- Email: [email protected]
Meningitis and meningoencephalitis associated with Orientia tsutsugamushi infection
156
Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163
Results: Most of larval water types were man-made artificial sites, and belonged to 10 water container or habitat categories for different uses (average productivity: 83.9±103.6 larva/site, 5.4±7.4 pupa/site). SNPs and NJ analyses of single and concatenated marker sequences identified different molecular haplotypes unique to Saudi Arabian Ae. aegypti populations and numerous haplotypes shared with Ae. aegypti from other zoogeographic regions. Microsatellite loci showed that Ae. aegypti from Saudi Arabia is most closely-related to Asian populations, although they are genetically distinct. These results indicate the presence of considerable genetic variation among the studied Ae. aegypti populations from Saudi Arabia and other world zoogeographic regions. Conclusion: This is the first report on Ae. aegypti phylogenetics from the Arabian Peninsula, the most eastern part of the Afrotropical zone, and bordering the Palaearctic and Oriental zones. These results are important for better understanding of dengue transmission and implementation of control programmes at both the national and global levels. http://dx.doi.org/10.1016/j.ijid.2016.11.380 20.197 First molecular identification of Dirofilaria spp. (Onchocercidae) in mosquitoes from Serbia K. Kurucz a , A. Kepner b , B. Krtinic c , B. Zana a , F. Földes a , K. Banyai d , M. Oldal a , F. Jakab a,∗ , G. Kemenesi a a
University of Pécs, Szentágothai Research Centre, Virological Research Group, Pécs/HU b University of Pécs, Institute of Biology, Faculty of Sciences, Pécs/HU c Ciklonizacija, Novi Sad/RS d Hungarian Academy of Sciences, Centre for Agricultural Research, Institute for Veterinary Medical Research, Budapest/HU Purpose: Dirofilariosis is a common and widespread veterinary health issue in several European countries with notable zoonotic potential. The causative agents are Dirofilaria immitis and Dirofilaria repens nematoda species which are transmitted by different mosquito vectors. Similar to other mosquito-borne infections, the knowledge about mosquito species involved in disease transmission is crucial for the complex understanding of local transmission cycles. Methods & Materials: Since there is no available data on mosquito species, potentially involved in disease transmission from Serbia, 6369 female mosquito individuals representing 11 species were retrospectively tested for Dirofilaria nematodes, collected within the framework of a municipal mosquito monitoring programme from 13 localities in Vojvodina province, Serbia, in 2013. After species identification by morphological taxonomic keys, nucleic acid extractions from mosquito homogenates were tested for Dirofilaria repens and Dirofilaria immitis using molecular biological technics. Results: Altogether, 8.33% of tested pools showed positivity, composed of five mosquito species, mainly, Culex pipiens and Aedes vexans the most abundant species of the area. Dirofilaria immitis (80% of infected mosquitoes) and Dirofilaria repens (20%) were both detected from multiple localities (n = 6, both urban and rural areas), during the whole period of mosquito breeding season (from May to August with a maximum rate in July), which provides the first data on local transmission characteristics regarding mosquitoes from the Balkans.
Conclusion: Since urban territories were found to be positive also, our results need to be concerned by veterinary and human health professionals as well and call increased attention to the importance of mosquito surveillance, particularly in humanassociated areas. http://dx.doi.org/10.1016/j.ijid.2016.11.381 20.198 Meningitis and meningoencephalitis associated with Orientia tsutsugamushi infection H.S. Lee a,∗ , J.-S. Sunwoo b , S.-J. Ahn a , J. Moon a , J.-A. Lim a , J.-S. Jun a , W.-J. Lee a , S.-T. Lee a , S.K. Lee a , K. Chu a a
Seoul National University Hospital, Neurology, Seoul/KR b Soonchunhyang University Seoul Hospital, Neurology, Seoul/KR Purpose: O. Tsutsugamushi is a rare entity of central nervous system infection but can result in life-threatening conditions and requires timely treatment. We investigated the clinical and laboratory findings of patients with O. Tsutsugamushi-related meningitis/meningoencephalitis and their outcome. Methods & Materials: Patients diagnosed with meningitis/meningoencephalitis who were admitted to the Department of Neurology, Seoul National University, Korea, between January 1, 2000 and December 31, 2015 were enrolled. O. Tsutsugamushi infection was diagnosed with serologic testing. Clinical and laboratory information was obtained by the electronic medical records of Seoul National University Hospital. Results: Sixteen cases were identified, of whom ten were diagnosed with meningitis and six with meningoencephalitis. Thirteen patients (82%) had headaches and nine patients (56%) had fever, though six out of the ten patients with meningitis only reported headaches without febrile illness. Eschar was found in two of the patients with meningoencephalitis but none in patients with meningitis. Cerebrospinal fluid (CSF) WBC counts were higher in patients with meningitis (mean ± S.E.M., 384.2 ± 132.8/•) than in patients with meningoencephalitis (44.8 ± 36.0/•) (p-value = 0.020). Four out of the six patients with meningoencephalitis showed no or mild (≤10/•) pleocytosis. One patient showed no WBC in the CSF on the day of admission despite dysarthria and personality change occurred 6 days earlier but showed delayed pleocytosis (16/•) 2 days after admission. Critical care was needed in 1 patient due to hemorrhagic fever with renal syndrome accompanied with scrub typhus. All patients were treated with doxycycline and recovered to normal without significant neurologic deficits. Conclusion: O. Tsutsugamushi should be suspected as an etiology of meningitis/meningoencephalitis in endemic areas and empirical treatment should be started on clinical suspicion despite the lack of CSF pleocytosis, especially in cases of meningoencephalitis. Repeated CSF studied may show delayed pleocytosis supporting the evidence of meningoencephalitis. A considerable proportion of patients only reported headaches, therefore the lack of febrile illness should not delay the diagnosis of meningitis. Neurologic recovery is excellent with minor sequelae if treated rapidly and systemic infection is well-controlled. http://dx.doi.org/10.1016/j.ijid.2016.11.382
Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163
Results: Most of larval water types were man-made artificial sites, and belonged to 10 water container or habitat categories for different uses (average productivity: 83.9±103.6 larva/site, 5.4±7.4 pupa/site). SNPs and NJ analyses of single and concatenated marker sequences identified different molecular haplotypes unique to Saudi Arabian Ae. aegypti populations and numerous haplotypes shared with Ae. aegypti from other zoogeographic regions. Microsatellite loci showed that Ae. aegypti from Saudi Arabia is most closely-related to Asian populations, although they are genetically distinct. These results indicate the presence of considerable genetic variation among the studied Ae. aegypti populations from Saudi Arabia and other world zoogeographic regions. Conclusion: This is the first report on Ae. aegypti phylogenetics from the Arabian Peninsula, the most eastern part of the Afrotropical zone, and bordering the Palaearctic and Oriental zones. These results are important for better understanding of dengue transmission and implementation of control programmes at both the national and global levels. http://dx.doi.org/10.1016/j.ijid.2016.11.380 20.197 First molecular identification of Dirofilaria spp. (Onchocercidae) in mosquitoes from Serbia K. Kurucz a , A. Kepner b , B. Krtinic c , B. Zana a , F. Földes a , K. Banyai d , M. Oldal a , F. Jakab a,∗ , G. Kemenesi a a
University of Pécs, Szentágothai Research Centre, Virological Research Group, Pécs/HU b University of Pécs, Institute of Biology, Faculty of Sciences, Pécs/HU c Ciklonizacija, Novi Sad/RS d Hungarian Academy of Sciences, Centre for Agricultural Research, Institute for Veterinary Medical Research, Budapest/HU Purpose: Dirofilariosis is a common and widespread veterinary health issue in several European countries with notable zoonotic potential. The causative agents are Dirofilaria immitis and Dirofilaria repens nematoda species which are transmitted by different mosquito vectors. Similar to other mosquito-borne infections, the knowledge about mosquito species involved in disease transmission is crucial for the complex understanding of local transmission cycles. Methods & Materials: Since there is no available data on mosquito species, potentially involved in disease transmission from Serbia, 6369 female mosquito individuals representing 11 species were retrospectively tested for Dirofilaria nematodes, collected within the framework of a municipal mosquito monitoring programme from 13 localities in Vojvodina province, Serbia, in 2013. After species identification by morphological taxonomic keys, nucleic acid extractions from mosquito homogenates were tested for Dirofilaria repens and Dirofilaria immitis using molecular biological technics. Results: Altogether, 8.33% of tested pools showed positivity, composed of five mosquito species, mainly, Culex pipiens and Aedes vexans the most abundant species of the area. Dirofilaria immitis (80% of infected mosquitoes) and Dirofilaria repens (20%) were both detected from multiple localities (n = 6, both urban and rural areas), during the whole period of mosquito breeding season (from May to August with a maximum rate in July), which provides the first data on local transmission characteristics regarding mosquitoes from the Balkans.
Conclusion: Since urban territories were found to be positive also, our results need to be concerned by veterinary and human health professionals as well and call increased attention to the importance of mosquito surveillance, particularly in humanassociated areas. http://dx.doi.org/10.1016/j.ijid.2016.11.381 20.198 Meningitis and meningoencephalitis associated with Orientia tsutsugamushi infection H.S. Lee a,∗ , J.-S. Sunwoo b , S.-J. Ahn a , J. Moon a , J.-A. Lim a , J.-S. Jun a , W.-J. Lee a , S.-T. Lee a , S.K. Lee a , K. Chu a a
Seoul National University Hospital, Neurology, Seoul/KR b Soonchunhyang University Seoul Hospital, Neurology, Seoul/KR Purpose: O. Tsutsugamushi is a rare entity of central nervous system infection but can result in life-threatening conditions and requires timely treatment. We investigated the clinical and laboratory findings of patients with O. Tsutsugamushi-related meningitis/meningoencephalitis and their outcome. Methods & Materials: Patients diagnosed with meningitis/meningoencephalitis who were admitted to the Department of Neurology, Seoul National University, Korea, between January 1, 2000 and December 31, 2015 were enrolled. O. Tsutsugamushi infection was diagnosed with serologic testing. Clinical and laboratory information was obtained by the electronic medical records of Seoul National University Hospital. Results: Sixteen cases were identified, of whom ten were diagnosed with meningitis and six with meningoencephalitis. Thirteen patients (82%) had headaches and nine patients (56%) had fever, though six out of the ten patients with meningitis only reported headaches without febrile illness. Eschar was found in two of the patients with meningoencephalitis but none in patients with meningitis. Cerebrospinal fluid (CSF) WBC counts were higher in patients with meningitis (mean ± S.E.M., 384.2 ± 132.8/•) than in patients with meningoencephalitis (44.8 ± 36.0/•) (p-value = 0.020). Four out of the six patients with meningoencephalitis showed no or mild (≤10/•) pleocytosis. One patient showed no WBC in the CSF on the day of admission despite dysarthria and personality change occurred 6 days earlier but showed delayed pleocytosis (16/•) 2 days after admission. Critical care was needed in 1 patient due to hemorrhagic fever with renal syndrome accompanied with scrub typhus. All patients were treated with doxycycline and recovered to normal without significant neurologic deficits. Conclusion: O. Tsutsugamushi should be suspected as an etiology of meningitis/meningoencephalitis in endemic areas and empirical treatment should be started on clinical suspicion despite the lack of CSF pleocytosis, especially in cases of meningoencephalitis. Repeated CSF studied may show delayed pleocytosis supporting the evidence of meningoencephalitis. A considerable proportion of patients only reported headaches, therefore the lack of febrile illness should not delay the diagnosis of meningitis. Neurologic recovery is excellent with minor sequelae if treated rapidly and systemic infection is well-controlled. http://dx.doi.org/10.1016/j.ijid.2016.11.382