Sandfly fever in the world

Introduction and Objective: Sandfly fever remains a significant health problem in many parts of the world (particularly in Africa, the Mediterranean Basin, the Middle East, Central Asia, and Europe). The aim of this study was to determine the latest circumstances of this disease at present in the world. Materials and Methods: Two methods were used to gather the information for this article. First, PubMed was searched for English language references to published relevant articles. Second, the term sandfly fever was searched on Google Scholar too. Results: In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sandfly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66%, 20.51%, 13.46%, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Australia, and America, with percentages being 26.92%, 17.30%, 17.0%, 1.28%, and 1.28%, respectively. Conclusion: Different countries have reported the disease either as an endemic or as an imported one. Further investigations on the pathology and virulence of ecology of sandfly fever are necessary to improve the understanding of this cycle in order to provide adequate preventive measures, and also to improve them.

Keywords: Present, sandfly fever, world

Sandfly fever, also called pappataci fever or three-day fever, is a vector-borne disease and rodents may play a key role in the life cycle of the diseases [Figure 1]. The disease is transmitted to humans by bites of the female species of Phlebotomus, which may differ from one country to another. ^[1] There are similar vectors for leishmaniasis, which is endemic in more than 88 countries. ^[2] Sandfly virus belongs to the Bunyaviridae family. ^[3] Bunyaviridae viruses are distributed worldwide including Europe, Africa, Central Asia, and the American continent. ^[4],[5] There are four main serotypes including sandfly fever Sicilian virus (SFSV), sandfly fever Cyprus virus (SFCV), sandfly fever Naples virus (SFNV), and Toscana virus (TOSV). SFSV, SFNV, and other related viruses cause sandfly fever. ^[6] The distribution of sandfly fever virus is different in many parts of the world [Figure 2]. In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sandfly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66%, 20.51%, 13.46%, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Africa, Australia, and America, with percentages of 26.92%, 17.30%, 17.0%, 1.28%, and 1.28%, respectively, [Figure 3] and [Figure 4]. The disease can occur during the warm season (in late spring and summer, and early autumn), parallel with the maximum activity of the sandfly vectors. So far, sandfly fever has been reported from different regions including the Islamic Republic of Iran, ^{[7],[8],[9],[10],[11]} , Southwest Asia, ^[12],[13] Pakistan, ^[14] Central Asian countries (e.g., Turkmenistan), ^[15] Turkey. ^[16] India, ^[17] Egypt, ^[18] Tunisia, ^[19] Algeria, ^[20] Morocco, ^[21] Malta ^[22] in addition to Italy, ^{[23],[24],[25],[26],[27],[28],[29],[30],[31],[32]} Spain, ^[33] France, ^[34],[35] Switzerland, ^[36],[37] Greece, ^[38],[39] Austria, ^[40] and Persian Gulf region. ^[41] Of course, there are no reports from other parts of the world, perhaps as a result of the fact that no studies have been designed in these countries or because of the lack information of seroepidemiological studies. I believe that sandfly fever has been described well by scientists in different parts of the world because this disease has the same vector as that of Leishmaniasis. As we all know, all the continents are infected by sandfly vector but the distribution of the vector is not the same in all parts of the world. There is no specific cure for sandfly fever, the patients will be cured by rest for a few days, have pain killer, and drink plenty of fluid either orally or intravenously. The reinfection in the same area may be seen after 1-2 year(s) but travellers are more susceptible to this infection due to lack of immunity against every sandfly fever serotype. For health care workers in many parts of the world, sandfly fever is still an unknown disease because it must be differentiated from similar diseases such as influenza, malaria, Q fever, and other febrile diseases; the distinction may be urgently required for important operations. ^[42],[43] The aim of this article is to review the current information about sandfly fever such as clinical diagnosis, treatment, epidemiology, prevention, and control in the health care settings. A review of the literature on the epidemiology, diagnosis, treatment, and prevention of sandfly fever till 23 January 2014 using computerized bibliographic databases, which include PubMed, and Google Scholar, was done in order to increase the understanding of sandfly fever in health care settings.

Figure 1: The possible life cycle of Sand fly fever. From: http://o.quizlet.com/zsFfr0Vhz7woviJOOP7d4q-m.png.Click here to view

Figure 4: Articles published regarding the term “sandfly fever” throughout the world in PubMed and Google Scholar as per geographical location Click here to view

Sandfly fever or phlebotomus fever, also known as pappataci fever, is an interesting disease that causes fever, myalgia, and malaise, along with abnormalities in liver enzymes and hematological test results. ^[44]

The disease may be mistaken as other diseases such as influenza and malaria. Clinical finding as well as laboratory diagnosis, particularly the molecular technique, may be helpful to differentiate this disease from other particular infectious diseases. As mentioned above, this disease is self-limited and there are no fatalities; the clinical picture of phlebotomus fever resembles that of influenza without the signs of acute inflammation of the respiratory tract. ^[72] It should be mentioned that so far, sandfly fever has not been found in Central Europe. However, in the course of global warming, an establishment of biological cycles after an introduction of the pathogens, particularly if vertebrates other than humans can also act as reservoir hosts, seems possible. ^{[45],[46],[47]}

Diagnosis

It is very hard to diagnose this disease in a nonendemic area, particularly if it is travel-associated and if the anamnesis is not clear The differential diagnosis consists of a very board spectrum list of diseases such as viral, parasitic, and bacterial infections. ^{[48],[49],[50]}

This disease must be differentiated from other diseases such as malaria and influenza too because it starts after an incubation period of 3-6 days with high fever (sometime near 40°C) that lasts for 2-3 days; other common symptoms may be included such as headache, anorexia, myalgia, photophobia, back pain, and malaise. Significant leukopenia and lymphopenia, followed by protracted neutropenia may be present too. ^[51]

Treatment

The treatment of sandfly fever is usually nonspecific; painkillers as well as relief medicine are prescribed by physicians.

The epidemiology of the disease may be related as follows:

Host

Infected humans and rodents are mostly the main hosts of this disease; however, other vertebrates may also be involved in spreading this disease [see the [Figure 1].

Transmission

The virus is transmitted to humans by the bite of Phlebotominae sandflies that belong to the Psychodidae family, mainly Phlebotomus papatasii, while it has to be said that the new vectors Phlebotomus perniciosus, Phlebotomus perfiliewi and Phlebotomus perniciosus for TOSV, and Phlebotomus major sensu lato for SFTV have also been recently reported.

Molecular evidence indicates that Phlebotomus major sensu lato (Diptera: Psychodidae) is the vector species of the recently identified SFSV variant. ^{[52],[53],[68]}

Prevention and control

The prevention of this disease is very difficult, particularly in developing countries, where there are not enough health care personnel and health care equipment such as beds, nets, and repellents. Sandfly fever has no vaccine so far; since researches are under way, there is hope to find out the best way to overcome this problem in the near future. ^[45]

This disease has been introduced very well by researchers; it is still a major problem in many parts of the world but the condition of the disease in some countries is unclear. Thus, further research may be needed to clarify the fact. It seems that the disease is more prevalent in some parts of the world, particularly in Asia, ^[54],[55] Africa, ^{[56],[57],[58],[59],[60]} and Europe; ^{[45],[46],[47],[48]} this disease has also been reported from other parts of the world. ^{[61],[62],[63],[64],[65],[66]} For the detection of sandfly fever, several laboratory techniques such as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) have been developed recently. ^{[66],[67],[68],[69],[70]} Sandfly fever is also very important for travelers; the imported cases of this fever are reported in many of the literature from nonendemic areas. ^[71] Military troops who have been in the endemic areas are also under risk. ^[72],[73] Thus, specific care must be given to military forces [i.e., United Nations (UN) peacekeepers) in endemic areas in order to prevent the outbreaks.

Recommendations

Here are some recommendations to be considered for sandfly fever prevention: 1. Conduct public awareness and education campaigns, 2. Avoid contact with animals in endemic areas, 3. Apply repellents on your face and hands at night when you are travelling to an endemic area, and 4. See your doctor if you have signs and symptoms of sandfly fever, as mentioned above, as soon as possible. Further investigations on the pathology and virulence of ecology of sandfly fever necessary to improve the understanding of this cycle and to provide adequate preventive measures. High level of personal and public health measures are needed to overcome this disease. The only effective way to prevent it is health education, either among the public or in special groups such as health care workers.

I would like to thank Professor Djavadian for his advice and my family for their help and support.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.162312

[Figure 1], [Figure 2], [Figure 3], [Figure 4]