Worldwide meta-analysis on Anaplasma phagocytophilum infections in animal reservoirs: Prevalence, distribution and reservoir diversity.

A wide range of vertebrate species are competent reservoirs of Anaplasma phagocytophilum, where the pathogen is maintained in the enzootic cycle and transmitted to humans through activities of tick vectors. An insight into the role and diversity of these reservoirs is vital in understanding the epidemiology of this pathogen. Here, we determined the prevalence, distribution and reservoir diversity of A. phagocytophilum using a systematic review and meta-analysis. Data pooling was performed by the random-effects model, heterogeneity was assessed by the Cochran's Q-test and publication bias by Egger's regression test. Eighty-nine studies from 33 countries across 5 continents revealed A. phagocytophilum pooled prevalence of 15.18% (95% CI: 11.64, 19.57). Continental estimates varied significantly (p < 0.0001), with a range of 2.88% (95% CI: 0.25, 26.20) in South America to 19.91% (95% CI: 13.57, 28.24) in Europe. Country-based estimates ranged between 2.93% (95% CI: 1.17, 7.16) in Slovakia and 71.58% (95% CI: 25.91, 94.77) in Norway. Studies on A. phagocytophilum were concentrated in Europe (51.69%; 46/89) by continent and the USA (22.47%; 20/89) by country. Prevalence in wildlife (17.64%; 95% CI: 12.21-28.59) was significantly higher (p < 0.001) than that among domestic animals (10.68%; 95% CI: 6.61-16.83). Diverse species of wildlife, domestic animals and birds were infected by A. phagocytophilum. To curtail the public health, veterinary and economic consequences of A. phagocytophilum infections, we recommend an all-inclusive epidemiological approach that targets the human, animal and environmental components of the disease.

Normogram of umbilical artery Doppler indices in singleton pregnancies in south-western Nigerian women.

AIM: To determine the Doppler indices of the umbilical arteries in normal singleton pregnancy with a view to generating local reference ranges. METHODS: In this prospective, cross-sectional study, 400 pregnant women at 15-39 weeks' gestational age, with estimated fetal weight within the 10th and 90th percentile, no fetal malformation(s), and without any history of maternal medical disease, were recruited. Umbilical arteries were assessed on ultrasound, with the subjects in the supine position. Resistivity index (RI), pulsatility index (PI) and systolic/diastolic (S/D) ratio were recorded and analyzed. RESULTS: All the umbilical arteries were paired; no single umbilical artery was seen. Mean RI, PI, and S/D ratio declined with gestational age, and decreased from 1.265 to 0.829, from 0.760 to 0.585 and from 4.068 to 2.365, respectively, from 15 to 39 weeks of gestation. With regard to correlation between gestational age and Doppler indices, r = - 0.598 for PI (P < 0.05), - 0.437 for RI (P < 0.05), and - 0.538 for S/D ratio (P < 0.05). Decline in the Doppler indices was progressive with gestational age. CONCLUSION: A normogram of umbilical artery Doppler indices was constructed, which showed that the indices decreased with gestational age. These normative data could serve as reference ranges for evaluation of the umbilical artery circulation in this locality.