Prevalence of selected sexually transmitted infectious agents in a cohort of asymptomatic soldiers in Austria.

BACKGROUND: According to the World Health Organization (WHO), more than one million sexually transmitted infections (STIs) are acquired every day worldwide. Although STIs may be asymptomatic in many cases, they can cause severe symptoms and can also lead to adverse pregnancy outcomes and both male and female infertility. Asymptomatic carriers seem to play an important role in terms of the distribution of STIs; however, studies revealing the prevalence of STIs in asymptomatic individuals are rare. METHODS: In the current study, 654 leftovers of standard urine samples from healthy, asymptomatic Austrian soldiers were investigated for the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, and genital mycoplasmas (Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, and Candidatus Mycoplasma girerdii) by specific PCRs. RESULTS: We detected T. vaginalis, M. hominis, U. urealyticum, U. parvum, and C. trachomatis in the investigated samples with prevalence of 7.6%, 4%, 2.4%, 5.4%, and 3.2%, respectively; neither M. genitalium nor Ca. Mycoplasma girerdii was found in our sample collection. CONCLUSIONS: Our study introduces data on STIs of a mainly male cohort, which are scarce because most of the available information on sexually transmitted infectious agents arises from fertility clinics (mainly women) or symptomatic patients.

Ecology, seasonality and host preferences of Austrian Phlebotomus (Transphlebotomus) mascittii Grassi, 1908, populations.

BACKGROUND: Sand flies are principal vectors of the protozoan parasites Leishmania spp. and are widely distributed in all warmer regions of the world, including the Mediterranean parts of Europe. In Central European countries, the sand fly fauna is still under investigation. Phlebotomus mascittii, a suspected but unproven vector of Leishmania infantum, is regarded as the most widely distributed species in Europe. However, many aspects of its biology and ecology remain poorly known. The aim of this study was to provide new data on the biology and ecology of Ph. mascittii in Austria to better understand its current distribution and potential dispersal. METHODS: Sand flies were collected by CDC light traps at four localities in Austria for 11 (2018) and 15 weeks (2019) during the active sand fly season. Climatic parameters (temperature, relative humidity, barometric pressure and wind speed) were retrospectively obtained for the trapping periods. Sand flies were identified by a combined approach (morphology, DNA barcoding, MALDI-TOF protein profiling), and blood meals of engorged females were analysed by DNA sequencing and MALDI-TOF mass spectrometry. RESULTS: In total, 450 individuals of Ph. mascittii were caught. Activity was observed to start at the beginning of June and end at the end of August with peaks in mid-July at three locations and early August at one location. Increased activity was associated with relatively high temperatures and humidity. Also, more individuals were caught on nights with low barometric pressure. Analysis of five identified blood meals revealed chicken (Gallus gallus) and equine (Equus spp.) hosts. Sand fly abundance was generally associated with availability of hosts. CONCLUSION: This study reports unexpectedly high numbers of Ph. mascittii at selected Austrian localities and provides the first detailed analysis of its ecology to date. Temperature and humidity were shown to be good predictors for sand fly activity. Blood meal analyses support the assumption that Ph. mascittii feeds on mammals as well as birds. The study significantly contributes to understanding the ecology of this sand fly species in Central Europe and facilitates prospective entomological surveys.

Phlebotomus (Adlerius) simici NITZULESCU, 1931: first record in Austria and phylogenetic relationship with other Adlerius species.

BACKGROUND: Phlebotomine sand flies are the principal vectors of Leishmania spp. (Kinetoplastida: Trypanosomatidae). Information on sand flies in Central Europe is scarce and, to date, in Austria, only Phlebotomus mascittii has been recorded. In 2018 and 2019, entomological surveys were conducted in Austria with the aim to further clarify sand fly distribution and species composition. RESULTS: In 2019, a Ph. simici specimen was trapped in Austria for the first time. Analyses of two commonly used marker genes, cytochrome c oxidase I (coxI) and cytochrome b (cytb), revealed high sequence identity with Ph. simici specimens from North Macedonia and Greece. Phylogenetic analyses showed high intraspecific distances within Ph. simici, thereby dividing this species into three lineages: one each from Europe, Turkey and Israel. Low interspecific distances between Ph. simici, Ph. brevis and an as yet unidentified Adlerius sp. from Turkey and Armenia highlight how challenging molecular identification within the Adlerius complex can be, even when standard marker genes are applied. CONCLUSION: To our knowledge, this study reports the first finding of Ph. simici in Austria, representing the northernmost recording of this species to date. Moreover, it reveals valuable insights into the phylogenetic relationships among species within the subgenus Adlerius. Phlebotomus simici is a suspected vector of L. infantum and therefore of medical and veterinary importance. Potential sand fly expansion in Central Europe due to climatic change and the increasing import of Leishmania-infected dogs from endemic areas support the need for further studies on sand fly distribution in Austria and Central Europe in general.

Integrative Approach to Phlebotomus mascittii Grassi, 1908: First Record in Vienna with New Morphological and Molecular Insights.

Sand flies (Diptera: Psychodidae: Phlebotominae) are blood-feeding insects that transmit the protozoan parasites Leishmania spp. and various arthropod-borne (arbo) viruses. While in Mediterranean parts of Europe the sand fly fauna is diverse, in Central European countries including Austria mainly Phlebotomus mascittii is found, an assumed but unproven vector of Leishmania infantum. To update the currently understudied sand fly distribution in Austria, a sand fly survey was performed and other entomological catches were screened for sand flies. Seven new trapping locations of Ph. mascittii are reported including the first record in Vienna, representing also one of the first findings of this species in a city. Morphological identification, supported by fluorescence microscopy, was confirmed by two molecular approaches, including sequencing and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) protein profiling. Sand fly occurrence and activity were evaluated based on surveyed locations, habitat requirements and climatic parameters. Moreover, a first comparison of European Ph. mascittii populations was made by two marker genes, cytochrome c oxidase subunit 1 (COI), and cytochrome b (cytb), as well as MALDI-TOF mass spectra. Our study provides new important records of Ph. mascittii in Austria and valuable data for prospective entomological surveys. MALDI-TOF MS protein profiling was shown to be a reliable tool for differentiation between sand fly species. Rising temperatures and globalization demand for regular entomological surveys to monitor changes in species distribution and composition. This is also important with respect to the possible vector competence of Ph. mascittii.

Application errors associated with topical treatment of scabies: an observational study.

BACKGROUND: In recent years, there has been a significant increase in scabies infestations throughout German-speaking countries. Given the high frequency of treatment failures, the question arises as to whether topical permethrin treatment is always performed correctly. PATIENTS AND METHODS: Our department uses a fluorescent test cream to teach patients on how to correctly apply topical permethrin. In the context of a prospective observational study of 21 patients, we systematically assessed and analyzed potential application errors. RESULTS: None of the participants succeeded in adequately applying the cream to the entire skin as previously instructed. The median number of regions left untreated was six (minimum: 2; maximum: 18), which included a median body surface area of 6 % (minimum: 2 %; maximum: 30 %). With regard to predilection sites of scabies, the ankles were left untreated in 62 % of cases, followed by the interdigital spaces (toes) (33 %) and the sacral region (24 %). All patients considered the pretreatment training to be very useful. CONCLUSIONS: The present findings clearly demonstrate potential shortcomings when it comes to the application of topical antiscabies treatment. This may provide a (potentially underestimated) explanation for the large number of reports on treatment failures in this regard, which falsely suggest potential treatment resistance.

Leishmania spp. seropositivity in Austrian soldiers returning from the Kosovo.

Leishmaniasis is a severe vector-borne disease with two main clinical forms, visceral leishmaniasis and cutaneous leishmaniasis. Both forms of leishmaniasis are also endemic in Mediterranean countries including the Balkan region from where mainly visceral leishmaniasis is reported. Austrian soldiers returning from Kosovo were screened for anti-Leishmania antibodies to assess the risk of infection during operations. Anti-Leishmania antibodies were detected in more than 20% of the soldiers investigated, which indicates a considerable risk of infection during missions in this area and thus suggests the application of protective measures.

Phlebovirus seroprevalence in Austrian Army personnel returning from missions abroad.

BACKGROUND: Phleboviruses are mainly transmitted by sand flies and infections can result in various symptoms, including meningitis and meningoencephalitis. In endemic regions, seroprevalences in humans and animals are high. Military personnel on missions in endemic areas are at increased risk of infection, however, for soldiers from central European countries, data are scarce. The aims of this study were to determine the exposure to phleboviruses of Austrian soldiers returning from missions abroad and to assess potential risk factors. A retrospective serological study was performed with sera of 753 healthy Austrian soldiers returning from missions in Bosnia and Herzegovina (BIH, n = 61), Kosovo (n = 261), Syria (n = 101) and Lebanon (n = 63) and of soldiers prior to their missions (n = 267). RESULTS: Altogether, 119 sera (15.8%, 119/753) were positive for anti-Phlebovirus IgG antibodies, with highest seroprevalences found in soldiers returning from Kosovo (20.69%, 54/261), followed by Syria (17.82%, 18/101), Lebanon (14.29%, 9/63) and BIH (11.48%, 7/61). Of the soldiers tested prior to their missions 11.61% (31/267) were positive. Of the 119 seropositive individuals, 30 (25.2%, 30/119) also had anti-Phlebovirus IgM antibodies. Phlebovirus seropositivity significantly correlated with symptoms of febrile illness during the respective mission (OR: 1.9, 95% CI: 1.1-3.4, P = 0.03) and with Leishmania seropositivity (OR: 2.7, 95% CI: 1.2-5.8, P = 0.009). Also, the outdoor activity "running" during the mission showed a strong trend towards an association with Phlebovirus seropositivity (OR: 1.9, 95% CI: 0.9-4.4, P = 0.08), and seropositivity generally increased with the duration of a mission (OR: 2.5, 95% CI: 0.9-7.5, P = 0.07). CONCLUSIONS: This study indicates that soldiers are exposed to sand flies and at significant risk for Phlebovirus infection during missions in the Mediterranean area and the Middle East. Adequate prevention measures should be applied particularly during vespertine outdoor activities.

Seroprevalence for Coxiella burnetii, Francisella tularensis, Brucella abortus and Brucella melitensis in Austrian adults: a cross-sectional survey among military personnel and civilians.

The prevalence of Coxiella burnetii, Francisella tularensis, Brucella abortus, and Brucella melitensis infections in Austria and the exposure risk of military personnel were assessed in an exploratory nationwide cross-sectional seroprevalence survey in 526 healthy adult individuals, 222 of which were soldiers and 304 were civilians. Screening for IgA/IgG antibodies to C. burnetii (Phase I) and IgG/IgM antibodies to C. burnetii (Phase II), and to F. tularensis was done with commercial enzyme-linked immunosorbent assays. To detect antibodies against B. abortus and B. melitensis, an in-house complement fixation test was used. Overall, 11 individuals (2.0%) showed antibodies to C. burnetii, 3 individuals (0.5%) were seropositive for F. tularensis, and one (0.3%) individual was borderline positive. All individuals positive or borderline for F. tularensis tested negative for antibodies against C. burnetii. All individuals tested negative for antibodies against B. melitensis/B. abortus. There were no significant differences between the seroprevalence of C. burnetii and F. tularensis among military personnel and civilians. Our data demonstrate serological evidence of a low rate of exposure to C. burnetii and F. tularensis among the Austrian adult population and military personnel.

Hepatitis E virus seroprevalence in Austrian adults: a nationwide cross-sectional study among civilians and military professionals.

BACKGROUND: Hepatitis E Virus (HEV) infection is globally increasing. The present study was performed to investigate the HEV seroprevalence, exposure risks as well as occupational risks for military personnel in Austria, a Central European country. METHODS AND FINDINGS: A nationwide cross-sectional seroprevalence study was performed in 997 healthy Austrian adults, professional soldiers and civilians. Routine laboratory and HEV specific antibodies were determined. In addition, epidemiological information on possible risk factors for exposure to HEV was obtained. The overall seropositivity for HEV antibodies was 14.3% and significantly increased with age. Seroprevalence was significantly higher among individuals with previous military employments abroad (21.4% vs. 9.9%) and among professional soldiers aged 30-39 years (20.2% vs. 7.3%). No association was found for private travel, occupational or private animal contact or regular outdoor activities. Individuals who tested positive for antibodies against HEV had significantly higher laboratory values regarding liver enzymes, lipid levels and blood fasting glucose. CONCLUSIONS: Exposure to HEV is common in Austria. Military employment abroad could be a potential risk factor for HEV infection. Further studies are required to investigate the significance of pathological laboratory results found among asymptomatic individuals previously exposed to HEV.

Emergence of sandflies (Phlebotominae) in Austria, a Central European country.

The possible existence of autochthonous sandfly populations in Central Europe north of the Alps has long been excluded. However, in the past years, sandflies have been documented in Germany, Belgium, and recently, also in Austria, close to the Slovenian border. Moreover, autochthonous human Leishmania and Phlebovirus infections have been reported in Central Europe, particularly in Germany. From 2010 to 2012, sandfly trapping (740 trap nights) was performed at 53 different capture sites in Austria using battery-operated CDC miniature light traps. Sites were chosen on the basis of their climate profile in the federal states Styria, Burgenland, and Lower Austria. Sandfly specimens found were transferred to 70% ethanol for conservation. Identification was based on morphological characters of the male genitalia and the female spermathecae, respectively. Altogether, 24 specimens, 22 females and 2 males, all identified as Phlebotomus (Transphlebotomus) mascittii Grassi, 1908, were found at six different sampling sites in all three federal states investigated. The highest number of catches was made on a farm in Lower Austria. Altogether, the period of sandfly activity in Austria was shown to be much longer than presumed, the earliest capture was made on July 3rd and the latest on August 28th. Sandflies have been autochthonous in Austria in small foci probably for long, but in the course of global warming, further spreading may be expected. Although P. mascittii is only an assumed vector of Leishmania spp.-data on its experimental transmission capacity are still lacking-the wide distribution of sandflies in Austria, a country thought to be free of sandflies, further supports a potential emergence of sandflies in Central Europe. This is of medical relevance, not only with respect to the transmission of Leishmania spp. for which a reservoir is given in dogs, but also with respect to the phleboviruses.

Cross-sectional survey of the seroprevalence of Puumala hantavirus in Austria.

The prevalence of Puumala hantavirus infections in Austria and the occupational exposure of military personnel to this virus were assessed in 2009 in an exploratory nationwide cross-sectional seroprevalence survey in 526 healthy individuals, of which 222 were soldiers and 304 were civilians. In addition, information on possible risk factors for hantavirus exposure, including previous foreign military assignments, residential area, occupational animal contact, and regular outdoor activities, was obtained. Immunoglobulin G antibodies against Puumala hantavirus were examined with a commercial enzyme-linked immunosorbent assay. Overall, 7 (1.3%) individuals, aged 19, 22, 24, 24, 26, 38, and 60 years, tested positive on serologic screening. There were no significant differences between the seroprevalence of the virus and any of the variables surveyed. Our data demonstrate serologic evidence of Puumala hantavirus infection among the Austrian population, with a stable prevalence in the past decade. When compared with the general population, no increased risk of exposure to Puumala hantavirus could be detected for military personnel.

Performance of the QuickVue Influenza A+B rapid test for pandemic H1N1 (2009) virus infection in adults.

To investigate the diagnostic accuracy of the QuickVue® Influenza A+B rapid test we conducted a prospective observational study in which this rapid test was compared with a real-time reverse transcription polymerase chain reaction (RT-PCR) for pandemic influenza A H1N1 (2009) infection in Austrian adults. The sensitivity, specificity, and positive and negative predictive values of the QuickVue test compared with the RT-PCR were 26% (95% CI 18-35), 98% (95% CI 92-100), 94% (95% CI 80-99) and 50% (95% CI 42-58), respectively. The prevalence of pandemic H1N1 (2009) virus infection among the 209 patients included in the study was 57%. Our data suggest that a positive QuickVue test provides considerable information for the diagnosis of pandemic influenza A H1N1 (2009) virus infection in young adults but that a negative QuickVue test result should, if relevant for patient management or public health measures, be verified using PCR.

Cutaneous leishmaniasis after travel to Cyprus and successful treatment with miltefosine.

A patient presenting with an atypical manifestation of cutaneous leishmaniasis after travel to Cyprus was successfully treated with miltefosine. The K26 typing revealed a hitherto undescribed strain of the Leishmania donovani/infantum complex as the causing agent.

[Cutaneous leishmaniasis--an import from Belize]. / Kutane Leishmaniose--Import aus Belize.

Cutaneous leishmaniasis of the New World, in particular when caused by Leishmania (L.) braziliensis, harbours the risk of lymphogenic as well as hematogenic dissemination. This may result in mucocutaneous leishmaniasis causing severe destruction of orofacial structures. Dissemination may occur years after the disappearance of the skin lesions. In contrast, cutaneous leishmaniasis of the old world, is typically restricted to the site of inoculation. Therefore, a conservative diagnostic and therapeutic approach is usually sufficient. Infections acquired in the new world should be treated systemically, if infection with Leishmania (Viannia) braziliensis complex cannot be excluded. Here we report on three Austrian soldiers, who, weeks after having participated in an international jungle patrol course in Belize, presented themselves with multiple ulcers on the upper limbs. Diagnosis of cutaneous leishmaniasis was made based upon histological evaluation of biopsies taken from several ulcers revealing the presence of leishmanial bodies, and detection of amastigote leishmania in smears of material obtained from the ulcers. As species phenotyping could not be performed, infection with L. brasiliensis as well as progression into a mucocutaneous form were possible, demanding systemic therapy. Several treatment options including local cryotherapy with liquid nitrogen, paromomycin (Humatis Pulvis, Parke-Davis) 15% topically or oral fluconazole (Diflucan, Pfizer) 200 mg/d were applied, but showed no effect. Hence, a systemic therapy with intravenous pentamidine (Pentacarinat, Gerot), three times in total, 3-4 mg/kg body weight each, led to a complete regression of the lesions within four weeks.