RESUMO
Background: Tick-borne relapsing fever (TBRF) caused by Borrelia persica is an endemic disease in Israel and highly prevalent in military personnel. Prevention among the Israel Defense Force soldiers is based on increased awareness mainly in hyperendemic areas and selective postexposure prophylaxis with doxycycline. In this study, we report the presence of a suspected outbreak of TBRF in four soldiers who spent 30 h inside a deserted bunker. Materials and Methods: Clinical data on TBRF suspected cases were retrieved from clinical records, soft ticks were collected using carbon dioxide (CO2) traps and their DNA was extracted and analysed by PCR and nucleotide sequencing. Environmental conditions such as relative humidity, air temperature, wind speed, and type of soil, as well as presence or absence of animal traces inside the bunkers were documented. Results: TBRF-like clinical symptoms in the patients included: tick bite scars, fever (37.5-39.2°C), rash, tachycardia, hypotension, myalgia, cough, headache, cervical lymphadenopathy and nausea. Microscopic search for B. persica in blood smears was performed in three patients and was negative. Out of the 255 Ornithodoros tholozani ticks collected from the bunker, 198 were analyzed and 2 (1%) were infected with B. persica. To determine if tick infestation in military bunkers is a common phenomenon, we surveyed nine additional military bunkers located in four different geographical areas for the presence of soft ticks. Only one additional bunker was infested with two O. tholozani ticks, both negative for B. persica. Presence of earth that probably helped sustain a relatively big tick population was observed on the floor in the highly infested bunker. Environmental treatment with lambda-cyhalothrin at 9.7% was performed and showed efficacy with no ticks recovered in the infested bunker 124 days after intervention. Conclusion: This study shows that military bunkers may harbor soft ticks infected with B. persica and entrance into bunkers should be considered as a risk for acquiring this infection like entrance into natural caves and archeological ruins.
RESUMO
Prevalence of Leishmania spp. infection was studied in stray cats in two military bases in Southern Israel during a cutaneous leishmaniosis (CL) human outbreak caused by Leishmania major. Human CL cases increased from 0/100 in 2008 to 1.28/100 in 2022 in camp #1, and from 0.17/100 in 2008 to 6.4/100 in 2022, in camp #2. Eight out of 29 cats sampled were Leishmania-seropositive (28 %) and 7/29 (24 %) were internal transcribed spacer 1 (ITS1) PCR-positive, out of which four (14 %) were positive for L. major and three (10 %) for L. infantum. Five positive-cats had skin lesions including ulcers, alopecia and scabs, and five had eye lesions. This is the first report of L. major infection in cats in Israel and one of the first descriptions in felines worldwide. A larger cohort of cats and vector studies are necessary to determine if felids may act as reservoirs or sentinels of human L. major infection.