Identification of tick-borne pathogens in ticks feeding on humans in Turkey

Background

The importance of tick-borne diseases is increasing all over the world, including Turkey. The tick-borne disease outbreaks reported in recent years and the abundance of tick species and the existence of suitable habitats increase the importance of studies related to the epidemiology of ticks and tick-borne pathogens in Turkey. The aim of this study was to investigate the presence of and to determine the infection rates of some tick-borne pathogens, including Babesia spp., Borrelia burgdorferi sensu lato and spotted fever group rickettsiae in the ticks removed from humans in different parts of Ankara.

Methodology/Principal Findings

A total of 169 ticks belonging to the genus Haemaphysalis, Hyalomma, Ixodes and Rhipicephalus were collected by removing from humans in different parts of Ankara. Ticks were molecularly screened for Babesia spp., Borrelia burgdorferi sensu lato and spotted fever group rickettsiae by PCR and sequencing analysis. We detected 4 Babesia spp.; B. crassa, B. major, B. occultans and B. rossi, one Borrelia spp.; B. burgdorferi sensu stricto and 3 spotted fever group rickettsiae; R. aeschlimannii, R. slovaca and R. hoogstraalii in the tick specimens analyzed. This is the report showing the presence of B. rossi in a region that is out of Africa and in the host species Ha. parva. In addition, B. crassa, for which limited information is available on its distribution and vector species, and B. occultans, for which no conclusive information is available on its presence in Turkey, were identified in Ha. parva and H. marginatum, respectively. Two human pathogenic rickettsia species (R. aeschlimannii and R. slovaca) were detected with a high prevalence in ticks. Additionally, B. burgdorferi sensu stricto was detected in unusual tick species (H. marginatum, H. excavatum, Hyalomma spp. (nymph) and Ha. parva).

Conclusions/Significance

This study investigates both the distribution of several tick-borne pathogens affecting humans and animals, and the presence of new tick-borne pathogens in Turkey. More epidemiological studies are warranted for B. rossi, which is very pathogenic for dogs, because the presented results suggest that B. rossi might have a wide distribution in Turkey. Furthermore, we recommend that tick-borne pathogens, especially R. aeschlimannii, R. slovaca, and B. burgdorferi sensu stricto, should be taken into consideration in patients who had a tick bite in Turkey.

Ticks are widespread in over all Turkey. Primary tick-borne diseases (TBDs), such as theileriosis, babesiosis, and anaplasmosis, affecting animals have been known for a long time in Turkey. However, TBDs have become a major concern in humans in recent years due to the recent Crimean-Congo hemorrhagic fever outbreak in Turkey. We know that some TBDs like CCHF, Lyme borreliosis, spotted fever group rickettsiosis, babesiosis and anaplasmosis exist in this geography. However, the other diseases except for CCHF are neglected in patients. In this study, we aimed to investigate Babesia spp., Borrelia burgdorferi sensu lato and spotted fever group rickettsiae in ticks removed from humans in different parts of Ankara by using PCR and sequencing. The result of this study showed that 4 Babesia species, one B. burgdorferi sensu lato, and 3 spotted fever group rickettsia are detected in ticks. The most striking result of this study is that B. rossi, which is very pathogenic for dogs, was reported for the first time from a region that is out of Africa and in Ha. parva. Therefore, B. rossi should be considered in dogs in Turkey. Furthermore, we propose that R. aeschlimannii, R. slovaca, and B. burgdorferi sensu stricto should be taken into consideration in patients who had a tick bite in Ankara.

Molecular identification of tick-borne bacteria in wild animals and their ticks in Central Anatolia, Turkey

Wild animals fulfill an important mission in the ecology of tick-borne diseases as both suitable hosts to tick vectors and reservoirs of the pathogens. However, current data regarding the role of wild animals in the ecology of tick-borne pathogens is insufficient and more investigations are required. In this study, we investigated tick-borne bacterial pathogens in wild boar, hare, and fox and their ticks in Turkey. A total of 102 tick pools comprised of 445 ticks and blood samples were analyzed for the presence of bacterial DNA by PCRs targeted rickettsial gltA and ompA genes, 5S-23S rDNA gene for Borrelia spp., and msp4 gene for Anaplasma spp. As a result of PCR and sequence analyses, three pathogenic spotted fever group (SFG) rickettsiae, two SFG rickettsiae with unknown pathogenicity and one pathogenic Borrelia burgdorferi sensu lato were detected in samples obtained from wild animals. Rickettsia slovaca was detected in ticks (13.7% of tick pools) collected from wild boars and blood of a wild boar. In addition, the presences of R. hoogstraalii (19.6% of tick pools), R. aeschlimannii (5.8% of tick pools), R. sibirica subsp. mongolitimonae (1.9% of tick pools) and Candidatus R. goldwasserii (0.9% of tick pools) were detected in ticks collected from wild animals. Furthermore, B. burgdorferi sensu stricto was detected in a tick pool collected from a wild boar. This is the first report on the presence of Candidatus R. goldwasserii in Turkey. Consequently, this study shows that pathogenic Rickettsia and Borrelia species are circulating in Turkish wildlife and these pathogens can pose a threat to human health. Also, it has been determined that the investigated wild animals play a role as maintenance host for vector ticks; therefore, these animals must also be considered in the ecology of the mentioned pathogens.

Molecular detection of a novel Babesia sp. and pathogenic spotted fever group rickettsiae in ticks collected from hedgehogs in Turkey: Haemaphysalis erinacei, a novel candidate vector for the genus Babesia

In this study, a total of 319 ticks were obtained from hedgehogs (Erinaceus concolor). All ticks were pooled into groups and screened by PCR for tick-borne pathogens (TBPs). PCR and sequence analyses identified the presence of a novel Babesia sp. in adult Haemaphysalis erinacei. In addition, the presence of natural transovarial transmission of this novel Babesia sp. was detected in Ha. erinacei. According to the 18S rRNA (nearly complete) and partial rRNA locus (ITS-1/5.8S/ITS-2) phylogeny, it was determined that this new species is located within the Babesia sensu stricto clade and is closely related to Babesia spp. found in carnivores. Furthermore, the presence of three pathogenic spotted fever group (SFG) rickettsiae was determined in 65.8% of the tick pools: Rickettsia sibirica subsp. mongolitimonae in Hyalomma aegyptium (adult), Hyalomma spp. (larvae), Rhipicephalus turanicus (adult), and Ha. erinacei (adult); Rickettsia aeschlimannii in H. aegyptium (adult); Rickettsia slovaca in Hyalomma spp. (larvae and nymphs) and H. aegyptium (adult). To our knowledge, this is the first report of R. sibirica mongolitimonae in H. aegyptium, Ha. erinacei, and Rh. turanicus, and the first report of R. slovaca in H. aegyptium. In addition, the presence of a single Hemolivia mauritanica haplotype was detected in H. aegyptium adults. Consequently, the presence of a novel Babesia sp. has been identified in a new candidate vector tick species in this study. Additionally, three SFG rickettsiae that cause infections in humans were identified in ticks collected from hedgehogs. Therefore, environmental wildlife monitoring for hedgehogs should be carried out for ticks and tick-borne pathogens in the region. Additionally, studies regarding the reservoir status of hedgehogs for the aforementioned pathogens must be carried out.

Turkey tick news: A molecular investigation into the presence of tick-borne pathogens in host-seeking ticks in Anatolia; Initial evidence of putative vectors and pathogens, and footsteps of a secretly rising vector tick, Haemaphysalis parva

This Turkey-based study investigated the presence of various tick-borne microorganisms in a broad-range of host-seeking ticks (n = 1019) that exhibit both hunter and ambusher characteristics. All collected ticks were analyzed individually via PCR-sequencing, resulting in the identification of 18 different microorganisms: six Babesia spp., including one putative novel species (Ba. occultans, Ba. crassa, Ba. rossi, Babesia sp. tavsan1, Babesia sp. tavsan2, and Babesia sp. nov.); six SFG rickettsiae (Ri. aeschlimannii, Ri. s. mongolitimonae, Ri. slovaca, Ri. raoultii, Ri. monacensis, and Ri. hoogstraalii); two Borrelia burgdorferi sensu lato spp. (Bo. afzelii and Bo. lusitaniae); two unnamed Hepatozoon spp.; Theileria annulata; and Hemolivia mauritanica. This provided evidence for the natural transstadial survival of these tick-borne microorganisms in adult ticks (in addition a nymph) of Turkey. Surprisingly, this study determined the presence of five different microorganisms (Ba. crassa, Ba. rossi, Babesia sp. Ucbas, Hepatozoon sp., and Ri. hoogstraalii) in host-seeking Haemaphysalis parva adults, for which poor data exist on its vectorial competence. Therefore, this study provides important data indicating the potential vectorial capacity of Ha. parva. This study also revealed the presence of the close ecological and evolutionary relationships between two important vector ticks, Hyalomma marginatum and Hy. aegyptium and determined genetic variations (distinct phylogenetic divergences inside the main clades) in some pathogenic SFG rickettsiae that are found in these ticks. Additionally, the presence of two Babesia species described very recently in hares with unknown vectors, namely Babesia sp. tavsan1 and Babesia sp. tavsan2, were detected for the first time in ticks. Finally, two unnamed Hepatozoon spp. were detected in Haemaphysalis ticks and their phylogenetic positions were demonstrated. Consequently, this study provides important data on the diversity of tick-borne microorganisms in host-seeking ticks and on potentially novel microorganisms (Babesia and Hepatozoon species) and their possible vectors (Ha. parva, Ha. sulcata, Hy. aegyptium, Hy. marginatum, and Rh. turanicus).

Prevalence of Haemoproteus spp. in Tumbler Pigeons (Columba livia domestica) in Kirikkale Province, Turkey

OBJECTIVE

Haemoproteus spp. are common blood parasites of pigeons. They have been reported in pigeons in many regions worldwide, including Turkey. Pigeon breeding is a popular hobby in Kirikkale province, and there is no information about the prevalence of Haemoproteus spp. The present study aimed to determine the prevalence of Haemoproteus spp. in tumbler pigeons in Kirikkale province (Kırıkkale and Yahsihan district).

METHODS

Blood samples were taken from the wing vein of pigeons (n: 173) through microcapillary (with/heparin) tubes between February and March 2016. Blood smears were stained with 5% Giemsa solution. Ectoparasites of the pigeons were collected in separate sealed boxes. Epidemiological data of the sampled pigeons (age and sex) were obtained from the breeders.

RESULTS

In total, 23 (%13.2) of 173 pigeons were infected with Haemoproteus spp. Parasite was detected in 73.9% of pigeons over 1 year old and 26.1% of pigeon under 1 year age. Haemoproteus spp. was observed in 56.2% of females (13/23) and 43.4% of males (10/23), Sex-related differences were not observed (p = 0.821). Ectoparasites of the pigeons were identified as Columbicola spp.

CONCLUSION

To the best of our knowledge, this is the first study in Kirikkale province that reported the prevalence of Haemoproteus spp. in pigeons.

Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology

OBJECTIVES

To investigate the optical coherence tomography angiography (OCTA) and specular microscopy (SM) findings in obese children and compare them with healthy ones.

METHODS

In this prospective study, 50 eyes of 25 obese children [body mass index (BMI) ≥95th percentile], 36 eyes of 18 control age- and sex- matched healthy subjects (BMI <85th percentile) were included. Demographic features and ophthalmological examination including OCTA measurements as well as SM findings were assessed. Cellular morphology was observed by noncontact SM and results for corneal endothelial cell density (cells/mm²), coefficient of variation of cell size and percentage of hexagonal cells were obtained. The OCTA was performed with 6 × 6 mm sections for macula and 4.5 × 4.5 mm sections for optic disc in all eyes. Foveal retinal thickness (FRT), retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of retina and optic nerve head were analyzed.

RESULTS

All SM parameters, RNFL thickness for average, and all quadrants and optic disc radial peripapillary capillary densities were similar between groups. However, FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities were significantly higher in obese group when compared to controls (242.4 ± 18.2 µm vs. 232.1 ± 16.5 µm, p=0.024, 2.2 ± 0.1 mm² vs, 2.2 ± 0.0 mm², p=0.042, 22.4 ± 6.9% vs. 15.6 ± 5.5%, p=0.001, and 38.9 ± 7.5% vs. 31.1 ± 8.6 %, p=0.001, respectively).

CONCLUSIONS

Obese children seem to have higher values of FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities. These results may have significant implications for understanding of how childhood obesity could affect retinal microvasculature.

Coexistence of Peripheral Retinal Diseases with Macular Hole

Objectives:

To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole.

Materials and Methods:

The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskişehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated.

Results:

Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient.

Conclusion:

This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.

Systemic and ocular determinants of mean ocular perfusion pressure in a population-based sample

PURPOSE

To investigate the associations between mean ocular perfusion pressure (MOPP) and several variables including body mass index (BMI), comorbid medical conditions and various ocular parameters in a population-based sample.

STUDY DESIGN

Cross-sectional.

METHODS

Data of 2091 healthy participants from a previous population based cross-sectional study were reviewed. Inclusion criteria were adults ≥40 years of age who were screened on-site for glaucoma. Data on medical history, height, weight, systolic and diastolic blood pressures (SBP and DBP, respectively) were obtained. A basic ocular examination was performed which included intraocular pressure (Tono-Pen XL, Reichert Technologies) and central corneal thickness (Pacline pachymetry;) measurement, slit-lamp examination and non-mydriatic optic disc photography (nonmydα fundus camera, Kowa). MOPP was calculated using the formula [2/3 x (DBP + 1/3(SBP-DBP)]-IOP and low MOPP was defined as MOPP ≤45 mmHg.

RESULTS

Mean age of the subjects was 63.04 ± 9.7 years (range: 44 and 99 years) and the majority were women (74.1%, n = 1549). Mean MOPP values in normal weight (BMI < 25), overweight (BMI = 25-29.9) and in obese individuals were 46.9 ± 9.0 mmHg, 48.6 ± 9.2 mmHg and 50.7 ± 10.0 mmHg, respectively (p < 0.001, in all pairwise comparisons). In the multivariable logistic regression analysis, migraine and IOP elevation (per 1 mmHg increment) were significantly associated with a low MOPP (OR: 2.10 and 1.22, p = 0.008 and < 0.001, respectively). On the other hand, risk of low MOPP was reduced in subjects with hypertension, and with increasing age (per 1-year increment) and BMI (per 1-unit increment) (OR: 0.15, 0.97, and 0.95, respectively, and p < 0.001 for all).

CONCLUSION

Migraine and elevated IOP increase the risk of low MOPP and this may have a causal relationship with impaired optic nerve head blood flow.

The Complete Success in Refractory Mooren's Ulcer Treated with Infliximab

PURPOSE

To describe the management and outcome of two extremely rare and painful cases of Mooren's ulcer, an idiopathic peripheral autoimmune-associated ulcerative corneal disease.

METHODS

Case report with literature review on the management of ocular inflammation in Mooren's ulcer.

RESULTS

A 47-year-old female and a 76-year-old female presented with progressive bilateral Mooren's ulcer that were refractory to conventional immunosuppressive therapy. Following treatment with infliximab, an anti-tumor necrosis factor alpha, a significant improvement in disease progression was observed, with no corneal thinning or perforation at follow-ups.

CONCLUSION

This case report highlights how infliximab can be effective in cases with Mooren's ulcer refractory to conventional therapies.

Investigation of the optic disc and retinal microvasculature by optical coherence tomography angiography in children with asthma

PURPOSE

To assess the optic disc and retinal microvasculature by optical coherence tomography angiography (OCTA) in asthmatic children.

MATERIALS AND METHODS

Thirty asthmatic children (asthma group) and 30 control age- and sex-matched healthy controls (control group) were included in this cross-sectional study. The asthma group was then divided into two subgroups according to the presence of inhaled steroid use. Demographic findings were noted. Retinal nerve fiber layer (RNFL) thickness and vessel density in different sections of the retina and optic nerve head were analyzed by OCTA.

RESULTS

RNFL thickness for temporal quadrants and flow area for outer retina levels were significantly lower in the asthma group than the control group (72.58 ± 10.99 μm vs 77.73 ± 9.73μm, P = 0.015, and 0.60 ± 0.31mm2 vs. 0.72 ± 0.31mm2, P = 0.047, respectively). However, inside disc vascular densities were significantly higher in the asthma group when compared to controls (55.16% ± 3.71% vs. 52.08% ± 3.79%, P < 0.001). Inside disc vascular densities were also significantly higher, and RNFL thickness for temporal quadrants was significantly lower in the asthmatic patients without steroid use subgroup when compared to others (P < 0.001, P = 0.012, respectively).

CONCLUSION

Lower values of temporal quadrant RNFL, and flow area for outer retina, but higher levels of inside disc vascular density seem to be associated with asthmatic children. OCTA findings in asthmatic children appear to be regardless of inhaled steroid use.

Giant retroperitoneal liposarcoma extending into the scrotum: a case report

Liposarcomas are the most common soft-tissue sarcomas in adults. Soft tissue sarcomas can be seen almost every localisation in the body, 10-15% of these are located in the retroperitoneum. Due to their slow growth and lack of specific anatomical compartments, retroperitoneal liposarcomas frequently reach an enormous size long before diagnosis. We describe a case of giant retroperitoneal liposarcoma successfully treated by surgical resection. The interest of our report is that the dimension alone should not be considered a contraindication for surgery and to remind the effectiveness of the first operation is the most important part of the therapy.

A Case of Extensive Wound Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) in a Patient with Maxillary Sinus Squamous Cell Carcinoma, in Turkey

The larvae causing myiasis can lead extensive tissue destruction, invasion into deep tissues and secondary infections. Poor hygiene, low socioeconomic condition and presence of open wounds are the most important predisposing factors. This case report describes destructive wound myiasis in a 58-year-old male patient diagnosed with maxillary sinus squamous cell carcinoma who lives in a rural area in Ankara, Turkey. Approximately 200 larvae were collected and identified as Lucilia sericata by morphological examination. Myiasis should be considered especially when the patient has open extensive lesions such as malignant wounds.

Optical coherence tomography and shear wave elastography findings in Graves ophthalmopathy

PURPOSE

The main feature of Graves ophthalmopathy (GO) is revealed by determining the activity and severity of the disease. We aimed to evaluate the use of imaging methods can also provide additional information about the severity of this disease.

METHODS

Optical coherence tomography (OCT) and shear wave elastography (SWE) findings were compared in 32 patients with mild GO group and in the healthy control group. Measuring for TSH receptor antibody (TRAb) serum level is used third-generation assay.

RESULTS

In Graves group, optic nerve sheath diameter (ONSD) values were increased in both eyes (p < 0.001, p < 0.001). SWE measurements showed a significant increase both eye optic nerve (ON) and right eye soft tissue elasticity values in GO group (p < 0.001, p < 0.001, p < 0.001, respectively). There was a significant thinning in left temporal retinal nerve fiber layer (RNFL) thickness and left RNFL peripapillary thickness in GO group (p < 0.001, p < 0.025, respectively). There was a correlation between left eye OCT and SWE findings. Also, there was a significant difference between the median left eye ON and soft tissue elasticity results in the TRAb-positive GO group (p = 0.049, p = 0.048, respectively).

CONCLUSION

SWE measurements showed a significant increase both eyes ONSD, ON and right eye soft tissue elasticity values in GO group. GO group was significant thinning in some left eye regions in OCT measurements. There was a correlation between left eye OCT and SWE findings. In addition to clinical activity score and TRAb, SWE and OCT can be used to monitor in patients with GO.

Optical Coherence Tomography Angiography in Schizophrenia

Objective:

The aim of this study is to investigate the retinovascular structure of schizophrenia patients using optical coherence tomography angiography (OCTA).

Methods:

47 eyes of schizophrenia patients were compared with 50 eyes of demographically matched healthy controls in terms of OCTA measurements. Schizophrenia patients were evaluated in two groups as short-term (≤ 5years) and long-term (> 5years) according to the time elapsed after the diagnosis of schizophrenia.

Results:

Schizophrenia patients showed overall thinning of retinal nerve fiber layer and macula, and lower vessel density (VD) compared to controls. The results were significant for thickness measurements of general macula and for VD in specific areas (P < 0.05); however, they were not significant for the RNFL measurements except the mean circumpapillary RNFL, which was noted to approach significance (P = 0.055). Long-term patients showed significantly lower VD in the whole and perifoveal region of superficial capillary plexus, the whole, perifoveal and foveal region of deep capillary plexus, and the whole area and the disc of radial peripapillary capillaries compared to short-term patients (P = 0.014, P = 0.009, P = 0.011, P = 0.010, P = 0.011, P = 0.035, P = 0.030).

Conclusions:

These findings suggest that schizophrenia may be a neurodegenerative disease with progressive microvascular involvement over the years, and that OCTA has the potential to be a useful tool in detecting retinovascular changes in patients with schizophrenia.