Alpha-Gal Syndrome in the Infectious Diseases Clinic: A Series of 5 Cases in Central North Carolina.

Background: Alpha-gal syndrome (AGS) is a recently described allergy to galactose-α-1,3-galactose, an oligosaccharide present in mammalian meat. AGS can present with angioedema, urticaria, and anaphylaxis arising 3-6 hours after ingestion, although symptoms such as gastrointestinal distress, fatigue, and arthralgias are also reported. Because AGS appears to be associated with tick bites, patients may present to infectious diseases (ID) clinics for evaluation. Methods: We documented a series of 5 patients referred to the University of North Carolina ID Clinic between 2020 and 2022 for various tick-borne infections that were found to have symptoms and laboratory testing consistent with AGS. Patients were subsequently referred to the Allergy and Immunology Clinic. Results: Patients were referred to the ID Clinic for persistent symptoms following positive tick-borne disease testing or presumed tick-borne infection. All patients had an elevated alpha-gal immunoglobulin E and clinical presentation consistent with AGS. Common symptoms included episodic gastrointestinal distress (eg, cramping, nausea, diarrhea), fatigue, arthralgias, and subjective cognitive impairment, but a notable absence of severe anaphylaxis. Four patients were seen by at least 1 nonallergy specialist prior to referral to ID. Patients reported substantial improvement in their symptoms following dietary restriction. Conclusions: ID physicians should be aware of AGS as a cause of persistent, nonspecific symptoms following a tick exposure or tick-borne illness. Further research is needed to determine the prevalence of alpha-gal sensitization and AGS following tick-borne bites.

Borrelia miyamotoi Infection in Immunocompromised Man, California, USA, 2021.

Infection with Borrelia miyamotoi in California, USA, has been suggested by serologic studies. We diagnosed B. miyamotoi infection in an immunocompromised man in California. Diagnosis was aided by plasma microbial cell-free DNA sequencing. We conclude that the infection was acquired in California.

The Troublesome Ticks Research Protocol: Developing a Comprehensive, Multidiscipline Research Plan for Investigating Human Tick-Associated Disease in Australia.

In Australia, there is a paucity of data about the extent and impact of zoonotic tick-related illnesses. Even less is understood about a multifaceted illness referred to as Debilitating Symptom Complexes Attributed to Ticks (DSCATT). Here, we describe a research plan for investigating the aetiology, pathophysiology, and clinical outcomes of human tick-associated disease in Australia. Our approach focuses on the transmission of potential pathogens and the immunological responses of the patient after a tick bite. The protocol is strengthened by prospective data collection, the recruitment of two external matched control groups, and sophisticated integrative data analysis which, collectively, will allow the robust demonstration of associations between a tick bite and the development of clinical and pathological abnormalities. Various laboratory analyses are performed including metagenomics to investigate the potential transmission of bacteria, protozoa and/or viruses during tick bite. In addition, multi-omics technology is applied to investigate links between host immune responses and potential infectious and non-infectious disease causations. Psychometric profiling is also used to investigate whether psychological attributes influence symptom development. This research will fill important knowledge gaps about tick-borne diseases. Ultimately, we hope the results will promote improved diagnostic outcomes, and inform the safe management and treatment of patients bitten by ticks in Australia.

Diversity of bat ectoparasites from the caves of selected Key Biodiversity Areas in Central Visayas, Philippines

Bats harbor numerous species of ectoparasites, such as ticks and mites. Many bat ectoparasites are implicated as vectors of pathogens ranging from bacteria to protozoa and viruses. Recent studies verified bats as a natural reservoir of multiple zoonotic viruses, including Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronaviruses. This study assessed the composition, diversity, and prevalence of ectoparasites of cave-dwelling bats in the four Key Biodiversity Areas (KBAs) of Central Visayas. A total of 20 species of bats were recorded in the 30 surveyed caves. Of these, 30 species of ectoparasites belonging to eight families (dipteran flies Streblidae and Nycteribiidae, mites Spinturnicidae, Macronyssidae and Trombiculidae, ticks Argasidae and Ixodidae, and Ischnopsyllidae fleas) were collected and identified. Leptotrombidium sp. had the highest number of individuals (n=1,684) harbored in 12 bat host species. The highest prevalence (100%) was noted in four bat host species: Philippine pygmy fruit bat Haplonycteris fischeri Lawrence 1939, Philippine forest roundleaf bat Hipposideros obscurus Peters 1861, Philippine pygmy roundleaf bat Hipposideros pygmaeus Waterhouse 1843, and Common bent-winged bat Miniopterus schreibersii Kuhl 1817. The lowest prevalence was noted in the Round-eared tube-nosed bat Murina cyclotis Dobson 1872, where no ectoparasite was collected. The highest intensity (n=65) of ectoparasites was observed in the Common Asian ghost bat Megaderma spasma Linnaeus 1758. This study provides essential data for future reference in monitoring bat population status and conservation efforts in the region. Given the close relationship between the local human community and bats (e.g., hunting and consumption), more work is needed to address the potential pathogen risks from zoonotic transmission from bats and ectoparasites. © 2023, Society for Indonesian Biodiversity. All rights reserved.

Powassan Virus Lineage I in Field-Collected Dermacentor variabilis Ticks, New York, USA.

Powassan virus is a tickborne flavivirus that can cause lethal or debilitating neurologic illness. It is canonically transmitted by Ixodes spp. ticks but might spill over to sympatric Dermacentor species. We detected Powassan virus lineage I from a pool of field-collected D. variabilis ticks in New York, USA.

Urban climate-health governance: charting the role of public health in large global city adaptation plans

Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress;the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as "promising practice" based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping;(ii) extreme weather preparedness and response;(iii) extreme heat plans (including heat early warning);(iv) non-heat early warning (e.g., flooding, vector-borne disease);and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies-notably urban planning, emergency management and public utilities-in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.

Don’t lose focus on diseases of poverty in COVID-19 crisis

Scientists in Africa, Asia and Europe from a range of disciplines have been researching these diseases of poverty as part of Zoonoses and Emerging Livestock Systems (ZELS), a United Kingdom Department for International Development (DFID) and UK Research and Innovation funded programme. Managing zoonoses A finding that treating cattle with insecticides to combat ticks and tsetse flies can contain the risk of sleeping sickness in people offers the possibility of simple and cost-effective disease-management strategies. Discovering that the majority of schistosomiasis transmission and sickness in Senegal and Niger is driven not by a human schistosome species, as had been previously assumed, but through schistosome species from people and their livestock combining to form highly transmissible viable parasitic hybrids, has helped ensure the WHO embraces a One Health approach to eliminating of a disease that infects more than 240 million people globally.

Potential pandemic pathogens series: Crimean-Congo haemorrhagic fever

In the last two years we have experienced the effects of the COVID-19 pandemic in our lives and hospitals. Pandemics are part of the history of humanity and we can be certain that in the future new pandemics will appear. In fact, due to the growth in the human population, increased travel and global warming, it is to be expected that new pandemic pathogens will arise more frequently than before. Additionally, decreased barriers between animals and humans will give rise to spillover events, which will result in the introduction of new zoonotic pathogens in humans. In each of the parts of this series we will, in a short format, highlight a potential pandemic pathogen and describe its characteristics, history and potential for global pandemics. This part of the series focusses on the Crimean-Congo haemorrhagic fever virus. Crimean-Congo haemorrhagic fever is a tick-borne disease, which is generally found in workers at farms and slaughterhouses and sometimes causes small outbreaks in families or hospital personal, as it can be spread by body fluids. Symptoms are unspecific, including myalgia, headache and fever. The disease course is often mild, but in patients who develop a haemorrhagic phase, the fatality rate is high. Treatment is primarily supportive but antiviral therapy including favipiravir and ribavirin are under investigation.

Research status and trend of zoonosis and zoonotic microorganisms based on pubmed database retrieval

Objective: To gather information on the research status and the hot spots of zoonosis and zoonotic microorganisms worldwide, and to provide references for the prevention and control of zoonotic diseases in China. Method: COOC 12.6 and Citespace 5.8 R1 software were used to carry out frequency statistics, co-occurrence analysis, cluster analysis, timeline analysis and burst analysis on the keywords associated with zoonosis and zoonotic microorganisms in PubMed database. Result: According to the keywords frequency statistics and co-occurrence analysis results from the year of 2001 to 2021 in pubMed database, the zoonosis and zoonotic microorganisms arousing high international attentions were classified into the following three categories: the first category was commonly observed zoonotic microorganisms such as Brucella, hepatitis E virus, Streptococcus, Escherichia coli (E. coli) and Salmonella, to which continuous public attentions were still needed to be paid;the second category was the zoonotic microorganisms worldwide concerned in recent years such as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and influenza A virus, which were worthy of more in-depth research to control the spread of these diseases as soon as possible;the third category was the zoonosis that had massively prevailed in specific regions abroad such as Q fever and middle east respiratory syndrome (MERS), and these diseases were expected to be noticed in terms of imported risks to avoid their outbreaks in China. In addition to the above mentioned zoonosis and zoonotic microorganisms, some keywords associated with detection and diagnosis such as phylogeny and PCR were also of high interests. The cluster analysis generated a total of 10 clusters, in which the tick-borne infectious disease cluster suggested the role of ticks in the transmission of zoonotic diseases;the results of timeline and burst analysis demonstrated that among the zoonotic microorganisms, the attentions being paid to influenza A virus and SARS-CoV-2 were gradually increasing. At the same time, the detection technology of zoonotic microorganisms was evolving from specific sequence detection to whole genome sequencing. These fields were likely to be the research direction and trend in the future.

Quarterly report of investigations of suspected exotic diseases: July to September 2021

Exotic pest and disease investigations are managed and reported by the Ministry for Primary Industries' (MPI's) Diagnostic and Surveillance Directorate. This article presents a summary of investigations of suspect exotic and emerging pests and diseases in New Zealand during the period from July to September 2021.

Old zoonotic agents and novel variants of tick-borne microorganisms from Benguela (Angola), July 2017.

BACKGROUND: Ticks and tick-borne diseases constitute a real threat for the livestock industry, which is increasing in Angola. In addition, ticks are vectors of zoonoses of public health concern, and scarce information is available from this country. In an effort to contribute to the prevention of zoonotic infectious diseases affecting humans and animals, the molecular screening of certain tick-related microorganisms collected on cattle in Angola was performed under a 'One Health' scope. METHODS: Ticks collected from cattle in Cubal (Benguela Province, Angola) in July 2017 were analysed in pools using specific PCR assays for bacteria (Rickettsia, Anaplasmataceae, Borrelia, Coxiella and Spiroplasma) and protozoa (Theileria and Babesia) detection. RESULTS: A total of 124 tick specimens were grouped in 25 pools (two Amblyomma variegatum, three Hyalomma truncatum, 16 Rhipicephalus decoloratus, two Rhipicephalus duttoni, one Rhipicephalus evertsi mimeticus and one Rhipicephalus sp.). The amplified microorganisms were (pools): Rickettsia africae (two A. variegatum and one R. decoloratus), Rickettsia aeschlimannii (three H. truncatum), Ehrlichia spp. (six R. decoloratus), Coxiella spp. (all but H. truncatum), Francisella sp. (one H. truncatum), Spiroplasma sp. closely related to Spiroplasma ixodetis (three R. decoloratus), Babesia bigemina (two R. decoloratus) and Babesia spp. (two A. variegatum). The obtained nucleotide sequences from Ehrlichia spp., two Coxiella genotypes (from R. duttoni and Rhipicephalus sp.), Francisella sp. and Babesia spp. (from A. variegatum) reached low identities with known genetically characterized species. CONCLUSIONS: This study demonstrates the circulation in Angola of the pathogen R. aeschlimannii and potential novel tick-related microorganisms belonging to Ehrlichia, Coxiella, Francisella, Spiroplasma and Babesia spp. and corroborates the presence of R. africae and B. bigemina. Our results should be considered in developing protocols for the management of fever of unknown origin and for veterinary practices. Further studies are required to evaluate the risk of tick-borne diseases in Angola.

Incidence of Tick-Borne Encephalitis during the COVID-19 Pandemic in Selected European Countries.

Ixodes ricinus ticks are one of the most important vectors and reservoirs of infectious diseases in Europe, and tick-borne encephalitis (TBE) is one of the most dangerous human diseases transmitted by these vectors. The aim of the present study was to investigate the TBE incidence in some European countries during the COVID-19 pandemic. To this end, we analyzed the data published by the European Center for Disease Prevention and Control (ECDC) and Eurostat on the number of reported TBE and COVID-19 cases in 2020 and TBE cases in 2015-2019 (reference period). Significant differences in the TBE incidence were found between the analyzed countries. The highest TBE incidence was found in Lithuania (25.45/100,000 inhabitants). A high TBE incidence was also observed in Central European countries. In 12 of the 23 analyzed countries, there was significant increase in TBE incidence during the COVID-19 pandemic during 2020 compared to 2015-2019. There was no correlation between the incidence of COVID-19 and TBE and between the availability of medical personnel and TBE incidence in the studied countries. In conclusion, Central Europe and the Baltic countries are areas with a high risk of TBE infection. Despite the COVID-19 pandemic and imposed restrictions, the incidence of TBE is increasing in more than half of the analyzed countries.

Diseases Transmitted by the Black-Legged Ticks in the United States: A Comprehensive Review of the Literature.

The black-legged tick is endemic to the midwestern, northeastern, western, south-eastern, and southern regions of the United States. There has been an increased burden of black-legged ticks in humans in recent years. COVID-19 pandemic has further heightened this burden. We thereby reviewed the literature to discuss the seasonality, infections, and clinical spectrum of diseases transmitted by the black-legged ticks. We also discuss the reported delay in the diagnosis of these diseases during the pandemic situation, the alpha-gal syndrome, the importance of prompt diagnosis, and early medical intervention with an aim to increase awareness of the black-legged tick-borne diseases.

Recreational behaviour, risk perceptions, and protective practices against ticks: a cross-sectional comparative study before and during the lockdown enforced by the COVID-19 pandemic in Romania.

BACKGROUND: Gaining insight into the risk perceptions and the knowledge evolution of the public about emerging or changing health risks is vital for the improvement of health promotion activities. Currently, scientific evidence regarding the attitudes of the Romanian public towards ticks is scanty. This study aimed to identify how the lockdown enforced by the COVID-19 pandemic in Romania impacted the recreational behaviour, risk perceptions, and protective practices of the Romanian population regarding ticks. METHODS: A cross-sectional, nationwide web-based questionnaire was designed and distributed via social media to evaluate if, and how, the COVID-19 lockdown impacted the behaviour of the Romanian public concerning ticks. The survey was available online from 6 May until 15 May 2020, which marked the last day of the travel ban in Romania. The collected data were processed by applying both uni- and multivariate methods. RESULTS: Respondents reported a higher frequency of finding ticks on themselves and their dogs during the lockdown. Bathing/showering and checking the body for ticks were the two most used protective behaviours both before and during the lockdown. Nevertheless, an overall lower usage rate of protective measures was registered during the lockdown. Almost all dog owners used a form of ectoparasite control for their dogs, and only three stopped due to lockdown-associated reasons. Respondent characteristics that were found to be positively associated with risk perceptions were being female and living in peri-urban/suburban/rural environments. CONCLUSIONS: Despite spending less time outdoors during the lockdown, more respondents reported finding ticks on themselves or their dogs. Changes in the preferences for recreational locations, rates of protective practices usage, amount of time spent in specific areas, or tick seasonal activity might have contributed to this outcome. Concerning risk groups, men of all ages, senior citizens, and rural inhabitants should be targeted by the relevant Romanian authorities when promoting local or nationwide tick awareness campaigns.