warsaw), measuring tick abundance/density, prevalence of infection with spirochaetes and diversity of these pathogens in spring-early summer and late summer-autumn periods between 2012 and 2015. Methods Questing I. ricinus ticks were collected from three urban sites in Warsaw, central Poland and three natural sites in Białowieża, NE Poland. A total of 2993 ticks were analyzed for the presence of Borreliella spp. and/or Borrelia miyamotoi DNA by PCR. Tick abundance was analyzed by General Linear Models (GLM). Prevalence and distribution of spirochaetes was analyzed by Maximum Likelihood techniques based on log-linear analysis of contingency tables (HILOGLINEAR). Species typing and molecular phylogenetic analysis based on the sequenced flaB marker were carried out. Results Overall 4617 I. ricinus ticks were collected (2258 nymphs and 2359 adults). We report well established population of ticks in urban areas (10.1 ± 0.9 ticks/100 m2), as in endemic natural areas with higher mean tick abundance (16.5 ± 1.5 ticks/100 m2). Tick densities were the highest in spring-early summer in both types of areas. We observed no effect of the type of area on Borreliella spp. and B. miyamotoi presence in ticks, resulting in similar prevalence of spirochaetes in urban and natural areas [10.9% (95% CI: 9.7–12.2%) vs 12.4% (95% CI: 10.1–15.1%), respectively]. Prevalence of spirochaetes was significantly higher in the summer-autumn period than in the spring-early summer [15.0% (95% CI: 12.8–17.5%) vs 10.4% (95% CI: 9.2–11.6%), respectively]. We have detected six species of bacteria present in both types of areas, with different frequencies: dominance of B. afzelii (69.3%) in urban and B. garinii (48.1%) in natural areas. Although we observed higher tick densities in forests than in maintained parks, the prevalence of spirochaetes was significantly higher in the latter [9.8% (95% CI: 8.6–11.0%) vs 17.5% (95% CI: 14.4–20.5%)]. Conclusions Surprisingly, a similar risk of infection with Borreliella spp. and/or B. miyamotoi was discovered in highly- and low-transformed areas. We suggest that the awareness of presence of these disease agents in cities should be raised

Additional file 5: Figure S1. of Ticks and the city - are there any differences between city parks and natural forests in terms of tick abundance and prevalence of spirochaetes?

Molecular phylogenetic analysis of flaB variants of sequences obtained in the study. The phylogenetic tree was obtained with use of Maximum Likelihood method of tree construction with Tamura-Nei + G evolutionary model chosen with accordance to data by implemented model-test. The percentage of trees in which the associated taxa clustered together is shown next to the branches. The tree is drawn to scale, with branch lengths measured in the number of substitutions per site. The analysis involved 94 nucleotide sequences. There were a total of 547 positions in the final dataset. Evolutionary analyses were conducted in MEGA v. 6.06. The newly generated sequences and their origin (type of area) are indicated with black symbols: triangle, natural areas; upside down tringle, urban areas; diamond, both natural and urban areas. (DOCX 1021 kb