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Feldmeier H. Head lice as vectors of pathogenic microorganisms. Trop Med Health 2023; 51:53. [PMID: 37730694 PMCID: PMC10510260 DOI: 10.1186/s41182-023-00545-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
Body lice and head lice are the most common ectoparasites of humans. Head lice (Pediculus humanus capitis) occur worldwide in children and their caretakers, irrespective of their social status. In contrast, body lice (Pediculus humanus corporis) are confined to marginalized population groups in countries of the Global South, homeless people, and refugees. Body lice are known to transmit an array of bacterial pathogens, such as R. prowazekii, R. rickettsii, C. burneti, B. quintana, B. recurrentis, and Y. pestis. The vector capacity of head lice is still a matter of debate. The objective of the review was to scrutinize the existing evidence on the vector capacity of head lice for the transmission of bacterial pathogens. The PUBMED database was searched using a combination of the terms "pediculus humanus" OR "body lice" OR "head lice" AND "pathogen" OR "Rickettsia prowazekii" OR "Bartonella quintana" OR "Borrelia recurrentis" OR "Coxiella burneti" without a time limit. Data from epidemiological studies as well as historical observations demonstrate that body lice and head lice can carry the same array of pathogens. Since the presence of a bacterial pathogen in an arthropod is not sufficient to state that it can be transmitted to humans, and since experimental models are lacking, as yet one cannot conclude with certainty that head lice serve as vectors, although this review presents circumstantial evidence that they do. Adequately designed experimental and epidemiological studies are needed to ascertain the exact transmission potential of head lice.
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Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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2
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Deng YP, Fu YT, Yao C, Shao R, Zhang XL, Duan DY, Liu GH. Emerging bacterial infectious diseases/pathogens vectored by human lice. Travel Med Infect Dis 2023; 55:102630. [PMID: 37567429 DOI: 10.1016/j.tmaid.2023.102630] [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: 05/12/2023] [Revised: 07/02/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
Human lice have always been a major public health concern due to their vector capacity for louse-borne infectious diseases, like trench fever, louse-borne relapsing fever, and epidemic fever, which are caused by Bartonella quintana, Borrelia recurrentis, and Rickettsia prowazekii, respectively. Those diseases are currently re-emerging in the regions of poor hygiene, social poverty, or wars with life-threatening consequences. These louse-borne diseases have also caused outbreaks among populations in jails and refugee camps. In addition, antibodies and DNAs to those pathogens have been steadily detected in homeless populations. Importantly, more bacterial pathogens have been detected in human lice, and some have been transmitted by human lice in laboratories. Here, we provide a comprehensive review and update on louse-borne infectious diseases/bacterial pathogens.
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Affiliation(s)
- Yuan-Ping Deng
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - Yi-Tian Fu
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China; Department of Parasitology, Xiangya School of Basic Medicine, Central South University, Changsha, Hunan, China
| | - Chaoqun Yao
- Department of Biomedical Sciences and One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis.
| | - Renfu Shao
- Centre for Bioinnovation, School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
| | - Xue-Ling Zhang
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - De-Yong Duan
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - Guo-Hua Liu
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China.
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3
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Kahlig P, Paris DH, Neumayr A. Louse-borne relapsing fever-A systematic review and analysis of the literature: Part 1-Epidemiology and diagnostic aspects. PLoS Negl Trop Dis 2021; 15:e0008564. [PMID: 33705384 PMCID: PMC7951878 DOI: 10.1371/journal.pntd.0008564] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Louse-borne relapsing fever (LBRF) is a classical epidemic disease, which in the past was associated with war, famine, poverty, forced migration, and crowding under poor hygienic conditions around the world. The disease's causative pathogen, the spirochete bacterium Borrelia recurrentis, is confined to humans and transmitted by a single vector, the human body louse Pediculus humanus. Since the disease has had its heyday before the days of modern medicine, many of its aspects have never been formally studied and to date, remain incompletely understood. In order to shed light on some of these aspects, we have systematically reviewed the accessible literature on LBRF, since the recognition of its mode of transmission in 1907, and summarized the existing data on epidemiology and diagnostic aspects of the disease. Publications were identified by using a predefined search strategy on electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of LBRF published in English, French, German, and Spanish since 1907 were included. Data extraction followed a predefined protocol and included a grading system to judge the certainty of the diagnosis of reported cases. Historically, Ethiopia is considered a stronghold of LBRF. The recognition of LBRF among East African migrants (originating from Somalia, Eritrea, and Ethiopia) arriving to Europe in the course of the recent migration flow from this region suggests that this epidemiological focus ostensibly persists. Currently, there is neither evidence to support or refute active transmission foci of LBRF elsewhere on the African continent, in Latin America, or in Asia. Microscopy remains the most commonly used method to diagnose LBRF. Data are lacking on sensitivity and specificity of most diagnostic methods.
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Affiliation(s)
- Pascal Kahlig
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H. Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
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4
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Ectoparasites. J Am Acad Dermatol 2020; 82:551-569. [DOI: 10.1016/j.jaad.2019.05.110] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
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Seth-Smith HMB, Egli A. Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings. Front Public Health 2019; 7:235. [PMID: 31497588 PMCID: PMC6713046 DOI: 10.3389/fpubh.2019.00235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Corynebacterium diphtheriae (C. diphtheriae) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis. Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.
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Affiliation(s)
- Helena M. B. Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
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6
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Di Meco E, Di Napoli A, Amato LM, Fortino A, Costanzo G, Rossi A, Mirisola C, Petrelli A. Infectious and dermatological diseases among arriving migrants on the Italian coasts. Eur J Public Health 2019; 28:910-916. [PMID: 30010744 DOI: 10.1093/eurpub/cky126] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Since 2008 Italy has been the destination of the 'central Mediterranean route', used by migrants to reach Europe. The aim of this study is to describe demographic characteristics and health problems of migrants at the time of arrival on the Italian coasts, focussing on dermatological and infectious diseases. Methods Cross-sectional study of data routinely collected (n = 6, 188) by the National Institute for Health Migration and Poverty (INMP) in the centres for migrants of Lampedusa and Trapani-Milo (2015-16). Logistic models were performed to identify factors associated with scabies, varicella and the occurrence of two or more not related diagnosis. Results The average age was 21.6 years; 83.5% of the patients were males. The most frequent countries of origin were Eritrea, Nigeria, and Somalia. The most frequent diagnosis was scabies (58% of patients), skin infections, pediculosis and dermatitis; respiratory infections and varicella were the most represented infectious diseases. The diagnosis of scabies was more probable among Somalis (OR: 11.60) and Eritreans (OR: 10.05); the diagnosis of varicella was more probable among Ghanaians (OR: 13.58) and Nigerians (OR: 9.79). Somalis (OR: 4.10) and Eritreans (OR: 3.32) were the patients more likely to receive two or more diagnosis. Conclusions The majority of the diseases affecting migrants is in most cases, related to the migration experience and is likely not to represent a major threat for public health. Up-to-date information regarding the burden of diseases is needed in order to identify the health needs of incoming migrants and to arrange the appropriate response in terms of health services provision.
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Affiliation(s)
- Eugenia Di Meco
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | | | - Antonio Fortino
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | | | - Alessandra Rossi
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
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7
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Isenring E, Fehr J, Gültekin N, Schlagenhauf P. Infectious disease profiles of Syrian and Eritrean migrants presenting in Europe: A systematic review. Travel Med Infect Dis 2018; 25:65-76. [PMID: 29702253 DOI: 10.1016/j.tmaid.2018.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In the past decade, a large influx of migrants presented in Europe. Their country of origin was mainly either Syria or Eritrea. Public health institutions in host countries in Europe are challenged to screen and care for migrant populations with regard to infectious diseases. METHODS We performed a systematic literature review (according to PRISMA guidelines) to define the infectious disease profile of migrants originating in Syria and Eritrea. RESULTS The search resulted in 825 papers of possible relevance for infectious diseases in migrants from Syria, of which, after screening, we included 35 in the systematic review. A further 265 papers of possible relevance for infectious diseases in Eritrean migrants were screened, of which we included 27 in the systematic review. In migrants from Syria, leishmaniasis was the most frequently reported infectious disease. In addition, colonisation with drug resistant, Gram-negativ bacteria was reported. In the Eritrean migrants the infectious disease most described in the selected papers was louse-borne relapsing fever. Other frequently reported infectious diseases were scabies and Plasmodium vivax malaria. CONCLUSION Our systematic analysis defines the profiles of infectious diseases for migrants from Syria and Eritrea and serves as an evidence base for public health screening and care of presenting migrants.
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Affiliation(s)
- Egon Isenring
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Jan Fehr
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Armed Forces Staff, Medical Services, Worblentalstrasse 36, Ittigen, CH 3063, Switzerland
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland; ESCMID Study Group for Infections in Travellers and Migrants, Switzerland.
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8
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Chernet A, Utzinger J, Sydow V, Probst-Hensch N, Paris DH, Labhardt ND, Neumayr A. Prevalence rates of six selected infectious diseases among African migrants and refugees: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2017; 37:605-619. [PMID: 29080108 DOI: 10.1007/s10096-017-3126-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/16/2017] [Indexed: 12/27/2022]
Abstract
The objective of this paper was to systematically review the literature on the prevalence of selected infectious diseases among migrants/refugees of African origin and to provide policy makers and health care professionals with evidence-based information. We pursued a systematic review and meta-analysis to determine the prevalence of six selected infectious diseases (i.e., syphilis, helminthiasis, schistosomiasis, intestinal protozoa infections, hepatitis B, and hepatitis C) among migrants/refugees of African origin. Three electronic databases (i.e., PubMed, EMBASE, and ISI Web of Science) were searched without language restrictions. Relevant data were extracted and random-effects meta-analyses conducted. Only adjusted estimates were analyzed to help account for heterogeneity and potential confounding. We assessed the quality of evidence using the GRADE approach. The results were stratified by geographical region. Ninety-six studies were included. The evidence was of low quality due to the small numbers of countries, infectious diseases, and participants included. African migrants/refugees had median (with 95% confidence interval [95% CI]) prevalence for syphilis, helminthiasis, schistosomiasis, intestinal protozoa infection, hepatitis B, and hepatitis C of 6.0% [95% CI: 2.0-7.0%], 13.0% [95% CI: 9.5-14.5%], 14.0% [95% CI: 13.0-17.0%], 15.0% [95% CI: 10.5-21.0%], 10.0% [95% CI: 6.0-14.0%], and 3.0% [95% CI: 1.0-4.0%], respectively. We found high heterogeneity regardless of the disease (I 2; minimum 97.5%, maximum 99.7%). The relatively high prevalence of some infectious diseases among African migrants/refugees warrants for systematic screening. The large heterogeneity of the available published data does not allow for stratifying such screening programs according to the geographical origin of African migrants/refugees.
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Affiliation(s)
- A Chernet
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - J Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - V Sydow
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N Probst-Hensch
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - D H Paris
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N D Labhardt
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A Neumayr
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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Antinori S, Tonello C, Edouard S, Parravicini C, Gastaldi D, Grande R, Milazzo L, Ricaboni D, Fenollar F, Raoult D, Corbellino M, Mediannikov O. Diagnosis of Louse-Borne Relapsing Fever despite Negative Microscopy in Two Asylum Seekers from Eastern Africa. Am J Trop Med Hyg 2017; 97:1669-1672. [PMID: 29016302 DOI: 10.4269/ajtmh.17-0320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report two cases of louse-borne relapsing fever observed at our Institution in June 2016. Both patients were young asylum seekers from Africa who had recently arrived in Milan, Italy. Notably, direct microscopic examination of peripheral blood smears was repeatedly negative for the presence of spirochetes and the diagnosis, supported by clinical and epidemiologic evidence, required molecular confirmation by polymerase chain reaction amplification of DNA extracted from blood and sequencing of the amplified products.
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Affiliation(s)
- Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Milano, Italy
| | - Cristina Tonello
- Pathology Unit, Ospedale L. Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Sophie Edouard
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Émergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitarie (IHU) Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Carlo Parravicini
- Pathology Unit, Ospedale L. Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Romualdo Grande
- Clinical Microbiology, Virology and Bioemergence Diagnostics, Ospedale L Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Davide Ricaboni
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Émergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitarie (IHU) Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Florence Fenollar
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Émergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitarie (IHU) Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Émergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitarie (IHU) Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Oleg Mediannikov
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Émergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitarie (IHU) Méditerranée-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
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10
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Chernet A, Neumayr A, Hatz C, Kling K, Sydow V, Rentsch K, Utzinger J, Probst-Hensch N, Marti H, Nickel B, Labhardt ND. Spectrum of infectious diseases among newly arrived Eritrean refugees in Switzerland: a cross-sectional study. Int J Public Health 2017; 63:233-239. [PMID: 28924741 DOI: 10.1007/s00038-017-1034-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Our study aimed at determining the prevalence of selected infectious diseases among recently arrived Eritrean refugees in Switzerland. METHODS In this cross-sectional study, asymptomatic Eritrean migrants aged ≥16 years who arrived <24 months ago were recruited at refugee centres in Switzerland. Infectious disease screening included serology for HIV, hepatitis B and C, syphilis and schistosomiasis, polymerase chain reaction (PCR) for malaria, stool microscopy for helminths and intestinal protozoa and circulating cathodic antigen (CCA) testing in urine for schistosomiasis. RESULTS Among 107 participating Eritrean refugees, point-of-care CCA urine test for Schistosoma mansoni was positive in 43 patients (40.2%; 95% CI 31.9-49.5). Stool microscopy detected eggs of S. mansoni in 23 (21.5%; 95% CI 13.7-29.3), Hymenolepis nana in 11 (10.3%; 95% CI 4.5-16.0), and cysts of Giardia intestinalis in 7 participants (6.5%: 95% CI 1.9-11.2). Two tested positive for hepatitis B (1.9%; 95% CI 0.0-4.4) and one for syphilis (0.9%; 95% CI 0.0-2.8), none tested positive for HIV or hepatitis C. Malaria PCR was positive in six participants (5.6%; 95% CI: 1.2-9.9). CONCLUSIONS Given the high prevalence of S. mansoni infection and potentially severe long-term sequelae of untreated schistosomiasis, routine screening for schistosomiasis in refugees from Schistosoma-endemic regions should be recommended.
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Affiliation(s)
- Afona Chernet
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kerstin Kling
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Véronique Sydow
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Katharina Rentsch
- University of Basel, Basel, Switzerland.,Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niklaus D Labhardt
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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11
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Marosevic D, Margos G, Wallich R, Wieser A, Sing A, Fingerle V. First insights in the variability of Borrelia recurrentis genomes. PLoS Negl Trop Dis 2017; 11:e0005865. [PMID: 28902847 PMCID: PMC5612729 DOI: 10.1371/journal.pntd.0005865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/25/2017] [Accepted: 08/10/2017] [Indexed: 11/21/2022] Open
Abstract
Background Borrelia recurrentis is the causative agent of louse-borne relapsing fever, endemic to the Horn of Africa. New attention was raised in Europe, with the highest number of cases (n = 45) reported among migrants in 2015 in Germany and sporadically from other European countries. So far only one genome was sequenced, hindering the development of specific molecular diagnostic and typing tools. Here we report on modified culture conditions for B. recurrentis and the intraspecies genome variability of six isolates isolated and cultured in different years in order to explore the possibility to identify new targets for typing and examine the molecular epidemiology of the pathogen. Methodology/Principal findings Two historical isolates from Ethiopia and four isolates from migrants from Somalia (n = 3) and Ethiopia (n = 1) obtained in 2015 were cultured in MPK-medium supplemented with 50% foetal calf serum. Whole DNA was sequenced using Illumina MiSeq technology and analysed using the CLC Genomics Workbench and SPAdes de novo assembler. Compared to the reference B. recurrentis A1 29–38 SNPs were identified in the genome distributed on the chromosome and plasmids. In addition to that, plasmids of differing length, compared to the available reference genome were identified. Conclusions/Significance The observed low genetic variability of B. recurrentis isolates is possibly due to the adaptation to a very conserved vector-host (louse-human) cycle, or influenced by the fastidious nature of the pathogen and their resistance to in vitro growth. Nevertheless, isolates obtained in 2015 were bearing the same chromosomal SNPs and could be distinguished from the historical isolates by means of whole genome sequencing, but not hitherto used typing methods. This is the first study examining the molecular epidemiology of B. recurrentis and provides the necessary background for the development of better diagnostic tools. Louse-borne relapsing fever, as the name suggests, is the only relapsing fever transmitted by lice, and caused by the spirochaete Borrelia recurrentis. Today it is endemic to the Horn of Africa, but due to the cosmopolitan nature of the vector, the pathogen still bears epidemic potential to spread globally among vulnerable populations. The most recent account of that has been observed among migrants arriving to Europe in 2015. Up to date, only one strain was sequenced, thus hampering the development of species-specific typing tools. We employed state-of-the-art high-throughput sequencing to six B. recurrentis isolates obtained at different time-points and currently available in culture. Our aim was to address the question of genome variability of this pathogen at the highest resolution and provide information necessary for the development of specific typing tools. B. recurrentis has highly conserved genomes, differing in 29–38 SNPs compared to the reference genome B. recurrentis A1, all identified outside the loci currently developed and used for relapsing fever Borrelia typing. Therefore, applying these typing methods would render them indistinguishable, while at the SNP level we found a distinction between isolates obtained in 2015 from migrants and the two historical isolates. Our data provide first insights in the genome variability and baseline information necessary for further studies of the molecular epidemiology of the pathogen and for the development of improved diagnostic tools.
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Affiliation(s)
- Durdica Marosevic
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
- European Programme for Public Health Microbiology Training, European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden
- * E-mail:
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | | | - Andreas Wieser
- Department of Bacteriology, Max von Pettenkofer Institute (LMU), Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Andreas Sing
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
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12
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Sullivan KE, Bassiri H, Bousfiha AA, Costa-Carvalho BT, Freeman AF, Hagin D, Lau YL, Lionakis MS, Moreira I, Pinto JA, de Moraes-Pinto MI, Rawat A, Reda SM, Reyes SOL, Seppänen M, Tang MLK. Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies. J Clin Immunol 2017; 37:650-692. [PMID: 28786026 PMCID: PMC5693703 DOI: 10.1007/s10875-017-0426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 12/18/2022]
Abstract
In today's global economy and affordable vacation travel, it is increasingly important that visitors to another country and their physician be familiar with emerging infections, infections unique to a specific geographic region, and risks related to the process of travel. This is never more important than for patients with primary immunodeficiency disorders (PIDD). A recent review addressing common causes of fever in travelers provides important information for the general population Thwaites and Day (N Engl J Med 376:548-560, 2017). This review covers critical infectious and management concerns specifically related to travel for patients with PIDD. This review will discuss the context of the changing landscape of infections, highlight specific infections of concern, and profile distinct infection phenotypes in patients who are immune compromised. The organization of this review will address the environment driving emerging infections and several concerns unique to patients with PIDD. The first section addresses general considerations, the second section profiles specific infections organized according to mechanism of transmission, and the third section focuses on unique phenotypes and unique susceptibilities in patients with PIDDs. This review does not address most parasitic diseases. Reference tables provide easily accessible information on a broader range of infections than is described in the text.
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Affiliation(s)
- Kathleen E Sullivan
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Hamid Bassiri
- Division of Infectious Diseases and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ahmed A Bousfiha
- Clinical Immunology Unit, Infectious Department, Hopital d'Enfant Abderrahim Harouchi, CHU Ibn Rochd, Laboratoire d'Immunologie Clinique, d'Inflammation et d'Allergie LICIA, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Beatriz T Costa-Carvalho
- Department of Pediatrics, Federal University of São Paulo, Rua dos Otonis, 725, São Paulo, SP, 04025-002, Brazil
| | - Alexandra F Freeman
- NIAID, NIH, Building 10 Room 12C103, 9000 Rockville, Pike, Bethesda, MD, 20892, USA
| | - David Hagin
- Division of Allergy and Immunology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yu L Lau
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Rm 106, 1/F New Clinical Building, Pok Fu Lam, Hong Kong.,Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Michail S Lionakis
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10, Room 11C102, Bethesda, MD, 20892, USA
| | - Ileana Moreira
- Immunology Unit, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425, Buenos Aires, Argentina
| | - Jorge A Pinto
- Division of Immunology, Department of Pediatrics, Federal University of Minas Gerais, Av. Alfredo Balena 190, room # 161, Belo Horizonte, MG, 30130-100, Brazil
| | - M Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, Rua Pedro de Toledo, 781/9°andar, São Paulo, SP, 04039-032, Brazil
| | - Amit Rawat
- Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shereen M Reda
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saul Oswaldo Lugo Reyes
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Av Iman 1, Torre de Investigacion, Piso 9, Coyoacan, 04530, Mexico City, Mexico
| | - Mikko Seppänen
- Harvinaissairauksien yksikkö (HAKE), Rare Disease Center, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Mimi L K Tang
- Murdoch Children's Research Institute, The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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13
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Hytönen J, Khawaja T, Grönroos JO, Jalava A, Meri S, Oksi J. Louse-borne relapsing fever in Finland in two asylum seekers from Somalia. APMIS 2016; 125:59-62. [PMID: 27859692 DOI: 10.1111/apm.12635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/21/2016] [Indexed: 11/25/2022]
Abstract
We report two cases of louse-borne relapsing fever (LBRF) in young Somali asylum seekers having recently arrived to Finland. They had sought medical attention for a febrile illness. Blood smears were examined for suspected malaria, but instead, spirochete shaped bacteria were observed. The bacteria were confirmed as Borrelia recurrentis by PCR and sequencing. The patients survived, but their treatment was complicated by Jarisch-Herxheimer reaction. We conclude that LBRF must be considered as a diagnostic option in febrile refugees also in the northernmost parts of Europe.
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Affiliation(s)
- Jukka Hytönen
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.,Microbiology and Genetics Department, Turku University Hospital, Turku, Finland
| | - Tamim Khawaja
- Helsinki University Central Hospital, Helsinki, Finland
| | - Juha O Grönroos
- Microbiology and Genetics Department, Turku University Hospital, Turku, Finland
| | - Anna Jalava
- Department of Bacteriology and Immunology, Haartman Institute, Helsinki, Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology, Haartman Institute, Helsinki, Finland.,Immunobiology Research Program, University of Helsinki, Helsinki, Finland.,HUSLAB, Helsinki, Finland
| | - Jarmo Oksi
- University of Turku and Turku University Hospital, Turku, Finland
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14
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Lucchini A, Lipani F, Costa C, Scarvaglieri M, Balbiano R, Carosella S, Calcagno A, Audagnotto S, Barbui AM, Brossa S, Ghisetti V, Dal Conte I, Caramello P, Di Perri G. Louseborne Relapsing Fever among East African Refugees, Italy, 2015. Emerg Infect Dis 2016; 22:298-301. [PMID: 26812354 PMCID: PMC4734540 DOI: 10.3201/eid2202.151768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During June 9–September 30, 2015, five cases of louseborne relapsing fever were identified in Turin, Italy. All 5 cases were in young refugees from Somalia, 2 of whom had lived in Italy since 2011. Our report seems to confirm the possibility of local transmission of louse-borne relapsing fever.
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15
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Costescu Strachinaru DI, Cambier J, Kandet-Yattara H, Konopnicki D. Relapsing fever in asylum seekers from Somalia arriving in Belgium in August 2015. Acta Clin Belg 2016; 71:353-355. [PMID: 27112219 DOI: 10.1080/17843286.2016.1157942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current population displacements favor the re-emerging of diseases, nowadays very rare in Europe. We report two cases of 'imported' relapsing fever in two Somali asylum seekers occurring shortly after their arrival in Belgium. A diagnosis of relapsing fever should be considered in all migrants coming from endemic regions or having traveled in low hygiene and crowded conditions, presenting with recurrent fever, especially if no malaria parasites are found.
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16
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Ciervo A, Mancini F, di Bernardo F, Giammanco A, Vitale G, Dones P, Fasciana T, Quartaro P, Mazzola G, Rezza G. Louseborne Relapsing Fever in Young Migrants, Sicily, Italy, July-September 2015. Emerg Infect Dis 2016; 22:152-3. [PMID: 26690334 PMCID: PMC4696720 DOI: 10.3201/eid2201.151580] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Meinel DM, Kuehl R, Zbinden R, Boskova V, Garzoni C, Fadini D, Dolina M, Blümel B, Weibel T, Tschudin-Sutter S, Widmer AF, Bielicki JA, Dierig A, Heininger U, Konrad R, Berger A, Hinic V, Goldenberger D, Blaich A, Stadler T, Battegay M, Sing A, Egli A. Outbreak investigation for toxigenic Corynebacterium diphtheriae wound infections in refugees from Northeast Africa and Syria in Switzerland and Germany by whole genome sequencing. Clin Microbiol Infect 2016; 22:1003.e1-1003.e8. [PMID: 27585943 DOI: 10.1016/j.cmi.2016.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/28/2016] [Accepted: 08/19/2016] [Indexed: 01/28/2023]
Abstract
Toxigenic Corynebacterium diphtheriae is an important and potentially fatal threat to patients and public health. During the current dramatic influx of refugees into Europe, our objective was to use whole genome sequencing for the characterization of a suspected outbreak of C. diphtheriae wound infections among refugees. After conventional culture, we identified C. diphtheriae using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and investigated toxigenicity by PCR. Whole genome sequencing was performed on a MiSeq Illumina with >70×coverage, 2×250 bp read length, and mapping against a reference genome. Twenty cases of cutaneous C. diphtheriae in refugees from East African countries and Syria identified between April and August 2015 were included. Patients presented with wound infections shortly after arrival in Switzerland and Germany. Toxin production was detected in 9/20 (45%) isolates. Whole genome sequencing-based typing revealed relatedness between isolates using neighbour-joining algorithms. We detected three separate clusters among epidemiologically related refugees. Although the isolates within a cluster showed strong relatedness, isolates differed by >50 nucleotide polymorphisms. Toxigenic C. diphtheriae associated wound infections are currently observed more frequently in Europe, due to refugees travelling under poor hygienic conditions. Close genetic relatedness of C. diphtheriae isolates from 20 refugees with wound infections indicates likely transmission between patients. However, the diversity within each cluster and phylogenetic time-tree analysis suggest that transmissions happened several months ago, most likely outside Europe. Whole genome sequencing offers the potential to describe outbreaks at very high resolution and is a helpful tool in infection tracking and identification of transmission routes.
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Affiliation(s)
- D M Meinel
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland; Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; Applied Microbiology Research, Department of Biomedicine, University Basel, Basel, Switzerland
| | - R Kuehl
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - R Zbinden
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - V Boskova
- Computational Evolution, D-BSSE, ETH Zurich, Basel, Switzerland
| | - C Garzoni
- Department of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland
| | - D Fadini
- Internal Medicine, Ospedale di Mendrisio, Mendrisio, Switzerland
| | - M Dolina
- Clinical Microbiology, EOLAB, Bellinzona, Switzerland
| | - B Blümel
- Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - T Weibel
- Clinical Microbiology, Labor Team W, Saint Gallen, Switzerland
| | - S Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A F Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - J A Bielicki
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - A Dierig
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - U Heininger
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - R Konrad
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - A Berger
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - V Hinic
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - D Goldenberger
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - A Blaich
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - T Stadler
- Computational Evolution, D-BSSE, ETH Zurich, Basel, Switzerland
| | - M Battegay
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A Sing
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - A Egli
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University Basel, Basel, Switzerland.
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18
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Colomba C, Scarlata F, Di Carlo P, Giammanco A, Fasciana T, Trizzino M, Cascio A. Fourth case of louse-borne relapsing fever in Young Migrant, Sicily, Italy, December 2015. Mini Review Article. Public Health 2016; 139:22-26. [PMID: 27340042 DOI: 10.1016/j.puhe.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Currently louse-borne relapsing fever (LBRF) is primarily found in limited endemic foci in Ethiopia, Somalia and Sudan; no case of imported LBRF has been reported in Europe in the 9 years prior to 2015. The aim of our paper is to describe a new case of imported LBRF detected in Sicily, Italy, and to review all cases reported in migrants arrived in Europe in the last 10 years. STUDY DESIGN Mini review of all published cases of louse-borne relapsing fever in Europe in the last 10 years. METHODS A computerized search without language restriction was conducted using PubMed combining the terms '(louse-borne relapsing fever or LBRF or recurrentis) and (refugee or Europe or migrant)' without limits. Furthermore, the 'Ahead-of-Print Articles' of the top 10 journals (ranked by Impact factor - Web of Science) of Infectious diseases and of Epidemiology were checked. RESULTS Our search identified 26 cases of LBRF between July and October 2015 in migrants recently arrived in Europe: 8 had been described in Italy; 1 in Switzerland; 2 in the Netherlands; 15 in Germany. We describe data regarding the clinical characteristics, diagnostic methods, therapy and outcome of these patients and of the new case. CONCLUSIONS LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.
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Affiliation(s)
- C Colomba
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy.
| | - F Scarlata
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
| | - P Di Carlo
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
| | - A Giammanco
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
| | - T Fasciana
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
| | - M Trizzino
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
| | - A Cascio
- Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro", Palermo, Italy
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Osthoff M, Schibli A, Fadini D, Lardelli P, Goldenberger D. Louse-borne relapsing fever - report of four cases in Switzerland, June-December 2015. BMC Infect Dis 2016; 16:210. [PMID: 27188655 PMCID: PMC4869252 DOI: 10.1186/s12879-016-1541-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background Louse-borne relapsing fever (LBRF) is a neglected disease that has been restricted to East Africa for many decades. Several cases in refugees from the Horn of Africa have been recently diagnosed in four European countries. Case presentation We report four additional cases of LBRF in asylum seekers from Somalia and Eritrea who presented with fever shortly after arriving in Switzerland during a seven-month period. Multiple spirochetes were visualized on stained blood films which were identified as Borrelia recurrentis by 16S rRNA gene sequencing. All patients recovered after antibiotic treatment with ceftriaxone and/or doxycycline. Concurrent infections (malaria and tuberculosis) were diagnosed in half of our patients. Possible modes of transmission and preventive measures are discussed. Conclusions These reported cases highlight the ongoing transmission of LBRF in migrants from East Africa. Diagnosis of LBRF cases and prevention of autochthonous transmission in asylum seeker camps are important steps for the near future.
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Affiliation(s)
- Michael Osthoff
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland.
| | - Adrian Schibli
- Division of Infectious Diseases & Hospital Epidemiology, Triemli Hospital, Birmensdorferstrasse 497, Zurich, 8063, Switzerland
| | - Davide Fadini
- Emergency Service, Ospedale Regionale, Via Turconi 23, Mendrisio, 6850, Switzerland
| | - Pietro Lardelli
- Department of Internal Medicine, Ospedale Regionale, Via Turconi 23, Mendrisio, 6850, Switzerland
| | - Daniel Goldenberger
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
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20
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Antinori S, Mediannikov O, Corbellino M, Grande R, Parravicini C, Bestetti G, Longhi E, Ricaboni D, Ehounoud CB, Fenollar F, Raoult D, Rimoldi SG. Louse-Borne Relapsing Fever (Borrelia recurrentis) in a Somali Refugee Arriving in Italy: A Re-emerging Infection in Europe? PLoS Negl Trop Dis 2016; 10:e0004522. [PMID: 27149282 PMCID: PMC4858251 DOI: 10.1371/journal.pntd.0004522] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Milano, Italy
- III Division of Infectious Diseases, Luigi Sacco Hospital, Milano, Italy
- * E-mail:
| | - Oleg Mediannikov
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Emergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitaire (IHU) Mediterranee-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Mario Corbellino
- III Division of Infectious Diseases, Luigi Sacco Hospital, Milano, Italy
| | - Romualdo Grande
- Department of Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, Luigi Sacco Hospital, Milano, Italy
| | - Carlo Parravicini
- Department of Diagnostic Services Pathology Unit, Luigi Sacco Hospital, Milano, Italy
| | - Giovanna Bestetti
- III Division of Infectious Diseases, Luigi Sacco Hospital, Milano, Italy
| | - Erika Longhi
- Department of Diagnostic Services Pathology Unit, Luigi Sacco Hospital, Milano, Italy
| | - Davide Ricaboni
- III Division of Infectious Diseases, Luigi Sacco Hospital, Milano, Italy
| | - Cyrille Bilé Ehounoud
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Emergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitaire (IHU) Mediterranee-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Florence Fenollar
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Emergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitaire (IHU) Mediterranee-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur le Maladies Infectieuses et Tropicales Emergentes (URMITIE) IRD198, CNRS 7278, INSERM 1095, Institute Hospitalo-Universitaire (IHU) Mediterranee-Infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Sara Giordana Rimoldi
- Department of Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, Luigi Sacco Hospital, Milano, Italy
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Ravensbergen SJ, Lokate M, Cornish D, Kloeze E, Ott A, Friedrich AW, van Hest R, Akkerman OW, de Lange WC, van der Werf TS, Bathoorn E, Stienstra Y. High Prevalence of Infectious Diseases and Drug-Resistant Microorganisms in Asylum Seekers Admitted to Hospital; No Carbapenemase Producing Enterobacteriaceae until September 2015. PLoS One 2016; 11:e0154791. [PMID: 27144599 PMCID: PMC4856320 DOI: 10.1371/journal.pone.0154791] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction The current refugee crisis emphasizes the need for information on infectious diseases and resistant microorganisms in asylum seekers with possible consequences for public health and infection control. Methods We collected data from asylum seekers admitted to our university hospital or who presented at the Emergency Department (n = 273). We collected general and demographic characteristics including country of origin, the reason of presentation, and the screening results of multi-drug resistant organisms. Results 67% of the patients were male with a median age of the study group of 24 years (IQR 15–33); 48% of the patients had an infectious disease—predominantly malaria with P. vivax or tuberculosis. Patients also reported with diseases which are less common—e.g. leishmaniasis, or even conditions rarely diagnosed in Europe—e.g. louse borne relapsing fever. A carriage rate of 31% for multi-drug resistant microorganisms (MDRO) was observed, with ESBL-expressing E.coli (n = 20) being the most common MDRO. No carriage of Carbapenemase Producing Enterobacteriaceae was found. Conclusion The current refugee crisis in Europe challenges hospitals to quickly identify and respond to communicable diseases and the carriage of MDRO. A rapid response is necessary to optimize the treatment of infectious diseases amongst asylum seekers to maximize infection control.
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Affiliation(s)
- Sofanne J. Ravensbergen
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Darren Cornish
- Primary Health Care Centre for Asylum Seekers (Gezondheidscentrum Asielzoekers), Ter Apel, The Netherlands
| | - Eveline Kloeze
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Alewijn Ott
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Medical Microbiology, Certe, Groningen, The Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rob van Hest
- Department of Tuberculosis Control, Regional Public Health Service Groningen, Groningen, The Netherlands
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wiel C. de Lange
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- * E-mail:
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22
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Catchpole M, Coulombier D. Refugee crisis demands European Union-wide surveillance! ACTA ACUST UNITED AC 2016; 20:30063. [PMID: 26606945 DOI: 10.2807/1560-7917.es.2015.20.45.30063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Mike Catchpole
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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23
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Fingerle V, Pritsch M, Wächtler M, Margos G, Ruske S, Jung J, Löscher T, Wendtner C, Wieser A. "Candidatus Borrelia kalaharica" Detected from a Febrile Traveller Returning to Germany from Vacation in Southern Africa. PLoS Negl Trop Dis 2016; 10:e0004559. [PMID: 27031729 PMCID: PMC4816561 DOI: 10.1371/journal.pntd.0004559] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/28/2016] [Indexed: 11/18/2022] Open
Abstract
A 26 year-old female patient presented to the Tropical Medicine outpatient unit of the Ludwig Maximilians-University in Munich with febrile illness after returning from Southern Africa, where she contracted a bite by a large mite-like arthropod, most likely a soft-tick. Spirochetes were detected in Giemsa stained blood smears and treatment was started with doxycycline for suspected tick-borne relapsing fever. The patient eventually recovered after developing a slight Jarisch-Herxheimer reaction during therapy. PCR reactions performed from EDTA-blood revealed a 16S rRNA sequence with 99.4% similarity to both, Borrelia duttonii, and B. parkeri. Further sequences obtained from the flagellin gene (flaB) demonstrated genetic distances of 0.066 and 0.097 to B. parkeri and B. duttonii, respectively. Fragments of the uvrA gene revealed genetic distance of 0.086 to B. hermsii in genetic analysis and only distant relations with classic Old World relapsing fever species. This revealed the presence of a novel species of tick-borne relapsing fever spirochetes that we propose to name “Candidatus Borrelia kalaharica”, as it was contracted from an arthropod bite in the Kalahari Desert belonging to both, Botswana and Namibia, a region where to our knowledge no relapsing fever has been described so far. Interestingly, the novel species shows more homology to New World relapsing fever Borrelia such as B. parkeri or B. hermsii than to known Old World species such as B. duttonii or B. crocidurae. A patient reported an arthropod bite on her dorsal metatarsal region 2/3 of her anterior foot during a trip to the Kalahari Desert in Southern Africa. Eventually, a rash developed at the site of the bite and high-grade fever started 8 days later. Spirochetes were detected in the blood smear and the patient was treated with the suspected diagnosis of tick-borne relapsing fever. The presence of Borrelia spp. in fresh patient blood could be confirmed using DNA amplification and sequencing techniques. Homology searches of the obtained sequences from 16S rRNA, flaB, and uvrA revealed surprisingly distant relationships to known Borrelia species. It is concluded that the infection was caused by a new species of tick-borne relapsing fever Borrelia capable of infecting humans that we propose to name “Candidatus Borrelia kalaharica”, which is described within this manuscript. The blood sample was discarded after initial analysis; therefore, no successful culture could be obtained.
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Affiliation(s)
- Volker Fingerle
- National Reference Centre for Borrelia, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Dienststelle Oberschleißheim, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the LMU, Munich, Germany
| | - Martin Wächtler
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität und Technischen Universität, Munich, Germany
| | - Gabriele Margos
- National Reference Centre for Borrelia, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Dienststelle Oberschleißheim, Germany
| | - Sabine Ruske
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the LMU, Munich, Germany
| | - Jette Jung
- Department of Bacteriology, Max von Pettenkofer-Institute LMU Munich, Germany
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the LMU, Munich, Germany
| | - Clemens Wendtner
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität und Technischen Universität, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the LMU, Munich, Germany
- Department of Bacteriology, Max von Pettenkofer-Institute LMU Munich, Germany
- College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
- * E-mail:
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24
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Hoch M, Wieser A, Löscher T, Margos G, Pürner F, Zühl J, Seilmaier M, Balzer L, Guggemos W, Rack-Hoch A, von Both U, Hauptvogel K, Schönberger K, Hautmann W, Sing A, Fingerle V. Louse-borne relapsing fever (Borrelia recurrentis) diagnosed in 15 refugees from northeast Africa: epidemiology and preventive control measures, Bavaria, Germany, July to October 2015. ACTA ACUST UNITED AC 2016; 20:30046. [PMID: 26538532 DOI: 10.2807/1560-7917.es.2015.20.42.30046] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
Abstract
We report 15 imported louse-borne relapsing fever (LBRF) cases in refugees in Bavaria, Germany. One patient died. Epidemiological findings confirmed that all were young males from the Horn of Africa (12 from Somalia), who had similar migration routes converging in Sudan continuing through Libya and Italy. The majority likely acquired their infection during migration. Healthcare workers should be aware of LBRF in refugees passing through north Africa to ensure correct treatment and preventive measures.
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Affiliation(s)
- Martin Hoch
- Task-Force Infectiology and International Health Regulations, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
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25
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Jones G, Haeghebaert S, Merlin B, Antona D, Simon N, Elmouden M, Battist F, Janssens M, Wyndels K, Chaud P. Measles outbreak in a refugee settlement in Calais, France: January to February 2016. Euro Surveill 2016; 21:30167. [DOI: 10.2807/1560-7917.es.2016.21.11.30167] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
We report a measles outbreak in a refugee settlement in Calais, France, between 5 January and 11 February 2016. In total, 13 confirmed measles cases were identified among migrants, healthcare workers in hospital and volunteers working on site. A large scale vaccination campaign was carried out in the settlement within two weeks of outbreak notification. In total, 60% of the estimated target population of 3,500 refugees was vaccinated during the week-long campaign.
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Affiliation(s)
- G Jones
- French Institute for Public Health Surveillance (InVS), Nord-Pas-de-Calais-Picardie regional office, Lille, France
| | - S Haeghebaert
- French Institute for Public Health Surveillance (InVS), Nord-Pas-de-Calais-Picardie regional office, Lille, France
| | - B Merlin
- Regional health agency Nord-Pas-de-Calais Picardie (ARS), Lille, France
| | - D Antona
- French Institute for Public Health Surveillance (InVS), Saint Maurice, France
| | - N Simon
- Etablissement de préparation et de réponse aux urgences sanitaires (EPRUS), Paris, France
| | - M Elmouden
- Medical centres for vulnerable populations, Calais Hospital and refugee camp, Calais, France
| | - F Battist
- Emergency ward and health care unit for vulnerable patients, Calais hospital, Calais, France
| | - M Janssens
- Médecins sans frontières (MSF), Paris, France
| | - K Wyndels
- French Institute for Public Health Surveillance (InVS), Nord-Pas-de-Calais-Picardie regional office, Lille, France
| | - P Chaud
- French Institute for Public Health Surveillance (InVS), Nord-Pas-de-Calais-Picardie regional office, Lille, France
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26
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Zammarchi L, Antonelli A, Bartolini L, Pecile P, Trotta M, Rogasi PG, Santini MG, Dilaghi B, Grifoni S, Rossolini GM, Bartoloni A. Louse-Borne Relapsing Fever with Meningeal Involvement in an Immigrant from Somalia to Italy, October 2015. Vector Borne Zoonotic Dis 2016; 16:352-5. [PMID: 26938933 DOI: 10.1089/vbz.2015.1928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia. CASE STUDY In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1. CONCLUSIONS LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.
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Affiliation(s)
- Lorenzo Zammarchi
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | - Alberto Antonelli
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy
| | - Laura Bartolini
- 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Patrizia Pecile
- 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Michele Trotta
- 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | - Pier Giorgio Rogasi
- 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | | | - Beatrice Dilaghi
- 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Stefano Grifoni
- 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Gian Maria Rossolini
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy .,4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .,7 I.R.C.C.S. Fondazione Don Carlo Gnocchi , Florence, Italy
| | - Alessandro Bartoloni
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
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27
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Cutler SJ. Refugee crisis and re-emergence of forgotten infections in Europe. Clin Microbiol Infect 2015; 22:8-9. [PMID: 26493842 DOI: 10.1016/j.cmi.2015.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Affiliation(s)
- S J Cutler
- School of Health, Sport and Bioscience, University of East London, London, UK.
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