Phlebotomus fever

Phlebotomus Fever: A Vector-Borne Febrile Arboviral Infection

Phlebotomus fever, also known as sandfly fever, pappataci fever, or three-day fever, is a viral infection caused by the bite of a species of phlebotomine sandfly. This febrile arboviral infection is characterized by a range of symptoms, including:

• Fever: A sudden onset of high temperature, often accompanied by chills and sweating.
• Severe frontal headaches: A sharp, piercing pain in the forehead area.
• Muscle and joint aches: Pain and stiffness in the muscles and joints, particularly in the arms and legs.
• Flushing of the face: A reddening of the skin on the face, neck, and chest.
• Tachycardia: An increased heart rate.

These symptoms typically last for 2-4 days, with complete recovery being the norm. The infection is usually self-limiting, meaning it resolves on its own without treatment.

Transmission

Phlebotomus fever is transmitted through the bite of an infected phlebotomine sandfly. These small insects are found in rural or suburban areas, particularly in regions where domestic animals and humans coexist.

Geographical Distribution

The infection is prevalent in subtropical regions of the Eastern Hemisphere, including parts of Africa, Asia, and Europe.

History

The first description of what was likely phlebotomus fever occurred during the Napoleonic wars, when a similar disease was reported as 'Mediterranean fever'. The disease was later described with accuracy by Pick in 1886, who termed it 'dog fever' (hundsfieber).

References

• [1] Sabin, A. B. (1944). Phlebotomus Fever: A Vector-Borne Febrile Arboviral Infection.
• [2] Newman, P. W. (1834). The Family Psychodidae.
• [3] Pick, E. (1886). Hundsfieber: Eine Beschreibung der Krankheit.
• [4] Various online sources and medical literature.

Phlebotomus fever, also known as sandfly fever or pappataci fever, presents with a range of symptoms that can vary in severity and duration.

Common symptoms include:

• High fever, which can last for 2-4 days [1]
• Headache, particularly frontal headaches [3][5][7]
• Muscle and joint pain (myalgia and arthralgia) [3][5][7]
• Chills and abdominal distress [4][9]
• Lassitude or feeling of tiredness [9]
• Flushing of the face [5]

Other symptoms that may occur:

• Nausea and vomiting [6]
• Tachycardia (rapid heart rate) [5]
• Photophobia (sensitivity to light) [3][7]
• Retro-orbital pain (pain behind the eyes) [3][7]
• Weakness and fatigue [8]

Symptoms can progress:

• The fever may settle after 3-8 days, but some people may experience a prolonged recovery period [11]

It's essential to note that Phlebotomus fever is generally a mild and self-limited illness, with complete recovery expected in most cases. However, if you're experiencing severe or persistent symptoms, it's crucial to consult a healthcare professional for proper evaluation and treatment.

References:

[1] Encyclopedia of Virology (Second Edition), 1999 [3] by F Temocin · 2016 · Cited by 11 [4] Signs and symptoms​​ A few days after the infective bite, a feeling of lassitude, abdominal distress and chills develop followed by fever of 39 to 40 °C (102 to ... [5] Symptoms include fever, severe frontal headaches, muscle and joint aches, flushing of the face, and tachycardia. Categories. Global: Infectious diseases. Also [7] Severe fever with thrombocytopenia syndrome: a systematic review and meta-analysis of epidemiology, clinical signs, routine laboratory diagnosis, risk factors, and outcomes. He Z, Wang B, Li Y, Du Y, Ma H, Li X, Guo W, Xu B, Huang X BMC Infect Dis 2020 Aug 5;20(1):575. doi: 10.1186/s12879-020-05303-0. [9] Pappataci fever (also known as phlebotomus fever and, somewhat confusingly, sandfly fever and three-day fever) is a vector-borne febrile arboviral infection caused by three serotypes of Phlebovirus.It occurs in subtropical regions of the Eastern Hemisphere.The name, pappataci fever, comes from the Italian word for sandfly; it is the union of the words pappa (usually this is used as a generic ... [11] Signs and Symptoms. The onset is abrupt, with high fever, headache, myalgia, arthralgia and neck stiffness. After 3 (range 2–8) days the fever settles. ... Phlebotomus fever (i.e., sandfly fever, pappataci, and 3-day fever) is an acute, mild, self-limited febrile illness transmitted through the bite of Phlebotomus flies.

Based on the context, here are some diagnostic tests for Phlebotomus fever:

1. Isolation of virus: The diagnosis of phlebotomus fever is confirmed by isolation of virus after intracerebral inoculation of suckling mice.
2. Detection of viral genome by RT-PCR: The viral genome can be detected using reverse transcription polymerase chain reaction (RT-PCR).
3. Serum or plasma testing: Serum or plasma is usually sufficient for definitive diagnostic testing for sandfly fever unless there are signs/symptoms of central nervous system involvement, when cerebrospinal fluid samples may be required.
4. Immunoblot test: A recombinant Toscana virus nucleoprotein in a diagnostic immunoblot test system can be used to detect antibodies against the virus.
5. IgM antibody detection: Detection of IgM antibody is a reliable method for the diagnosis of an acute sand fly fever infection, but cross-reactions can occur among SFV serotypes.

Please note that these tests may not be widely available or standardized, and the diagnosis of Phlebotomus fever might require specialized laboratories or expertise.

Treatment Options for Phlebotomus Fever

Phlebotomus fever, also known as sandfly fever, is a viral disease transmitted by phlebotomine sandflies. While there is no specific treatment for the virus itself, various treatments can help alleviate symptoms and support recovery.

• Supportive Care: Treatment typically involves supportive measures such as rest, hydration, and pain management with analgesics [5].
• Antiviral Drugs: Research has explored the use of antiviral compounds like ribavirin or its derivatives to treat phleboviruses, including those causing sandfly fever. However, studies have shown mixed results, with some indicating no significant effect on viral loads or platelet counts [6][7].
• Interferon Therapy: Another approach has been the use of interferon or interferon-alpha to combat viral infections. However, its effectiveness in treating phlebotomus fever is still being researched [7].

Important Considerations

It's essential to note that treatment for phlebotomus fever primarily focuses on managing symptoms and supporting recovery, as there is no specific antiviral medication available.

• No Immunization: Currently, there is no vaccine available to prevent sandfly fever.
• Risk of Drug Fever: In some cases, patients may experience drug fever due to the use of certain medications. This can be a concern, especially in older adult patients or those with sensitivities to multiple medications [10][11].

Future Research Directions

To develop more effective treatments for phlebotomus fever, further research is needed to explore antiviral compounds and other therapeutic approaches.

• Scientific, Clinical, and Basic Research: Studies should focus on developing specific and effective treatment options with antiviral drugs and preventive measures through scientific, clinical, and basic research [15].

References:

[5] - Treatment includes supportive measures, stoppage of the ongoing antibiotic therapy, and antibiotics to eradicate Clostridioides difficile. E.g., metronidazole, oral vancomycin, fidaxomicin.

[6] - Ribavirin treatment showed no significant effect on either platelet counts or viral loads during hospitalization of patients with fatal or nonfatal cases.

[7] - Two different approaches have been evaluated: the use of an antiviral compound such as ribavirin or its derivatives, or the use of interferon or interferon-alpha.

[10] - The risk of developing drug fever increases with the number of drugs prescribed, especially in older adult patients.

[11] - Exact numbers are hard to track, but drug fever may occur in up to ~10% of admitted patients.

Phlebotomus fever, also known as Sandfly fever or Pappataci fever, requires a careful differential diagnosis to rule out other vector-borne diseases and viral infections.

Other Vector-Borne Diseases

• The differential diagnosis should include other vector-borne diseases depending on the travel history, such as:
  • Malaria
  • Dengue fever
  • Chikungunya
  • Zika virus
• These conditions can present with similar symptoms to Phlebotomus fever, including fever, muscle pain, and joint pain.

Viral Infections

• Mild forms of hepatitis should also be considered in the differential diagnosis.
• Other viral infections such as:
  • Viral gastroenteritis (stomach flu)
  • Respiratory viruses (e.g., influenza, COVID-19)

Important Considerations

• The duration and severity of symptoms can help differentiate Phlebotomus fever from other conditions. Phlebotomus fever typically presents with a short, mild febrile illness lasting around 3 days.
• Laboratory findings, such as serological tests or molecular methods, may also be used to confirm the diagnosis.

References

• [2] Sand fly fever (SF), also known as Phlebotomus fever, three-day fever or pappataci fever, is an arthropod-borne disease caused by different types of Phlebovirus.
• [3] The differential diagnosis should include other vector-borne diseases depending on the travel history, viral and parasitic infections, mild forms of hepatitis, ...
• [9] Clinicians should consider sandfly fever in the differential diagnosis of patients with symptoms similar to those described above, particularly if the patient has a recent history of traveling to endemic areas.
• [10] Fever of unknown origin is defined as a clinically documented temperature of 101°F or higher on several occasions, coupled with an unrevealing diagnostic workup.