Browsing by Author "de Sousa, R."
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- Country-wide surveillance of norovirus outbreaks in the Portuguese Army, 2015-2017Publication . Lopes-João, A.; Mesquita, J.R.; de Sousa, R.; Oleastro, M.; Silva, C.; Penha-Gonçalves, C.; Nascimento, M.S.J.INTRODUCTION: Gastrointestinal infections are among the most common foodborne and waterborne diseases in military populations, with direct implications in operational efficiency and force readiness. Through the surveillance system of reportable acute gastrointestinal illness in the Portuguese Army, four norovirus outbreaks were identified between October 2015 and October 2017 in mainland Portugal and the Azores archipelago. The present study documents the epidemiological, clinical and laboratory investigations of these norovirus outbreaks. METHODS: Cases were investigated and epidemiological questionnaires were distributed to all soldiers in each military setting where the outbreaks occurred. Stool samples from soldiers with acute gastroenteritis illness were collected and screened for common enteropathogenic agents. Food and water samples served on the settings were also collected for microbiological investigation. Norovirus-positive samples were further characterised by sequence analysis using a public automated genotyping tool. RESULTS: The four outbreaks affected a total of 99 soldiers among the 618 stationed on base units and in a military exercise. A total of 27 soldiers provided a stool sample, of which 20 were positive for norovirus by real-time PCR. Phylogenetic analysis showed that the noroviruses involved were all genogroup II, namely GII.17, GII.Pe-GII.4 Sydney 2012, GII.P2-GII.2 and GII.P16-GII.2. Of note, 30 soldiers had to receive treatment at the military hospital due to severity of symptoms. CONCLUSION: In this short, two-year surveillance period, a total of four norovirus gastroenteritis outbreaks were detected in the Portuguese Army which caused a considerable morbidity, showing once again the impact of norovirus on Army effectiveness and force readiness.
- Doença de arranhadela do gato em mulher de 44 anos de idadePublication . Murinello, Natacha; Murinello, N.; Murinello, A.; Damásio, H.; Carvalho, A.; de Sousa, R.A doença da arranhadela do gato é uma zoonose causada pela bactéria Bartonella henselae, e transmitida ao homem por inoculação em lesões de arranhadelas ou mordeduras de gatos. Descreve-se aqui um caso de doença da arranhadela do gato numa mulher de 44 anos de idade, imunocompetente, que se apresentou com uma pápula/crosta num dedo da mão direita, linfadenopatias regionais e foi tratada com azitromicina por apresentar uma linfadenopatia epitroclear muito dolorosa. O diagnóstico de infecção por B. henselae foi confirmado laboratorialmente por serologia, e PCR (polymerase chain reaction) numa biópsia de gânglio axilar. Foi também detectado DNA de B. henselae no sangue do gato da doente, mas não nas quatro pulgas, Ctenocephalides felis que parasitavam o gato. Importantes métodos de diagnóstico como a técnica de PCR e sequenciação permitem caracterizar a espécie ou estirpe responsáveis pela infecção no homem uma vez que actualmente existem novas espécies de Bartonella emergentes a causar a mesma doença. Para além disso é extremamente importante para a epidemiologia das doenças existentes no nosso país saber quais as espécies que circulam e que podem causar doença no homem.
- Guidelines for the Detection of Rickettsia spp.Publication . Portillo, A.; de Sousa, R.; Santibánez, S.; Duarte, A.; Edouard, S.; Fonseca, I.P.; Marques, C.; Novakova, M.; Palomar, A.M.; Santos, M.; Silaghi, C.; Tomassone, L.; Zúquete, S.; Oteo, J.A.The genus Rickettsia (Rickettsiales: Rickettsiaceae) includes Gram-negative, small, obligate intracellular, nonmotile, pleomorphic coccobacilli bacteria transmitted by arthropods. Some of them cause human and probably also animal disease (life threatening in some patients). In these guidelines, we give clinical practice advices (microscopy, serology, molecular tools, and culture) for the microbiological study of these microorganisms in clinical samples. Since in our environment rickettsioses are mainly transmitted by ticks, practical information for the identification of these arthropods and for the study of Rickettsia infections in ticks has also been added.
- Importance of Common Wall Lizards in the Transmission Dynamics of Tick-Borne Pathogens in the Northern Apennine Mountains, ItalyPublication . Tomassone, L.; Ceballos, L.A.; Ragagli, C.; Martello, A.; de Sousa, R.; Stella, M.C.; Mannelli, A.During the investigations on ticks and tick-borne pathogens (TBP) range expansion in the Northern Apennines, we captured 107 Podarcis muralis lizards. Sixty-eight animals were infested by immature Ixodes ricinus, Haemaphysalis sulcata and H. punctata. Borrelia burgdorferi s.l. was detected in 3.7% of I. ricinus larvae and 8.0% of nymphs. Together with the species-specific B. lusitaniae, we identified B. garinii, B. afzelii and B. valaisiana. Rickettsia spp. (18.1% larvae, 12.0% nymphs), namely R. monacensis, R. helvetica and R. hoogstraalii, were also found in I. ricinus. R. hoogstraalii was detected in H. sulcata nymphs as well, while the two H. punctata did not harbour any bacteria. One out of 16 lizard tail tissues was positive to R. helvetica. Our results support the hypothesis that lizards are involved in the epidemiological cycles of TBP. The heterogeneity of B. burgdorferi genospecies mirrors previous findings in questing ticks in the area, and their finding in attached I. ricinus larvae suggests that lizards may contribute to the maintenance of different genospecies. The rickettsiae are new findings in the study area, and R. helvetica infection in a tail tissue indicates a systemic infection. R. hoogstraalii is reported for the first time in I. ricinus ticks. Lizards seem to favour the bacterial exchange among different tick species, with possible public health consequences.
- Ixodes ventalloi: a vector role to be exploredPublication . Santos, A.S.; de Bruin, A.; Veloso, R.; Marques, C.; Pereira da Fonseca, I.; de Sousa, R.; Sprong, H.; Santos-Silva, M.M.Ixodes ventalloi is still a poorly studied tick and its public health relevance largely unknown. In Portugal it is known to share habitats with Ixodes ricinus in mainland littoral areas and to parasitize a variety of wild and domesticated animals and also humans. The potential involvement of I. ventalloi in the natural cycle of tick‐borne agents was first suggested by the detection of a new variant of Anaplasma phagocytophilum in questing and cat‐feeding ticks from Setúbal and Santarém, and is again questioned here. In this study we present the detection of A. phagocytophilum, Candidatus Neoehrlichia mikurensis and Coxiella burnetii in questing I. ventalloi collected from Parque Florestal de Monsanto (PFM), a Lisbon recreational park.
- A nationwide surveillance on tick-borne pathogens, 2011-2015, PortugalPublication . de Sousa, R.; Santos, A.S.; Santos-Silva, M.M.; Luz, T.; Parreira, P.; Bessa, S.; Núncio, M.S.; Lopes de Carvalho, I.; REVIVE Workgroup
- Neglected aspects of tick-borne rickettsiosesPublication . Tomassone, L.; Portillo, A.; Nováková, M.; de Sousa, R.; Oteo, J.A.Rickettsioses are among the oldest known infectious diseases. In spite of this, and of the extensive research carried out, many aspects of the biology and epidemiology of tick-borne rickettsiae are far from being completely understood. Their association with arthropod vectors, the importance of vertebrates as reservoirs, the rarity of clinical signs in animals, or the interactions of pathogenic species with rickettsial endosymbionts and with the host intracellular environment, are only some examples. Moreover, new rickettsiae are continuously being discovered. In this review, we focus on the 'neglected' aspects of tick-borne rickettsioses and on the gaps in knowledge, which could help to explain why these infections are still emerging and re-emerging threats worldwide.
- Phylogenetic Evidence for the Existence of Multiple Strains of Rickettsia parkeri in the New WorldPublication . Nieri-Bastos, F.A.; Marcili, A.; de Sousa, R.; Paddock, C.D.; Labruna, M.B.The bacterium Rickettsia parkeri has been reported to infect ticks of the "Amblyomma maculatum species complex" in the New World, where it causes spotted fever illness in humans. In South America, three additional rickettsial strains, namely, Atlantic rainforest, NOD, and Parvitarsum, have been isolated from the ticks Amblyomma ovale, Amblyomma nodosum, and Amblyomma parvitarsum, respectively. These three strains are phylogenetically closely related to R. parkeri, Rickettsia africae, and Rickettsia sibirica Herein, we performed a robust phylogenetic analysis encompassing 5 genes (gltA, ompA, virB4, dnaA, and dnaK) and 3 intergenic spacers (mppE-pur, rrl-rrf-ITS, and rpmE-tRNAfMet) from 41 rickettsial isolates, including different isolates of R. parkeri, R. africae, R. sibirica, Rickettsia conorii, and strains Atlantic rainforest, NOD, and Parvitarsum. In our phylogenetic analyses, all New World isolates grouped in a major clade distinct from the Old World Rickettsia species (R. conorii, R. sibirica, and R. africae). This New World clade was subdivided into the following 4 clades: the R. parkerisensu stricto clade, comprising the type strain Maculatum 20 and all other isolates of R. parkeri from North and South America, associated with ticks of the A. maculatum species complex; the strain NOD clade, comprising two South American isolates from A. nodosum ticks; the Parvitarsum clade, comprising two South American isolates from A. parvitarsum ticks; and the strain Atlantic rainforest clade, comprising six South American isolates from the A. ovale species complex (A. ovale or Amblyomma aureolatum). Under such evidences, we propose that strains Atlantic rainforest, NOD, and Parvitarsum are South American strains of R. parkeriIMPORTANCE Since the description of Rickettsia parkeri infecting ticks of the "Amblyomma maculatum species complex" and humans in the New World, three novel phylogenetic close-related rickettsial isolates were reported in South America. Herein, we provide genetic evidence that these novel isolates, namely, strains Atlantic rainforest, NOD, and Parvitarsum, are South American strains of R. parkeri. Interestingly, each of these R. parkeri strains seems to be primarily associated with a tick species group, namely, R. parkerisensu stricto with the "Amblyomma maculatum species group," R. parkeri strain NOD with Amblyomma nodosum, R. parkeri strain Parvitarsum with Amblyomma parvitarsum, and R. parkeri strain Atlantic rainforest with the "Amblyomma ovale species group." Such rickettsial strain-tick species specificity suggests a coevolution of each tick-strain association. Finally, because R. parkerisensu stricto and R. parkeri strain Atlantic rainforest are human pathogens, the potential of R. parkeri strains NOD and Parvitarsum to be human pathogens cannot be discarded.
- Rare Case of Rickettsiosis Caused by Rickettsia monacensis, Portugal, 2021Publication . de Sousa, R.; Santos, M. L.; Cruz, C.; Almeida, V.; Garrote, A. R.; Ramirez, F.; Seixas, D.; Manata, M.J.; Maltez, F.We report a case of rickettsiosis caused by Rickettsia monacensis in an immunocompetent 67-year-old man in Portugal who had eschar, erythematous rash, and an attached Ixodes ricinus tick. Seroconversion and eschar biopsy led to confirmed diagnosis by PCR. Physicians should be aware of this rare rickettsiosis, especially in geographic regions with the vector.
- REVIVE a surveillance programme for ticks and tick-borne diseases: molecular detection of B. burgdorferi s.l. and Rickettsia spp.Publication . Lopes de Carvalho, I.; Santos, A.S.; Santos-Silva, M.M.; de Sousa, R.; Núncio, M.S.Objectives: To assess the risk posed by ticks and tick-borne pathogens to Public Health is essential to have reliable data on tick population, namely main species, status, distribution and the changing trends in tick distribution and abundance. Since 2011 the Ministry of Health requested the National Institute of Health to implement and coordinate a national surveillance programme for ticks and tick-borne diseases. Methods: During 2012 and 2013, ticks were collected from hosts and on the vegetation by flagging method. Results: Through the engagement of several health agencies, more than > 18 000 ticks from 119 municipalities across mainland Portugal have been submitted, representing 13 tick species Dermacentor marginatus; D. reticulatus; Haemaphysalis punctata; Hyalomma lusitanicum; H. marginatum; Ixodes canisuga; I. hexagonus; I. ricinus; I. ventalloi; Rhipicephalus annulatus; R. bursa; R. pusillus and R. sanguineus. The majority of ticks sent to the laboratory were R. sanguineus (69%), followed by R. pusillus (16.4%) and H. marginatum (9.7%). The other tick species were collected in occasionally, such as I. ricinus with only 0.3%. Two hundred and thirty three ticks were collected on humans and R. sanguineus was the most frequent (41%) followed by I. ricinus (20%). All the human ticks and about 5% of the ticks collected from vegetation or in hosts were analyzed for the presence of Borrelia spp and Rickettsia spp. B. lusitaniae and seven rickettsial species were detected, R. aeschlimannii, R. conorii Malish, R. helvetica, R. massilae, R. raoulti and R. slovaca. Some ticks species was found only infected with a bacterial agent, as for example H. marginatum with R. aeschlimannii, and D. reticulatus with R. slovaca, when others as R. sanguineus and I. ricinus were infected with three different agents (R. conorii Malish, R. massilae and B. lusitaniae and R. helvetica, R. monacensis, B. lusitaniae, respectively). Due to the high density of Hyalomma spp. present in Portugal and the recent detection of crimean congo hemorrhagic fever virus (CCHF) in Spain, the surveillance of this virus is being implemented during this year. Conclusions: REVIVE program has already produced valuable results and will be maintained for at least the next three years that will allow to observe the trends in the Portuguese tick fauna and pathogens. Another important output of this network is to raise awareness about tick-borne diseases among the populations and the healthcare providers as medical doctors and nurses. Keywords: surveillance programme, ticks, tick-borne diseases