Pappataci fever A93.1

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 19.02.2021

Synonym(s)

Dog Disease; Phlebotomus fever; Sandfly-Fever; Summer fever; Third Day Fever

Definition
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Influenza-like viral disease caused by Bunyaviruses (Bunyaviridae) transmitted by Phlebotomus pappatasii, the Phlebotomus fever virus S.a.u. Phlebotomes.

Pathogen
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Bunyaviruses ('phleboviruses') of different serotypes. Of particular pathogenetic importance are the pathogens of the Sicilian type of sandfly fever (Sicilian SF, SFS), the Toscana type (SF-Toscana, TOS) and the Naples type (SF-Naples, SFN).

Natural hosts are farm animals such as dogs, sheep and cattle or wild small animals such as forest mice.

SFS and SFN are widely distributed in the Mediterranean region and Arab countries.

TOS has so far only been detected in some regions of Italy, Portugal, Spain and Cyprus.

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Occurrence/Epidemiology
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Occurrence in the summer and autumn months in endemic areas of the Mediterranean Sea, the Balkans, the Middle East and Middle East, Central Asia and East Africa.

Clinical features
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General: 2-4 day acute onset fever, headache, retrobulbar eye pain, conjunctivitis, flushed face.

Integument: Hot, dry skin. Skin and mucous membrane haemorrhages occur, rarely morbilliform exanthema, roseolar exanthema, scarlatiniform exanthema or urticarial exanthema. Patchy or striate, dusky red enanthema, especially on the soft palate. Occasional mucopurulent gastroenteritis, bradycardia.

Laboratory
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Leukopenia.

Differential diagnosis
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Dengue fever; abdominal typhoid; malaria; flu.

Complication(s)
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Aseptic meningitis, paralysis, cephalgias in infections with TOS (usually occurring about 2 weeks after febrile symptoms have subsided)

Therapy
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Symptomatic therapy with antipyretic and analgesic agents such as paracetamol (e.g. Ben-u-ron Tbl.) 3 times/day 500 mg p.o. The symptoms usually subside within a few days.

Progression/forecast
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Cheap.

Case report(s)
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2 weeks after several sandfly bites in Tuscany, a 40-year-old woman fell ill with an acute, high-fever illness which was accompanied by photophobia and severe headaches 2 days after the onset of the illness. A neck stiffness that started on the 3rd day led to an inpatient admission.

In the following, double images appeared as a result of a unilateral paralysis of the abducted nerve.

Laboratory:

CSF puncture: lymphocytosis in
Blood count: Normal range
Further laboratory parameters: Standard range
Serology: Detection of IgG and IgM antibodies of the Tuscany serotype. Virus detection was not possible.

After 15 days the patient could be discharged. Headaches, double vision, fatigue and sleeping disorders were still present.

Literature
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Baldelli F et al (2004) Unusual presentation of life-threatening Toscana virus meningoencephalitis. Clin Infect Dis 38: 515-520
Fisher AF et al (2003) Induction of severe disease in hamsters by two sandfly fever group viruses, Punta toro and Gabek Forest (Phlebovirus, Bunyaviridae), similar to that caused by Rift Valley fever virus. At J Trop Med Hyg 69: 269-276
Fleming J et al (1947) Sandfly Fever, Review of 664 cases. Lancet I 443-446
RKI (1996) Epidemiological Bulletin 32/96