If you vacation in the Mediterranean or Middle East and return home with the flu, you may have contracted phlebotomus or sandfly fever. Mosquito protection is tremendously important in the areas where it spreads.
What is phlebotomus fever?
Phlebotomus fever is a viral infectious disease that occurs throughout the Mediterranean, North Africa, the Middle East and the Gulf States. In some cases, it is known to spread as far as the Himalayas. The disease is also found in tropical and subtropical areas of Asia and the Americas. The causative agents are phleboviruses from the Bunya virus family and are transmitted by sandflies, which are also called butterfly mosquitoes and belong to the genus Phlebotomus. This is where the name Phlebotomus fever is derived from. Synonymous names are sandfly fever, Pappataci fever, Dalmatian fever, Tuscan fever, Pick fever, Karimabad fever, and Chitral fever. Phlebovirus is divided into four distinct subgenera, Tuscany, Karimabad, Tehran, and Sabin phlebotomus fever viruses. Tuscany virus is the most common worldwide. The other subgenera appear only in certain regions.
Causes
Phlebotomus fever is transmitted by sandflies. Human-to-human infection is not possible. Phlebovirus usually lives in bats and rodents, and sometimes in cattle, goats, and sheep. If a sandfly bites an animal carrying the virus, the mosquito becomes infected. Eggs and larvae of the mosquitoes can also already be infected with the virus. After about six days, the virus has multiplied to such an extent that it can also be transmitted to humans. This happens through the blood meal of an infected sandfly on a human. In late spring and summer, Phlebotomus fever occurs more frequently, because at this time the sandflies multiply more. In the fall and winter, there is virtually no risk of infection. It is also typical for Phlebotomus fever that a particularly high number of infections occur in one year, and that the frequency of the disease decreases again in the following years. In the areas where the virus occurs, most adult inhabitants have become immune to it through repeated, symptomless infections. Young children and foreign tourists in particular can contract Phlebotomus fever.
Symptoms, complaints, and signs
Phlebotomus fever is manifested by symptoms such as fever and chills. Accompanying these symptoms may be severe headache and eye pain, which occur in phases and become more severe as the fever progresses. Eye pain is particularly painful, occurring with any movement of the eyes. They may radiate to the ears and jaw, resulting in further symptoms and discomfort. Many patients also complain of muscle, joint and limb pain. The pain is usually described as burning or aching. Phlebotomus fever also manifests with flu symptoms such as fatigue, lassitude and sweating. Typically, the first symptoms appear three to six days after infection. They eventually subside after three to four days, although it can take several weeks to fully recover. Possible subsequent symptoms include a renewed rise in fever, painful skin rashes and inflammation all over the body. In severe cases, mentioned conjunctivitis develops. The Tuscany virus can also lead to paralysis and impaired consciousness. These also usually subside as soon as the fever recedes. Externally, the disease is primarily recognized by the sickly appearance and the typical reddening of the skin.
Diagnosis and course
Phlebotomus fever is diagnosed by antibody detection. This is because immediately after infection, the immune system begins to produce antibodies that are precisely matched to the attacking viruses. The physician can also recognize the disease by means of the symptoms, the last vacation or business destination abroad and the history of the disease. The course of the disease is similar to that of influenza: fever, joint pain, muscle pain and headache, as well as a general feeling of illness follow about three to six days after infection. Extremely severe pain on movement of the eyes is particularly typical. In most cases, the symptoms disappear again after three to four days, but it can take several weeks until final recovery.In more severe cases, there may be a renewed rise in fever, exanthema (skin rash) or conjunctivitis. Tuscany virus can cause meningitis. Eventually, impaired consciousness and signs of paralysis may occur, but in most cases these symptoms resolve completely.
Complications
Although West Nile fever is a serious illness that should definitely be followed by a doctor, it is rarely accompanied by threatening complications in healthy adults. The flu-like symptoms that patients develop can become extremely distressing if severe. For example, a very high fever may develop or the headache and pain in the limbs may become so severe that drug treatment becomes necessary. If a patient suffers from severe diarrhea and vomiting, there is a risk of dehydration and circulatory collapse. In rare cases, dangerous sequelae may occur. In some patients, the pathogens affect the brain and lead to severe encephalitis (inflammation of the brain) or meningitis (meningitis). In these cases, the patient is at risk for long-term damage due to brain impairment. Acute signs of paralysis that do not recover, or do not recover completely, are observed sporadically in ill individuals. In addition, both encephalitis and meningitis are potentially life-threatening. Occasionally, the virus also affects other organs such as the pancreas, heart, or eyes. However, these severe complications almost exclusively affect children and seniors, as well as people who suffer from a weakened immune system. Persons suffering from AIDS have a particularly high risk of severe sequelae.
When should you see a doctor?
The doctor should be consulted if there is a fever, severe headache, and an increasing feeling of illness. The symptoms indicate an infectious disease that must be treated with medication. If phlebotomus fever is indeed the underlying cause, rapid medical clarification is necessary in any case. The sick person should consult the family doctor immediately and have the symptoms examined. Particular danger exists after a tick bite or other contact with possibly infected animals. If in this context mentioned complaints occur, it is best to contact the emergency medical service. At the latest, if neck stiffness, tremors or paralysis are added to the symptoms described, a visit to the doctor is recommended. Phlebotomus fever can be treated well, as long as it is diagnosed early. Diagnosis and treatment is done by the family physician or an internist. Children should be presented to the pediatrician if the described symptoms occur. During therapy, close consultation with the responsible physician should be maintained due to the high risk of complications. In addition, regular follow-up examinations are indicated, since meningitis can occur long after recovery.
Treatment and therapy
Because there is as yet no treatment option for the virus itself, only the symptoms of Phlebotomus fever are treated. For example, antipyretic and analgesic agents are administered. In most cases, these therapeutic methods are also sufficient, and the prognosis for a complete cure is generally very good, even in the more severe cases. Complications are rather rare overall.
Outlook and prognosis
The further course of phlebotomus fever is in the first place very much dependent on the time of diagnosis, so that a general prediction can not be made thereby. The affected person should therefore see a doctor at the first symptoms and signs of the disease and thereby also have treatment initiated to prevent the occurrence of further complaints or compilations. It is not possible for Phlebotomus fever to heal on its own, so treatment by a doctor is always necessary. The symptoms of Phlebotomus fever usually do not heal until medication is taken. Without treatment, in the worst case scenario, the affected person may die. With treatment, there are usually no complications. Even relatively severe infections can be combated well with the help of medicines.After treatment, however, the affected person can also become infected again with this disease and should therefore protect himself particularly well against mosquitoes in the affected regions. There is no immunity after contracting the disease. Follow-up care is also rarely necessary, so that the disease can ideally be cured after only a few days. Only rarely does this fever reduce the life expectancy of the affected person.
Prevention
To date, there is no vaccination against Phlebotomus fever. In the areas of distribution, infected mosquito populations are controlled to prevent the disease. Mosquito nets and anti-mosquito sprays are also good precautions. The mesh size of the net should be smaller than two millimeters, as sandflies are very small. Especially at night you should protect yourself sufficiently from mosquito bites, because the insects are particularly active then. Long pants and sleeves also protect the body from mosquito bites. Body oils made of eucalyptus, cedar wood or citrus fruits can also deter the pesky bloodsuckers, however, each person must individually try out which body oil works best for him.
Aftercare
Phlebotomus fever is treated symptomatically by the doctor prescribing the patient suitable medicines against the individual complaints. In addition to treatment with antibiotics, the patient must primarily take it easy. Stress and strenuous physical exercise should be avoided. In addition, contact with other people should be limited or avoided altogether. Otherwise, transmission of the pathogens may occur. The diet should be changed to a sparing diet. In addition, sufficient fluids must be consumed, since the body loses a large amount of water due to symptoms such as diarrhea and vomiting. The symptoms of phlebotomus fever should resolve on their own after a few days. If they persist longer or even become more severe, a doctor must be consulted. The medical professional will help treat the symptoms by prescribing a stronger antibiotic or consulting alternative medical professionals. In severe cases, inpatient treatment in the hospital is necessary. After hospitalization, the sufferers again require bed rest so that they can fully recover. If the complaints occur on vacation in one of the risk areas, it is emphielt to break off the trip and if possible to be treated by the family doctor.
What you can do yourself
Individuals who have contracted phlebotomus fever after traveling to the Mediterranean or Middle East should talk to their primary care physician or receptionist daily. After administration of antipyretic medication, the illness usually subsides within three to four days. The patient must take it easy during this period and alleviate the individual symptoms with the help of home remedies. For headaches and eye pain, it helps to darken the bedroom and spend some time in bed. Any ear and jaw pain is treated by cooling. Cool packs from the pharmacy help, as do cooling compresses or gauze bandages with soothing ointments. Possible skin rashes should not be scratched open. The skin lesions should disappear as the fever recedes and usually do not leave scars or pigment changes. If the measures do not help and the fever becomes stronger instead, the family doctor must be informed. Then inpatient treatment in the hospital may be necessary. Individuals suffering from phlebotomus fever should be monitored by a family member or friend so that necessary steps can be taken quickly if complications arise.
