Human Lymphadenopathy Caused by Ratborne Bartonella, Tbilisi, Georgia.

Lymphadenopathy and fever that developed in a woman in Tbilisi, Georgia, most likely were caused by a ratborne Bartonella strain related B. tribocorum and B. elizabethae. The finding suggests that this Bartonella strain could be spread by infected rats and represents a potential human risk.

Evidence of Extensive Circulation of Yersinia enterocolitica in Rodents and Shrews in Natural Habitats from Retrospective and Perspective Studies in South Caucasus.

Yersinia enterocolitica culture-positive rodents and shrews were reported in different territories across Georgia during 14 of 17 years of investigations conducted for the period of 1981-1997. In total, Y. enterocolitica was isolated from 2052 rodents (15 species) and 33 shrews. Most isolates were obtained from Microtus arvalis, Rattus norvegicus, Mus musculus, and Apodemus spp. During the prospective study (2017-2019), isolates of Yersinia-like bacteria were cultured from 53 rodents collected in four parts of Georgia. All the Yersinia-like isolates were confirmed as Y. enterocolitica based on the API 20E and the BD Phenix50 tests. Whole-genome (WG) sequencing of five rodents and one shrew strain of Y. enterocolitica revealed that they possessed a set of virulence genes characteristic of the potentially pathogenic strains of biogroup 1A. All isolates lacked distinguished virulence determinants for YstA, Ail, TccC, VirF, and virulence plasmid pYV but carried the genes for YstB, YmoA, HemPR-HmuVSTU, YaxAB, PhlA, PldA, ArsCBR, and a flagellar apparatus. One strain contained a gene highly homologous to heat-labile enterotoxin, a chain of E. coli, a function not previously described for Y. enterocolitica. The WG single-nucleotide polymorphism-based typing placed the isolates in four distinct phylogenetic clusters.

Long-term outcomes of 217 botulism cases in the Republic of Georgia.

BACKGROUND: The acute paralytic syndrome of botulism has been well-described; however, little is known about its long-term consequences. METHODS: We conducted a case-control study in the Republic of Georgia to evaluate the health of patients > or =6 months after they had experienced an episode of botulism. Case patients were selected on the basis of who had had a clinical diagnosis of foodborne botulism reported to the national surveillance system from 1998 through 2003. Three control subjects were randomly selected from each patient's community. RESULTS: We located 217 patients who had had botulism from surveillance records, with a median time since onset of illness of 4.3 years. The median age was 37 years, and 49% of the patients were female, similar to the control subjects. Most of the patients (68%) had acquired botulism from home-conserved vegetables (probably containing toxin type B), 15% had been hospitalized for >1 month, and 25% had required mechanical ventilation. Six patients died. Of the remaining 211 patients, 68% reported having worse health at the time of the interview than 6 years before the interview, compared with 17% of 656 control subjects (matched odds ratio, 17.6; 95% confidence interval, 10.9-28.4). Overall, 49% of the patients reported their current health as "fair" or "poor," versus 25% of the control subjects (odds ratio, 5.0; 95% confidence interval, 3.2-7.6). Patients were more likely than control subjects to report fatigue, weakness, dizziness, dry mouth, and difficulty lifting objects (P<.05, for each). Patients were more likely than control subjects to report difficulty breathing caused by moderate exertion (P<.001) but not by minimal exertion or at rest. Patients were also more likely to report being limited in vigorous activities, walking 3 blocks, and climbing 3 flights of stairs (P<.05, for each). Finally, patients reported feeling significantly worse than control subjects for 6 of 11 questions regarding psychosocial well-being (P<.05, for each). In a multivariable model involving patients who had had botulism, mechanical ventilation during acute illness, older age, and region of residence independently predicted worse health. CONCLUSIONS: Several years after acute botulism, patients reported significant health, functional, and psychosocial limitations that are likely to be consequences of the illness.

Traditional risk factors for Helicobacter pylori infection not found among patients undergoing diagnostic upper endoscopy-Republic of Georgia, 2007-2008.

OBJECTIVES: Helicobacter pylori causes gastritis, duodenal ulcers, and gastric cancer. Although household crowding, low socioeconomic status (SES), and poor sanitation are associated with infection elsewhere, risk factors of infection in the Republic of Georgia (ROG), a country with a high prevalence rate (>70%), remain unknown. In this study we explored potential risk factors of infection among symptomatic patients in ROG. METHODS: During 2007-2008, we prospectively recruited 390 subjects with gastrointestinal symptoms referred to five tertiary care centers for diagnostic upper endoscopy. We administered a questionnaire on potential risk factors and tested patients using three diagnostic tests: gastric biopsies underwent histological evaluation and rapid urease test (CLO test), and an ELISA was used to detect IgG against H. pylori in serum. We defined a case as having two or more positive results from the three available tests. Univariate and multivariate logistic regression analyses were performed. RESULTS: Overall, 217 (56%) patients met the study case definition. Subjects diagnosed with cancer had the highest rate of H. pylori infection (62%), followed by those with gastritis (55%), and ulcer (54%). Age >30 years (adjusted odds ratio (aOR 2.6, 95% confidence interval (CI) 1.6-4.3) and residing in the capital city (aOR 0.6, 95% CI 0.4-0.9) were significantly associated with infection. CONCLUSIONS: In this large cohort with gastrointestinal symptoms, only age >30 years and living in the capital were significant factors associated with infection. Lower SES, less education, and crowding did not confer an increased risk, in contrast to the findings of previous studies. Population-based studies are needed to identify potential routes and risk factors of H. pylori infection in ROG.