Volume 97, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Every year Christian pilgrims from around the world visit the holy sites located around the Sea of Galilee. Some become ill during their stay with infectious diseases that were acquired in their country of origin, and are hospitalized at Poriya Medical Center. They pose a diagnostic challenge due to language barriers, the rarity of these infections in Israel, and the fact that diagnostic tests are not readily available. All patient records from 2015 of Holy Land tourists hospitalized at Poriya Medical Center were screened for the diagnosis of imported zoonotic diseases that are not commonly diagnosed in Israel. Three patients who were on a Holy Land tour were hospitalized during 2015 with laboratory-confirmed diagnostically challenging zoonotic infectious diseases: a 91-year-old priest from Ethiopia diagnosed with relapsing fever due to , an 85-year-old retired mountaineer from New Hampshire diagnosed with human granulocytic anaplasmosis, and a 57-year-old farmer from central Brazil diagnosed with leptospirosis. These case reports emphasize the importance of considering imported zoonotic infectious diseases and obtaining appropriate diagnostic tests when treating Holy Land travelers to Israel.


Article metrics loading...

Loading full text...

Full text loading...



  1. Assous MV, Wilamowski A, Bercovier H, Marva E, , 2006. Molecular characterization of tickborne relapsing fever Borrelia, Israel. Emerg Infect Dis 12: 17401743.[Crossref]
  2. Fukunaga M, Ushijima Y, Aoki LY, Talbert A, , 2001. Detection of Borrelia duttonii, a tick-borne relapsing fever agent in central Tanzania, within ticks by flagellin gene-based nested polymerase chain reaction. Vector Borne Zoonotic Dis 1: 331338.[Crossref]
  3. Barbour AG, Hayes SF, , 1986. Biology of Borrelia species. Microbiol Rev 50: 381400 [Review].
  4. Badiaga S, Brouqui P, , 2012. Human louse-transmitted infectious diseases. Clin Microbiol Infect 18: 332337.[Crossref]
  5. Cutler SJ, , 2010. Relapsing fever: a forgotten disease revealed. J Appl Microbiol 108: 11151122.[Crossref]
  6. Trape JF, ., 2013. The epidemiology and geographic distribution of relapsing fever borreliosis in West and North Africa, with a review of the Ornithodoros erraticus complex (Acari: Ixodida). PLoS One 8: e78473.[Crossref]
  7. Yimer M, Abera B, Mulu W, Bezabih B, Mohammed J, , 2014. Prevalence and risk factors of louse-borne relapsing fever in high risk populations in Bahir Dar city Northwest, Ethiopia. BMC Res Notes 7: 615.[Crossref]
  8. Colomba C, Scarlata F, Di Carlo P, Giammanco A, Fasciana T, Trizzino M, Cascio A, , 2016. Fourth case of louse-borne relapsing fever in young migrant, Sicily, Italy, December 2015. Mini review article. Public Health 139: 2226 [Review].[Crossref]
  9. Seilmaier M, ., 2016. Louse-borne-relapsing-fever in refugees from the Horn of Africa; a case series of 25 patients [in German]. Dtsch Med Wochenschr 141: e133e142.[Crossref]
  10. Antinori S, Mediannikov O, Corbellino M, Raoult D, , 2016. Louse-borne relapsing fever among East African refugees in Europe. Travel Med Infect Dis 14: 110114.[Crossref]
  11. Ramos JM, Malmierca E, Reyes F, Wolde W, Galata A, Tesfamariam A, Gorgolas M, , 2004. Characteristics of louse-borne relapsing fever in Ethiopian children and adults. Ann Trop Med Parasitol 98: 191196.[Crossref]
  12. Sciotto CG, Lauer BA, White WL, Istre GR, , 1983. Detection of Borrelia in acridine orange-stained blood smears by fluorescence microscopy. Arch Pathol Lab Med 107: 384386.
  13. Fotso Fotso A, Drancourt M, , 2015. Laboratory diagnosis of tick-borne African relapsing fevers: latest developments. Front Public Health 3: 254.[Crossref]
  14. Perine PL, Krause DW, Awoke S, McDade JE, , 1974. Single-dose doxycycline treatment of louse-borne relapsing fever and epidemic typhus. Lancet 2: 742744.[Crossref]
  15. Isacsohn M, Gondard G, Yaoul E, Gindacu A, Kadosh D, Greenberg Z, , 1985. Louse-borne relapsing fever in Ethiopian immigrants. Isr J Med Sci 21: 710.
  16. Dumler JS, Choi KS, Garcia-Garcia JC, Barat NS, Scorpio DG, Garyu JW, Grab DJ, Bakken JS, , 2005. Human granulocytic anaplasmosis and Anaplasma phagocytophilum . Emerg Infect Dis 11: 18281834 Review.[Crossref]
  17. Centers for Disease Control and Prevention (CDC), 2009. Anaplasmosis and ehrlichiosis: Maine, 2008. Morb Mortal Wkly Rep 58: 10331036.
  18. Jin H, Wei F, Liu Q, Qian J, , 2012. Epidemiology and control of human granulocytic anaplasmosis: a systematic review. Vector Borne Zoonotic Dis 12: 269274.[Crossref]
  19. Nadelman RB, Horowitz HW, Hsieh TC, Wu JM, Aguero-Rosenfeld ME, Schwartz I, Nowakowski J, Varde S, Wormser GP, , 1997. Simultaneous human granulocytic ehrlichiosis and Lyme borreliosis. N Engl J Med 337: 2730.[Crossref]
  20. Ismail N, Bloch KC, McBride JW, , 2010. Human ehrlichiosis and anaplasmosis. Clin Lab Med 30: 261292.[Crossref]
  21. Esbenshade A, Esbenshade J, Domm J, Williams J, Frangoul H, , 2010. Severe Ehrlichia infection in pediatric oncology and stem cell transplant patients. Pediatr Blood Cancer 54: 776778.
  22. Bakken JS, Dumler JS, , 2000. Human granulocytic ehrlichiosis. Clin Infect Dis 31: 554560 Review.[Crossref]
  23. Wormser GP, ., 2006. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43: 10891134.[Crossref]
  24. Keysary A, Amram L, Keren G, Sthoeger Z, Potasman I, Jacob A, Strenger C, Dawson JE, Waner T, , 1999. Serologic evidence of human monocytic and granulocytic ehrlichiosis in Israel. Emerg Infect Dis 5: 775778.[Crossref]
  25. Brouqui P, Dumler JS, , 2000. Serologic evidence of human monocytic and granulocytic ehrlichiosis in Israel. Emerg Infect Dis 6: 314315.[Crossref]
  26. Smythe L, Adler B, Hartskeerl RA, Galloway RL, Tureene CY, Levett PM, International Committee on Systematics of Prokaryotes Subcommittee on the Taxonomy of Leptospiraceae, 2013. Classification of Leptospira genomospecies 1, 3, 4 and 5 as Leptospira alstonii sp. nov., Leptospira vanthielii sp. nov., Leptospira terpstrae sp. nov. and Leptospira yanagawae sp. nov., respectively. Int J Syst Evol Microbiol 63: 18591862.[Crossref]
  27. Wasiński B, Dutkiewicz J, , 2013. Leptospirosis: current risk factors connected with human activity and the environment. Ann Agric Environ Med 20: 239244.
  28. Antony SJ, , 1996. Leptospirosis—an emerging pathogen in travel medicine: a review of its clinical manifestations and management. J Travel Med 3: 113118.[Crossref]
  29. Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Faijardin JB, , 1997. Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 25: 720724.[Crossref]
  30. Limmathurotsakul D, Turner EL, Wuthiekanun V, Thaipadungpanit J, Suputtamongkol Y, Chierakul W, Smythe LD, Day NP, Cooper B, Peacock SJ, , 2012. Fool’s gold: why imperfect reference tests are undermining the evaluation of novel diagnostics: a reevaluation of 5 diagnostic tests for leptospirosis. Clin Infect Dis 55: 322331.[Crossref]
  31. Kariv R, Klempfner R, Barnea A, Sidi Y, Schwartz E, , 2001. The changing epidemiology of leptospirosis in Israel. Emerg Infect Dis 7: 990992.[Crossref]
  32. Halperin T, Orr N, Cohen R, Hasin T, Davidovitch N, Klement E, Kayouf R, Baneth G, Cohen D, Yavzori M, , 2006. Detection of relapsing fever in human blood samples from Israel using PCR targeting the glycerophosphodiester phosphodiesterase (GlpQ) gene. Acta Trop 98: 189195.[Crossref]
  33. Safdie G, ., 2010. Molecular characterization of Borrelia persica, the agent of tick borne relapsing fever in Israel and the Palestinian Authority. PLoS One 5: e14105.[Crossref]
  • Received : 09 Feb 2017
  • Accepted : 03 Apr 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error