Pappataci fever

The Phlebotomusfieber is a by certain sandflies ( Phlebotomus genus ) transmitted virus infection in humans. It is distributed throughout the Mediterranean and the Near East, Afghanistan, India to southern China. The disease is benign, even a meningoencephalitis occurring disappear without specific treatment after a few days. The pathogens of the family Bunyaviridae occurs regionally different in three different subtypes, so that the Phlebotomusfieber under many different names trades: Pappataci fever ( papatasi fever), sandfly fever, Tuscany fever, Dalmatia fever, Chitral fever, Karimabad fever or pick- fever. The included used in the ICD -10 designation " Sandfly Fever " ( from the English. Sandfly fever ) is vague because it does not concern sandflies but - mosquitoes.

Pathogens and vectors

The causative agent of Phlebotomusfiebers is the sandfly fever virus ( Sandfly fever Naples virus, SFNV ) of the genus Phlebovirus the family Bunyaviridae. The species is in the four different subtypes Karimabad virus ( KARV ), sandfly fever virus Sabin ( SFNV - Sabin ), divided Tehran virus ( Gospel of Thomas ) and Tuscany virus ( TOSV ). The subtype Tuscany virus is the most common pathogen and has the largest distribution area, while the other subtypes locally restricted. Within the subtype Tuscany virus three serotypes are distinguished, which are named after their original discovery site Tuscany (T ), Sicily (S) and Naples ( N); serotypes have a geographically different distribution pattern ( see figure).

The virus is transmitted by different sandfly species of the family Psychodidae ( sandflies ) during the blood meal to humans. Common species that act as a vector of the pathogen in this way are Phlebotomus perniciosus, P. and P. perfiliewi pappatasi; the latter preferred the people as the main host.

The natural reservoir of the virus are various rodents and bats, and possibly also sheep, goats and cattle. In these animals, and non- human pathogenic species were found, which also belong to the genus Phlebovirus and are serologically very closely related to the human pathogenic viruses of Phlebotomusfiebers. By a blood meal in these animals, the virus enters the mosquito population, where the infection and replication in insect to man can be transmitted in about six days. The viruses can also spread vertically within the mosquito population, ie the eggs of mosquitoes are already infected and the resulting hatching larvae carry the virus ( transovarial infection). The sandflies are therefore vector for the transmission and partly reservoir host at the same time.

Epidemiology

A seasonal increase of Phlebotomusfiebers is observed in the late spring and summer, although the proliferation and activity of sandflies is highest. In the fall and winter months, the disease does not occur in appearance. The Phlebotomusfieber is available in the European and North African Mediterranean spread, also in parts of Portugal, and of the southern Alpine region, the Middle East, the countries of 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 southwest China's Yunnan Province. In these endemic areas the local adult population is immune by multiple, inapparent infections, whereas children or entering the country, tourists can fall ill at Phlebotomusfieber. At about 0.8 to 1% of the population in Germany antibody to the virus are detectable Tuscany.

Disease

Most infections with the Tuscany - virus infections without symptoms, the infection also leaves a lifelong immunity without disease for each serotype, reinfection with another of the three serotypes is possible. After an incubation period of 3 to 5 days, there is a very sudden onset of high fever, malaise and very severe headaches that are perceived particularly on the forehead and behind the eyes ( retrobulbar ). In addition, nausea, dizziness, vomiting, muscle and joint pain, back pain, stiffness feeling in the legs and possibly a facial flushing. The symptoms begin to fade, in a few cases there is then a brief resurgence of fever before the disease subsides finally after three days. A weakness is often persist for several weeks. In a frequently supervening meningoencephalitis and serous meningitis ( serotype at Tuscany in 2-12 % of cases) occur more neurological symptoms such as stiff neck ( meningismus ), clouding of consciousness, tremors, paralysis, nystagmus and coma.

Diagnostics

The diagnosis of acute Phlebotomusfieber disease is serologically secured. The detection of IgG and IgM antibodies against the Tuscany virus in the blood serum is considered as seroconversion or 4-fold rise in IgG titer as proof for a fresh or recent infection. In this laboratory, the indirect immunofluorescence assay or neutralization test used. The antibodies are detectable later than 5-8 days after onset of disease. The direct detection of pathogens in cell culture or by PCR hardly plays a role in clinical diagnostics.

Therapy and prophylaxis

The Phlebotomusfieber is treated only symptomatically, a specific antiviral therapy is not required and is not available. Pharmacological reduction of fever and consistent pain relief is usually sufficient.

Since a vaccine is not available, the prevention to combat the infected mosquito populations in endemic areas, and a personal mosquito repellent limited. The exposure to the mosquitoes can be achieved by mosquito nets with a mesh size less than 2 mm and the use of repellents. Since the sandfly are particularly active at night, a stay in mosquito areas during these times should be avoided.

Compulsory registration

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