Pappataci fever (also known as Phlebotomus fever and, somewhat confusingly, sandfly fever and three-day fever) is a

vector-borne In epidemiology, a disease vector is any living agent that carries and transmits an infectious pathogen to another living organism; agents regarded as vectors are organisms, such as Parasitism, parasites or Microorganism, microbes. The first major ...

febrile Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

arboviral Arbovirus is an informal name for any virus that is Transmission (medicine), transmitted by arthropod Vector (epidemiology), vectors. The term ''arbovirus'' is a portmanteau word (''ar''thropod-''bo''rne ''virus''). ''Tibovirus'' (''ti''ck-''bo ...

infection caused by three

serotype A serotype or serovar is a distinct variation within a species of bacteria or virus or among immune cells of different individuals. These microorganisms, viruses, or cells are classified together based on their surface antigens, allowing the epi ...

s of

Phlebovirus ''Phlebovirus'' is one of twenty genera of the family ''Phenuiviridae'' in the order ''Bunyavirales''. The genus contains 66 species. It derives its name from Phlebotominae, the Vector (disease vector, vectors of member species ''Naples phlebovir ...

. It occurs in subtropical regions of the

Eastern Hemisphere The Eastern Hemisphere is the half of the planet Earth which is east of the prime meridian (which crosses Greenwich, London, United Kingdom) and west of the antimeridian (which crosses the Pacific Ocean and relatively little land from pole to pol ...

. The name, pappataci fever, comes from the

Italian Italian(s) may refer to: * Anything of, from, or related to the people of Italy over the centuries ** Italians, an ethnic group or simply a citizen of the Italian Republic or Italian Kingdom ** Italian language, a Romance language *** Regional Ita ...

word for

sandfly Sandfly (or sand fly) is a colloquial name for any species or genus of flying, biting, blood-sucking dipteran (fly) encountered in sandy areas. In the United States, ''sandfly'' may refer to certain horse flies that are also known as "greenhea ...

; it is the union of the words ''pappa'' (usually this is used as a generic name for food, but in this case it is a ''verb'' meaning "eating") and ''taci'' (silent), distinguishing these insects from blood-feeding mosquitoes, which produce a typical noise while flying.

Signs and symptoms

A few days after the infective bite, a feeling of lassitude, abdominal distress and

chills Chills is a feeling of coldness occurring during a high fever, but sometimes is also a common symptom which occurs alone in specific people. It occurs during fever due to the release of cytokines and prostaglandins as part of the inflammatory r ...

develop followed by fever of , severe frontal headaches, muscle and joint aches, flushing of the face and a

fast heart rate Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...

. After two days the fever begins to subside and the temperature returns to normal. Fatigue, a

slow heart rate Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, a ...

and

low blood pressure Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...

may persist from a few days to several weeks but complete recovery is the rule.

Cause

Three serotypes of

are known as the causative agents: Naples virus, Sicilian virus and

Toscana virus ''Toscana phlebovirus'' (TOSV) is an arbovirus (arthropod-borne virus) belonging to ''Bunyavirales'', an order of negative-stranded, enveloped RNA viruses. The virus can be transmitted to humans by the bite of an infected sandfly of the genus ' ...

Diagnosis

Although commercial tests are not readily available, diagnosis can be confirmed by serology-based assays or

quantitative PCR A real-time polymerase chain reaction (real-time PCR, or qPCR) is a laboratory technique of molecular biology based on the polymerase chain reaction (PCR). It monitors the amplification of a targeted DNA molecule during the PCR (i.e., in real ...

by laboratories that have developed assays to perform such identification.

Prevention

Prevention of sandfly bites, and control of sandflies and their breeding grounds with

insecticide Insecticides are substances used to kill insects. They include ovicides and larvicides used against insect eggs and larvae, respectively. Insecticides are used in agriculture, medicine, industry and by consumers. Insecticides are claimed to b ...

s are the principal methods for prevention.

Mosquito net A mosquito net is a type of meshed curtain that is circumferentially draped over a bed or a sleeping area, to offer the sleeper barrier protection against bites and stings from mosquitos, flies, and other pest insects, and thus against the di ...

s may not be sufficient to prevent sandfly bites.

Treatment

There is no specific treatment for the disease. Pain killers and fluid replacement may be useful.Tavana AM. Sandfly fever in the world. Ann Trop Med Public Health 2015;8:83–7

Epidemiology

Phlebotomus pappatasi bloodmeal continue2

Pappataci fever is prevalent in the subtropical zone of the

between 20°N and 45°N, particularly in

Southern Europe Southern Europe is the southern regions of Europe, region of Europe. It is also known as Mediterranean Europe, as its geography is essentially marked by the Mediterranean Sea. Definitions of Southern Europe include some or all of these countrie ...

North Africa North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...

, the

Balkans The Balkans ( ), also known as the Balkan Peninsula, is a geographical area in southeastern Europe with various geographical and historical definitions. The region takes its name from the Balkan Mountains that stretch throughout the who ...

Eastern Mediterranean Eastern Mediterranean is a loose definition of the eastern approximate half, or third, of the Mediterranean Sea, often defined as the countries around the Levantine Sea. It typically embraces all of that sea's coastal zones, referring to communi ...

Iraq Iraq,; ku, عێراق, translit=Êraq officially the Republic of Iraq, '; ku, کۆماری عێراق, translit=Komarî Êraq is a country in Western Asia. It is bordered by Turkey to Iraq–Turkey border, the north, Iran to Iran–Iraq ...

Iran Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...

Pakistan Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...

Afghanistan Afghanistan, officially the Islamic Emirate of Afghanistan,; prs, امارت اسلامی افغانستان is a landlocked country located at the crossroads of Central Asia and South Asia. Referred to as the Heart of Asia, it is bordere ...

and

India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...

. The disease is transmitted by the bites of phlebotomine sandflies of the

Genus Genus ( plural genera ) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In the hierarchy of biological classification, genus com ...

Phlebotomus ''Phlebotomus'' is a genus of " sand flies" in the Diptera family Psychodidae. In the past, they have sometimes been considered to belong in a separate family, Phlebotomidae, but this alternative classification has not gained wide acceptance. E ...

'', in particular, ''

Phlebotomus papatasi ''Phlebotomus'' is a genus of " sand flies" in the Diptera family Psychodidae. In the past, they have sometimes been considered to belong in a separate family, Phlebotomidae, but this alternative classification has not gained wide acceptance. E ...

'', '' Phlebotomus perniciosus'' and ''

Phlebotomus perfiliewi ''Phlebotomus'' is a genus of " sand flies" in the Diptera family Psychodidae. In the past, they have sometimes been considered to belong in a separate family, Phlebotomidae, but this alternative classification has not gained wide acceptance. ...

''. The sandfly becomes infected when biting an infected human in the period between 48 hours before the onset of fever and 24 hours after the end of the fever, and remains infected for its lifetime. Besides this horizontal virus transmission from man to sandfly, the virus can be transmitted in insects transovarially, from an infected female sandfly to its offspring. Pappataci fever is seldom recognised in endemic populations because it is mixed with other febrile illnesses of childhood, but it is more well known among immigrants and military personnel from non-endemic regions.

References

External links

{{Zoonotic viral diseases Arthropod-borne viral fevers and viral haemorrhagic fevers Insect-borne diseases