Papataci fever

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Classification according to ICD-10
A93.1 Pappataci fever
Phlebotomus fever
Sand fly fever
ICD-10 online (WHO version 2019)

The Pappataci fever , pappataci fever or sandfly fever , also Sandfly Fever called, is a by sandflies (genus Phlebotomus transmitted) virus infection of humans. It was discovered by Alois Pick . It is widespread from the entire Mediterranean region through the Middle East , Afghanistan and India to southern China . The course of the disease is uncomplicated. A meningoencephalitis disappears without any specific treatment after a few days.

Designations

The pathogen , viruses from the Bunyaviridae family , occur regionally in three different subtypes , so that Pappataci fever goes by many different names: Pappataci fever (Papatasi fever), sand fly fever , Tuscany fever , Dalmatia fever , Chitral fever Fever , Karimabad fever or Pick fever (also three-day fever , dog fever and mosquito fever ). The 10 ICD designation used among others in the "Sandfly Fever" (of English sandfly fever ) is inaccurate because the carriers do not sand flies but sandflies.

Pathogen and carrier

Sand fly fever virus
Systematics
Classification : Viruses
Area : Riboviria
Empire : Orthornavirae
Phylum : Negarnaviricota
Subphylum : Polyploviricotina
Class : Ellioviricetes
Order : Bunyavirales
Family : Phenuiviridae
Genre : Phlebovirus
Taxonomic characteristics
Genome : (-) and (+/-) ssRNA segmented
Baltimore : Group 5
Symmetry : helical
Cover : available
Scientific name
Naples phlebovirus
Short name
SFNV
Left

The causative agent of papataci fever are viruses from the genus Phlebovirus of the family Bunyaviridae , which are transmitted by sandflies . These form a serogroup called sandflies group (engl. Sandlfy fever serocomplex ) which earlier than species sandfly fever virus (also known as Phlebotomus fever virus , Sandfly fever Naples virus , SFNV) was performed. In the meantime, the sand fly virus has been broken down by the ICTV. The earlier subtypes are now recognized as an independent species, only with the earlier subtype Tuscany virus (TOSV) its three serotypes (N, T and S - named after their original place of discovery Naples, Tuscany and Sicily, see figure) were upgraded to species :

  • Naples Phlebovirus ( Naples Phlebovirus , SFNV, Toscana virus serotype N)
  • Tuscany phlebovirus ( Toscana phlebovirus , Tuscany virus serotype T)
  • Sicilian sand fly fever virus ( Sicilian phlebovirus , SFSV, Tuscany virus serotype S)
  • Karimabad virus ( Karimabad phlebovirus , KARV)
  • Tehran virus ( Tehran phlebovirus , THEV)
The sand fly Phlebotomus pappatasi during the blood meal

These viruses are transmitted to humans by various species of sandflies belonging to the Psychodidae family (butterfly mosquitoes) during the blood meal. Common species that act as pathogen vectors in this way are Phlebotomus perniciosus , P. perfiliewi and P. pappatasi ; the latter prefers humans as the main host. The viruses' natural reservoirs are various rodents and bats , possibly also sheep , goats and cattle . In these animals non- human pathogenic virus species were also found, which also belong to the genus phlebovirus and are serologically very closely related to the human pathogenic virus species of papataci fever. The virus particles enter the mosquito population through a blood meal in these animals. From there, after about six days of infection and reproduction in the insect, the virus can be transmitted to humans. The viruses can also spread vertically within the mosquito population; H. the mosquito eggs are already infected and the larvae hatching from them carry the virus (transovarial infection). The sand flies are therefore the vector for the transmission and sometimes also the reservoir host at the same time.

Epidemiology

Spread of papataci fever and the three serotypes of sand fly fever virus: T (Tuscany), S (Sicily), N (Naples)

A seasonal accumulation of papataci fever can be observed in late spring and summer, when the reproduction and activity of sandflies is highest. The disease does not appear in the autumn and winter months. Pappataci fever is spread throughout the European and North African Mediterranean region, also in parts of Portugal , and the southern Alpine region, in the Middle East , the states on the Red Sea , the Arabian Peninsula, Iran , Iraq , Afghanistan , Pakistan , northern India , Bangladesh , Myanmar , Parts of the Himalayas (also at altitudes up to 4000 m), southern Tibet and the southwest Chinese province of Yunnan . In these endemic areas , the native adult population is immune from multiple, inapparent infections, whereas children or incoming tourists can develop papataci fever. Antibodies against the Tuscany virus (ie serotype N, S or T) can be detected in around 0.8 to 1% of the population in Germany.

Clinical picture

Most infections with these viruses run without symptoms of the disease, the infection leaves lifelong immunity for the respective serotype even without disease , but reinfection with another of the different serotypes is possible.

After an incubation period of 3 to 5 days, the onset of the disease occurs very suddenly with a high fever , severe feeling of illness and very severe headaches, which are particularly noticeable on the forehead and behind the eyes (retrobulbar). In addition, there are nausea, dizziness , vomiting, muscle and joint pain, back pain, a feeling of stiffness in the legs and possibly reddening of the facial skin. The symptoms begin to wane after three days, and in a few cases the fever briefly rises again before the disease finally subsides. A feeling of weakness often persists for several weeks. In the case of meningoencephalitis and serous meningitis (with the Tuscany serotype in 2 to 12% of cases), more severe neurological symptoms such as neck stiffness ( meningism ), clouding of consciousness, tremors, paralysis, nystagmus and comatose conditions occur.

Diagnosis

The diagnosis of acute papataci fever is confirmed serologically. The detection of IgG and IgM antibodies against the Tuscany virus in the blood serum , as well as the seroconversion or the 4-fold increase in the IgG titer, are considered to be evidence of a fresh or recent infection. The indirect immunofluorescence test or neutralization test is used for this in the laboratory . The antibodies can be detected no later than 5 to 8 days after the onset of the disease. The direct detection of pathogens in cell culture or by means of PCR hardly plays a role in clinical diagnostics.

Therapy and prophylaxis

Pappataci fever is only treated symptomatically; specific antiviral therapy is not required and is also not available. Medicinal lowering of the fever and consistent pain relief are usually sufficient.

As a vaccine is not available, prevention is limited to controlling the infected mosquito populations in the endemic areas and using personal mosquito repellent. The exposure against the mosquitoes, by mosquito nets mm with a mesh width below 2, and the use of repellents are achieved. Since the sand flies are particularly active at night, staying in mosquito areas during these times should be avoided.

Reporting requirement

The disease and the detection of the pathogen are not notifiable in Germany, Austria and Switzerland.

literature

  • W. Lang, Th. Löscher: Tropical medicine in clinic and practice , 3rd edition Stuttgart 2000, p. 339f, ISBN 3-13-785803-8
  • R. Marre, T. Mertens, M. Trautmann, E. Vanek: Clinical Infectiology . Munich Jena 2000, p. 593, ISBN 3-437-21740-2
  • H. Hahn, D. Falke, SHE Kaufmann, U. Ullmann: Medical microbiology and infectious diseases . 5th edition, Heidelberg 2005, p. 568, ISBN 3-540-21971-4
  • Th. Mertens, O. Haller, H.-D. Klenk (Hrsg.): Diagnosis and therapy of viral diseases - guidelines of the society for virology . 2nd edition Munich 2004 pp. 279 ff, ISBN 3-437-21971-5
  • Christof E. Pauli: On the importance of infection with sand fly fever viruses in Germany . Dissertation LMU Munich 1998.

Individual evidence

  1. Karl Wurm, A. M. Walter: Infectious diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 9-223, here: p. 207 ( Pappatacifieber ).
  2. Georg Sticker : Hippokrates: The common diseases first and third book (around the year 434-430 BC). Translated from the Greek, introduced and explained by Georg Sticker. Johann Ambrosius Barth, Leipzig 1923 (= Classics of Medicine. Volume 29); Unchanged reprint: Central antiquariat of the German Democratic Republic, Leipzig 1968, p. 101 f.
  3. ICTV Master Species List 2018b v1 MSL # 34, Feb. 2019
  4. a b ICTV: ICTV Taxonomy history: Akabane orthobunyavirus , EC 51, Berlin, Germany, July 2019; Email ratification March 2020 (MSL # 35)