Epidemiology and cost of Lyme disease‐related hospitalizations among patients with employer‐sponsored health insurance—United States, 2005–2014

An estimated 300,000 cases of Lyme disease occur in the United States annually. Disseminated Lyme disease may result in carditis, arthritis, facial palsy or meningitis, sometimes requiring hospitalization. We describe the epidemiology and cost of Lyme disease‐related hospitalizations. We analysed 2005–2014 data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Databases to identify inpatient records associated with Lyme disease based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. We estimated the annual number and median cost of Lyme disease‐related hospitalizations in the United States in persons under 65 years of age. Costs were adjusted to reflect 2016 dollars. Of 20,983,165 admission records contained in the inpatient databases during the study period, 2,823 (0.01%) met inclusion criteria for Lyme disease‐related hospitalizations. Over half of the identified records contained an ICD‐9‐CM code for meningitis (n = 614), carditis (n = 429), facial palsy (n = 400) or arthritis (n = 377). Nearly 60% of hospitalized patients were male. The median cost per Lyme disease‐related hospitalization was $11,688 (range: $140–$323,613). The manifestation with the highest median cost per stay was carditis ($17,461), followed by meningitis ($15,177), arthritis ($13,012) and facial palsy ($10,491). Median cost was highest among the 15‐ to 19‐year‐old age group ($12,991). Admissions occurring in January had the highest median cost ($13,777) for all study years. Based on extrapolation to the U.S. population, we estimate that 2,196 Lyme disease‐related hospitalizations in persons under 65 years of age occur annually with an estimated annual cost of $25,826,237. Lyme disease is usually treated in an outpatient setting; however, some patients with Lyme disease require hospitalization, underscoring the need for effective prevention methods to mitigate these serious cases. Information from this analysis can aid economic evaluations of interventions that prevent infection and advances in disease detection.     

Tick paralysis in dogs and cats in Australia: treatment and prevention deliverables from 100 years of research

This review of tick paralysis caused by Ixodes holocyclus in Australia addresses the question: What are the key discoveries that have enabled effective treatment and prevention of tick paralysis in dogs and cats? Critical examination of 100 years of literature reveals that arguably only three achievements have advanced treatment and prevention of tick paralysis in animals. First, the most significant treatment advance was the commercial availability of tick antiserum in the 1930s. Hyperimmune serum currently remains the only specific anti-paralysis tick therapy available to veterinarians in Australia. Second, advances in veterinary critical care have increased survival rates of the most severely affected dogs and cats. Critical care advancements have been enabled through specialised veterinary hospitals that can provide appropriate care 24 h a day, and advanced training of veterinarians, veterinary nurses and technicians. Third, perhaps that biggest advance of all in the last 100 years of research has been the commercial availability of the isooxazoline class of acaricidal preventatives in Australia specifically for I. holocyclus. This highly effective class of preventatives offers long duration of action, low cost, spot-on or oral formulations and a low rate of adverse reactions. Animal owners and veterinarians now have the most useful tool of all – a reliable preventative. This review reveals the key events in research over the last 100 years and the tortuous pathway to delivering better treatment and preventative options for this enigmatic Australian parasite.     

永靖县羊血液原虫病综合防治试验

1999-2001年，在永靖县羊血液原虫病流行区进行了最佳灭蜱药物筛选试验和抗原虫药物预防、治疗羊泰勒虫病效果对比观察试验。结果表明：最佳灭蜱药物是灭蜱灵，平均有效期为55d，灭蜱预防后的发病率可降低到3.07％；虫克星是理想的防治辅助用药；贝尼尔脂质体和贝尼尔与蜱灵配合应用后，预防保护期达54d、45d，用药后60d发病率为2％、2.27％，比对照组49.46％降低47.46、47.19个百分点，预防效果明显；贝尼尔脂质体和焦虫净的治愈率为95％、87.85％，比对照组35.71％提高59.29、52.14个百分点，是首选治疗药物。     

应用镰形扇头蜱及巴贝斯虫病水牛的染虫血感染黄牛试验

从非流行区购进无蜱寄生的健康黄牛５头与水牛犊１头，其中３头成年黄牛（２～８岁）在畜舍内用从流行区水牛身上采得的镰形扇头蜱Ｒｈｉｐｉｃｅｐｈａｌｕｓｈａｅｍａｐｈｙｓａｌｏｉｄｅｓｈａｅｍａｐｈｙｓａｌｏｉｄｅｓ成虫，置于牛耳壳内叮咬；１头运至流行区放牧，让蜱上身叮咬；１头黄牛犊（１０年龄）去蜱后２周，用液氮保存的患病水牛染虫血４ｍｌ（４×１０ ８个虫体）皮下注射；另一头去蜱水牛犊亦同时注射相同剂量的染虫血，作为对照。５头黄牛在试验期间其体温、精神、食欲正常，未出现任何临床症状，感染后１０～１２ｄ外周血液中出现少量不典型的牛巴贝斯虫，红细胞染虫率在０．１％以下，持续３～５６消失；对照牛则体温升高（３９．８～４１．１℃），出现贫血、黄疸等症状，红细胞压积（ＰＣＶ）降至２６％，外周血液中出现典型的牛巴贝斯虫，红细胞染虫率（ＰＰＥ）高达１２％。对采用蜱叮咬及注射来自病水牛的染虫血为何不能使黄牛感染发病，文中进行了讨论。     

蜱免疫球蛋白结合蛋白研究进展

蜱体内的免疫球蛋白结合蛋白（immunoglobulin binding protein，IGBP）主要存在于血淋巴和唾液腺中，可以与进入蜱血淋巴中的宿主免疫球蛋白（immunoglobulin，Ig）结合，从而避免宿主免疫球蛋白对蜱内部器官的损害。免疫球蛋白结合蛋白结构和功能的进一步阐明，可为抗蜱疫苗的研发提供新的思路。本文综述了免疫球蛋白结合蛋白的发现及其研究进展。     

四种硬蜱的实验室人工饲养和部分生物学特性的观察

为了给蜱及蜱传疾病研究提供充足、有效的实验材料，我们对镰形扇头蜱(Rhipicephalus haemphysa loides haentaphysaloides)、亚洲璃眼蜱(Hyalomma asiaticum asiaticum)、微小牛蜱(Boophilus microplus)和嗜群血蜱(Haemaphysalis concinna)进行了实验室人工饲养。在25℃，92％相对湿度，黑暗条件下．以兔为唯一饲血动物，四种硬蜱均可完成整个生活史的发育。镰形扇头蜱完成一代需86一l20天，亚洲璃眼蜱需l04一l47天，微小牛蜱需50一74天，嗜群血蜱需88一l25天。通过实验室人工饲养，成功进行了单雌蜱蜱群的繁殖。除微小牛蜱外，其他三种蜱均可进行大量增殖。     

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province,South Africa

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii, the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities (“dip tanks”) were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9–30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002–1.06). Twenty‐one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58–45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49–43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001–0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non‐significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.