Page 74 - JSOM Fall 2024

The differential diagnosis for a patient with a history of sand- • Coronavirus (Middle East respiratory syndrome [MERS]
a
fly bites (with or without flu-like symptoms) includes: or severe acute respiratory syndrome [SARS])
• Lassa fever
• Sandfly fever virus • Meningitis (similar symptomology to Toscana sandfly virus)
• Leishmaniasis
• Bartonellosis A definitive diagnosis for sandfly fever virus can be obtained
3
• Chandipura virus with RT-PCR testing. Infection with Toscana virus may ex-
• Changuinola virus hibit leukocytosis (or sometimes leukopenia) in addition to
3
• Vesicular stomatitis viruses decreased mental status, neck rigidity, Kernig’s sign, nystag-
mus, etc.
a In Medical Entomology for Students, blood-feeding sandflies
are described as a “biting nuisance.” The initial bite of the Treatment
sandfly can sensitize the host, producing further irritation of
the skin in subsequent bites (a condition referred to as harara As there is no vaccine against sandfly fever, prevention lies in
4
in the Arabic language). Note that in some parts of the world avoidance of sandfly bites. Owing to the limited flying ability
the Ceratopogonidae genus biting midges and Simulium genus of the sandfly, nighttime bites can be mitigated by sleeping in
blackflies are also referred to by locals as sandflies. Though an elevated position such as in a hammock and within an in-
these arthropods are disease vectors (Oropouche virus and Af- secticide-treated bednet. In addition, personal insect repellents
rican river blindness, respectively), they do not vector sandfly such as DEET or neem oil should be used. 4
fever viruses. 4
Supportive care remains the mainstay treatment for sandfly
The differential diagnosis for a patient with flu-like symptoms fever. 3
and history of non-sandfly arthropod bites includes:
Importance in a Deployed Setting
• Malaria and O’nyong-nyong virus (Anopheles mosquito)
• Arboviruses, including dengue, Zika, yellow fever, chikun- The Medical Entomology for Students text notes that sandfly
4
gunya, Ross River, Sindbis (Aedes mosquito) fever virus has potential as a bioterrorism agent. Sandfly fe-
• Arboviruses, including West Nile, Japanese encephalitis, ver first gained the world’s collective attention when it struck
Ross River, and Sindbis (Culex mosquito) allied troops deployed to Italy in World War II—hence the use
• Venezuelan equine encephalitis (Aedes, Culex, and Psoro- of virus species names such as Naples, Sicily, and Toscana—
phora mosquitoes) and continues to thrive throughout the tropics and subtropical
• Western equine encephalitis (Culex and Tarsalis mosquitoes) regions of the world. The studies cited in this article provide
• Scrub typhus (Leptotrombidium mite) evidence that the virus remains entrenched within the human,
• Endemic typhus (Xenopsylla flea and others) animal, and sandfly populations in endemic areas. Deploying
• Epidemic typhus (Pediculus humanus body louse) personnel should take precautions to avoid sandflies and other
• Plague (Xenopsylla flea) arthropod vectors that may have a deleterious impact upon
• Lyme disease (Ixodes hard tick) mission performance, and medical personnel should bring a
• Tick-borne relapsing fever borreliosis (Ornithodoros soft tick) comprehensive array of preventive measures, diagnostic tools,
• Louse-borne relapsing fever borreliosis (Pediculus humanus and therapeutics to prevent, identify, and treat vector-borne
body louse) disease threats such as sandfly fever.
• Ehrlichiosis (Amblyomma and Ixodes hard ticks)
• Oropouche virus (Ceratopogonidae midge) Disclaimer
• Tick-borne encephalitis (Ixodes hard tick) The views expressed in this publication are those of the au-
• African tick-bite fever (Amblyomma hard tick) thor and do not reflect the official policy or position of the
• Mediterranean spotted fever (Rhipicephalus hard tick) Department of the Army, Department of Defense, or the U.S.
• Crimean-Congo hemorrhagic fever (Hyalomma margina- Government.
tum species complex hard tick)
• African trypanosomiasis (Glossina tsetse fly) Disclosures
• Tularemia (Ixodidae family hard tick) The author has nothing to disclose.

The differential diagnosis for a patient with an acute onset of References
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arthropod bite includes: edition. Alpha Press; 2015.
2. Paquette S-J, Simon AY, Xiii A, et al. Medically significant vector-
borne viral diseases in Iran. Microorganisms. 2023;11(12):3006.
• Influenza 3. Charell RN, de Lamballerie X. In: Magill AJ, Ryan ET, Hill D, Sol-
• Q fever omon T, eds. Hunter’s Tropical Medicine and Emerging Infectious
• Leptospirosis Diseases. 9th edition. Elsevier; 2013:320–321.
• Brucellosis 4. Service M. Phlebotomine sand flies. In: Medical Entomology for
• Toxoplasmosis Students. 5th edition. Cambridge University Press; 2020;99–106.
• Acute HIV infection 5. Cheesbrough M. Tropical Medicine Point-of-Care Testing. Tropical
Health Technology; 2020:81.
• Cytomegalovirus 6. Al-numaani SA, Al-Nemari AT, El-Kafrawy SA, et al. Seropreva-
• Typhoid lence of Toscana and sandfly fever Sicilian viruses in humans and
• Listeriosis livestock animals from western Saudi Arabia. One Health. 2023;
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