Lethal pulmonary embolism in a pregnant woman with severe acute respiratory syndrome coronavirus-2 receiving prophylactic anticoagulation: a case report.

BACKGROUND: A limited number of studies have described thrombotic complications in pregnant women with COVID-19. Here we report on fatal pulmonary embolism in a pregnant woman with laboratory confirmed SARS-CoV-2 infection. CASE PRESENTATION: A 28-year-old Kazakh woman was hospitalized with muscle pain, dry cough and a temperature of 37.5 °C at the 29th week of gestation. Upon admission, a blood test demonstrated elevated neutrophil-to-lymphocyte ratio, decreased levels of erythrocytes and hemoglobin, as well as prolonged prothrombin and activated partial thromboplastin time. Within 14 days of admission, she experienced respiratory distress and underwent transfer to the intensive care unit, intubation and a cesarean section. The patient received intravenous antibiotics, antiviral medications, systemic corticosteroids and dual anticoagulation with aspirin and enoxaparin. Death outcome was reported on day 18 of illness despite aggressive supportive care. Histological analysis demonstrated that obstruction of the main pulmonary arthery and disseminated intravascular coagulation were the causes of death. CONCLUSIONS: This case demonstrates that in the management of pregnancy and childbirth in patients with suspected or confirmed COVID-19 infection, special attention should be paid to coagulation system parameters and timely appropriate prophylaxis of thromboembolic complications, which has yet to be determined.

Molecular and seroepidemiological investigation of Сoxiella burnetii and spotted fever group rickettsiae in the southern region of Kazakhstan.

Ticks are involved in the circulation of a number of human pathogens, including spotted fever group (SFG) Rickettsia spp. and Coxiella burnetii. Little is known about the occurrence of these microorganisms in the southern region of Kazakhstan. In 2018-2022, a total of 726 ticks were collected from bitten humans, livestock, and vegetation in four oblasts of the southern region of Kazakhstan and subjected to DNA extraction. The overall infection rate of Coxiella spp. and Rickettsia spp. in the ticks was 3.3% (24/726) and 69.9% (300/429), respectively. Phylogenetic analysis of ompA and gltA genes revealed the presence of three pathogenic SFG rickettsiae: Candidatus R. tarasevichiae, R. aeschlimannii and R. raoultii in ticks collected from bitten humans. In addition, Candidatus R. barbariae was detected in six Rhipicephalus turanicus ticks for the first time in Kazakhstan. To determine the seroprevalence of C. burnetii infection, we performed a serological analysis of samples collected from 656 domestic ruminants (cattle, sheep, and goats) in the region. Overall, 23.5% (154/656) of the animals tested were positive for IgG against C. burnetii. Seroprevalence at the herd level was 54% (28/52). Goats (43%; 12/28; odds ratio (OD) = 28.9, p < 0.05) and sheep (31.9%; 137/430; OD = 18.1, p < 0.05) had higher seroprevalence than cattle (2.5%; 5/198). Among the risk factors considered in this study, age (p = 0.003) and the oblast in which the animals were sampled (p = 0.049) were statistically associated with seropostivity for Q fever in sheep, according to the results of multivariate logistic regression analysis. Seroprevalence ranged from 0% to 55.5% in animals in different districts of the southern region of Kazakhstan. Active C. burnetii bacteremia was detected in four of 154 (2.6%) seropositive animals. The data obtained provide strong evidence of the presence of pathogenic rickettsiae and C. burnetii in the southern region of Kazakhstan and emphasize the need to improve epidemiological surveillance in the region.

A Case of Combined Infection with Tick-Borne Encephalitis and Lyme Borreliosis with Severe Meningoencephalitis and Complete Recovery.

Here, we present a case of severe meningoencephalitis caused by combined infection with tick-borne encephalitis (TBE) and Lyme borreliosis (LB) in a 25-year-old woman in a rural area of Zhambyl region, Kazakhstan. She presented with fever, nausea, vomiting, weakness, sweating, severe headache, arthralgia, and malaise. The course of illness was further complicated by encephalitis with symmetric lesions of the midbrain cerebral peduncles and serous meningitis. TBE and LB co-infection were established by a two-fold increase in serum IgG titers between day 21 and day 25 of illness. Both infections responded well to combined therapy with human TBE immunoglobulins, antibiotics, antiviral drugs, glucocorticoids, and diuretics. The outcome of the disease was favorable and the patient recovered completely.

Monitoring of pathogenic Borrelia burgdorferi sensu lato in the Almaty oblast, Kazakhstan.

Lyme borreliosis (LB) is one of the most common vector-borne diseases transmitted by ticks. It is caused by the Borrelia burgdorferi sensu lato (s.l.) genospecies. The Almaty oblast of Kazakhstan is considered endemic for LB. Nevertheless, there are significant gaps in the tick surveillance for LB agents in the region. We evaluated B. burgdorferi s.l. prevalence in 413 ixodid ticks collected from bitten people and the seroprevalence of antibodies to B. burgdorferi s.l. in 589 residents of the Almaty oblast, Kazakhstan. All samples were collected between 2018 and 2020. Borrelia burgdorferi s.l. DNA was detected in 24 % (9/38) of I. persulcatus ticks that attacked humans in the city of Almaty and the Talgar and Karasay districts. Multilocus sequence typing identified two novel B. afzelii sequence types in I. persulcatus. The seroprevalence of IgG antibodies against B. burgdorferi s.l. in the analyzed population was detected to be 5.8 %. The obtained results confirm active circulation of B. burgdorferi s.l. in the Almaty oblast of Kazakhstan and raise concern regarding LB preventive measures in the region.

The prevalence of Borrelia in Ixodes persulcatus in southeastern Kazakhstan.

Borreliosis is one of the most common vector-borne zoonotic diseases in the world. Limited data are available regarding Borrelia spp. and their genotypes in Kazakhstan. The goal of this study was to investigate the prevalence of Borrelia spp. in ixodid ticks collected in the southeastern region of Kazakhstan. A total of 1907 ixodid ticks were collected by flagging vegetation at three collection areas in the Almaty oblast between 2015 and 2018. They were grouped into 407 pools and examined by qPCR for Borrelia burgdorferi sensu lato (s.l.). A conventional PCR with specific primers targeting 16S rRNA gene was used to differentiate B. burgdorferi s.l. genospecies. Sequence analysis of the PCR products was performed for sixteen samples. Lyme borreliosis agents were only detected in adult questing Ixodes persulcatus. The overall B. burgdorferi s.l. prevalence in I. persulcatus estimated as the minimum infection rate reached 10.7 %. Borrelia burgdorferi sensu stricto was not detected in any of the tick pools. Partial 16S rRNA gene sequencing revealed the presence of B. miyamotoi, B. afzelii, and B. garinii. Borrelia afzelii was the dominant genospecies in Almaty oblast. A significantly lower proportion of B. garinii positive tick pools was detected in the Zailiyskiy Alatau as compared to the Dzungarian Alatau (χ2 = 16.243; p = 0.0001) and Yenbekshikazakh district (χ2 = 7.4156; p = 0.0065). The obtained results indicate the epidemiological significance of B. afzelii and B. garinii in southeastern Kazakhstan. These new data aim to improve the diagnostics of Lyme borreliosis and monitoring of tick-borne infections in Kazakhstan.

Tick-borne pathogens and their vectors in Kazakhstan - A review.

Tick-borne diseases (TBDs), in particular Crimean-Congo hemorrhagic fever (CCHF) and tick-borne encephalitis (TBE), have been found to be expanding beyond their traditional geographic locations in Kazakhstan, which led to increased awareness and concern against TBDs in recent years. The tick fauna of Kazakhstan includes more than 30 species of human-biting ixodid ticks, recognized as carriers of a number of dangerous infectious pathogens that cause CCHF, TBE, tularemia, tick-borne rickettsioses and Lyme borreliosis. This paper presents the current knowledge of the main vectors of tick-borne pathogens (TBP) occurring in Kazakhstan, as well as a review of recent studies of ticks performed with the use of molecular methods being currently developed and widely utilized by Kazakh epidemiologists.

Two case reports of neuroinvasive West Nile virus infection in the Almaty region, Kazakhstan.

BACKGROUND: West Nile virus (WNV) is a member of the genus Flavivirus, which transmitted to humans mainly by mosquitoes. Recent pilot serosurveillance data from the Almaty region, Kazakhstan, suggest widespread WNV circulation in this area. This report includes two cases of neuroinvasive WNV infection in the same family living in a rural area near Tekeli city, Eskeldinsky district, Almaty region, Kazakhstan. Occurring concurrently and manifesting as WNV infection with febrile illness and symptoms of meningoencephalitis. METHODS: The study performed retrospective analysis of clinical histories and achieved serum samples obtained from patients with febrile and meningoencephalitic syndromes of unknown origin in the Almaty region spanning from April 1 to October 31, 2019. All sera samples obtained from patients with clinically suspected cases of acute WNV infection were retrospectively tested for WNV and tick-borne encephalitis virus by commercial immunoassays. Two cases were selected. CASES PRESENTATION: We report two cases that occurred in August 2019 in a rural area near Tekeli city. Previously healthy 28- and 19-year-old husband and wife with febrile illness and neurological manifestations were hospitalized with the diagnosis of meningoencephalitis of unknown etiology and treated empirically. Retrospective serological analysis showed the presence of high titers of IgG against WNV on day 9 after onset of symptoms in cases. CONCLUSIONS: This is the first report of aseptic meningitis with WNV infection in the background in Kazakhstan. The obtained data suggest circulation of WNV in the Almaty region and emphasize importance of laboratory testing for WNV in suspicious cases occurring in the region.