巴尔瑙尔由蜱虫传播的细菌感染:流行病学和动物流行病学状况、诊断问题

T. Chekanova, Alexey V. Rakov, K. Petremgvdlishvili, A. V. Timonin, N. V. Lukyanenko, T. V. Safyanova, S. V. Shirokostup, N. Y. Lukyanenko, U. V. Kalinina, I. G. Pashchenko
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引用次数: 0

摘要

相关性。以巴尔瑙尔为行政中心的阿尔泰克雷地区是蜱传立克次体病的流行区。其他蜱媒感染(TBI)在该地区总发病率中所占比例明显较低。为了评估细菌性 TBI(蜱传立克次体病、包虫病、人类粒细胞无形体病、人类单核细胞埃希氏病、柯西氏病)流行病学状况的并发症风险,并了解该地区的诊断水平,必须研究蜱虫中病原体的发生情况,并将其与官方登记的发病率进行比较。目的是研究巴尔瑙尔地区蜱传细菌感染的流行病学和动物流行病学情况,并分析影响这些感染发病率登记的因素。材料和方法。材料为阿尔泰地区卫生部 Rospotrebnadzor 局的官方统计报告数据、信息、分析材料、会计和报告文件。使用分子生物学方法研究了在巴尔瑙尔不同地貌的生物群落中采集的蜱虫感染蜱传脑炎、人粒细胞无形体病(HGA)、人单核细胞埃希氏病(HME)、包虫病、立克次体病和Q热等病原体的情况。通过桑格测序确定立克次体的种类,然后进行系统发育分析。研究结果在皮蜱中检测到的 Rickettsia conorii subsp.raoultii发生率很高(61.9%),在 Ixodes 蜱中检测到 R. helvetica 的 DNA(5.1%)。没有检测到 R. sibirica。蜱虫感染 Borrelia burgdoferi s.l.的比例为 27.8%;5.1%的图像含有 B. miyamotoi DNA。HGA和HME病原体分别在6.2%和1.0%的Ixodes蜱个体中发现。在 300 份样本中,有 2 份样本确定了 Q 热的病原体。在 2014-2023 年期间,受蜱虫叮咬影响的人数没有减少的趋势,在此背景下,西伯利亚蜱斑疹伤寒的发病率居高不下,与包虫病的发病率形成鲜明对比。巴尔瑙尔官方尚未发现其他细菌性创伤后应激反应。结论在巴尔瑙尔市,已发现蜱传包虫病(包括非红斑型包虫病)的流行病学状况具有很高的并发症风险,而且该疾病很可能诊断不足。蜱传立克次体病的病原学结构、非典型感染者的出现等问题仍不清楚。由于缺乏主要用于检测特异性抗体的试剂盒,诊断无皮疹的蜱传立克次体病变得更加困难。在组织长期固定观察点以监测和预测流行病学和动物流行病学情况时,应考虑到 Dermacentor 和 Ixodes 蜱虫的地形限制。还注意到巴尔瑙尔人口感染 HGA、MECH 和 Q 热病原体的风险。应特别注意在临床实践中采用试剂盒对蜱传感染进行复杂的实验室验证。
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Bacterial Infections Transmitted by Ticks in Barnaul: Epidemiological and Epizootological Situation, Diagnostic Problems
Relevance. The Altai Кray with its administrative center, Barnaul, is an endemic region for tick–borne rickettsioses. The contribution of other tick-borne infections (TBI) to the structure of overall morbidity in the subject is significantly lower. To assess the risks of complication of the epidemiological situation for bacterial TBI (tick-borne rickettsioses, borrelioses, human granolucytic anaplasmoses, human monocytic ehrlichiosis, coxiellosis) and understand the level of their diagnosis in the region, it is important to study the occurrence of their pathogens in ticks, comparing them with the officially registered incidence. The aim is the study of the epidemiological and epizootological situation in Barnaul for bacterial tick-borne infections as well as an analysis of the factors influencing the registration of the incidence of these infections. Materials and methods. The materials were official statistical reporting data, information, analytical materials, accounting and reporting documentation of the Department of Rospotrebnadzor and the Ministry of Health of the Altai Region. The infection of ticks collected in the biotopes of Barnaul with different landscapes by pathogens of tick-borne encephalitis, human granulocytic anaplasmosis (HGA), human monocytic ehrlichiosis (HME), borrelioses, rickettsioses, and Q fever were studied using molecular biological methods. The species of Rickettsia were determined by Sanger sequencing followed by phylogenetic analysis. Results. Rickettsia conorii subsp. raoultii detected in the Dermacentor ticks with a high occurrence (61.9%), DNA of R. helvetica detected in the Ixodes ticks (5.1%). R. sibirica was not been detected. The infection rate of ticks by Borrelia burgdoferi s.l. was 27.8%; 5.1% of imagos contained B. miyamotoi DNA. Pathogens of HGA, HME were founded in 6.2%, 1.0% of individuals of Ixodes ticks, respectively. In two copies out of 300, the causative agent of Q fever identified. The dynamics of the number of people affected by tick bite over the period 2014-2023 did not tend to decrease, and against this background, there is a continuing high incidence of Siberian tick typhus, in contrast to the incidence of borreliosis. Other bacterial TBI have not been noted in Barnaul officially. Conclusions. In Barnaul, high risks of complications of the epidemiological situation of ixodic tick-borne borreliosis (including non-erythemic forms) have identified, and underdiagnosis of the disease is likely. The question of the etiological structure of tick-borne rickettsiosis, the occurrence of infected individuals with an atypical picture remains unknown. The difficulty of diagnostic of tick-borne rickettsiosis without rash is aggravated by the shortage of reagent kits, primarily for the detection of specific antibodies. The landscape confinement of Dermacentor and Ixodes ticks should take into account when organizing long-term stationary observation sites for monitoring and forecasting the epidemiological and epizootological situation. The risks of Barnaul population infection by HGA, MECH and Q fever pathogens were also noted. Special attention should be paid to the introduction into clinical practice of reagent kits for complex laboratory verification of tick-borne infections. 
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