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Banović P, Foucault-Simonin A, Papić L, Savić S, Potkonjak A, Jurišić A, Radenković M, Mijatović D, Simin V, Bogdan I, Zając Z, Kulisz J, Woźniak A, Hartmann D, Perner J, Wu-Chuang A, Mateos-Hernandez L, Moutailler S, Cabezas-Cruz A. One health approach to study human health risks associated with Dermanyssus gallinae mites. Heliyon 2024; 10:e30539. [PMID: 38742058 PMCID: PMC11089355 DOI: 10.1016/j.heliyon.2024.e30539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Despite the significant health risks associated with Dermanyssus gallinae infestations in humans, they are often overlooked. This study investigated a household case of D. gallinae infestation and explored the resulting clinical manifestations and risk of infection in family members. Microfluidic PCR was employed for high-throughput screening of pathogens in collected mites and blood samples from both chickens and family members. Morphological and molecular examinations confirmed the identity of the mites as D. gallinae sensu stricto (s.s.), with evidence indicating recent blood feeding. Results indicated that the mites exclusively harbored various pathogens, including Bartonella spp., Ehrlichia spp., Apicomplexa, and Theileria spp. Blood samples from family members and poultry tested negative for these pathogens, suggesting a potential reservoir role for D. gallinae. The study further identified haplotypes of D. gallinae, classifying them into D. gallinae s.s., cosmopolitan haplogroup A. Serological analysis revealed elevated IgE seroreactivity against mite proteins in the family member with bite lesions. Antibodies against Bartonella spp. were detected in this individual, indicating exposure to the pathogen. In summary, this study sheds light on the clinical manifestations, pathogen detection, and genetic characterization of D. gallinae infestations, underscoring the necessity of adopting comprehensive approaches to manage such infestations effectively.
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Affiliation(s)
- Pavle Banović
- Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad, 21000, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, Novi Sad, 21000, Serbia
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
| | - Angélique Foucault-Simonin
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Luka Papić
- Veterinary clinic “Darvin”, Bate Brkića 32, Novi Sad, 21000, Serbia
| | - Sara Savić
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Scientific Veterinary Institute “Novi Sad”, 21000, Novi Sad, Serbia
| | - Aleksandar Potkonjak
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000, Novi Sad, Serbia
| | - Aleksandar Jurišić
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Department for Environmental and Plant Protection, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Marko Radenković
- Department of Biology and Ecology, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, 21000, Novi Sad, Serbia
| | - Dragana Mijatović
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000, Novi Sad, Serbia
| | - Verica Simin
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Department of Microbiology, Pasteur Institute Novi Sad, 21000, Novi Sad, Serbia
| | - Ivana Bogdan
- Diagnostics and Laboratory Research Task Force, Balkan Association for Vector-Borne Diseases, 21000, Novi Sad, Serbia
- Department of Microbiology, Pasteur Institute Novi Sad, 21000, Novi Sad, Serbia
| | - Zbigniew Zając
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - Joanna Kulisz
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - Aneta Woźniak
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - David Hartmann
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 37005, Ceske Budejovice, Czech Republic
| | - Jan Perner
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, 37005, Ceske Budejovice, Czech Republic
| | - Alejandra Wu-Chuang
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Lourdes Mateos-Hernandez
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Sara Moutailler
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
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Polsomboon Nelson S, Ergunay K, Bourke BP, Reinbold-Wasson DD, Caicedo-Quiroga L, Kirkitadze G, Chunashvili T, Tucker CL, Linton YM. Nanopore-based metagenomics reveal a new Rickettsia in Europe. Ticks Tick Borne Dis 2024; 15:102305. [PMID: 38150911 DOI: 10.1016/j.ttbdis.2023.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
Accurate identification of tick-borne bacteria, including those associated with rickettsioses, pose significant challenges due to the polymicrobial and polyvectoral nature of the infections. We aimed to carry out a comparative evaluation of a non-targeted metagenomic approach by nanopore sequencing (NS) and commonly used PCR assays amplifying Rickettsia genes in field-collected ticks. The study included a total of 310 ticks, originating from Poland (44.2 %) and Bulgaria (55.8 %). Samples comprised 7 species, the majority of which were Ixodes ricinus (62.9 %), followed by Dermacentor reticulatus (21.2 %). Screening was carried out in 55 pools, using total nucleic acid extractions from individual ticks. NS and ompA/gltA PCRs identified Rickettsia species in 47.3 % and 54.5 % of the pools, respectively. The most frequently detected species were Rickettsia asiatica (27.2 %) and Rickettsia raoultii (21.8 %), followed by Rickettsia monacensis (3.6 %), Rickettsia helvetica (1.8 %), Rickettsia massiliae (1.8 %) and Rickettsia tillamookensis (1.8 %). Phylogeny construction on mutS, uvrD, argS and virB4 sequences and a follow-up deep sequencing further supported R. asiatica identification, documented in Europe for the first time. NS further enabled detection of Anaplasma phagocytophilum (9.1 %), Coxiella burnetii (5.4 %) and Neoehrlichia mikurensis (1.8 %), as well as various endosymbionts of Rickettsia and Coxiella. Co-detection of multiple rickettsial and non-rickettsial bacteria were observed in 16.4 % of the pools with chromosome and plasmid-based contigs. In conclusion, non-targeted metagenomic sequencing was documented as a robust strategy capable of providing a broader view of the tick-borne bacterial pathogen spectrum.
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Affiliation(s)
- Suppaluck Polsomboon Nelson
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA; Smithsonian Institution, Department of Entomology, National Museum of Natural History (NMNH), Washington, DC, USA
| | - Koray Ergunay
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA; Smithsonian Institution, Department of Entomology, National Museum of Natural History (NMNH), Washington, DC, USA; Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Brian P Bourke
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA; Smithsonian Institution, Department of Entomology, National Museum of Natural History (NMNH), Washington, DC, USA
| | | | - Laura Caicedo-Quiroga
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA; Smithsonian Institution, Department of Entomology, National Museum of Natural History (NMNH), Washington, DC, USA
| | - Giorgi Kirkitadze
- U.S. Army Medical Research Directorate - Georgia (USAMRD-G), Tbilisi, Georgia
| | - Tamar Chunashvili
- U.S. Army Medical Research Directorate - Georgia (USAMRD-G), Tbilisi, Georgia
| | - Cynthia L Tucker
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA
| | - Yvonne-Marie Linton
- Walter Reed Biosystematics Unit (WRBU), Smithsonian Institution, Museum Support Center, Suitland, MD, USA; Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA; Smithsonian Institution, Department of Entomology, National Museum of Natural History (NMNH), Washington, DC, USA
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Kapo N, Zuber Bogdanović I, Gagović E, Žekić M, Veinović G, Sukara R, Mihaljica D, Adžić B, Kadriaj P, Cvetkovikj A, Djadjovski I, Potkonjak A, Velo E, Savić S, Tomanović S, Omeragić J, Beck R, Hodžić A. Ixodid ticks and zoonotic tick-borne pathogens of the Western Balkans. Parasit Vectors 2024; 17:45. [PMID: 38297327 PMCID: PMC10832161 DOI: 10.1186/s13071-023-06116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Ixodid ticks are distributed across all countries of the Western Balkans, with a high diversity of species. Many of these species serve as vectors of pathogens of veterinary and medical importance. Given the scattered data from Western Balkan countries, we have conducted a comprehensive review of available literature, including some historical data, with the aim to compile information about all recorded tick species and associated zoonotic pathogens in this region. Based on the collected data, the tick fauna of the Western Balkans encompasses 32 tick species belonging to five genera: Ixodes, Haemaphysalis, Dermacentor, Rhipicephalus and Hyalomma. A range of pathogens responsible for human diseases has also been documented, including viruses, bacteria and parasites. In this review, we emphasize the necessity for integrated surveillance and reporting, urging authorities to foster research by providing financial support. Additionally, international and interdisciplinary collaborations should be encouraged that include the exchange of expertise, experiences and resources. The present collaborative effort can effectively address gaps in our knowledge of ticks and tick-borne diseases.
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Affiliation(s)
- Naida Kapo
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Ema Gagović
- Department for Bacteriology and Parasitology, Laboratory for Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - Marina Žekić
- Scientific Veterinary Institute "Novi Sad", Novi Sad, Serbia
| | - Gorana Veinović
- Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Ratko Sukara
- Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Darko Mihaljica
- Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Bojan Adžić
- Diagnostic Veterinary Laboratory, Podgorica, Montenegro
| | - Përparim Kadriaj
- Vector Control Unit, Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Aleksandar Cvetkovikj
- Veterinary Institute, Faculty of Veterinary Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Igor Djadjovski
- Veterinary Institute, Faculty of Veterinary Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Enkelejda Velo
- Vector Control Unit, Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Sara Savić
- Scientific Veterinary Institute "Novi Sad", Novi Sad, Serbia
| | - Snežana Tomanović
- Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jasmin Omeragić
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Relja Beck
- Department for Bacteriology and Parasitology, Laboratory for Parasitology, Croatian Veterinary Institute, Zagreb, Croatia.
| | - Adnan Hodžić
- Department of Microbiology and Ecosystem Science, Centre for Microbiology and Environmental Systems Science (CMESS), University of Vienna, Vienna, Austria.
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Banović P, Mijatović D, Bogdan I, Simin V, Meletis E, Kostoulas P, Resman Rus K, Knap N, Korva M, Avšič-Županc T, Cabezas-Cruz A. Evidence of tick-borne encephalitis virus neutralizing antibodies in Serbian individuals exposed to tick bites. Front Microbiol 2023; 14:1314538. [PMID: 38156013 PMCID: PMC10754514 DOI: 10.3389/fmicb.2023.1314538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Tick-borne encephalitis (TBE) is an emerging vector-borne and food-borne disease caused by the tick-borne encephalitis virus (TBEV; Orthoflavivirus encephalitidis), with a distribution spanning the Eurasian continent. Despite its significant public health impact in various European regions, TBE remains largely underdiagnosed in Serbia due to limited awareness and diagnostic challenges. In response to this, our study aimed to comprehensively assess TBEV exposure in individuals infested with ticks and to identify potential TBEV foci within Serbia. Materials and methods From 2019 to 2021, we conducted an observational study involving 450 patients who reported tick infestations. Results Our demographic analysis revealed a median age of 38 years, with a slight male predominance among the participants. We documented tick infestations in 38 municipalities across 14 districts of Serbia, with a notable concentration in proximity to Fruška Gora Mountain. The ticks most frequently removed were Ixodes ricinus, with nymphs and adult females being the predominant stages. On average, nymphs were removed after about 27.1 hours of feeding, while adult females remained attached for approximately 44.4 hours. Notably, we found age as a significant predictor of infestation time for both nymphs and adult females. Furthermore, we detected TBEV-neutralizing antibodies in 0.66% of the serum samples, shedding light on potential TBEV foci, particularly in Fruška Gora Mountain and other regions of Serbia. Conclusion Our study emphasizes the urgent need for active TBE surveillance programs, especially in areas suspected of hosting TBEV foci, in order to assess the true TBE burden, identify at-risk populations, and implement effective preventive measures.
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Affiliation(s)
- Pavle Banović
- Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, Novi Sad, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Mijatović
- Department for Research and Monitoring of Rabies and Other Zoonoses, Pasteur Institute Novi Sad, Novi Sad, Serbia
| | - Ivana Bogdan
- Department of Microbiology, Pasteur Institute Novi Sad, Novi Sad, Serbia
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, Novi Sad, Serbia
| | - Eleftherios Meletis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Polychronis Kostoulas
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Katarina Resman Rus
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Knap
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alejandro Cabezas-Cruz
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
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Zając Z, Kulisz J, Woźniak A, Bartosik K, Foucault-Simonin A, Moutailler S, Cabezas-Cruz A. Tick Activity, Host Range, and Tick-Borne Pathogen Prevalence in Mountain Habitats of the Western Carpathians, Poland. Pathogens 2023; 12:1186. [PMID: 37764994 PMCID: PMC10534405 DOI: 10.3390/pathogens12091186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
In mountainous regions, diverse ecosystems provide a habitat for numerous species of organisms. In this study, we focused on ixodid ticks and their presence in the Western Carpathians, Poland. Our objectives were to investigate the impact of environmental factors on tick occurrence and activity, the prevalence of vectored pathogens, and tick hosts, and their role as reservoir organisms for tick-borne pathogens (TBPs). To this end, we collected ticks from the vegetation and from animals (Apodemus agrarius, A. flavicollis, Capreolus capreolus, Microtus spp., Myodes glareolus, Ovis aries). In addition, we collected blood samples from rodents. The collected material underwent molecular analysis, utilizing the high-throughput microfluidic real-time PCR technique, to detect the presence of TBPs. Our findings confirmed the occurrence of only two species of ixodid ticks in the study area: the dominant Ixodes ricinus, and Dermacentor reticulatus with very limited abundance. Temperature significantly influenced tick activity, and the number of I. ricinus nymphs varied with altitude. We also observed a circadian pattern of questing activity in I. ricinus ticks. The main hosts for juvenile tick stages were M. glareolus and A. agrarius, while adult stages were frequently found on C. capreolus. I. ricinus ticks collected from the vegetation were often infected with Rickettsia helvetica (up to 35.71%), Borrelia afzelii (up to 28.57%), and Ehrlichia spp. (up to 9.52%). In contrast, juvenile stages frequently carried Bartonella spp. (up to 10.00%), Mycoplasma spp. (up to 16.67%) and R. helvetica (up to 16.67%). Moreover, we detected genetic material of Mycoplasma spp. (up to 100.00%), Ehrlichia spp. (up to 35.71%), Bartonella spp. (up to 25.00%), and Borrelia spp. (up to 6.25%) in rodent blood samples. The obtained results indicate A. agrarius and M. glareolus as reservoir animals for TBPs in the studied region.
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Affiliation(s)
- Zbigniew Zając
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.K.); (A.W.); (K.B.)
| | - Joanna Kulisz
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.K.); (A.W.); (K.B.)
| | - Aneta Woźniak
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.K.); (A.W.); (K.B.)
| | - Katarzyna Bartosik
- Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (J.K.); (A.W.); (K.B.)
| | - Angélique Foucault-Simonin
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France; (A.F.-S.); (S.M.)
| | - Sara Moutailler
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France; (A.F.-S.); (S.M.)
| | - Alejandro Cabezas-Cruz
- Anses, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France; (A.F.-S.); (S.M.)
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Cabezas-Cruz A, Banović P. Understanding Tick-Borne Encephalitis Virus Foci, a Tale of Two Mountains. Pathogens 2023; 12:pathogens12020265. [PMID: 36839537 PMCID: PMC9963062 DOI: 10.3390/pathogens12020265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
What factors influence the formation and disappearance of tick-borne encephalitis virus (TBEV) foci [...].
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Affiliation(s)
- Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, F-94700 Maisons-Alfort, France
- Correspondence: (A.C.-C.); (P.B.)
| | - Pavle Banović
- Clinic for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence: (A.C.-C.); (P.B.)
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