Some viral and rickettsial infections in Bosnia and Herzegovina; a sero-epidemiological study

Investigating viral and rickettsial infections in Bosnia and Herzegovina, the authors submitted 115 sera of healthy persons to complement-fixation tests with typhus, Q fever, mumps, rickettsialpox, and psittacosis antigens. The results obtained indicate that the Moslem population tends to show more typhus-positive titres, and at an earlier age, than the non-Moslem. While Moslems under 20 years old tend to develop typhus in epidemic form, an approximately equal number of epidemic and apparently sporadic cases occurs among non-Moslems. On the other hand, Q fever is more frequent, and occurs earlier, in the non-Moslems. An epidemiological explanation of these phenomena is advanced.From the findings on mumps, it is thought possible that this disease tends to be primarily one of children in Moslems but not in non-Moslems. The rickettsialpox titres suggest the presence of an agent or agents antigenically related to Ricksettsia akari, and the psittacosis titres are thought to be caused by contact with organisms of the psittacosis and lymphogranuloma venereum group.     

Rudolf Stefan Weigl--scientist and human being

Rudolf Stefan Weigl died in 1957, 45 years ago. This year we are celebrating 120 anniversary of his birthday. He was a great Polish scientist who led research on Rickettsia prowazeki and epidemic typhus. R. Weigl developed a method of R. prowazeki culture in louse gut and elaborated the technology of epidemic typhus vaccine production. He and his co-workers introduced first vaccination of medical staff, people from endemic area in Poland and missionaries working in Asia. He was an international authority on prophylactics and control of rickettsial epidemic typhus.     

Evidence of rickettsial disease agents in ticks from Ethiopian cattle

Evidence has recently been accumulating that domestic animals may play an ancillary role in rickettsial zoonoses. In particular, attention has been focused on the activity of Rickettsia prowazekii in Egyptian and Ethiopian livestock and their ticks. An attempt has now been made to confirm previous findings of R. prowazekii in the sera of zebus, sheep and goats in Ethiopia, which brought epidemic typhus into the category of a zoonosis. This attempt was not successful, but tests did indicate that some ticks were infected with R. conori (boutonneuse fever or tick-borne typhus) and Coxiella burneti (Q fever), this being the first evidence for the existence of these agents in Ethiopia.     

Acute Q Fever and Scrub Typhus, Southern Taiwan

Acute Q fever and scrub typhus are zoonoses endemic to southern Taiwan. Among the 137 patients with acute Q fever (89, 65.0%) or scrub typhus (43, 31.4%), we identified 5 patients (3.6%) who were co-infected with Coxiella burnetii and Orientia tsutsugamushi.     

The susceptibility of the South African Gerbils (Genus tatera) to rickettsial diseases and their use in the preparation of anti-typhus vaccine

During experiments to determine the susceptibility of various veld rodents to tick-bite fever, the variety of tick typhus occurring in South Africa, it was discovered that the South African gerbils (Tatera brantsi and T. afra) are very susceptible and often die showing a heavy infection of the peritoneum.After exposure to X-rays to lower their resistance most animals showed a very heavy infection of the peritoneum comparable to the growth of rickettsiae occurring in X-rayed white rats inoculated with a murine strain of typhus.Further experiments showed that these gerbils were also susceptible to epidemic louse-borne typhus and after exposure to X-rays the growth of Rickettsia prowazeki is also a profuse as the growth of R. mooseri in X-rayed white rats.Finally, it was shown that the inoculation intraperitoneally of Tatera brantsi with a murine strain of typhus, after exposure to X-rays, yielded a growth of rickettsiae more profuse than that seen in white rats similarly inoculated.These findings indicate clearly that the gerbil is suitable not only for the preparation of vaccine from murine typhus strains, but also for the preparation in a similar way of vaccines from strains of epidemic typhus and tick-bite fever. As far as is known the gerbil is the first animal to be discovered suitable for this purpose.     

Typhus-like Fevers of Unknown ?tiology,with Special Reference to the Malay States

Typhus exanthematicus, Rocky Mountain fever, and the tsutsugamushi disease have been classified in the “typhus group” by Megaw, as louse-typhus, tick-typhus, and mite-typhus. He has added a fourth-class, comprising typhus-like fevers, with unknown vectors. It is the diseases of this class with which this paper is concerned.Endemic typhus (Brill''s disease) is very closely related to typhus fever; the Weil-Felix reaction is positive, typhus-like vascular lesions are present, and there is cross-immunity with typhus. In the exanthematic fever of Marseilles the relationship is more superficial; there is neither cross-immunity nor vascular lesion, and the Weil-Felix reaction is negative. Some, e.g., the scrub-typhus of Malaya (vector probably a mite), are more nearly related to tsutsugamushi than to typhus; others, e.g., Indian “tick-typhus” (vector probably a tick), to Rocky Mountain fever.All are non-contagious, non-epidemic, warm-weather diseases. They are unassociated with dirt, squalor, or lice, and are restricted to definite foci. Probably rodents or other animals are the reservoirs of the virus. On the question of identity with typhus, health authorities decide that notification is unnecessary; typhus introduced into America spreads, Brill''s disease does not.These typhus-like diseases are not the same in all the countries where they occur. There are two main groups: (1) an urban group, more closely related to typhus, in which the Weil-Felix reaction is positive; (2) a rural group, more closely related to tsutsugamushi and Rocky Mountain fever, in which the Weil-Felix reaction is negative. There is a special non-indologenic strain of B. proteus, which is agglutinated in some of the fevers belonging to the second group.Tropical typhus in the Malay States: (1) urban form, or “shop-typhus,” resembling Brill''s disease; (2) rural form or “scrub-typhus.” Peculiar association with oil-palms and coarse grass.     

Update: chikungunya fever diagnosed among international travelers--United States, 2006

Chikungunya virus (CHIKV) is a mosquitoborne alphavirus indigenous to tropical Africa and Asia, where it causes endemic and epidemic chikungunya (CHIK) fever, an acute illness characterized by fever, arthralgias, and sometimes arthritis, commonly accompanied by conjunctivitis and rash. Although symptoms of CHIKV infection usually last days to weeks, joint symptoms and signs usually last for months and occasionally for 1 year or longer; deaths from CHIKV infection are rare. No specific antiviral treatment exists for CHIKV infection; treatment consists of supportive care, including analgesics and anti-inflammatory medication for joint symptoms. During 2005-2006, an epidemic of CHIK fever occurred on islands in the Indian Ocean and in India, resulting in millions of clinically suspected cases, mainly in southern India. In the United States, CHIK fever has been diagnosed in travelers from abroad. CDC previously reported 12 imported cases of CHIK fever diagnosed in the United States from 2005 through late September 2006, including 11 with illness onset in 2006. This report of 26 additional imported cases with onset in 2006 underscores the importance of recognizing such cases among travelers. Health-care providers are encouraged to suspect CHIKV infection in travelers with fever and arthralgias who have recently returned from areas with CHIKV transmission. Acute- and convalescent-phase serum specimens can be submitted to CDC for testing through state health departments. Public health officials and health-care providers are encouraged to be vigilant for the possibility of indigenous CHIKV transmission in areas of the United States where CHIKV mosquito vectors are prevalent.     

The natural history of recrudescent typhus (Brill-Zinsser disease) in Bosnia

Between 1954 and 1963, typhus, both epidemic and recrudescent, has been studied in Bosnia. The recrudescent typhus cases occur sporadically throughout the year, whereas epidemic typhus occurs mainly between November and June. During 1954-63, some 10-20 years after the extensive typhus epidemics of the Second World War, the highest incidence of recrudescent typhus was in the 20-50 year age-group, whereas epidemic typhus reached its highest incidence in the 2-30 year age-group. Field observations support Zinsser''s hypothesis that man is the interepidemic reservoir of typhus. Recrudescent typhus is not likely to cause epidemics of primary epidemic typhus in environments where lice are scarce. However, if typhus is to be eradicated, it seems that it will be necessary to destroy all lice in areas where there are people who have at some time had the disease.     

Rickettsiae and rickettsial diseases

This paper summarizes present knowledge on rickettsiae and rickettsial diseases, and on their epidemiological characteristics, control, and public health significance. There are many natural foci of rickettsial diseases, from where the disease may spread to other areas in the world under changing socioeconomic conditions. Because of rapid long-distance travel, sporadic cases of serious rickettsial diseases may today appear far from endemic areas where the infection occurred. Even in endemic areas the disease may be misdiagnosed and deaths may occur as a result of inadequate treatment. Rapid treatment of rickettsial infections (preferably with tetracyclines) is therefore most important. Epidemic louse-borne typhus, though no longer subject to the International Health Regulations, remains one of the diseases in the WHO epidemiological surveillance programme. This disease continues to be a major cause of morbidity and mortality in some parts of Africa and it is present also in parts of the Americas and of Asia. Scrub typhus remains a continuing and serious public health problem in areas of South-East Asia and in the Western Pacific. The annual number of reported cases of Rocky Mountain spotted fever in the USA showed an increase during the last two decades, which may be due to improved recognition as well as to increased outdoor activities and migration of people from the city centres to the suburbs. Related forms of tick-borne typhus occur in South America, the Mediterranean region, Africa, South-East Asia, the Far East, and the Western Pacific. Increasing in number, though still sporadic, are reports of serious illness from chronic Q fever infection in many parts of the world.     

The role of Czech physicians in the etiology, clinical aspects and epidemiology of exanthematous typhus

Typhus fever was a lethal disease of mankind. Elucidation of its origin and spread was due to more or less unscientific approaches at the time. Only in the second half of the 19th and at the beginning of the 20th century the period of a scientific approach to knowledge of its etiology, clinical aspects and epidemiology started. A great contribution was made in this respect by Czech doctors. The latter included Professor Hlava who made a series of experiments which were among the first which investigated the etiology of this disease. He may be therefore quite rightly included among one of the discoverers of the origin of typhus fever.     

黄热病现情分析与卫生检疫工作的研究进展

黄热病（Yellow Fever,YF）病毒是一种黄热病毒属虫媒病毒。经媒蚊传播,在非洲和南美洲热带地区呈地方性流行。据世界卫生组织（WHO）估计,全球年发病人数20万例,死亡3万例。其中90％以上发生在非洲,严重威胁人类的健康。随着全球经济的不断发展,国际间人群交往的频繁,黄热病疫情进入非黄热病流行区的风险日益增加。因此,我国对及时预防、控制该病通过国境口岸传入的警惕性不容忽视。     

2006-2017年楚雄州3种鼠传疾病流行分析

目的 分析2006-2017年楚雄州肾综合征出血热、恙虫病、斑疹伤寒流行特征,为制定防控策略提供科学依据。方法 收集《中国疾病预防控制信息系统》中报告的2006-2017年楚雄州3种鼠传疾病进行统计分析。结果 2006-2017年间楚雄州共报告肾综合征出血热、恙虫病、斑疹伤寒3种鼠传疾病共3207例,报告死亡4例,年均报告发病率9.83/10万,其中以恙虫病报告病例最多,占3种鼠传疾病病例总数的85.53%(2743/3207)。肾综合征出血热报告发病率位居第1的是楚雄市,恙虫病和斑疹伤寒报告发病率位居第1的是永仁县;肾综合征出血热的报告发病高峰是4月,恙虫病的报告发病高峰是7-10月,斑疹伤寒的报告发病高峰是8-9月;肾综合征出血热和恙虫病发病人群均以农民为主,斑疹伤寒发病人群以农民、学生和散童为主。结论 楚雄州3种鼠传疾病疫情呈上升趋势,发病有明显的地区性、季节性和人群分布特征,应在高发季节做好重点地区、重点人群的防控工作。     

北京市平谷区15例恙虫病的流行特征

目的分析北京市平谷区恙虫病流行病学特点以及临床特征,了解恙虫病在该地区的分布状况,以便进行深一步研究。方法对该组病例进行回顾性调查,采用描述流行病学方法分析该次调查的恙虫病流行特点。结果自2009年10月3—22日共发生恙虫病15例,男性8例,女性7例;平均发病年龄为51.6岁。其中农民10例,工人5例。15个病例均有发热症状,以稽留热为主。有溃疡焦痂症状者14例,占发病数的93.3%。在应用间接免疫荧光试验进行单份血清检测后,1例患者IgM抗体滴度≥1:32,14例IgG抗体滴度≥1:64;在应用PCR检测恙虫病东方体特异基因片段的结果中,呈阳性反应者10例。首诊误诊率为93.3%。结论该地区恙虫病的流行是典型的秋季型恙虫病,症状复杂,早期误诊率较高。同时,在该地区可能存在恙虫病自然疫源地,应对疫源地范围进行深一步的监测和研究。     

Control of rickettsial diseases

Prevention of rickettsial infections is aimed at individual control and epidemic measures (especially in epidemic typhus), vector and rodent control, milk pasteurization (in Q fever), chemoprophylaxis and immunoprophylaxis. In vector and rodent control, the main obstacle is the rise in resistance to insecticides and rodenticides. For this reason in vector control, apart from insecticides, enhancement of the natural immunity acquired by animals in response to tick infestation and vaccination with concealed tick antigens as well as the use of hormones, chemosterilants and genetic manipulation can also be considered. For short-term high-risk exposure, doxycycline may be an effective prophylaxis of illness but may not prevent infection with scrub typhus or spotted fever group rickettsiae. At present, for specific prevention by vaccination, only Q fever vaccines are available for common use. However, development of subunit vaccines, namely immunogenic rickettsial proteins, cloned and expressed in Escherichia coli, seems to be very promising.Presented at the 4th International Symposium on Rickettsiae and Rickettsial Diseases, Pietany C.S.F.R., 1–6 October, 1990.     

Infections in travellers arriving from Australia

An unwell traveller whose itinerary has included Australia may be infected with agents that are uniquely found in that country or by more cosmopolitan agents that exist there. This brief review will discuss some of the more common or important infectious disease diagnoses and discuss some features that can be elicited on examination or from the history that would be useful in directing investigation and treatment. Diseases discussed include epidemic polyarthritis, dengue fever, Murray Valley encephalitis, melioidosis, leptospirosis, Buruli ulcer, scrub typhus and spotted fever.     

Antigenic relationships between the typhus and spotted fever groups of rickettsiae.

Paired sera from cases of epidemic typhus in Ethiopia and from probable cases of Rocky Mountain spotted fever (RMSF) in the United States were examined by microagglutination (MA) and microimmunofluorescence (micro-IF) tests for antibodies against Rickettsia prowazekii, Rickettsia typhi, Rickettsia canada, Rickettsia rickettsii, Rickettsia conorii and Ricksettsia akari. IgG and IgM antibodies against the various rickettsiae were titrated with specific fluorescein-conjugated anti-IgG and anti-IgM sera. Purified, particulate rickettsial antigens were employed in all tests. A majority of patients acutely ill with epidemic typhus produced both IgG and IgM antibodies against R. prowazekii, R. typhi and R. canada. Concurrently they produced IgG (but seldom IgM) antibodies against members of the spotted fever group. In contrast, patients ill with probably spotted fever, while producing IgG and IgM antibodies against R. rickettsii, R. conorii and R. akari, also produced both IgG and IgM antibodies with about equal frequency against members of the typhus group. It was concluded that a relatively broad antigenic relationship exists between rickettsiae of the typhus and spotted fever groups.     

1994-2013年贵阳市自然疫源及虫媒传染病流行特征及防控策略探讨

目的 分析1994-2013年贵阳市自然疫源及虫媒传染病流行病学特征及其变化趋势,探讨防控策略,为制定预防控制措施提供依据。方法 采用描述性流行病学方法和动态数列方法,对1994-2013年贵阳市传染病疫情报告资料中报告的自然疫源及虫媒传染病的流行病学特征及其变化趋势进行分析。结果 1994-2013年贵阳市自然疫源及虫媒传染病有11种4 317例,发病率波动在0.39～33.84/10万之间,呈大幅下降趋势;报告死亡323例,死亡率波动在0.00～1.23/10万之间;出血热、狂犬病、乙脑、炭疽、钩体病的发病率是郊县高于市区,具有统计学意义（χ2=4 548.679,P<0.001）;每年6~8月和10月至次年1月为疾病流行高峰;农民、散居儿童和学生是主要发病人群,近10年,发病所占构成升高的主要是学生和民工,降幅最大的是农民。结论 1994-2013年贵阳市自然疫源及虫媒传染病发病总体呈下降趋势;发病有明显的季节性和地域分布、人群分布特点;应实施重点人群、重点区域、重点疾病、重点环节的防控策略,以预防和控制该类疾病的发生和流行。     

Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007

Zika virus (ZIKV) is a mosquito-borne flavivirus first isolated in Uganda from a sentinel monkey in 1947. Mosquito and sentinel animal surveillance studies have demonstrated that ZIKV is endemic to Africa and Southeast Asia, yet reported human cases are rare, with <10 cases reported in the literature. In June 2007, an epidemic of fever and rash associated with ZIKV was detected in Yap State, Federated States of Micronesia. We report the genetic and serologic properties of the ZIKV associated with this epidemic.     

Human rickettsioses in the Batna area,eastern Algeria

In order to investigate the prevalence of rickettsioses in febrile exanthemas in eastern Algeria, we conducted a prospective serological analysis of all patients presenting with this clinical picture at the Infectious Diseases Department in the Batna Hospital from January 2000 to September 2006. One hundred and eight adult patients were included in the study, 46% of whom younger than 25 years, and 72.5% were admitted from May to September. Patients were tested for antibodies to Rickettsia conorii conorii, R. conorii israelensis, R. aeschlimannii, R. felis, R. sibirica mongolitimonae, R. africae, R. massiliae, R. typhi, and R. prowazekii using microimmunofluorescence and Western blot as confirmation procedure. Both methods confirmed the diagnosis of Mediterranean spotted fever in 5 patients (4.6%), flea spotted fever in 2 patients (1.9%), and R. aeschlimannii infection in 2 patients (1.9%). In addition, 4 patients were diagnosed as having murine typhus (3.7%) and one with epidemic typhus (0.9%). To the best of our knowledge, this is the first report of R. felis infection and R. aeschlimannii infection in Algeria. In conclusion, at least 5 different kinds of rickettsiosis coexist in eastern Algeria and, being responsible for 13% of cases of febrile exanthemas, should be considered among major causes of this clinical picture in this area. In addition, we emphasize the high incidence of typhus group rickettioses, including epidemic typhus, in this area.