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Abstract:
Rickecttsioses
have played a significant role in the history of world civilization. (1,2,3)
Epidemic typhus has affected over 30 million people in both world wars, with
the outcome of 3 million people who died. Additionally, during World Wars I and
II, it hit all Balkan countries hard. (4). The tragic outcome of the epidemic
in Serbia and Montenegro during World War I, resulted with over 100,000 victims
and more than half of the entire medical staff infected, entered the history of
medicine. (5,6,7) In the XX and XXI century, the renaissance of rickettsial
diseases is characterized by the reappearance of typhus in the world with high
mortality and the appearance in regions of the world where it did not exist
previously. The drastic increase in rickettsial spotted fever (abb. SFRD) in
the late 1970s, ehrliosis in 1990, testify to the strong association of these
diseases with changes in the eco-environment, which were largely influenced by
human activity. In addition, there are difficulties for health systems to
predict epidemics of these diseases and protect the population at risk.
(8,9,10)
Drastic changes in the eco-environment have
contributed to increasing adaptability of rickettsial agents, as well as the
possibility of acquiring the new features. They influenced changes in vector
properties and their expansion, contributing to the return of old and the
appearance of new rickettsioses in the Vector Borne Diseases (abb. VBD) group,
emphasizing Hans Zinzer's prediction: "Typhus is not dead, moreover it
exists in the nature and will always return, as long as human stupidity allows
it.”(2,3)
A retrospective - prospective study of rickettsial
diseases in Montenegro conveyed until the end of 2017, used historical data for
epidemic typhus. For other rickettsioses, in the period from 1996 to 2017
standard epidemiological, clinical and laboratory methods were used. For the
etiological confirmation of the clinical diagnosis of rickettsioses, and the
detection of multi etiological (co-infectious) forms of the disease,
serological tests were used: Indirect immuneo fluorescence (IIF), ELISA, and
latex agglutination test, for detection of specific antibodies. From the group
of micromolecular methods, the results of Polimerase Chain Reaction (PCR) for
DNA detection, were of special importance. (7)
Montenegro is an endemic area for numerous
rickettsial diseases. In our country, endemic-epidemic typhus has not been
registered since 1946. In the period from 1996 to 2017, we analyzed 657
patients with an etiologically confirmed diagnosis of various rickettsial and
rickettsial-like diseases.
The first serological confirmations of rickettsial
spotted fever (SFRD) and Q fever were registered in 1995/1996. By the end of
2017, 293 cases of rickettsial spotted fever and 158 cases of Q fever were
registered. The first serological evidence of ehrlichiosis was obtained in the
period from 2008 to 2017; with serological confirmation of Ehrlichiaecanis in
64 cases. Bartonelosis was confirmed in 42 cases in these studies.
Clinically, rickettsial diseases vary greatly in
relation to severity, clinical presentation, from self-limiting to fulminant,
life-threatening diseases. The problem of modern presentation of these diseases
is evidenced by their increasingly frequent registration in co-infectious forms
with the participation of various rickettsial agents, wider range of agents of
VBD complex, as well as agents that do not belong to this complex, which was
proven during our tests. The multi etiological (co-infectious) form of the
disease additionally complicates the diagnosis, therapy and prognosis of the
disease. It affects the creation of new species and subspecies of rickettsial
agents, which move from enzotic cycles to zoonotic cycles, without the need for
long-term evolution in enzotic cycles.
From ancient times to the
present day, rickettsial diseases represent a significant public health problem
in relation to diagnosis, therapy and prognosis, with possible negative
implications for the future.
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