斯维尔德洛夫斯克地区现阶段伊蜱传播感染的病原学结构、临床和流行病学特征

N. Kolyasnikova, M. Toporkova, J. P. Sanchez-Pimentel, A. S. Nazarenko, O. Stukolova, I. G. Starodubova, T. Chekanova, A. Titkov, A. A. Tihomirova, E. A. Kuznetsova, Y. Beikin, Y. Naumov, N. Pestov, V. Mishchenko, I. V. Vyalykh, A. Ishmukhametov, V. Akimkin
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In case of negative results for antibodies to the pathogens of the above infections, the diagnosis may remain unknown. Aims. To study the etiological structure of infections transmitted by ixodic ticks in the Sverdlovsk region at the present stage, as well as to characterize the epidemiological and clinical features of the course of tick-borne infections detected in conditions of a combination of natural foci. Materials and methods. The study included 227 patients undergoing inpatient or outpatient treatment during the epidemic season of tick activity in 2021 (June-August) at LLS MO \"New Hospital\" (Urban Center of Natural Focal Infections). The case histories (epidemiological, clinical and laboratory indicators) were studied from each patient, as well as the material (blood) was examined prospectively and retrospectively using molecular biological (PCR) and serological (ELISA, planar protein biochip) methods. Results and discussion. During the study, six diseases were identified among the examined patients: TBE, LD (erythematous and nonerythematous forms), Borrelia miyamotoi disease (BMD), human granulocytic anaplasmosis (HGA), human monocytic ehrlichiosis (HME), as well as \"Viral fever transmitted by arthropods\" (VFTA). Among the examined patients, the proportion of patients with monoinfection was 49,5%, with mixed infection – 50,5%. Additional studies conducted by us using specific PCR for the presence DNA rickettsia and the causative agent of Q-fever in the blood of patients gave negative results. 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引用次数: 1

摘要

的相关性。斯维尔德洛夫斯克地区是由蜱虫传播的传染病的高度流行地区。目前,在该地区临床医生的常规实践中,对蜱传感染进行实验室诊断的可能性主要受限于检测血清中蜱传脑炎病毒(TBE病毒)和莱姆病病原体(伯氏疏螺旋体)的抗体,因此,目前在该地区的蜱传感染中主要登记了TBE和LD。如果对上述感染的病原体的抗体结果为阴性,则诊断可能仍然未知。目标研究斯维尔德洛夫斯克地区现阶段由蜱传播的感染的病原学结构,以及在自然疫源地组合条件下发现的蜱传感染过程的流行病学和临床特征。材料和方法。该研究包括在2021年蜱虫活动流行季节(6月至8月)在LLS MO“新医院”(城市自然局灶性感染中心)接受住院或门诊治疗的227名患者。采用分子生物学(PCR)和血清学(ELISA、平面蛋白生物芯片)方法对每位患者的病例史(流行病学、临床和实验室指标)进行研究,并对材料(血液)进行前瞻性和回顾性检查。结果和讨论。在研究中,在检查的患者中发现了6种疾病:TBE、LD(红斑型和非红斑型)、宫本氏疏螺旋体病(BMD)、人粒细胞无形体病(HGA)、人单核细胞埃利希体病(HME)和“节肢动物传播的病毒性热”(VFTA)。在检查的患者中,单一感染患者占49.5%,混合感染患者占50.5%。我们对患者血液中DNA立克次体和致病菌q热进行了特异性PCR检测,结果为阴性。上述确定的感染的一般流行病学特征是媒介传播机制,疾病在中老年人群体中流行,在叶卡捷琳堡及其周边地区发生的任何蜱传感染的病原体感染病例最多,对于所有感染,大多数病例的蜱叮咬持续时间不超过一天;不同性别和潜伏期有差异。临床症状是相似的,除了红斑形式的LD(在蜱的byte部位存在红斑迁移),因为绝大多数患者有一般的感染综合征;一般实验室指标各不相同。诊断的确认是基于分子生物学和血清学研究方法的复杂应用结果。结论。斯维尔德洛夫斯克地区蜱类传播感染的现代病原学结构不仅以TBE和LD为代表,而且以BMD、HGA、HME等新发疾病为代表,同时还显示出多种组合的混合感染比例较高。
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Etiological Structure, Clinical and Epidemiological Characteristics of Infections Transmitted by Ixodic Ticks in the Sverdlovsk Region at the Present Stage
Relevance. The Sverdlovsk region is a highly endemic territory for infections transmitted by ixodic ticks. The possibilities of laboratory diagnostics of tick–borne infections in the routine practice of a clinician in the region today are limited mainly by testing blood serum for antibodies to the tick-borne encephalitis virus (TBE virus) and Lyme disease (LD) pathogens – Borrelia burgdorferi sensu lato complex, therefore, among tick-borne infections in the region currently mainly TBE and LD are registered. In case of negative results for antibodies to the pathogens of the above infections, the diagnosis may remain unknown. Aims. To study the etiological structure of infections transmitted by ixodic ticks in the Sverdlovsk region at the present stage, as well as to characterize the epidemiological and clinical features of the course of tick-borne infections detected in conditions of a combination of natural foci. Materials and methods. The study included 227 patients undergoing inpatient or outpatient treatment during the epidemic season of tick activity in 2021 (June-August) at LLS MO "New Hospital" (Urban Center of Natural Focal Infections). The case histories (epidemiological, clinical and laboratory indicators) were studied from each patient, as well as the material (blood) was examined prospectively and retrospectively using molecular biological (PCR) and serological (ELISA, planar protein biochip) methods. Results and discussion. During the study, six diseases were identified among the examined patients: TBE, LD (erythematous and nonerythematous forms), Borrelia miyamotoi disease (BMD), human granulocytic anaplasmosis (HGA), human monocytic ehrlichiosis (HME), as well as "Viral fever transmitted by arthropods" (VFTA). Among the examined patients, the proportion of patients with monoinfection was 49,5%, with mixed infection – 50,5%. Additional studies conducted by us using specific PCR for the presence DNA rickettsia and the causative agent of Q-fever in the blood of patients gave negative results. The general epidemiological characteristics for the above identified infections were the vector-borne mechanism, the prevalence of diseases in groups of middle-aged and elderly people, the largest number of cases of infection with pathogens of any tick-borne infection occurred in Yekaterinburg and its surroundings, for all infections, the duration of tick bite in most cases did not exceed one day; there were differences by sex, incubation period. Clinical symptoms were similar, except for the erythematous form of LD (the presence of erythema migrans at the byte site of tick), because the vast majority of patients had a general infectious syndrome; general laboratory indicators varied. Confirmation of the diagnosis was based on the results of the complex application of molecular biological and serological research methods. Conclusions. The modern etiological structure of infections transmitted by ixodic ticks in the Sverdlovsk region is represented not only by TBE and LD, but also by new disease to our country, such as BMD, HGA, HME, while a high proportion of mixed infections in various combinations has been revealed.
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