Introduction and Objective: Sandfly fever remains a significant health problem in many parts of the world (particularly in Africa, the Mediterranean Basin, the Middle East, Central Asia, and Europe). The aim of this study was to determine the latest circumstances of this disease at present in the world. Materials and Methods: Two methods were used to gather the information for this article. First, PubMed was searched for English language references to published relevant articles. Second, the term sandfly fever was searched on Google Scholar too. Results: In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sandfly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66%, 20.51%, 13.46%, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Australia, and America, with percentages being 26.92%, 17.30%, 17.0%, 1.28%, and 1.28%, respectively. Conclusion: Different countries have reported the disease either as an endemic or as an imported one. Further investigations on the pathology and virulence of ecology of sandfly fever are necessary to improve the understanding of this cycle in order to provide adequate preventive measures, and also to improve them.
Keywords: Present, sandfly fever, world
|How to cite this article:
Tavana AM. Sandfly fever in the world. Ann Trop Med Public Health 2015;8:83-7
|How to cite this URL:
Tavana AM. Sandfly fever in the world. Ann Trop Med Public Health [serial online] 2015 [cited 2021 Apr 14];8:83-7. Available from: https://www.atmph.org/text.asp?2015/8/4/83/162312
Sandfly fever, also called pappataci fever or three-day fever, is a vector-borne disease and rodents may play a key role in the life cycle of the diseases [Figure 1]. The disease is transmitted to humans by bites of the female species of Phlebotomus, which may differ from one country to another.  There are similar vectors for leishmaniasis, which is endemic in more than 88 countries.  Sandfly virus belongs to the Bunyaviridae family.  Bunyaviridae viruses are distributed worldwide including Europe, Africa, Central Asia, and the American continent. , There are four main serotypes including sandfly fever Sicilian virus (SFSV), sandfly fever Cyprus virus (SFCV), sandfly fever Naples virus (SFNV), and Toscana virus (TOSV). SFSV, SFNV, and other related viruses cause sandfly fever.  The distribution of sandfly fever virus is different in many parts of the world [Figure 2]. In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sandfly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66%, 20.51%, 13.46%, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Africa, Australia, and America, with percentages of 26.92%, 17.30%, 17.0%, 1.28%, and 1.28%, respectively, [Figure 3] and [Figure 4]. The disease can occur during the warm season (in late spring and summer, and early autumn), parallel with the maximum activity of the sandfly vectors. So far, sandfly fever has been reported from different regions including the Islamic Republic of Iran, ,,,, , Southwest Asia, , Pakistan,  Central Asian countries (e.g., Turkmenistan),  Turkey.  India,  Egypt,  Tunisia,  Algeria,  Morocco,  Malta  in addition to Italy, ,,,,,,,,, Spain,  France, , Switzerland, , Greece, , Austria,  and Persian Gulf region.  Of course, there are no reports from other parts of the world, perhaps as a result of the fact that no studies have been designed in these countries or because of the lack information of seroepidemiological studies. I believe that sandfly fever has been described well by scientists in different parts of the world because this disease has the same vector as that of Leishmaniasis. As we all know, all the continents are infected by sandfly vector but the distribution of the vector is not the same in all parts of the world. There is no specific cure for sandfly fever, the patients will be cured by rest for a few days, have pain killer, and drink plenty of fluid either orally or intravenously. The reinfection in the same area may be seen after 1-2 year(s) but travellers are more susceptible to this infection due to lack of immunity against every sandfly fever serotype. For health care workers in many parts of the world, sandfly fever is still an unknown disease because it must be differentiated from similar diseases such as influenza, malaria, Q fever, and other febrile diseases; the distinction may be urgently required for important operations. , The aim of this article is to review the current information about sandfly fever such as clinical diagnosis, treatment, epidemiology, prevention, and control in the health care settings. A review of the literature on the epidemiology, diagnosis, treatment, and prevention of sandfly fever till 23 January 2014 using computerized bibliographic databases, which include PubMed, and Google Scholar, was done in order to increase the understanding of sandfly fever in health care settings.
|Figure 1: The possible life cycle of Sand fly fever.
From: http://o.quizlet.com/zsFfr0Vhz7woviJOOP7d4q-m.png.Click here to view
|Figure 2: Distibution of Papatasi fever by serotype: T, Toscana, S, Sicilian; N, Naples. From: http://en.wikipedia.org/wiki/file:Sandflyfevermap.jpg
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|Figure 3: Articles published regarding the term “sandfly fever” throughout the world in PubMed and Google Scholar about the different aspects of this disease
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|Figure 4: Articles published regarding the term “sandfly fever” throughout the world in PubMed and Google Scholar as per geographical location
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|Public Health Aspect|
Sandfly fever or phlebotomus fever, also known as pappataci fever, is an interesting disease that causes fever, myalgia, and malaise, along with abnormalities in liver enzymes and hematological test results. 
The disease may be mistaken as other diseases such as influenza and malaria. Clinical finding as well as laboratory diagnosis, particularly the molecular technique, may be helpful to differentiate this disease from other particular infectious diseases. As mentioned above, this disease is self-limited and there are no fatalities; the clinical picture of phlebotomus fever resembles that of influenza without the signs of acute inflammation of the respiratory tract.  It should be mentioned that so far, sandfly fever has not been found in Central Europe. However, in the course of global warming, an establishment of biological cycles after an introduction of the pathogens, particularly if vertebrates other than humans can also act as reservoir hosts, seems possible. ,,
It is very hard to diagnose this disease in a nonendemic area, particularly if it is travel-associated and if the anamnesis is not clear The differential diagnosis consists of a very board spectrum list of diseases such as viral, parasitic, and bacterial infections. ,,
This disease must be differentiated from other diseases such as malaria and influenza too because it starts after an incubation period of 3-6 days with high fever (sometime near 40°C) that lasts for 2-3 days; other common symptoms may be included such as headache, anorexia, myalgia, photophobia, back pain, and malaise. Significant leukopenia and lymphopenia, followed by protracted neutropenia may be present too. 
The treatment of sandfly fever is usually nonspecific; painkillers as well as relief medicine are prescribed by physicians.
The epidemiology of the disease may be related as follows:
Infected humans and rodents are mostly the main hosts of this disease; however, other vertebrates may also be involved in spreading this disease [see the [Figure 1].
The virus is transmitted to humans by the bite of Phlebotominae sandflies that belong to the Psychodidae family, mainly Phlebotomus papatasii, while it has to be said that the new vectors Phlebotomus perniciosus, Phlebotomus perfiliewi and Phlebotomus perniciosus for TOSV, and Phlebotomus major sensu lato for SFTV have also been recently reported.
Molecular evidence indicates that Phlebotomus major sensu lato (Diptera: Psychodidae) is the vector species of the recently identified SFSV variant. ,,
Prevention and control
The prevention of this disease is very difficult, particularly in developing countries, where there are not enough health care personnel and health care equipment such as beds, nets, and repellents. Sandfly fever has no vaccine so far; since researches are under way, there is hope to find out the best way to overcome this problem in the near future. 
This disease has been introduced very well by researchers; it is still a major problem in many parts of the world but the condition of the disease in some countries is unclear. Thus, further research may be needed to clarify the fact. It seems that the disease is more prevalent in some parts of the world, particularly in Asia, , Africa, ,,,, and Europe; ,,, this disease has also been reported from other parts of the world. ,,,,, For the detection of sandfly fever, several laboratory techniques such as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) have been developed recently. ,,,, Sandfly fever is also very important for travelers; the imported cases of this fever are reported in many of the literature from nonendemic areas.  Military troops who have been in the endemic areas are also under risk. , Thus, specific care must be given to military forces [i.e., United Nations (UN) peacekeepers) in endemic areas in order to prevent the outbreaks.
Here are some recommendations to be considered for sandfly fever prevention: 1. Conduct public awareness and education campaigns, 2. Avoid contact with animals in endemic areas, 3. Apply repellents on your face and hands at night when you are travelling to an endemic area, and 4. See your doctor if you have signs and symptoms of sandfly fever, as mentioned above, as soon as possible. Further investigations on the pathology and virulence of ecology of sandfly fever necessary to improve the understanding of this cycle and to provide adequate preventive measures. High level of personal and public health measures are needed to overcome this disease. The only effective way to prevent it is health education, either among the public or in special groups such as health care workers.
I would like to thank Professor Djavadian for his advice and my family for their help and support.
Tavana AM. Minireview on sand fly fever. J Entomol 2007;4:401-3.
Maroli M, Rossi L, Baldelli R, Capelli G, Ferroglio E, Genchi C, et al. The northward spread of leishmaniasis in Italy: Evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors. Trop Med Int Health 2008;13:256-64.
Charrel RN, Moureau G, Temmam S, Izri A, Marty P, Parola P, et al. Massilia virus, a novel Phlebovirus (Bunyaviridae) isolated from sandflies in the Mediterranean. Vector Borne Zoonotic Dis 2009;9:519-30.
Tavana AM. The seroepidemiological studies of sand fly fever in Iran during imposed war. Iran J Public Health 2001;30:145-6.
Tavana AM, Javadian E, Nategh R, Shojaei A, Vatan Doost H, Asmar M, Mokhtari Azad T. Journal: Hakim Research Journal 1999;2:14-7.
Ozbel Y. The infections transmitted by sand flies in Turkey. Ankara Univ Vet Fak Derg 2013;60:225-8.
Javadian E, Tesh R, Saidi S, Nadim A. Studies on the epidemiology of sandfly fever in Iran. III. Host-feeding patterns of Phlebotomus papatasi in an endemic area of disease. Am J Trop Med Hyg 1977;26:294-8.
Saidi S, Tesh R, Javadian E, Sahabi Z, Nadim A. Studies on the epidemiology of sand fly fever in Iran. II: The prevalence of human and animal infection with five phlebotomus fever virus serotypes in Isfahan province. Am Soc Trop Med Hyg 1997;26:288-93.
Tesh R, Saidi S, Javadian E, Nadim A, Seedi-Rashti MA. The distribution and prevalence of human infection with phlebotomus fever group viruses in Iran. Iran J Public Health 1976;5:1-7.
Tesh R, Saidi S, Javadian E, Nadim A. Studies on the epidemiology of sandfly fever in Iran. I. Virus isolates obtained from Phlebotomus. Am J Trop Med Hyg 1977;26:282-7.
Tesh RB, Chaniotis BN. Transovarial transmission of viruses by Phlebotomine sandflies. Ann N Y Acad Sci 1975;266:125-34.
Cross ER, Hyams KC. The potential effect of global warming on the geographic and seasonal distribution of Phlebotomus papatasi in Southwest Asia. Environ Health Perspect 1996;104:724-7.
Cross ER, Newcomb WW, Tucker CJ. Use of weather data and remote sensing to predict the geographic and seasonal distribution of Phlebotomus papatasi in Southwest Asia. Am J Trop Med Hyg 1996;54:530-6.
Bryan JP, Iqbal M, Ksiazek TG, Ahmed A, Duncan JF, Awan B, et al. Prevalence of sand fly fever, West Nile, Crimean-Congo hemorrhagic fever, and leptospirosis antibodies in Pakistani military personnel. Mil Med 1996;161:149-53.
Ponirovskiĭ EN, Kondrashin AV, Erokhin PI, Annacharyeva D. Milestones and major results of studies on leishmaniasis and sand fly fevers in Turkmenistan. Med Parazitol (Mosk) 2010;29-34.
Torun Edis C, Yağçı Çağlayık D, Uyar Y, Korukluoğlu G, Ertek M. Sandfly fever outbreak in a province at Central Anatolia, Turkey. Mikrobiyol Bul 2010;44:431-9.
Gurav YK, Tandale BV, Jadi RS, Gunjikar RS, Tikute SS, Jamgaonkar AV, et al. Chandipura virus encephalitis outbreak among children in Nagpur division, Maharashtra, 2007. Indian J Med Res 2010 ;132:395-9.
Feinsod FM, Ksiazek TG, Scott RM, Soliman AK, Farrag IH, Ennis WH, et al. Sand fly fever-Naples infection in Egypt. Am J Trop Med Hyg 1987;37:193-6.
Bichaud L, Dachraoui K, Piorkowski G, Chelbi I, Moureau G, Cherni S, et al. Toscana virus isolated from sandflies, Tunisia. Emerg Infect Dis 2013;19:322-4.
Izri A, Temmam S, Moureau G, Hamrioui B, de Lamballerie X, Charrel RN. Sandfly fever Sicilian virus, Algeria. Emerg Infect Dis 2008. Available from http://www.cdc.gov/EID/content/14/5/795.htm
Es-Sette N, Nourlil J, Hamdi S, Mellouki F, Lemrani M. First detection of Toscana virus RNA from sand flies in the genus Phlebotomus (Diptera:Phlebotomidae) naturally infected in Morocco. J Med Entomol 2012;49:1507-9.
Whittingham HE. Observations on sand-fly fever in Malta. Proc R Soc Med 1923;16:1-14.
Verani P, Ciufolini MG, Nicoletti L. Arbovirus surveillance in Italy. Parassitologia 1995;37:105-8.
Dantas-Torres F, Latrofa MS, Otranto D. Occurrence and genetic variability of Phlebotomus papatasi in an urban area of southern Italy. Parasit Vectors 2010;3:77.
Nicoletti L, Ciufolini MG, Fortuna C, Magurano F, Fiorentini C, Marchi A, et al. Arboviruses in Italy. Parassitologia 2008;50:109-11.
Beersma MF, Grimbergen YA, Kroon FP, Veldkamp PJ. Meningitis caused by Toscana virus during a summer stay in Italy. Ned Tijdschr Geneeskd 2004;148:286-8.
Nicoletti L, Ciufolini MG, Verani P. Sandfly fever viruses in Italy. Arch Virol Suppl 1996;11:41-7.
Maroli M, Bigliocchi F, Khoury C. Sandflies in Italy: Observations on their distribution and methods for control. Parassitologia 1994;36: 251-64.
Verani P, Nicoletti L, Ciufolini MG, Balducci M. Viruses transmitted by sandflies in Italy. Parassitologia 1991;33(Suppl):513-8.
Verani P, Ciufolini MG, Caciolli S, Renzi A, Nicoletti L, Sabatinelli G, et al. Ecology of viruses isolated from sand flies in Italy and characterized of a new Phlebovirus (Arabia virus). Am J Trop Med Hyg 1988;38:433-9.
Endris RG, Perkins PV. Transmission of Toscana virus by sandflies in Italy. Lancet 1987;1:808-9.
Verani P, Caciolli S, Renzi A, Ciufolini MG, Nicoletti L. Ecology and epidemiology of transmissible viruses of sandflies in Italy. Ann Ist Super Sanita 1986;22:79-85.
Sanbonmatsu-Gámez S, Pérez-Ruiz M, Collao X, Sánchez-Seco MP, Morillas-Márquez F, de la Rosa-Fraile M, et al. Toscanavirus in Spain. Emerg Infect Dis 2005;11:1701-7.
De Lamballerie X, Tolou H, Durand JP, Charrel RN. Prevalence of Toscana virus antibodies in volunteer blood donors and patients with central nervous system infections in southeastern France. Vector Borne Zoonotic Dis 2007;7:275-7.
Charrel RN, Izri A, Temmam S, Delaunay P, Toga I, Dumon H, et al. Cocirculation of 2 genotypes of Toscana virus, southeastern France. Emerg Infect Dis 2007;13:465-8.
Schultze D, Korte W, Rafeiner P, Niedrig M. First report of sandfly fever virus infection imported from Malta into Switzerland, October 2011. Euro Surveill 2012;17. pii: 20209.
Gabriel M, Resch C, Günther S, Schmidt-Chanasit J. Toscana virus infection imported from Elba into Switzerland. Emerg Infect Dis 2010;16:1034-6.
Anagnostou V, Papa A. Prevalence of antibodies to phleboviruses within the sand fly fever Naples virus species in humans, northern Greece. Clin Microbiol Infect 2013;19:566-70.
Papa A, Andriotis V, Tzilianos M. Prevalence of Toscana virus antibodies in residents of two Ionian Islands, Greece. Travel Med Infect Dis 2010;8:302-4.
Flamm H. Elucidation of pappataci fever by Austrian miliary physicians. Wien Klin Wochenschr 2008;120:198-208.
Cope SE, Schultz GW, Richards AL, Savage HM, Smith GC, Mitchell CJ, et al. Assessment of arthropod vectors of infectious diseases in areas of U.S. troop deployment in the Persian Gulf. Am J Trop Med Hyg 1996;54:49-53.
Sánchez-Seco MP, Navarro JM. Infections due to Toscana virus, West Nile virus, and other arboviruses of interest in Europe. Enferm Infecc Microbiol Clin 2005;23:560-8.
Tavana AM. Sand fly fever: The disease which must be introduced to doctors, health care workers and public now. Health Med 2012;6: 3657-9.
Kocak Tufan Z, Weidmann M, Bulut C, Kinikli S, Hufert FT, Dobler G, et al. Clinical and laboratory findings of a sandfly fever Turkey Virus outbreak in Ankara. J Infect 2011;63:375-81.
José María Navarro-Marí, Cristina Gómez-Camarasa, Mercedes Pérez-Ruiz, Sara Sanbonmatsu-Gámez, Irene Pedrosa-Corral, María Jiménez-Valera. Clinic-Epidemiologic Study of Human Infection by Granada Virus, a New Phlebovirus within the Sandfly Fever Naples Serocomplex. Am J Trop Med Hyg 2013;88:1003-6.
Hendrickx G, Lancelot R. A perspective on emerging mosquito and phlebotomine-borne diseases in Europe. Euro Surveill 2010;15:19503.
Aspöck H, Gerersdorfer T, Formayer H, Walochnik J. Sandflies and sandfly-borne infections of humans in Central Europe in the light of climate change. Wien Klin Wochenschr 2008;120 (Suppl 4):24-9.
Guler S, Guler E, Caglayik DY, Kokoglu OF, Ucmak H, Bayrakdar F, et al. A sandfly fever virus outbreak in the East Mediterranean region of Turkey. Int J Infect Dis 2012;16:e244-6.
Nissen NB, Jespersen S, Vinner L, Fomsgaard A, Laursen A. Sandfly virus meningitis in a Danish traveller returning from Tuscany. Ugeskr Laeger 2011;173:2505-6.
Becker M, Zielen S, Schwarz TF, Linde R, Hofmann D. Pappataci fever. Klin Padiatr 1997;209:377-9.
Konstantinou GN, Papa A, Antoniadis A. Sandfly-fever outbreak in Cyprus: Are Phleboviruses still a health problem? Travel Med Infect Dis 2007;5:239-42.
Bichaud L, Souris M, Mary C, Ninove L, Thirion L, Piarroux RP, et al. Epidemiologic relationship between Toscana virus infection and Leishmania infantum due to common exposure to Phlebotomus perniciosus sandfly vector. PLoS Negl Trop Dis 2011;5:e1328.
George JE. Isolation of Phlebotomus fever virus from Phlebotomus papatasi and determination of the host ranges of sandflies (Diptera: Psychodidae) in West Pakistan. J Med Entomol 1970;7:670-6.
Bhatt PN, Dandawate CN, Rodrigues FM, Bhagwat RB. Isolation of a virus belonging to the Phlebotomus fever virus group from febrile cases in Aurangabad. Indian J Med Res 1971;59:1633-40.
Lewis DJ, Mesghali A, Djanbakhsh B. Observations on phlebotomine sandflies in Iran. Bull World Health Organ 1961;25:203-8.
Watts DM, el-Tigani A, Botros BA, Salib AW, Olson JG, McCarthy M, et al. Arthropod-borne viral infections associated with a fever outbreak in the northern province of Sudan. J Trop Med Hyg 1994;97:228-30.
Fontenille D, Traore-Lamizana M, Trouillet J, Leclerc A, Mondo M, Ba Y, et al. First isolations of arboviruses from phlebotomine sand flies in West Africa. Am J Trop Med Hyg 1994;50:570-4.
Morsy TA, el-Missiry AG, Kamel AM, Fayad ME, el-Sharkawy IM. Distribution of Phlebotomus species in the Nile Delta, Egypt. J Egypt Soc Parasitol 1990;20:589-97.
Salim AR. Phlebotomus (sand fly) fever viruses in hamster-embryo tissue culture. Am J Trop Med Hyg 1967;16:92-8.
Faure RM. Fever and phlebotomus. Clinical studies on the possible occurrence of phlebotomus fever in North Africa. Bull Soc Pathol Exot Filiales 1951;44:77-83.
Ellis BA, Rotz LD, Leake JA, Samalvides F, Bernable J, Ventura G, et al. An outbreak of acute bartonellosis (Oroya fever) in the Urubamba region of Peru, 1998. Am J Trop Med Hyg 1999;61:344-9.
Pakshin MF, Nikitin AM, Demina SN. Data on a study of a natural focus of sandfly fever in Sevastopol during 1945-1988. Med Parazitol (Mosk) 1990;38-40.
Tesh RB, Boshell J, Young DG, Morales A, Corredor A, Modi GB, et al. Biology of Arboledas virus, a new phlebotomus fever serogroup virus (Bunyaviridae: Phlebovirus) isolated from sand flies in Colombia. Am J Trop Med Hyg 1986;35:1310-6.
Standfast HA, Dyce AL, St George TD, Muller MJ, Doherty RL, Carley JG, et al. Isolation of arboviruses from insects collected at Beatrice Hill, Northern Territory of Australia, 1974-1976. Aust J Biol Sci 1984;37:351-66.
Travassos da Rosa AP, Tesh RB, Pinheiro FP, Travassos da Rosa JF, Peterson NE. Characterization of eight new phlebotomus fever serogroup arboviruses (Bunyaviridae: Phlebovirus) from the Amazon region of Brazil. Am J Trop Med Hyg 1983;32:1164-71.
Touny I, Moussa MI, Shehata MG, Fryauff D, el Said S. Development of an enzyme linked-immunosorbent assay (ELISA) for the sand fly fever viruses detection. J Egypt Public Health Assoc 1989;64:515-31.
Kadanalı A. An overview of Toscana virus infections. Mikrobiyol Bul 2012;46:144-52.
Ergunay K, Erisoz Kasap O, Kocak Tufan Z, Turan MH, Ozkul A, Alten B. Molecular evidence indicates that Phlebotomus major sensu lato (Diptera: Psychodidae) is the vector species of the recently-identified sandfly fever Sicilian virus variant: Sandfly fever turkey virus. Vector Borne Zoonotic Dis 2012;12:690-8.
Cusi MG, Savellini GG. Diagnostic tools for Toscana virus infection. Expert Rev Anti Infect Ther 2011;9:799-805.
Sánchez-Seco MP, Navarro JM. Infections due to Toscana virus, West Nile virus, and other arboviruses of interest in Europe. Enferm Infecc Microbiol Clin 2005;23:560-8.
Kocak Tufan Z, Tasyaran MA, Guven T. Sandfly Fever: A Mini Review. Virol Mycol 2013;2:109.
Sabin AB, Philp CB, Paul JR. Phlebotomus (pappataci or sandfly) Fever. A Disease of Military importance: Summary of existing knowledge and preliminary report of original investigations. JAMA 1944;125:603-6.
Brett-Major DM, Claborn DM. Sand fly fever: What have we learned in one hundred years? Mil Med 2009;174:426-31.
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]