Case studies of rickettsiosis, anaplasmosis and Q fever in Slovak population from 2011 to 2020

Ticks are medically important hematophagous ectoparasites transmitting pathogens such as Borrelia , Rickettsia , Babesia , Anaplasma , and Coxiella species that may seriously affect the health of animals and humans. More than a million cases of rickettsiosis, anaplasmosis, and Q fever occur annually worldwide, often in farmers or other occupationally exposed people. Despite the confirmed presence of the causative agents in endemic areas, the attention to these intriguing illnesses is frequently neglected in many countries, including Slovakia. We performed serological and molecular analyses of 403 human sera and 118 blood samples obtained from Slovak patients in the last decade. Herein, we describe seven particular cases to illustrate how clinicians and public health professionals are performing laboratory diagnostic work together to monitor the circulation of rickettsiae and rickettsia-like pathogens and solve health challenges associated with these infections. The results of laboratory testing were related to the symptoms of the diseases and possible tick infestations. Fever and erythema or rash were commonly reported in the cases of rickettsial infections, which were confirmed by the presence of IgM anti-SFGR antibodies and PCR assay positive for either Rickettsia helvetica, Rickettsia raoultii, or Rickettsia sp. On the other hand, an acute Q fever was commonly associated with fever and close contact with livestock or their products. Additionally, for the first time in Slovakia, we described a case with the presence of Anaplasma phagocytophilum DNA in human patient’s blood for 47 days. In conclusion, we assume that effective surveillance of rickettsioses and Rickettsia -like infections is essential for public health. It certainly contributes to better prevention and management of these communicable diseases.