Simpson Gregory J G, Quan Vanessa, Frean John, Knobel Darryn L, Rossouw Jennifer, Weyer Jacqueline, Marcotty Tanguy, Godfroid Jacques, Blumberg Lucille H
1 Production Animal Studies Department, Faculty of Veterinary Science, University of Pretoria , Pretoria, South Africa .
2 Division of Public Health Surveillance and Response, National Institute for Communicable Diseases , Sandringham, South Africa .
Vector Borne Zoonotic Dis. 2018 Jun;18(6):303-310. doi: 10.1089/vbz.2017.2158. Epub 2018 Apr 17.
A lack of surveillance and diagnostics for zoonotic diseases in rural human clinics limits clinical awareness of these diseases. We assessed the prevalence of nine zoonotic pathogens in a pastoral, low-income, HIV-endemic community bordering wildlife reserves in South Africa. Two groups of participants were included: malaria-negative acute febrile illness (AFI) patients, called febrilers, at three clinics (n = 74) and second, farmers, herders, and veterinary staff found at five government cattle dip-tanks, called dip-tanksters (n = 64). Blood samples were tested using one PCR (Bartonella spp.) and eight antibody-ELISAs, and questionnaires were conducted to assess risk factors. Seventy-seven percent of febrilers and 98% of dip-tanksters had at least one positive test. Bartonella spp. (PCR 9.5%), spotted fever group (SFG) Rickettsia spp. (IgM 24.1%), Coxiella burnetii. (IgM 2.3%), and Leptospira spp. (IgM 6.8%) were present in febrilers and could have been the cause of their fever. Dip-tanksters and febrilers had evidence of past infection to Rickettsia spp. (IgG 92.2% and 63.4%, respectively) and C. burnetii (IgG 60.9% and 37.8%, respectively). No Brucella infection or current Bartonella infection was found in the dip-tanksters, although they had higher levels of recent exposure to Leptospira spp. (IgM 21.9%) compared to the febrilers. Low levels of West Nile and Sindbis, and no Rift Valley fever virus exposure were found in either groups. The only risk factor found to be significant was attending dip-tanks in febrilers for Q fever (p = 0.007). Amoxicillin is the local standard treatment for AFI, but would not be effective for Bartonella spp. infections, SFG rickettsiosis, Q fever infections, or the viral infections. There is a need to revise AFI treatment algorithms, educate medical and veterinary staff about these pathogens, especially SFG rickettsiosis and Q fever, support disease surveillance systems, and inform the population about reducing tick and surface water contact.
农村人类诊所缺乏对人畜共患病的监测和诊断，这限制了对这些疾病的临床认知。我们评估了南非一个与野生动物保护区接壤的畜牧、低收入、艾滋病毒流行社区中九种人畜共患病原体的流行情况。研究纳入了两组参与者：三家诊所的疟疾阴性急性发热性疾病（AFI）患者，称为发热者（n = 74）；以及在五个政府牲畜浸洗池找到的农民、牧民和兽医工作人员，称为浸洗池工作人员（n = 64）。使用一种聚合酶链反应（PCR，检测巴尔通体属）和八种抗体酶联免疫吸附测定（ELISA）对血样进行检测，并通过问卷调查评估风险因素。77%的发热者和98%的浸洗池工作人员至少有一项检测呈阳性。发热者中存在巴尔通体属（PCR检测阳性率9.5%）、斑点热群立克次体属（IgM阳性率24.1%）、伯氏考克斯体（IgM阳性率2.3%）和钩端螺旋体属（IgM阳性率6.8%），这些病原体可能是他们发热的原因。浸洗池工作人员和发热者都有立克次体属（IgG阳性率分别为92.2%和63.4%）和伯氏考克斯体（IgG阳性率分别为60.9%和37.8%）既往感染的证据。浸洗池工作人员中未发现布鲁氏菌感染或当前巴尔通体感染，不过与发热者相比，他们近期接触钩端螺旋体属的水平更高（IgM阳性率21.9%）。两组中均发现西尼罗河病毒和辛德毕斯病毒水平较低，且未发现裂谷热病毒暴露情况。唯一被发现有显著意义的风险因素是发热者中去过浸洗池与感染Q热有关（p = 0.007）。阿莫西林是当地治疗AFI的标准疗法，但对巴尔通体属感染、斑点热群立克次体病、Q热感染或病毒感染无效。有必要修订AFI治疗方案，对医护人员和兽医工作人员进行有关这些病原体的教育，尤其是斑点热群立克次体病和Q热，支持疾病监测系统，并告知民众减少与蜱虫和地表水的接触。
