Abstract:A 45-year-old woman presented at the outpatient department of a center for tropical diseases with fever, diarrhea, headache, myalgia, malaise, and an itchy papular rash. She had been on holiday with her family for 11 days in a mountain village in northern Cyprus. The place was infested with a lot of small, stinging flies or mosquitoes. She and her family became sick after they returned home. The physical examination was normal apart from the rash on the inside of the extremities. Significantly elevated transam… Show more
“…Because the presence of arboviruses in Cyprus had been reported previously (15, 24, 29–32), we evaluated the residents’ exposure to SFV and WNV following Cyprus’ demography in terms of age, sex and location.…”
Background: Sandfly fever is an incapacitating disease caused by sandfly-borne Phleboviruses that can lead to meningitis, encephalitis or meningoencephalitis. West Nile virus (WNV), a mosquito-borne Flavivirus, can induce neuroinvasive disease manifested by meningitis, encephalitis or acute flaccid paralysis. Both vectors are endemic in Cyprus and very active during summer. The aims of this study were to determine first the prevalence of sandfly fever viruses (SFV) and WNV infections in Cyprus and second, to investigate their role in central nervous system (CNS) infections.
Methods: For the prevalence study, 327 sera collected in 2013 and 2014 were tested for anti-SFV and anti-WNV IgG using indirect immunofluorescence assay and ELISA, respectively. In order to investigate a possible role of SFV and WNV in CNS infections, 127 sera of patients presenting symptoms of SFV or WNV infections were screened for IgM specific to SFV and WNV.
Results: The overall anti-SFV IgG seroprevalence was 28% and was increasing with age (P< 0.01). The seroprevalence rate for anti-WNV IgG in Cyprus was 5%. Concerning the role of SFVs in CNS infections, anti-SFV IgM was detected in 8 out of 127 sera from selected patients presenting relevant symptoms of infections during vector’s active period. In addition, anti-WNV IgM were detected in 17 out of the 127 patients with compatible symptoms.
Conclusion: The findings confirm the presence of sandfly fever and WNV in Cyprus and should, therefore, be considered in the differential diagnosis of patients with febrile illness/meningitis.
“…Because the presence of arboviruses in Cyprus had been reported previously (15, 24, 29–32), we evaluated the residents’ exposure to SFV and WNV following Cyprus’ demography in terms of age, sex and location.…”
Background: Sandfly fever is an incapacitating disease caused by sandfly-borne Phleboviruses that can lead to meningitis, encephalitis or meningoencephalitis. West Nile virus (WNV), a mosquito-borne Flavivirus, can induce neuroinvasive disease manifested by meningitis, encephalitis or acute flaccid paralysis. Both vectors are endemic in Cyprus and very active during summer. The aims of this study were to determine first the prevalence of sandfly fever viruses (SFV) and WNV infections in Cyprus and second, to investigate their role in central nervous system (CNS) infections.
Methods: For the prevalence study, 327 sera collected in 2013 and 2014 were tested for anti-SFV and anti-WNV IgG using indirect immunofluorescence assay and ELISA, respectively. In order to investigate a possible role of SFV and WNV in CNS infections, 127 sera of patients presenting symptoms of SFV or WNV infections were screened for IgM specific to SFV and WNV.
Results: The overall anti-SFV IgG seroprevalence was 28% and was increasing with age (P< 0.01). The seroprevalence rate for anti-WNV IgG in Cyprus was 5%. Concerning the role of SFVs in CNS infections, anti-SFV IgM was detected in 8 out of 127 sera from selected patients presenting relevant symptoms of infections during vector’s active period. In addition, anti-WNV IgM were detected in 17 out of the 127 patients with compatible symptoms.
Conclusion: The findings confirm the presence of sandfly fever and WNV in Cyprus and should, therefore, be considered in the differential diagnosis of patients with febrile illness/meningitis.
“…The sandfly species is the vector of two diseases namely leishmaniaisis and phlebovirus infections of the Sicilian sandfly fever virus group which are prevalent in southern Europe. Notably sandflies feed on many animals including bats, cats, dogs, hares, rodents, cattle besides humans [5] , [6] . Fig.…”
SARS-CoV-2 incidence and mortality in Europe have shown wide variation. Northern Italy in particular the Lombardy region, north-eastern French regions, Switzerland and Belgium were amongst the hardest hit, while the central and southern Italian regions, all the Balkan countries from Slovenia to Greece and the Islands of Malta and Cyprus had much fewer cases and deaths per capita, and deaths per number of cases. Differences in public health measures, and health care delivery, in the author’s opinion, can only partly explain the difference. The geographical distribution of Phlebotomus sand-flies and the relative distribution of arthropod borne diseases Leishmaniasis and Phlebovirus infections especially the Sicilian Sandfly fever group corresponds to most areas of low prevalence of SARS-CoV-2. A hypothesis is proposed whereby repeated arthropod or sandfly vector infection of humans by novel viruses of zoonotic origins carrying bat or mammalian RNA/DNA, such as phleboviruses may have resulted in the development of an effective evolutionary immune response to most novel zoonotic viruses such as SARS-CoV-2 by means of survival of the fittest possibly over many generations. This process probably ran in parallel and concurrent with the progressive evolution of novel coronaviruses which spread from one mammalian species to another. Other possible, but less likely mechanisms for the role of sandfly meals within a much shorter time frame may have led to, (i) previous exposure and infection of humans with the SARS-Cov-2 virus itself, or a closely related corona virus in the previous decades, or (ii) exposure of human populations to parts coronavirus protein namely either S or more likely N protein carried mechanically by arthropods, but without clinical disease causing direct immunity or (iii) by causing infection with other arthropod borne viruses which could carry bat DNA/RNA and have similar functional proteins resulting in an immediate cross-reactive immune response rather than by natural selection. The Evidence possibly supporting or disputing this hypothesis is reviewed, however the major problem with the hypothesis is that to date no coronavirus has ever been isolated from arthropods. Such a hypothesis can only be supported by research investigating the possible biological relationship of arthropods and coronaviruses where paradoxically they may be promoting immunity rather than disease.
“…Endemik bölgelere seyahat eden kişilerde tatarcık humması seyahat ilişkili infeksiyonlar arasında önemli bir paya sahiptir. Literatürde, başta Kuzey Kıbrıs olmak üzere Akdeniz ülkelerine tatil amaçlı seyahatler sonrası olgular ve endemik bölgelerde görevlendirilen askeri birliklerde salgınlar bildirilmektedir(9,15,16). Tatarcık hummasının endemik olduğu Antalya ili, turizm bölgesi olup her yıl yüz binlerce yerli ve yabancı turisti ağırlamaktadır.…”
Objective: Sandfly fever (SF) is a self-limited vector-related viral infection caused by the SF virus and is spread by phlebotomine sandflies (PSF). Fever, headache, myalgia, arthralgia, loss of appetite, weakness, nausea, and vomiting are the most common symptoms. Laboratory findings include leukopenia, thrombocytopenia, and elevated liver transaminase enzymes. We aimed to examine the demographic, clinical, and laboratory data of patients who were followed with SF diagnosis.
Methods: Patients who were followed with SF diagnosis in our hospital between January 2011 and December 2018 were included. The data were obtained retrospectively.
Results: A total of 64 patients were included in the study. The mean age was 33.1 ± 9.7(min:19-max:58) years and 35(54.7%) of them were male. Although 53.1% had a history of contact with PSF, 92.2% had a bite mark. 91.6% of the patients were living on the ground and first floor. Fever was the most common symptom in 95.3% of the patients; 89% had myalgia-weakness, 79.6% had a headache, and 50% had a conjunctival rash. Increased transaminase enzyme levels were observed in approximately 93% of the patients. The average of ALT and AST were 284.7 U/L and 243.5 U/L, respectively. Leukopenia was observed in 79.6% (51/64) of them, and thrombocytopenia in 78% (50/64). CK elevation was 54% ratio (35/64). Samples were tested from 19 patients for the serological diagnosis of SF. IgM was positive in 15 (78.9%) of 19 patients and negative in 4(21%) patients. IgG was positive in 10 (52.6%) of 19 patients. Both IgG and IgM were positive in 9 patients. Only IgG positivity was detected in one patient.
Conclusion: SF should be considered in patients presenting with complaints such as fever, headache, muscle joint pain, nausea-vomiting, redness in the eyes, leukopenia, thrombocytopenia, elevated transaminase enzyme, CK level, and living in or having a history of travel to subtropical regions, especially during the summer season and a history of PSF contact.
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