Work

Coinfection patterns and associations of tick-borne pathogens in natural foci of severe fever with thrombocytopenia syndrome: A One Health approach

Year: 2026

Type: article

Abstract: Background Tick-borne pathogens (TBPs) circulate in complex ecological systems involving vectors, animal hosts, and humans. Coinfections have been shown to influence clinical outcomes and may complicate pathogen associations, yet current research remains limited. Methods We adopted a One Health approach in Taizhou City, a severe fever with thrombocytopenia syndrome (SFTS) endemic area, by collecting 485 community residents, 90 confirmed SFTS patients, 1081 ticks, and 471 small mammals. Five TBPs, including Anaplasma spp., Bartonella spp., Coxiella spp., Ehrlichia spp., and spotted fever group rickettsiae (SFGR), were detected using indirect immunofluorescence assay or polymerase chain reaction. We subsequently analyzed pathogen prevalence and coinfection patterns, assessed pathogen-pathogen associations, and evaluated cross-host correlations at the township level. Results All five TBPs were detected across ticks, small mammals, and humans, with prevalence varying substantially. Human IgG showed diverse co-seropositivity, while coinfections in ticks and small mammals were limited. Significant pathogen-pathogen associations were observed: Anaplasma spp./ Ehrlichia spp. and Ehrlichia spp./SFGR in humans, and Anaplasma spp./ Coxiella spp. in small mammals. Cross-host correlations included positive associations of SFGR in ticks with community residents, Bartonella spp. in small mammals with community residents, and significant links of Anaplasma spp./ Ehrlichia spp. and Anaplasma spp./SFGR between ticks and community residents. Conclusions Multiple TBPs co-circulate in this SFTS epidemic area, following distinct exposure routes involving ticks and small mammals. Anaplasma spp., Ehrlichia spp., and SFGR are tick-borne, while Bartonella spp. is more associated with small mammals. IgG co-seropositivity in humans likely reflects repeated or long-term exposures rather than a single tick bite. These findings suggest that effective prevention should consider human activity patterns and the role of small mammals in sustaining pathogen circulation, while a One Health approach integrating humans, animals, and vectors can guide the development of more targeted control strategies.

Source: One Health

DOI: 10.1016/j.onehlt.2026.101543