Consideration of Vector-Borne and Zoonotic Diseases

Consideration of Vector-Borne and Zoonotic Diseases During Differential Diagnosis

Steven T. Peper, PhD; Adam C. Jones, PhD; Cynthia Reinoso Webb, PhD; Mark Lacy, MD; Steven M. Presley, PhD

South Med J. 2021;114(5):277-282.

Abstract and Introduction

Abstract

Objective: Recognition and reporting of vector-borne and zoonotic disease (VBZD) cases is largely dependent upon the consideration of such diseases by healthcare practitioners during the initial diagnosis and ordering of specific confirmative diagnostic tests. This study was conducted to assess the general knowledge and understanding of VBZD transmission and clinical presentation.

Methods: Healthcare practitioners were surveyed to determine the extent of training and educational experiences they received relative to VBZDs, and their likelihood to consider such diseases during differential diagnoses. In addition, an assessment of their knowledge of arthropod species that may transmit VBZD pathogens was conducted.

Results: Having postprofessional school training relevant to VBZDs significantly influenced diagnostic accuracy for such disease cases based on the presented clinical signs and symptoms.

Conclusions: The prevalence of VBZDs in the United States likely is significantly underestimated. The authors suggest the enhancement of VBZD-focused education as an important initiative that would significantly improve timely diagnosis, treatment, and, ultimately, prevention of these diseases.

Introduction

The Centers for Disease Control and Prevention reported in 2018 that the incidence rate of vector-borne and zoonotic diseases (VBZDs) more than tripled during the past 15 years in the United States, with nine new arthropod-vectored pathogens identified or introduced during that time period.

Abstract and Introduction
Methods
Results
Discussion
References
Sidebar

Table 1. Clinical signs and symptoms of vector-bone and zoonotic diseases presented to healthcare practitioners for consideration for initial differential diagnoses
Disease	Signs and symptoms presented
Chagas disease	Headache, fever, vomiting, nausea, diarrhea, rash, fatigue, unilateral eyelid swelling resulting from an apparent insect bite, and swollen lymph nodes
Chikungunya disease	Prolonged arthralgia (focused in wrist, knees, and ankles), rash focused on the trunk and limbs, severe congenital infection, fever, and headache
Dengue fever	Fever, myalgia, headache, bone pain, arthralgia, rash, retroorbital pain, vomiting, and bleeding gums
West Nile fever	Headache, slight fever, myalgia, arthralgia, vomiting, diarrhea, and a maculopapular rash
West Nile neuroinvasive disease	High fever, stiff neck, tremors, muscle weakness, encephalopathy, and vision loss
Zika fever	Fever, rash, headache, myalgia, conjunctivitis, and arthralgia

Symptoms derived fromAPHA 2014.⁷ APHA, American PublicHealth Association.

Table 2. Participant responses of the most likely and second most likely initial diagnoses of diseases based on patient presentation of signs and symptoms listed in the survey
Survey participant responses (%)	Diseases corresponding to signs and symptoms presented to survey participants^a
	Chagas		Chikungunya		Dengue		WNF		WNND		Zika
	1^st	2^nd	1^st	2^nd	1^st	2^nd	1^st	2^nd	1^st	2^nd	1^st	2^nd
	(n = 39)	(n = 25)	(n = 33)	(n = 19)	(n = 39)	(n = 25)	(n = 48)	(n = 34)	(n = 45)	(n = 21)	(n = 41)	(n = 28)
Correct diagnosis	10.3	4.0	6.1	0	51.3	8.0	0	0	13.3	0	2.4	10.7
Other VBZDs	48.7	44.0	15.2	10.5	2.6	36.0	16.7	8.8	4.4	4.8	2.4	10.7
Influenza	0	0	0	0	0	0	12.5	5.9	0	0	12.2	7.1
Other/nonspecific viral	20.5	24.0	30.3	36.8	12.8	16.0	50.0	47.1	6.7	42.9	63.4	17.9
Bacterial	5.1	20.0	12.1	10.5	0	4.0	6.3	8.8	11.1	4.8	2.4	21.4
Meningitis/encephalitis	0	0	9.1	10.5	5.1	4.0	6.3	11.8	62.2	33.3	2.4	3.6
Other	17.9	8.0	27.3	31.6	28.2	32.0	2.1	17.6	2.2	9.5	14.6	28.6
Uncertain	28.2	–	54.5	–	30.8	–	10.4	–	17.8	–	31.7	–

VBZD, vector-borne and zoonotic disease; WNF, West Nile fever; WNND, West Nile neuroinvasive disease.^a 1st, the most likely disease selected by survey participants; 2^nd, the second most likely disease selected by survey participants.

Table 3. Participants indicating they previously diagnosed a patient with the diseases outlined
Disease	Previously diagnosed disease, %
Chagas disease	13.5 (7/52)
Chikungunya disease	9.6 (5/52)
Dengue fever	17.6 (9/51)
Heartland disease	0 (0/51)
Lyme disease	36.5 (19/52)
Lymphocytic choriomeningitis	3.9 (2/51)
Rocky Mountain spotted fever	19.6 (10/51)
Tularemia	9.8 (5/51)
West Nile fever/neuroinvasive disease	28.9 (15/52)
Zika fever	2.0 (1/50)

Table 4. Percentage of respondents matching arthropod vectors to the various listed pathogens
Pathogen (total respondents)	Arthropod vectors, %
Pathogen (total respondents)	Flea	Fly	Kissing bug	Louse	Mosquito	Cockroach	Tick	Uncertain
Borrelia burgdorferi (52)	—	1.9	—	—	—	—	98.1	—
Chikungunya virus (49)	—	—	2.0	2.0	73.5	—	—	22.5
Dengue virus (48)	4.2	12.5	—	—	81.3	—	—	8.3
Heartland virus (49)	2.0	6.1	—	—	10.2	—	22.4	67.3
Rickettsia rickettsii (48)	10.4	—	—	14.6	8.3	—	72.9	8.3
Francisella tularensis (48)	25.0	20.8	—	6.3	4.2	—	33.3	22.9
Trypanosoma cruzi (47)	—	12.8	44.7	2.1	4.3	—	12.7	27.7
Typhus fevers (47)	29.8	4.3	—	31.9	8.5	—	17.0	23.4
West Nile virus (50)	—	—	—	—	100	—	2.0	—
Yersinia pestis (49)	65.3	6.1	—	14.3	2.0	2.0	—	12.2
Zika virus (48)	—	—	—	—	100	—	—	—