Serologic evidence of ehrlichiosis among humans and wild animals in The Netherlands.

The seroprevalence of antibodies directed against granulocytic and monocytic Ehrlichia was determined by use of human granulocytic ehrlichiosis agent and Ehrlichia chaffeensis as surrogate antigens. Seven hundred twenty-one serum samples were collected between 1992 and 1999 from febrile patients with unresolved aetiology (n=108), patients suspected of having Lyme disease (n=174), forestry workers (n=154) and healthy controls (n=54) as well as from wild deer (n=96), hares (n=60), wild boar (n=15) and red foxes (n=60). Reactive antibodies against granulocytic Ehrlichia were detected in 4% of febrile patients with unresolved aetiology and in 4% of patients suspected of having Lyme disease. Among the forestry workers, 1% tested positive for antibodies against granulocytic Ehrlichia, whereas all the healthy controls were negative. Antibody reaction against monocytic Ehrlichia was detected in only 2% of the febrile patients. Granulocytic Ehrlichia and monocytic Ehrlichia-reactive serum antibodies were detected in 22% and 3% of the deer samples, respectively, and in 2% of the hares. In wild boars and in red foxes, only serum antibodies reactive against monocytic Ehrlichia were detected in 13% and 7%, respectively. The demonstration of the presence of both granulocytic and monocytic Ehrlichia-reactive serum antibodies among humans and wild animals in The Netherlands indicates that patients suspected of having Lyme disease and febrile patients with unresolved aetiology should be tested for the presence of granulocytic and monocytic Ehrlichia antibodies or by polymerase chain reaction. Furthermore, granulocytic Ehrlichia are most prevalent in humans and animals in The Netherlands.

Need to increase awareness among family doctors and medical specialists of rickettsioses as an import disease in non-endemic areas.

Europeans travelling to (sub)-tropical countries have an increased risk for infections with Rickettsia. As serious consequences are associated with delay in specific antibiotic therapy, unequivocal diagnosis of this condition is needed. We focus here on the benefits of early, and consequences of late laboratory diagnosis, and emphasise the need of an increased awareness of rickettsioses among family doctors, as well as medical specialists, in non-endemic areas when evaluating patients with travel associated fever.

Prevalence of serum antibodies against bloodborne and sexually transmitted agents in selected groups in Somalia.

Somalia has suffered from a civil war during the last 10 years. In this period the use of whole blood has increased at least twofold in Mogadishu, Somalia compared with pre-war. Screening possibilities are limited. Recent data concerning the prevalence of infections with blood-borne and sexually transmitted agents are not available from this country. To investigate the spread of human immunodeficiency virus (HIV-1/2) and other blood-borne or sexually transmitted agents we tested a total of 256 serum samples collected in the summer of 1995 from blood donors, hospitalized children and adults in Mogadishu. The hepatitis B surface antigen (HbsAg) carrier rate was 191%, 5.6% and 21.3 % among blood donors, hospitalized children and hospitalized adults, respectively. However, no children under 2 years of age were HbsAg positive. The overall presence of antibodies against hepatitis C virus (HCV) was 2.4% (6/256). In blood donors this was 0.6% (1/157). In none of the samples tested, antibodies against HIV 1 and 2 or human T-cell lymphotropic viruses (HTLV I and II) were detected. Our results indicate that, during the civil war in Somalia, no evidence of an increase of HIV infections was found. Our findings indicate that preventive measures in Somalia should focus mainly on prevention of HBV-infections. HBV-vaccine could be administered within the framework of the expanded programme on immunization, as none of the children less than 2 years of age were HbsAg positive.

IgM antibodies in hospitalized children with febrile illness during an inter-epidemic period of measles, in Somalia.

BACKGROUND: In the context of the measles elimination programme, endorsed by the expanded programme on immunization of the World Health Organization, the identification of infections which may be confused with measles is a major challenge. OBJECTIVE: To determine the causes of febrile illness in children in an inter-epidemic period of measles in a Somalian hospital. STUDY DESIGN: Serological tests were performed on sera from 23 Somali children with febrile illness and from 23 age matched children, to measure the specific IgM and IgG antibodies against measles virus, mumps virus, rubella virus, human herpes-6 virus, Epstein Barr virus, parvovirus B19, dengue virus, Mycoplasma pneumoniae and Rickettsia conorii. RESULTS: In about one third of the cases of febrile illness viral, mycoplasmal and rickettsial agents could be identified serologically as the probable cause of the disease. CONCLUSIONS: Although febrile illness with rash in children needing hospitalization is usually assumed to be due to measles, there are several other important virological causes of this condition which need to be considered in the differential diagnosis. Moreover there is a growing need to develop a simple, sensitive, specific and ready to use test to identify each case of measles, if this disease is to be eliminated.

An outbreak of West Nile fever among migrants in Kisangani, Democratic Republic of Congo.

In February 1998, an outbreak of acute febrile illness was reported from the Kapalata military camp in Kisangani, the Democratic Republic of Congo. The illness was characterized by an acute onset of fever associated with severe headache, arthralgia, backache, neurologic signs, abdominal pain, and coughing. In 1 individual, hemorrhagic manifestations were observed. The neurologic signs included an altered level of consciousness, convulsions, and coma. Malaria was initially suspected, but the patients showed negative blood films and failed to respond to antimicrobial drugs. A total of 35 sera collected from the military patients in the acute phase were tested for the presence of IgM against vector-borne agents. Serum IgM antibodies against West Nile fever virus were found in 23 patients (66%), against Chikungunya virus in 12 patients (34%), against dengue virus in 1 patient (3%), and against Rickettsia typhi in 1 patient (3%). All sera were negative for IgM antibody against Rift Valley fever virus, Crimean Congo hemorrhagic fever virus, and Sindbis virus. These data suggest that infections with West Nile fever virus have been the main cause of the outbreak.