Eosinophilic meningitis due to Angiostrongylus cantonensis in Europe.

OBJECTIVES: To describe and analyse the epidemiological and clinical characteristics of imported human angiostrongyliasis in Europe. METHODS: A systematic literature review of cases of human angiostrongyliasis in Europe was performed. Seven databases were searched. The epidemiological and clinical characteristics were extracted from included records and simple summary statistics were performed on extracted data. RESULTS: Twenty-two cases reported between 1988 and 2019 were identified. They were mainly from French Polynesia, Southeast Asia, and the Caribbean Islands. The dominant suspected mode of transmission was ingestion of prawns, shrimp, or salad. For patients with data, 90% had a history of headache, often lasting, and half had paresthesia. Eighty-nine percent had eosinophilia, 93% had cerebrospinal fluid (CSF) eosinophilia, and 92% had elevated CSF protein. Central nervous system (CNS) imaging was normal in most cases. Two-thirds received albendazole or mebendazole treatment, although this is not currently recommended. CONCLUSIONS: We have increased previous numbers to 22 reported cases in total since 1988. Angiostrongyliasis should generally be suspected in patients with a lasting headache who have returned from Southeast Asia, China, the Caribbean Islands, Australia, or French Polynesia, as well as parts of North America and Tenerife, Spain, although one autochthonous case from mainland Europe has also been reported. A dietary history should focus on prawns, shrimp, and salad, whilst also including slugs and snails and other paratenic hosts where relevant. The clinical diagnosis is supported by the presence of blood eosinophilia, CSF eosinophilia, and elevated CSF protein. A definitive laboratory diagnosis should be sought, and CNS imaging should be used to support, not to rule out the diagnosis. The most up-to-date evidence should always be consulted before initiating treatment. Current recommendations include analgesics, corticosteroids, and periodic removal of CSF for symptom relief, while antihelminthic treatment is debated

Survey of Tickborne Infections in Denmark

We conducted a study of the distribution and prevalence of tickborne infections in Denmark by using roe deer as sentinels. Blood samples from 237 roe deer were collected during the 2002–2003 hunting season. Overall, 36.6% of deer were Borrelia seropositive, while 95.6% were Anaplasma phagocytophilum positive; all animals were negative for Bartonella quintana and B. henselae by indirect immunofluorescence assay. When a hemagglutination-inhibition test was used, 8.7% of deer were found positive for tickborne encephalitis (TBE)-complex virus. A total of 42.6% were found positive by polymerase chain reaction (PCR) for A. phagocytophilum with significant seasonal variation. All were PCR negative for Rickettsia helvetica. PCR and sequencing also showed a novel bacterium in roe deer previously only found in ticks. The study showed that the emerging pathogen A. phagocytophilum is widely distributed and that a marked shift has occurred in the distribution of TBE-complex virus in Denmark. This finding supports studies that predict alterations in distribution due to climatic changes

Monitoring Temporal Trends in Internet Searches for “Ticks” across Europe by Google Trends:Tick–Human Interaction or General Interest?

SIMPLE SUMMARY: It is notoriously difficult to track the spread of vector-borne diseases, and to determine the underlying causes of change in disease occurrence. Importantly, public health representatives have limited access to information, which permit them to assess trends and changes in vector–human contact. Exposed individuals may, however, seek information on the Internet and thereby deliver input to a search record for the given vector. The variation in search-frequencies may reflect the variation in contact rates, but varying general interest could also influence the data. We here investigated records for search terms synonymous with “tick(s)”, and found that the records reflect the seasonal variation, which one would expect when these result from tick encounters. Albeit, variable use of search terminology suggest that these records should not be used to make comparisons between years. ABSTRACT: Monitoring vector–human interaction is pivotal for assessing potential transmission rates of vector borne diseases and their associated public health impact. People often seek information following an insect bite in order to identify hematophagous arthropods, which in recent years often is done using Internet resources. Through this activity, a record of net searches is generated, which include information that reflect local human–arthropod interaction, e.g., for the common tick (Ixodes ricinus) in European countries. Such records could in principle provide low cost real-time monitoring data, if indeed Internet search activities adequately reflect tick–human interaction. We here explore Google Trends records for within-year and between-year trends, for four different Danish search terms for “tick(s)”. We further assess the relationship between monthly search-frequencies and local weather conditions (temperatures and precipitation from 2007 to 2016) in nine European countries. Our findings point to significant limitations in the records due to changes in search-term preferences over the given years. However, the seasonal dynamics are comparable among search-terms. Moreover, the seasonal pattern in search terms vary across Europe in tune with changes in temperature and precipitation. We conclude that, the within-year variation for given search-terms provide credible information, which systematically vary with local weather patterns. We are not convinced that these records merely reflect general interest. It will, however, require a more in-depth analysis by researchers that have specific insight into local language practices to fully assess the strength and weaknesses of this approac

The predictive value of CXCL13 in suspected Lyme neuroborreliosis: a retrospective cross-sectional study

The role of CXCL13 as a marker of Lyme neuroborreliosis (LNB) is under investigation, and CXCL13 is not part of routine diagnostics in suspicion of LNB. Our aim was to find the optimal cut-off value of CXCL13 for LNB in a Danish population and to investigate the role of CXCL13 both in early LNB and as a discriminatory marker between LNB and other neuroinflammatory disorders. We conducted a retrospective cross-sectional study including all patients with a cerebrospinal CXCL13 test performed at the Department of Clinical Immunology, Odense University Hospital, Denmark, between 1 January 2015 and 31 December 2018. We included 619 patients, of which 51 had definite LNB, 14 patients had possible LNB with neurological symptoms suggestive of LNB and pleocytosis but no intrathecal Borrelia antibodies, eight patients had prior LNB and 546 had no LNB. With an optimal CXCL13 cut-off of 49 ng/L we found a sensitivity of 100% and specificity of 94% (AUC 0.988, 95% CI 0.980–0.996) when patients treated with antibiotics prior to lumbar puncture were excluded (n = 130). All patients with possible LNB had a CXCL13 value above the cut-off value; 18/546 patients (3.3%) without LNB had a CXCL13 value ≥ 50 ng/L. While CXCL13 cannot be used as a stand-alone test, it can be used as a reliable additional marker in treatment-naive patients suspected of LNB. CXCL13 can be used to monitor treatment response in LNB patients

Evaluation of factors influencing tick bites and tick-borne infections: a longitudinal study

International audienceAbstract Background Various tick-borne infections like borreliosis and rickettsiosis pose a health risk to humans in many parts of the world. We investigated seroprevalence of and seroconversion to Borrelia burgdorferi and Rickettsia spp. and relation to tick-bites, weather and clinical manifestations in Denmark. Methods Blood donors were enrolled at the Hospital of Southern Jutland in June–July with follow-up November–February of 2018 and 2019. Blood samples were collected, and a questionnaire regarding tick bites, potential exposures and symptoms was completed at each visit. Samples were tested for presence of IgM and IgG antibodies directed against B. burgdorferi and Rickettsia spp. using R. helvetica and R. felis as antigens. Data were examined for correlation between tick bites, serological results, potential exposures and symptoms. Results Two-hundred and fourteen (93 follow-ups) and 130 (38 follow-ups) blood donors were included in 2018 and 2019, respectively. The total borrelia seroconversion rate was 6.3% (CI 2.1–10.5), while the prevalence of IgM and IgG antibodies was 7.8% (CI 4.9–10.6) and 6.7% (CI 4–9.3), respectively. Seroconversion to Rickettsia spp. was detected in one participant. Tick bites and seroconversion were not significantly associated with the reported unspecific symptoms, but unspecific symptoms were common in the study population. There was no significant difference in number of tick bites or seroconversion/prevalence between seasons with highly alternating weather. Conclusions Results suggest that weather conditions in an individual year have a limited impact. Anti- Borrelia -antibodies do not seem to persist in serum for several years. Rickettsiosis is of limited concern in Denmark. Graphic abstrac