Zoonosis as a cause of acute febrile illness at a one health interface in rural south africa: it's the little five, not the big five

The Mnisi area of Bushbuckridge District, Mpumalanga Province, South Africa, has a population of approximately 80 000, mainly agro-pastoralists. The area is bordered by the Kruger National Park and contact between wildlife, livestock and humans is frequent. Cattle are brought to community diptanks weekly for tick control and active veterinary surveillance.Between October 2012 through to present, consenting malaria-negative adult patients with acute febrile illness (AFI; body temperature >37.5°C) were enrolled. Additionally, we enrolled healthy herders and veterinary staff at five dip tanks. Serological testing was done for brucellosis, bartonella, leptospirosis, Q fever, tick bite fever (TBF), and West Nile virus, Sindbis, Rift Valley fever and chikungunya virus infections; more recently, a range of tick-borne pathogens, including Anaplasma species, were investigated using metagenomic methods only.Between 2012 and 2019, 328 AFI patients were enrolled, with a median age of 34 years; about 2/3 were female. Duration of illness was generally 2 to 3 days. All patients had contact with domestic or commensal animals and the majority reported tick and/or flea bites. 64 healthy adult herders/veterinary staff were recruited; 46/64 (72%) were male, median age 55 years. The median duration of diptank attendance was 15 years. Amongst the AFI patients, serological evidence of recent TBF was present in 14% and past infection in 61%; 24% had Q fever antibodies, 6% had acute bartonellosis, 3% had leptospirosis, 6% had previous West Nile, Sindbis or chikungunya virus infection, and 2% had recent brucellosis. Of the healthy diptank attenders, 63/64 (98%) were positive for exposure to at least one of the nine zoonoses tested. 22% had previous leptospirosis, 59% Q fever, 3% chikungunya, 3% Sindbis and 92% TBF.There was a high background exposure to TBF, Q fever and leptospirosis in the community. A surprising finding was the number of bartonella infections, not previously described in this population. There is a need to re-look at AFI treatment algorithms in the clinic setting; also to educate the population about reducing tick and surface water contact. Zoonosis surveillance is to continue with a focus on metagenomics.