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Król N, Chitimia-Dobler L, Dobler G, Kiewra D, Czułowska A, Obiegala A, Zajkowska J, Juretzek T, Pfeffer M. Identification of New Microfoci and Genetic Characterization of Tick-Borne Encephalitis Virus Isolates from Eastern Germany and Western Poland. Viruses 2024; 16:637. [PMID: 38675977 PMCID: PMC11055073 DOI: 10.3390/v16040637] [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: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Tick-borne encephalitis (TBE) is the most important tick-borne viral disease in Eurasia, although effective vaccines are available. Caused by the tick-borne encephalitis virus (TBEV, syn. Orthoflavivirus encephalitidis), in Europe, it is transmitted by ticks like Ixodes ricinus and Dermacentor reticulatus. TBEV circulates in natural foci, making it endemic to specific regions, such as southern Germany and northeastern Poland. Our study aimed to identify new TBEV natural foci and genetically characterize strains in ticks in previously nonendemic areas in Eastern Germany and Western Poland. (2) Methods: Ticks were collected from vegetation in areas reported by TBE patients. After identification, ticks were tested for TBEV in pools of a maximum of 10 specimens using real-time RT-PCR. From the positive TBEV samples, E genes were sequenced. (3) Results: Among 8400 ticks from 19 sites, I. ricinus (n = 4784; 56.9%) was predominant, followed by D. reticulatus (n = 3506; 41.7%), Haemaphysalis concinna (n = 108; 1.3%), and I. frontalis (n = 2; <0.1%). TBEV was detected in 19 pools originating in six sites. The phylogenetic analyses revealed that TBEV strains from Germany and Poland clustered with other German strains, as well as those from Finland and Estonia. (4) Conclusions: Although there are still only a few cases are reported from these areas, people spending much time outdoors should consider TBE vaccination.
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Affiliation(s)
- Nina Król
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
- Clinical Center for Emerging and Vector-Borne Infections, Odense University Hospital, 5000 Odense, Denmark
| | - Lidia Chitimia-Dobler
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
- Fraunhofer Institute of Immunology, Infection and Pandemic Research, 80799 Munich, Germany
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
- Department of Parasitology, Institute of Biology, University of Hohenheim, 70599 Stuttgart, Germany
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University Munich, 80336 Munich, Germany
| | - Dorota Kiewra
- Department of Microbial Ecology and Acaroentomology, University of Wrocław, 51-148 Wrocław, Poland
| | - Aleksandra Czułowska
- Department of Microbial Ecology and Acaroentomology, University of Wrocław, 51-148 Wrocław, Poland
| | - Anna Obiegala
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University in Białystok, 15-089 Białystok, Poland;
| | - Thomas Juretzek
- Center for Laboratory Medicine, Microbiology and Hospital Hygiene, Carl-Thiem-Klinikum Cottbus gGmbH, 03048 Cottbus, Germany
| | - Martin Pfeffer
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
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Gynthersen R, Ørbæk M, Høgdall E, Glintborg B, Ostrowski SR, Harritshøj L, Hetland ML, Lebech AM, Mens H. Neoehrlichia mikurensis is uncommon in rheumatological patients receiving tumour necrosis factor inhibitors and in blood donors: a retrospective cohort study. RMD Open 2024; 10:e003660. [PMID: 38176737 PMCID: PMC10773428 DOI: 10.1136/rmdopen-2023-003660] [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: 10/26/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Neoehrlichia mikurensis is a tick-borne bacterium that primarily causes disease in immunocompromised patients. The bacterium has been detected in ticks throughout Europe, with a 0%-25% prevalence. N. mikurensis infection presents unspecific symptoms, which can easily be mistaken for inflammatory disease activity. We aimed to determine the prevalence of N. mikurensis in rheumatological patients receiving tumour necrosis factor inhibitors (TNFi) and a cohort of healthy individuals. MATERIALS AND METHODS This retrospective cohort study included 400 rheumatological patients treated with TNFi and 400 healthy blood donors. Plasma samples were retrieved from the Danish Rheumatological Biobank and the Danish Blood Donor Study between 2015 and 2022. Age, sex, diagnosis and duration of TNFi treatment were recovered from the Danish Rheumatological Database, DANBIO. Data on age and sex were available for the blood donors. One plasma sample per individual was tested for N. mikurensis DNA-specific real-time PCR targeting the groEL gene. RESULTS In the rheumatological patients, the median age was 61 years (IQR 55-68 years), 62% were women, and 44% had a diagnosis of seropositive rheumatoid arthritis. In total, 54% of the patients were treated with infliximab. The median time from TNFi initiation to blood sampling was 20 months (IQR, 5-60 months). N. mikurensis DNA was not detected in any samples from patients or blood donors. CONCLUSION N. mikurensis infection does not appear to represent a prevalent risk in Danish rheumatological patients receiving TNFi or in blood donors.
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Affiliation(s)
- Rosa Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Estrid Høgdall
- Bio- and Genome Bank Denmark (RBGB), Molecular Unit, Department of Pathology, Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bente Glintborg
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- DANBIO, The Danish Rheumatologic Biobank and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Harritshøj
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- DANBIO, The Danish Rheumatologic Biobank and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Moutailler S, Galon C. Real-Time Microfluidic PCRs: A High-Throughput Method to Detect 48 or 96 Tick-borne Pathogens in 48 or 96 Samples. Methods Mol Biol 2024; 2742:1-17. [PMID: 38165611 DOI: 10.1007/978-1-0716-3561-2_1] [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] [Indexed: 01/04/2024]
Abstract
Tick-borne pathogens (TBPs) are often detected through classical molecular tools (PCR, nested PCR, real-time PCR), but these are limited in terms of the number of targeted pathogens due to the volume of DNA available for analysis. To solve this problem, in 2014 we developed a new high-throughput method based on real-time microfluidic PCRs that can detect 48 or 96 pathogens in 48 or 96 samples in a single run, such as ten species from the Borrelia burgdorferi sensu lato group. We then used this technique for large-scale epidemiological studies of TBPs in tick and animal samples on an international scale through numerous collaborative projects.
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Affiliation(s)
- Sara Moutailler
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France.
| | - Clemence Galon
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
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Jensen BB, Andersen NS, Wölfel S, Chen M, Paarup HM, Olesen CR, Fournier PE, Jensen PM, Skarphedinsson S. Rickettsiosis in Denmark: A nation-wide survey. Ticks Tick Borne Dis 2023; 14:102236. [PMID: 37708802 DOI: 10.1016/j.ttbdis.2023.102236] [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: 01/05/2022] [Revised: 06/03/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023]
Abstract
Rickettsia helvetica has been reported at varying prevalences in Danish and other European Ixodes ricinus populations. Though apparently widespread and with reported cases of human infection, the significance of the bacteria as a threat to public health remains unclear. We present a nation-wide survey of rickettsia in ticks, roe deer and humans in Denmark. Ticks were collected by flagging and screened for presence of rickettsial DNA by polymerase chain reaction. Sera from roe deer, hunters, neuroborreliosis patients and blood donors were analyzed for presence of anti-R. helvetica and Rickettsia felis antibodies by immunofluorescence microscopy. The Rickettsia minimum infection rate in ticks was 4.9 % (367/973 pools positive, 7510 ticks in total), with 3.9 % in nymphs and 9.3 % in adults. Rickettsia helvetica accounted for 4.17 % and Rickettsia monacensis for 0.03 %, 0.6 % comprised non-differentiable rickettsial DNA. The prevalence of antibodies against R. helvetica was 2.8 % (9/319) in roe deer, while no hunters (n = 536) or blood donors (n = 181) were positive. The prevalence of anti-R. helvetica antibodies among Lyme neuroborreliosis patients was 6 % (3/47), where it co-occurred with Anaplasma phagocytophilum. Based on our study autochthonous rickettsiosis is of limited concern to the public health in Denmark, but our finding of R. monacensis for the first time in Denmark illustrates the dynamic nature of tick-borne pathogens, emphasizing that continuous surveillance is necessary.
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Affiliation(s)
- Bo Bødker Jensen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark; Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
| | - Nanna Skaarup Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Silke Wölfel
- Bundeswehr Institute of Microbiology, Munich, Germany; amedes MVZ for Laboratory Medicine and Microbiology, Fuerstenfeldbruck, Germany
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Helene M Paarup
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Pierre Edouard Fournier
- Aix-Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Mediterranée Infection, Marseille, France
| | | | - Sigurdur Skarphedinsson
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Schwartz T, Hoornstra D, Øie E, Hovius J, Quarsten H. Case report: First case of Borrelia miyamotoi meningitis in an immunocompromised patient in Norway. IDCases 2023; 33:e01867. [PMID: 37577049 PMCID: PMC10412827 DOI: 10.1016/j.idcr.2023.e01867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/30/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
Background Tick-borne disease caused by B. miyamotoi (BMD) usually manifest as a febrile illness in humans. Complications include relapsing fever and in rare occasions involvement of the central nervous system. Only a few cases of meningoencephalitis have been described, mostly in immunosuppressed patients. Case presentation A 70-year-old female receiving immunosuppressive rituximab therapy presented with frontal headache, dizziness, nausea, vomiting and chills. Clinical laboratory blood analyses were normal. Cerebrospinal fluid (CSF) was translucent and analysis showed increased leucocyte count (187 106/L) and elevated level of protein (1056 mg/L). Empiric antibiotic treatment was initiated. The patient showed an early symptomatic relief and 24 h after admission she was discharged from the hospital and antibiotic treatment was discontinued. Two weeks after hospitalisation the B. miyamotoi specific PCR turned out positive in both CSF and serum. At the time, the patient was recovered with mild residual headache. She was treated with high dose doxycycline and her subtle symptoms disappeared. Conclusions To our knowledge, we present the first patient with BMD-associated meningitis in Norway, one of eight cases reported worldwide. The patient had mild symptoms and received an early diagnosis. A more severe progression or relapse of disease may have been prevented by antibiotic treatment. BMD should be considered as causes of aseptic meningitis, especially in immunosuppressed patients living in endemic areas.
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Affiliation(s)
- Thomas Schwartz
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
- Oslo New University College, Oslo, Norway
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Joppe Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Hanne Quarsten
- Department of Medical Microbiology, Sørlandet Hospital, Kristiansand, Norway
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Hansen MF, Sørensen PK, Sørensen AE, Krogfelt KA. Can protection motivation theory predict protective behavior against ticks? BMC Public Health 2023; 23:1214. [PMID: 37349761 PMCID: PMC10286392 DOI: 10.1186/s12889-023-16125-5] [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: 11/07/2022] [Accepted: 06/14/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Cases of reported tick-borne diseases in humans have increased over the past decades. Strategies informing the public about ticks, their associated diseases, and preventive measures are often highlighted as important in limiting pathogen transfer and disease. However, knowledge about the motivation for people to apply preventative measures is sparse. METHODS The aim was to examine if Protection Motivation Theory, a model of disease prevention and health promotion, can predict the use of protective measures against ticks. Ordinal logistic regression and Chi-square tests were used on data from a cross-sectional survey with respondents from Denmark, Norway, and Sweden (n = 2658). We examined the effect of (1) the perceived seriousness of tick bites, Lyme borreliosis (LB), and tick-borne encephalitis (TBE), and (2) the perceived probability of getting a tick bite, Lyme borreliosis, and tick-borne encephalitis on protection against ticks. Finally, we examined if there was an association between the use of a protective measure and the perceived efficacy of that measure. RESULTS The perceived seriousness of a tick bite and LB significantly predict who is more likely to apply protective measures for all three countries combined. The perceived seriousness of TBE did not significantly predict the level of adoption of protective measures applied by respondents. The perceived likelihood of getting a tick bite within the next 12 months and the perceived likelihood of getting LB if bitten by a tick significantly predicted the application of protective measures. However, the increases in the likelihood of protection were very small. The application of a certain type of protection was always correlated with the perceived efficacy of the same protective measure. CONCLUSION Some variables of PMT may be used to predict the level of adoption of protection applied against ticks and tick-borne diseases. We found that the perceived seriousness of a tick bite and LB significantly predict the level of adoption protection. The perceived likelihood of getting a tick bite or LB also significantly predicted the level of adoption of protection, although the change was very small. The results regarding TBE were less clear. Lastly, there was an association between applying a protective measure and the perceived efficacy of the same measure.
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Affiliation(s)
- Mette Frimodt Hansen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4100 Denmark
| | - Pelle Korsbaek Sørensen
- Research Centre for Health Promotion, Roskilde University, Roskilde, Denmark
- Research and Development, Centre for Nursing, University College Absalon, Roskilde, Denmark
| | - Anja Elaine Sørensen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4100 Denmark
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4100 Denmark
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Kjær LJ, Johansson M, Lindgren PE, Asghar N, Wilhelmsson P, Fredlund H, Christensson M, Wallenhammar A, Bødker R, Rasmussen G, Kjellander P. Potential drivers of human tick-borne encephalitis in the Örebro region of Sweden, 2010-2021. Sci Rep 2023; 13:7685. [PMID: 37169798 PMCID: PMC10175290 DOI: 10.1038/s41598-023-34675-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023] Open
Abstract
Incidence of tick-borne encephalitis (TBE) has increased during the last years in Scandinavia, but the underlying mechanism is not understood. TBE human case data reported between 2010 and 2021 were aggregated into postal codes within Örebro County, south-central Sweden, along with tick abundance and environmental data to analyse spatial patterns and identify drivers of TBE. We identified a substantial and continuing increase of TBE incidence in Örebro County during the study period. Spatial cluster analyses showed significant hotspots (higher number of cases than expected) in the southern and northern parts of Örebro County, whereas a cold spot (lower number of cases than expected) was found in the central part comprising Örebro municipality. Generalised linear models showed that the risk of acquiring TBE increased by 12.5% and 72.3% for every percent increase in relative humidity and proportion of wetland forest, respectively, whereas the risk decreased by 52.8% for every degree Celsius increase in annual temperature range. However, models had relatively low goodness of fit (R2 < 0.27). Results suggest that TBE in Örebro County is spatially clustered, however variables used in this study, i.e., climatic variables, forest cover, water, tick abundance, sheep as indicator species, alone do not explain this pattern.
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Affiliation(s)
- Lene Jung Kjær
- Section for Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Magnus Johansson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Naveed Asghar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Hans Fredlund
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Örebro County Council, Örebro, Sweden
| | - Madeleine Christensson
- Grimsö Wildlife Research Station, Department of Ecology, Swedish University of Agricultural Sciences (SLU), Riddarhyttan, Sweden
| | - Amélie Wallenhammar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - René Bødker
- Section for Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Gunløg Rasmussen
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Örebro County Council, Örebro, Sweden
| | - Petter Kjellander
- Grimsö Wildlife Research Station, Department of Ecology, Swedish University of Agricultural Sciences (SLU), Riddarhyttan, Sweden
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Quarsten H, Henningsson A, Krogfelt K, Strube C, Wennerås C, Mavin S. Tick-borne diseases under the radar in the North Sea Region. Ticks Tick Borne Dis 2023; 14:102185. [PMID: 37116420 DOI: 10.1016/j.ttbdis.2023.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
The impact of tick-borne diseases caused by pathogens such as Anaplasma phagocytophilum, Neoehrlichia mikurensis, Borrelia miyamotoi, Rickettsia helvetica and Babesia species on public health is largely unknown. Data on the prevalence of these pathogens in Ixodes ricinus ticks from seven countries within the North Sea Region in Europe as well as the types and availability of diagnostic tests and the main clinical features of their corresponding diseases is reported and discussed. Raised awareness is needed to discover cases of these under-recognized types of tick-borne disease, which should provide valuable insights into these diseases and their clinical significance.
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Affiliation(s)
- Hanne Quarsten
- Department of Medical Microbiology, Sørlandet Hospital, Kristiansand 4615, Norway.
| | - Anna Henningsson
- Department of Clinical Microbiology in Jönköping, County Hospital Ryhov, Jönköping 55185, Sweden; Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping 58183, Sweden
| | - Karen Krogfelt
- Department of Science and Environment, University of Roskilde, Roskilde 4000, Denmark
| | - Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hanover 30559, Germany
| | - Christine Wennerås
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg 413 46, Sweden
| | - Sally Mavin
- Scottish Lyme Disease and Tick-Borne Infections Reference Laboratory, Raigmore Hospital, Inverness IV2 3BW, United Kingdom
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Gynthersen RMM, Hansen MF, Ocias LF, Kjaer A, Petersen RF, Ostrowski SR, Harritshøj L, Jacobsen S, Overgaard U, Krogfelt KA, Lebech AM, Mens H. Neoehrlichia mikurensis in Danish immunocompromised patients: a retrospective cohort study. Ann Clin Microbiol Antimicrob 2023; 22:20. [PMID: 36941613 PMCID: PMC10026440 DOI: 10.1186/s12941-023-00571-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The tick-borne bacterium, Neoehrlichia mikurensis (N. mikurensis) can cause severe febrile illness and thromboembolic complications in immunocompromised individuals. We investigated the presence of N. mikurensis DNA in retrospectively collected plasma from a well-characterized cohort of Danish immunocompromised patients. METHODS Plasma samples from 239 patients with immune dysfunction related to hematological or rheumatological disease or due to immunosuppressive therapy, were retrieved from a transdisciplinary biobank (PERSIMUNE) at Rigshospitalet, Copenhagen, Denmark. Serving as immunocompetent controls, plasma samples from 192 blood donors were included. All samples were collected between 2015 and 2019. Real-time PCR targeting the groEL gene was used to detect N. mikurensis DNA. Sequencing was used for confirmation. Borrelia burgdorferi sensu lato IgG antibodies were detected by ELISA as a proxy of tick exposure. Prevalence was compared using Fisher's exact test. RESULTS Neoehrlichia mikurensis DNA was detected in 3/239 (1.3%, 95% confidence interval (CI): 0.3 - 3.6%) patients, all of whom primarily had a hematological disease. Follow-up samples of these patients were negative. N. mikurensis DNA was not detected in any of the blood donor samples. IgG antibodies against B. burgdorferi s.l. were detected with similar prevalence in immunocompromised patients and blood donors, i.e., 18/239 (7.5%, 95% CI: 4.8-11.5%) and 11/192 (5.7%, 95%: CI 3.2-10.0%). CONCLUSION In this study, patients with N. mikurensis were not identified by clinical indication and N. mikurensis may therefore be underdiagnosed in Danish patients. Further investigations are needed to explore the clinical significance and implications of this infection.
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Affiliation(s)
- Rosa Maja Møhring Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mette Frimodt Hansen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark.
| | - Lukas Frans Ocias
- Department of Clinical Microbiology, Karlstad Hospital, Region Värmland, Karlstad, Sweden
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital - Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Randi Føns Petersen
- Department of Bacteria, Fungi and Parasites, Statens Serum Institut, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jacobsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases - COPEACT, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Overgaard
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Cull B, Burkhardt NY, Wang XR, Thorpe CJ, Oliver JD, Kurtti TJ, Munderloh UG. The Ixodes scapularis Symbiont Rickettsia buchneri Inhibits Growth of Pathogenic Rickettsiaceae in Tick Cells: Implications for Vector Competence. Front Vet Sci 2022; 8:748427. [PMID: 35071375 PMCID: PMC8770908 DOI: 10.3389/fvets.2021.748427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/22/2021] [Indexed: 12/26/2022] Open
Abstract
Ixodes scapularis is the primary vector of tick-borne pathogens in North America but notably does not transmit pathogenic Rickettsia species. This tick harbors the transovarially transmitted endosymbiont Rickettsia buchneri, which is widespread in I. scapularis populations, suggesting that it confers a selective advantage for tick survival such as providing essential nutrients. The R. buchneri genome includes genes with similarity to those involved in antibiotic synthesis. There are two gene clusters not found in other Rickettsiaceae, raising the possibility that these may be involved in excluding pathogenic bacteria from the tick. This study explored whether the R. buchneri antibiotic genes might exert antibiotic effects on pathogens associated with I. scapularis. Markedly reduced infectivity and replication of the tick-borne pathogens Anaplasma phagocytophilum, R. monacensis, and R. parkeri were observed in IRE11 tick cells hosting R. buchneri. Using a fluorescent plate reader assay to follow infection dynamics revealed that the presence of R. buchneri in tick cells, even at low infection rates, inhibited the growth of R. parkeri by 86-100% relative to R. buchneri-free cells. In contrast, presence of the low-pathogenic species R. amblyommatis or the endosymbiont R. peacockii only partially reduced the infection and replication of R. parkeri. Addition of host-cell free R. buchneri, cell lysate of R. buchneri-infected IRE11, or supernatant from R. buchneri-infected IRE11 cultures had no effect on R. parkeri infection and replication in IRE11, nor did these treatments show any antibiotic effect against non-obligate intracellular bacteria E. coli and S. aureus. However, lysate from R. buchneri-infected IRE11 challenged with R. parkeri showed some inhibitory effect on R. parkeri infection of treated IRE11, suggesting that challenge by pathogenic rickettsiae may induce the antibiotic effect of R. buchneri. This research suggests a potential role of the endosymbiont in preventing other rickettsiae from colonizing I. scapularis and/or being transmitted transovarially. The confirmation that the observed inhibition is linked to R. buchneri's antibiotic clusters requires further investigation but could have important implications for our understanding of rickettsial competition and vector competence of I. scapularis for rickettsiae.
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Affiliation(s)
- Benjamin Cull
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Nicole Y. Burkhardt
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Xin-Ru Wang
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Cody J. Thorpe
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Jonathan D. Oliver
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Timothy J. Kurtti
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Ulrike G. Munderloh
- Department of Entomology, College of Food, Agricultural, and Natural Resource Sciences, University of Minnesota, Saint Paul, MN, United States
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Kjær LJ, Jensen LM, Chriél M, Bødker R, Petersen HH. The raccoon dog ( Nyctereutes procyonoides) as a reservoir of zoonotic diseases in Denmark. INTERNATIONAL JOURNAL FOR PARASITOLOGY-PARASITES AND WILDLIFE 2021; 16:175-182. [PMID: 34660192 PMCID: PMC8502833 DOI: 10.1016/j.ijppaw.2021.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
Raccoon dogs have successfully invaded Europe, including Denmark. Raccoon dogs are potential vectors and reservoir hosts of several zoonotic pathogens and thus have the potential for posing a threat to both human and animal health. This study includes analysis of four zoonotic parasites, 16 tick-borne pathogens and two pathogen groups from 292 raccoon dogs collected from January 2018 to December 2018. The raccoon dogs were received as a part of the Danish national wildlife surveillance program and were hunted, found dead or road killed. The raccoon dogs were screened for Alaria alata and Echinococcus multilocularis eggs in faeces by microscopy and PCR, respectively, Trichinella spp. larvae in muscles by digestion, antibodies against Toxoplasma gondii by ELISA and screening of ticks for pathogens by fluidigm real-time PCR. All raccoon dogs tested negative for E. multilocularis and Trichinella spp., while 32.9% excreted A. alata eggs and 42.7% were T. gondii sero-positive. Five tick-borne pathogens were identified in ticks collected from 15 raccoon dogs, namely Anaplasma phagocytophilum (20.0%), Babesia venatorum (6.7%), Borrelia miyamotoi (6.7%), Neoehrlichia mikurensis (6.7%) and Rickettsia helvetica (60.0%). We identified raccoon dogs from Denmark as an important reservoir of T. gondii and A. alata infection to other hosts, including humans, while raccoon dogs appear as a negligible reservoir of E. multilocularis and Trichinella spp. infections. Our results suggest that raccoon dogs may be a reservoir of A. phagocytophilum.
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Affiliation(s)
- Lene Jung Kjær
- Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Laura Mark Jensen
- Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Marian Chriél
- Centre for Diagnostics, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - René Bødker
- Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Heidi Huus Petersen
- Centre for Diagnostics, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
- Corresponding author. Tel.: +45 93 51 16 45.
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12
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Blahove MR, Carter JR. Flavivirus Persistence in Wildlife Populations. Viruses 2021; 13:v13102099. [PMID: 34696529 PMCID: PMC8541186 DOI: 10.3390/v13102099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022] Open
Abstract
A substantial number of humans are at risk for infection by vector-borne flaviviruses, resulting in considerable morbidity and mortality worldwide. These viruses also infect wildlife at a considerable rate, persistently cycling between ticks/mosquitoes and small mammals and reptiles and non-human primates and humans. Substantially increasing evidence of viral persistence in wildlife continues to be reported. In addition to in humans, viral persistence has been shown to establish in mammalian, reptile, arachnid, and mosquito systems, as well as insect cell lines. Although a considerable amount of research has centered on the potential roles of defective virus particles, autophagy and/or apoptosis-induced evasion of the immune response, and the precise mechanism of these features in flavivirus persistence have yet to be elucidated. In this review, we present findings that aid in understanding how vector-borne flavivirus persistence is established in wildlife. Research studies to be discussed include determining the critical roles universal flavivirus non-structural proteins played in flaviviral persistence, the advancement of animal models of viral persistence, and studying host factors that allow vector-borne flavivirus replication without destructive effects on infected cells. These findings underscore the viral–host relationships in wildlife animals and could be used to elucidate the underlying mechanisms responsible for the establishment of viral persistence in these animals.
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Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab. Microorganisms 2021; 9:microorganisms9102138. [PMID: 34683459 PMCID: PMC8537581 DOI: 10.3390/microorganisms9102138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Neoehrlichia (N.) mikurensis, an intracellular tick-borne bacterium not detected by routine blood culture, is prevalent in ticks in Scandinavia, Central Europe and Northern Asia, and may cause long-standing fever, nightly sweats, migrating pain, skin rashes and thromboembolism, especially in patients treated with rituximab. The multiple symptoms may raise suspicion of both infection, inflammation and malignancy, and lead in most cases to extensive medical investigations across many medical specialist areas and a delay of diagnosis. We describe a complex, albeit typical, case of neoehrlichiosis in a middle-aged splenectomised male patient with a malignant lymphoma, receiving treatment with rituximab. The multifaceted clinical picture associated with this tick-borne disease is addressed, and longitudinal clinical and laboratory data, as well as imaging, are provided. Longstanding relapsing fever in combination with thrombosis in superficial and deep veins in an immunocompromised patient living in a tick-endemic region should raise the suspicion of the emerging tick-borne disease neoehrlichiosis. Given the varied clinical presentation and the risk of delay in diagnosis and treatment, we believe it is important to raise clinicians' awareness of this emerging infection, which is successfully treated with doxycycline.
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Jensen BB, Bruun MT, Jensen PM, Pedersen AK, Fournier PE, Skarphedinsson S, Chen M. Evaluation of factors influencing tick bites and tick-borne infections: a longitudinal study. Parasit Vectors 2021; 14:289. [PMID: 34051820 PMCID: PMC8164064 DOI: 10.1186/s13071-021-04751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Bo Bødker Jensen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark. .,Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark. .,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | | | - Pierre-Edouard Fournier
- Aix-Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Mediterranée Infection, Marseille, France
| | - Sigurdur Skarphedinsson
- Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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