HEALTH BURDEN OF CO INFECTING DEER ASSOCIATED ZOONOTIC CNS DISEASE

虽然公众的注意力主要集中在莱姆病上，但在美国东部鹿群丰富的地区，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。鹿和依赖这种宿主的病媒节肢动物的丰度最近有所增加。这些与鹿有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，无论是单独的还是联合的，并确定所产生的疾病谱是否可能反映病原体之间的协同作用。特别是，我们将：(1)确定美国东北部居民中由鹿相关病原体引起脑膜炎和脑炎的频率，以及这些病原体合并发生的频率。虽然我们将重点关注莱姆病、巴贝斯虫病、人类粒细胞埃立克体病和tbe类虫媒病毒，但我们将寻求记录其他蜱传微生物的存在，以及与鹿相关的蚊子传播病原体的感染频率，如詹姆斯敦峡谷病毒、Cache谷热病毒和LaCrosse脑炎病毒，以及其他两种重要的嗜神经病毒：肠病毒和单纯疱疹病毒。我们将通过一项病例调查研究，前瞻性地确定由鹿相关病原体引起脑膜炎和脑炎的频率。(2)评估这些鹿相关病原体对人类健康造成的负担，并确定共同感染是否与发病机制协同作用。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后的结果，以及患有脑膜炎或脑炎的合并感染者是否比仅存在一种此类病原体时急性疾病的严重程度更大、病程更长或神经系统后遗症更大。一组患有脑膜炎或脑炎的患者将被纳入一项前瞻性纵向研究。这项拟议的努力将有助于确定居住在鹿附近的人们所承受的神经系统疾病的健康负担，并将有助于这些地区居民的脑膜炎和脑炎的诊断和病例管理。

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.