HEALTH BURDEN OF CO INFECTING DEER ASSOCIATED ZOONOTIC CNS DISEASE

尽管公众的注意力主要集中在莱姆病上，但在美国东部鹿丰富的地区，一系列螺旋体、原生动物、病毒和立克次体病原体同时感染了居民。 鹿的数量和依赖于这种宿主的媒介节肢动物的数量最近有所增加。 这些鹿相关的病原体中有几种会引起神经系统疾病。 因此，我们的目标是描述由这些感染引起的脑膜炎和脑炎的频率，无论是单独的还是组合的，并确定所产生的疾病谱是否反映了病原体之间的协同作用。 我们尤其应：（1）确定脑膜炎和脑炎在美国东北部居民中由鹿相关病原体引起的频率，以及这些病原体组合发生的频率。 虽然我们将重点关注莱姆病、巴贝虫病、人粒细胞埃立克体病和TBE组虫媒病毒的病原体，但我们将试图记录其他蜱媒微生物的存在以及与鹿相关的蚊子传播病原体（如詹姆斯敦峡谷病毒、卡什谷热病毒和长曲棍球脑炎病毒）以及其他两种重要的嗜神经病毒的感染频率：肠道病毒和单纯疱疹病毒。 我们将通过病例发现研究，前瞻性地确定鹿相关病原体引起脑膜炎和脑炎的频率。(2)估计这些鹿相关病原体对人类健康造成的负担，并确定合并感染是否会协同致病。 特别是，我们将确定由这些鹿相关病原体引起的脑膜炎或脑炎的结果，以及合并感染脑膜炎或脑炎的人是否比仅存在一种病原体时经历更严重的急性疾病、更长的病程或更大的神经系统后遗症。 一项前瞻性纵向研究将招募一组脑膜炎或脑炎患者。 这项拟议的努力将有助于确定神经系统疾病对居住在鹿附近的人造成的健康负担，并将有助于诊断和管理居住在这些地区的人的脑膜炎和脑炎。

Although public attention has focused largely on Lyme disease, an array of spirochetal, protozoan, viral and rickettsial pathogens concurrently infect residents of sites in the eastern US in which deer are abundant. The abundance of deer and that of the vector arthropods that depend on this host recently have increased. Several of these deer-associated pathogens cause neurologic disease. Our objective, therefore, is to describe the frequency of meningitis and encephalitis caused by these infections, both individually and in combination, and to determine whether the resulting spectrum of disease may reflect a synergy between pathogens. In particular, we shall: (1) Determine how frequently meningitis and encephalitis are caused by deer-associated pathogens in residents of the northeastern U.S. and how frequently these pathogens occur in combination. Although we shall focus on the agents of Lyme disease, babesiosis, human granulocytic ehrlichiosis and TBE-group arboviruses, we shall seek to document the presence of other tick-borne microbes and the frequency of infection by such deer-associated, mosquito-transmitted agents as Jamestown Canyon virus, Cache Valley fever virus, and LaCrosse encephalitis virus, as well as two other important neurotropic viral species: enteroviruses and Herpes simplex virus. We shall determine prospectively how frequently meningitis and encephalitis is caused by deer-associated pathogens by means of a case-finding study. (2) Estimate the burden on human health imposed by these deer-associated pathogens and determine whether coinfection synergizes pathogenesis. In particular, we shall determine the outcome following meningitis or encephalitis caused by these deer-associated pathogens and whether coinfected people suffering from meningitis or encephalitis experience a greater severity of acute illness, a longer duration of illness or greater neurologic sequelae than if only one such pathogen were present. A cohort of patients experiencing meningitis or encephalitis will be enrolled in a prospective longitudinal study. This proposed effort will help define the health burden of neurological disease imposed on people residing in proximity to deer and will contribute to diagnosis and case-management of meningitis and encephalitis in people living in these areas.