The Prevalence of Tick-Borne Pathogens in Ticks Collected from the Northernmost Province (Sinop) of Turkey.

Ixodes ricinus is a potential vector for some of the tick-borne microorganisms that can cause significant diseases in animals and humans. This study aims to determine the prevalence of Anaplasma, Rickettsia, Bartonella, and Francisella species in host-seeking ticks collected from the forest areas in the Sinop region located in the northernmost part of Turkey. Between May and July 2017, a total of 135 tick pools formed from 2571 of the 2734 ticks collected out of the vegetation. Samples of each pool were homogenized and analyzed by PCR. Infection prevalence was statistically analyzed in view of the maximum likelihood estimation (MLE) with a 95% confidence interval (CI). DNA of the infectious agents was determined only in the adult and nymph pools of I. ricinus. MLE values of Anaplasma spp. and Bartonella spp. in 58 pools formed from 517 of I. ricinus adults were 1.20% (95% CI: 0.50-2.49) and 0.80% (95% CI: 0.26-1.91), respectively. In 42 pools generated from 1222 of I. ricinus nymph, MLE values of infection prevalence for Anaplasma spp. and Bartonella spp. were calculated to be 0.17% (95% CI: 0.03-0.54) and 0.34% (95% CI: 0.11-0.82) in respective order. MLE values for Rickettsia spp. were 7.55% (95% CI: 5.21-10.69) and 0.52% (95% CI: 0.22-1.083) for the adult and nymph I. ricinus, respectively. The DNA of Francisella tularensis was not detected in any tick pool. The outcomes of this research are the first molecular evidence of Bartonella spp. and Bartonella henselae in questing I. ricinus in Turkey. The results also suggested that I. ricinus plays considerable roles in enzootic transmission cycles of Anaplasma phagocytophilum, B. henselae, and Rickettsia monacensis in the northernmost region of Turkey.

Serosurvey of Coxiella burnetii in high risk population in Turkey, endemic to Crimean-Congo haemorrhagic fever virus.

BACKGROUND & OBJECTIVES: Q fever caused by Coxiella burnetii is a zoonotic infection that spreads to human beings from animals. This study was aimed to demographically examine the C. burnetii seroprevalence in the people living in villages where Crimean-Congo haemorrhagic fever virus (CCHFV) is endemic, in terms of various risk factors such as tick bites, tick contact, and occupational groups. METHODS: A total of 440 serum samples from those living in rural areas of Sivas and Tokat regions in Turkey were included in the study as a risk group; 387of them were serologically CCHFV positive (as confirmed in our previous research). Serums of the control group composed of 110 people living in urban areas. In all serum samples, IgG antibodies of C. burnetii against phase-I and phase-II antigens were diagnosed using the ELISA method. RESULTS: Coxiella burnetii seropositivity was detected in 19.09% of those living in rural areas and 4.55% of those living in urban areas (p < 0.001, OR = 4.96). In terms of their approach to the ticks, no statistical difference was observed between the risk groups in the chi-square test (p = 0.787). However, according to univariate analysis, the absorbance means of antibodies reactive to C. burnetii was statistically higher for the rural people who have made contact with ticks than those who have not (p = 0.017). No seroepidemiological relation was found between CCHFV and C. burnetii serology (p = 0.787), and the rate of co-seropositivity between them was 5.43% (21/387). INTERPRETATION & CONCLUSION: The findings of the study showed that C. burnetii infection is epidemic especially in the people living in rural areas. Contact with ticks in various ways might have resulted in the increased risk of C. burnetii infection in the study. Personal protective measures against tick bites may be important for reducing Q fever risk as in other tick-borne infectious disease.

Sequential determination of serum viral titers, virus-specific IgG antibodies, and TNF-α, IL-6, IL-10, and IFN-γ levels in patients with Crimean-Congo hemorrhagic fever.

BACKGROUND: Although there have been a number of studies on the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF) recently, knowledge on this topic is still insufficient. This study aims to reveal the kinetics of serum CCHF virus (CCHFV) titers, serum levels of anti-CCHFV immunoglobulin (Ig)G, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and interferon (IFN)-γ in CCHF patients. METHODS: In total, 31 CCHF cases (11 fatal) were studied. Serum samples were obtained daily from all patients from the time of admission and continued for a 7-day hospitalization period for serologic (ELISA), virologic (real-time PCR), and cytokine (ELISA) analysis. RESULTS: The mean serum CCHFV titer at admission was 5.5E + 09 copies/mL in fatal cases and 5.7E + 08 copies/mL in survivors (p < 0.001). Compared to survivors, both the mean serum levels of IL-6 and TNF-α at admission were found to be significantly increased in fatal cases. The serum levels of IL-6, TNF-α and serum CCHFV titer at admission were significantly and positively correlated with disseminated intravascular coagulation (DIC) scores (r = 0.626, p = 0.0002; r = 0.461, p = 0.009; and r = 0.625, p = 0.003, respectively). When the data obtained from the sequential determination of CCHFV titer and levels of anti-CCHFV IgG, IL-6, TNF-α, IL-10 and IFN-γ were grouped according to the days of illness, the initial serum CCHFV titer of a fatal patient was 5.5E + 09 (copies/mL) and it was 6.1E + 09 (copies/mL) in a survivor on the 2 day of illness. While significant alterations were observed in all cytokines during the monitoring period, IL-6 levels remained consistently higher in fatal cases and TNF-α levels increased in both in fatal and non-fatal CCHF cases. CONCLUSIONS: The increased CCHFV load and higher concentrations of IL-6 and TNF-α, the presence of DIC, and the absence of CCHFV specific immunity are strongly associated with death in CCHF.

Crimean-Congo hemorrhagic fever virus in ticks collected from humans, livestock, and picnic sites in the hyperendemic region of Turkey.

During June and July 2007, about 3125 adult ticks were collected from humans, animals, and vegetation in a hyperendemic region (Sivas and Tokat) of Turkey. A total of 2193 ticks were pooled in 225 pools and screened for the Crimean Congo hemorrhagic fever virus (CCHFV) presence by antigen-capture enzyme-linked immunosorbent assay. Infection rates were calculated as the maximum likelihood estimation with 95% confidence intervals (CI). The dominant tick species was found to be Hyalomma marginatum with the following infestation rates in human, cattle and sheep, respectively: 47.43%, 66.07%, and 30.12%. Maximum likelihood estimation values of CCHFV in H. marginatum ticks collected from human, cattle, and sheep were 0.91% (CI 0.05-4.42), 2.10% (CI 1.12-3.64), and 3.11% (CI 1.18-6.87), respectively. CCHFV antigens were also demonstrated in Hyalomma excavatum, Haemaphysalis parva, and Boophilus annulatus ticks collected from cattle and Rhipicephalus bursa ticks from sheep. Our results suggest that the studied area might maintain its endemic properties in the near future unless effective tick control measures are implemented.

[Seroprevalence of tick-borne encephalitis virus (TBEV) among the residents of rural areas in Sinop, central Black-Sea region, Turkey]. / Sinop'ta kirsal kesimde yasayan kisilerde kene kaynakli ensefalit virusu (TBEV) seroprevalansi

Tick-borne encephalitis (TBE), caused by tick-borne encephalitis virus (TBEV) is one of the serious neurological infections seen especially in the Asian and North European countries. The principal vectors of TBEV are hard ticks belonging to Ixodes genus. The major vector of European TBEV subtype is I.ricinus and the major vector of Far-Eastern and Siberian subtypes is I.persulcatus. I.ricinus exists in many climatic regions of Turkey, especially in the coastal areas. The aim of this study was to investigate the TBEV seroprevalence among the residents of rural areas in Sinop (a province located at the coast of Central Black-Sea region of Turkey). A total of 273 blood samples have been collected from the subjects (age range: 11-83 years) inhabiting in 12 villages of the central district of Sinop, during the months of May and June in 2006 and 2007. The presence of TBEV IgG antibodies in serum samples were searched by a commercial indirect fluorescent antibody kit (Euroimmun, Deutschland). TBEV IgG positivity was detected in 2.9% (8/273) of the subjects at a screening titer (1/10) and 7 (2.6%) of them also yielded positive results at further dilutions (1/100). The rates of TBEV seropositivity were not found statistically significant (p > 0.05), with respect to gender (141 of the subjects were male), age (142 of the subjects were between 21-50 years old), occupation (17 foresters, 57 were shepherds, 199 were farmers/stockbreeders) and history of tick bite (169 of the subjects had been bitten by ticks). Presence of IgG antibodies against Borrelia burgdorferi, another agent which is transmitted by the same vector, were also investigated in TBEV seropositive 8 subjects by a commercial ELISA kit (Zeus Scientific, The Netherlands). Four of these subjects yielded B.burgdorferi IgG positivity, so the TBEV - B.burgdorferi coinfection rate was estimated as 1.5% (4/273). However, since the results obtained by the tests used in this study (TBEV IgG IFA and B.burgdorferi IgG ELISA) have not been confirmed by additional confirmational tests, these subjects were referred as "probable cases". In recent years the detection rates of vector-borne viral infections is in an increment trend in Turkey due to the developments in diagnostic tests and awareness for emerging infections. In conclusion since Sinop, which is placed in the northernmost point of Turkey, is located close to TBEV endemic areas, the presence of TBEV in Sinop and the Black Sea region should always be considered.

[Seroprevalance of Babesia microti in humans living in rural areas of the Sinop region]. / Sinop Yöresinde Kirsal Kesimde Yasayan Insanlarda Babesia microti Seroprevalansi.

Babesia species are blood parasites which transmitted by ticks and located in erythrocytes. Babesia divergens in Europe and Babesia microti in America are the most significant etiologic agents of human babesiosis cases. The aim of this study was to determine serologically whether people living in Sinop where Ixodes ricinus ticks are commonly seen have been exposed to B. microti or not. For this purpose, during May and June of 2006-2007, blood specimens were obtained from 273 individuals who lived in villages of the Sinop region. B. microti IgG antibodies were investigated by the indirect fluorescent antibody test in sera obtained from blood specimens. B. microti seropositivity was found in 6.23% of these sera. There was no statistical difference in antibody seropositivity rates according to sex groups, age groups, occupational groups and recall of tick bites (p > 0.05). This study is the first seroepidemiologic report of B. microti antibodies in people living in Turkey.

Crimean-Congo hemorrhagic fever virus in high-risk population, Turkey.

In the Tokat and Sivas provinces of Turkey, the overall Crimean-Congo hemorrhagic fever virus (CCHFV) seroprevalence was 12.8% among 782 members of a high-risk population. CCHFV seroprevalence was associated with history of tick bite or tick removal from animals, employment in animal husbandry or farming, and being >40 years of age.

[Crimean-Congo Hemorrhagic Fever]. / Kirim-Kongo Hemorajik Atesi.

Crimean-Congo Hemorrhagic Fever (CCHF) virus is a tick-borne virus, which is a member of Bunyaviridae family, Nairovirus genus. CCHF virus has been isolated from 31 different tick species so far, and genus Hyalomma includes the basic vectors of which H. anatolicum, H. marginatum, H. detritum, H. dromedarii, H. excavatum and H. turanicum are frequently found in the geography in which Turkey takes place. The virus is transmitted via the bite of infected ticks or direct contact with CCHF infected patients and the products of infected animals. Following 2-9 days incubation period, the disease abruptly starts with fever, feeling cold, shivering, headache, muscle and joint aches. After a few days hemorrhage develops at various parts of the body. Since an effective vaccine and a specific antiviral therapy have not been found yet, the high mortality rate which may reach to 10-60%, and a wide geography affecting approximately 40 countries including Turkey, CCHF attracts the attention of both scientific and mediatic world, in recent years. In this article, the structure, vectors and reservoirs of CCHF virus, together with the epidemiology, clinical features, laboratory diagnosis and strategies of treatment and prevention, have been reviewed.

[Investigation of vectors for Borrelia burgdorferi and Lyme seropositivity in Sivas region]. / Sivas yöresinde Borrelia burgdorferi vektörlerinin ve lyme seropozitifliginin arastirilmasi.

The aims of this study were to investigate the presence of vector ticks for Borrelia burgdorferi and to determine the seropositivity of lyme disease in Sivas region of Middle Anatolia. A total of 10,303 ticks were collected and classified at genus level, however, none of them belonged to Ixodes genus, the vector of B. burgdorferi. For the seroepidemiological study, serum samples were collected from 270 subjects who inhabited in rural area and raised livestock, and from 135 subjects as the control group who inhabited in urban area and have no livestock story. The samples were screened for the presence of B. burgdorferi IgG antibodies with a commercial enzyme immunoassay kit (ImmunoWell Borrelia, Genbio, San Diego). As a result, one subject in the each group (0.4% and 0.7%, respectively) yielded positive result, however as these sera gave positive reaction in rapid plasma reagin (RPR) test, these were evaluated as cross-reactivity (false positivity). These results indicated that lyme disease is not endemic in our region since neither Ixodes genus ticks nor seropositive subjects were detected.