REVIEW PAPER
Candidatus Neoehrlichia mikurensis – distribution and evaluation of potential risk exposure for human health
1
Instytut Medycyny Wsi im. Witolda Chodźki w Lublinie, Polska
Corresponding author
Anna Sawczyn-Domańska
Instytut Medycyny Wsi im. Witolda Chodźki w Lublinie, Jaczewskiego 2, 20-090, Lublin, Polska
Instytut Medycyny Wsi im. Witolda Chodźki w Lublinie, Jaczewskiego 2, 20-090, Lublin, Polska
Med Og Nauk Zdr. 2019;25(2):63-69
KEYWORDS
TOPICS
ABSTRACT
Introduction and Objective:
Tick-borne diseases are the most prevalent vector-borne diseases concerning human health. During the last two decades the incidences of human tick-borne diseases have increased rapidly. Moreover, newly-recognisedtick-borne pathogens have been described throughout Europe, incl. Candidatus Neoehrlichia mikurensis. The objectiveof the study was an attempt to evaluate the potential risk of human exposure to the new tick-borne pathogen CandidatusNeoehrlichia mikurensis in Poland, based on a literature analysis.
Brief description of the state of knowledge:
Candidatus Neoehrlichia mikurensis is a tick-borne intracellular pathogen belonging to the family Anaplasmataceae. Ixodes ricinus, the most common vector for zoonotic pathogens in Europe and suspected of transmitting Candidatus Neoehrlichia mikurensis to humans. Small mammals, especially rodents, are considered to be the reservoir. The first human infection with Candidatus Neoehrlichia mikurensis was reported in 2010. Since then, neoerlichiosis has been detected mainly in immunocompromised patients in Switzerland, Germany and the Czech Republic.
Summing up:
Candidatus Neoehrlichia mikurensis was detected in questing Ixodes ricinus ticks in Poland, there is therefore the probability of infection among patients bitten by ticks. Available data shows that exposure of people to ticks infected with Candidatus Neoehrlichia mikurensis is relatively low. For this reason, further research to investigate the prevalence of Candidatus Neoehrlichia mikurensis in ticks is necessary. Moreover, knowledge about neoehrlichiosis, even among health professionals, is still limited. Thus, it is vital to implement information and promotional measures to raise the awareness of people about this and other tick-borne diseases.
Tick-borne diseases are the most prevalent vector-borne diseases concerning human health. During the last two decades the incidences of human tick-borne diseases have increased rapidly. Moreover, newly-recognisedtick-borne pathogens have been described throughout Europe, incl. Candidatus Neoehrlichia mikurensis. The objectiveof the study was an attempt to evaluate the potential risk of human exposure to the new tick-borne pathogen CandidatusNeoehrlichia mikurensis in Poland, based on a literature analysis.
Brief description of the state of knowledge:
Candidatus Neoehrlichia mikurensis is a tick-borne intracellular pathogen belonging to the family Anaplasmataceae. Ixodes ricinus, the most common vector for zoonotic pathogens in Europe and suspected of transmitting Candidatus Neoehrlichia mikurensis to humans. Small mammals, especially rodents, are considered to be the reservoir. The first human infection with Candidatus Neoehrlichia mikurensis was reported in 2010. Since then, neoerlichiosis has been detected mainly in immunocompromised patients in Switzerland, Germany and the Czech Republic.
Summing up:
Candidatus Neoehrlichia mikurensis was detected in questing Ixodes ricinus ticks in Poland, there is therefore the probability of infection among patients bitten by ticks. Available data shows that exposure of people to ticks infected with Candidatus Neoehrlichia mikurensis is relatively low. For this reason, further research to investigate the prevalence of Candidatus Neoehrlichia mikurensis in ticks is necessary. Moreover, knowledge about neoehrlichiosis, even among health professionals, is still limited. Thus, it is vital to implement information and promotional measures to raise the awareness of people about this and other tick-borne diseases.
REFERENCES (71)
1.
Wójcik-Fatla A, Kloc A, Sawczyn A, Zając V, Sroka J, Cisak E, Kulsharowa A, Dutkiewicz J. Potential role of ticks of the species Dermacentor reticulatus and Ixodes ricinus in the circulation of parasitic protozoa: Theileria spp., Babesia spp. and Toxoplasma gondii in the natural environment [Potencjalna rola kleszczy z gatunków Dermacentor reticulatus i Ixodes ricinus w krążeniu pasożytniczych pierwotniaków: Theileria spp., Babesia spp. i Toxoplasma gondii w środowisku naturalnym]. Med Ogól Nauk Zdr. 2016; 22(3): 165–168 (in Polish).
2.
Dantas-Torres F, Chomel BB, Otranto D. Ticks and tick-borne diseases: a one health perspective. Trends Parasitol. 2012; 28(10): 437–446.
3.
Karbowiak G, Biernat B, Szewczyk T, Sytykiewicz H. The role of particular tick developmental stages in the circulation of tick-borne pathogens affecting humans in Central Europe. 1. The general pattern. Ann Parasitol. 2015; 61(4): 221–228.
4.
Dutkiewicz J, Cisak E, Sroka J, Wójcik-Fatla A, Zając V. Biological agents as occupational hazards – selected issues. Ann Agric Environ Med. 2011; 18(2): 286–293.
5.
Karbowiak G, Biernat B, Stańczak J, Werszko J, Wróblewski P, Szewczyk T i wsp. The role of particular ticks developmental stages in the circulation of tick-borne pathogens in Central Europe. 4. Anaplasmataceae. Ann Parasitol. 2016; 62(4): 267–284.
6.
Schouls LM, Van De Pol I, Rijpkema SG, Schot CS. Detection and identification of Ehrlichia, Borrelia burgdorferi sensu lato, and Bartonella species in Dutch Ixodes ricinus ticks. J Clin Microbiol. 1999; 37(7): 2215–2222.
7.
Alekseev AN, Dubinina HV, Van De Pol I, Schouls LM. Identification of Ehrlichia spp. and Borrelia burgdorferi in Ixodes ticks in the Baltic regions of Russia. J Clin Microbiol. 2001; 39: 2237–2242.
8.
Pan H, Liu S, Ma Y, Tong S, Sun Y. Ehrlichia-like organism gene found in small mammals in the suburban district of Guangzhou of China. Ann N Y Acad Sci. 2003; 990: 107–111.
9.
Brouqui P, Sanogo YO, Caruso G, Merola F, Raoult D. Candidatus Ehrlichia walkerii: a new Ehrlichia detected in Ixodes ricinus tick collected from asymptomatic humans in northern Italy. Ann N Y Acad Sci. 2003; 990: 134–140.
10.
Sanogo YO, Parola P, Shpynov S, Camicas JL, Brouqui P, Caruso G i wsp. Genetic diversity of bacterial agents detected in ticks removed from asymptomatic patients in northeastern Italy. Ann N Y Acad Sci. 2003; 990: 182–190.
11.
Kawahara M, Rikihisa Y, Isogai E, Takahashi M, Misumi H, Suto C i wsp. Ultrastructure and phylogenetic analysis of ‘Candidatus Neoehrlichia mikurensis’ in the family Anaplasmataceae, isolated from wild rats and found in Ixodes ovatus ticks. Int J Syst Evol Microbiol. 2004; 54: 1837–1843.
12.
Murray RG, Stackebrandt E. Taxonomic note: implementation of the provisional status Candidatus for incompletely described prokaryotes. Int J Syst Bacteriol. 1995; 45: 186–187.
13.
Rar V, Golovljova I. Anaplasma, Ehrlichia, and “Candidatus Neoehrlichia” bacteria: pathogenicity, biodiversity, and molecular genetic characteristics, a review. Infect Genet Evol. 2011; 11(8): 1842–1861.
14.
Yabsley MJ, Murphy SM, Luttrell MP, Wilcox BR, Ruckdeschel C. Raccoons (Procyon lotor), but not rodents, are natural and experimental hosts for an ehrlichial organism related to “Candidatus Neoehrlichia mikurensis”. Vet Microbiol. 2008; 131(3–4): 301–308.
15.
Gofton AW, Doggett S, Ratchford A, Ryan U, Irwin P. Phylogenetic characterisation of two novel Anaplasmataceae, ‘Candidatus Neoehrlichia australis’ and ‘Candidatus Neoehrlichia arcana’, from Australian Ixodes holocyclus ticks. Int J Syst Evol Microbiol. 2016; 66: 4256–4261.
16.
Hodžić A, Cézanne R, Duscher GG, Harl J, Glawischnig W, Fuehrer HP. Candidatus Neoehrlichia sp. in an Austrian fox is distinct from Candidatus Neoehrlichia mikurensis, but closer related to Candidatus Neoehrlichia lotoris. Parasit Vectors. 2015; 8: 539.
17.
Muller A, Monti G, Otth C, Sepulveda P, Bittencourt P, Nachum-Biala Y i wsp. ‘Candidatus Neoehrlichia chilensis’ sp. nov.: Molecular detection and characterization of a novel Anaplasmataceae in wild rodents from Valdivia, southern Chile. Transbound Emerg Dis. 2018; 65: 357–362.
18.
Pekova S, Vydra J, Kabickova H, Frankova S, Haugvicova R, Mazal O i wsp. Candidatus Neoehrlichia mikurensis infection identified in 2 hematooncologic patients: benefit of molecular techniques for rare pathogen detection. Diagn Microbiol Infect Dis. 2011; 69(3): 266–270.
19.
Glatz M, Müllegger RR, Maurer F, Fingerle V, Achermann Y, Wilske B i wsp. Detection of Candidatus Neoehrlichia mikurensis, Borrelia burgdorferi sensu lato genospecies and Anaplasma phagocytophilum in a tick population from Austria. Ticks Tick Borne Dis. 2014; 5(2): 139–144.
20.
Schötta AM, Wijnveld M, Stockinger H, Stanek G. Approaches for reverse line blot-based detection of microbial pathogens in Ixodes ricinus ticks collected in Austria and impact of the chosen method. Appl Environ Microbiol. 2017; 83(13): e00489–17.
21.
Derdáková M, Václav R, Pangrácova-Blaňárová L, Selyemová D, Koči J, Walder G i wsp. Candidatus Neoehrlichia mikurensis and its co- -circulation with Anaplasma phagocytophilum in Ixodes ricinus ticks across ecologically different habitats of Central Europe. Parasit Vectors. 2014; 7: 160.
22.
Nader J, Król N, Pfeffer M, Ohlendorf V, Marklewitz M, Drosten C i wsp. The diversity of tick-borne bacteria and parasites in ticks collected from the Strandja Nature Park in south-eastern Bulgaria. Parasit Vectors. 2018; 11(1): 165.
23.
Richter D, Matuschka FR. “Candidatus Neoehrlichia mikurensis”, Anaplasma phagocytophilum, and Lyme disease spirochetes in questing European vector ticks and in feeding ticks removed from people. J Clin Microbiol. 2012; 50(3): 943–947.
24.
Venclikova K, Rudolf I, Mendel J, Betasova L, Hubalek Z. Rickettsiae in questing Ixodes ricinus ticks in the Czech Republic. Ticks Tick Borne Dis. 2014; 5(2): 135–138.
25.
Fertner ME, Mølbak L, Boye Pihl TP, Fomsgaard A, Bødker R. First detection of tick-borne “Candidatus Neoehrlichia mikurensis” in Denmark 2011. Euro Surveill. 2012; 17(8): 20096.
26.
Michelet L, Delannoy S, Devillers E, Umhang G, Aspan A, Juremalm M i wsp. High-throughput screening of tick-borne pathogens in Europe. Front Cell Infect Microbiol. 2014; 4: 103.
27.
Ivanova A, Geller J, Katargina O, Värv K, Lundkvist Å, Golovljova I. Detection of Candidatus Neoehrlichia mikurensis and Ehrlichia muris in Estonian ticks. Ticks Tick Borne Dis. 2017; 8(1): 13–17.
28.
Laaksonen M, Klemola T, Feuth E, Sormunen JJ, Puisto A, Mäkelä S i wsp. Tick-borne pathogens in Finland: comparison of Ixodes ricinus and I. persulcatus in sympatric and parapatric areas. Parasit Vectors. 2018; 11(1): 556.
29.
Coipan EC, Jahfari S, Fonville M, Maassen CB, van der Giessen J, Takke W i wsp. Spatiotemporal dynamics of emerging pathogens in questing Ixodes ricinus. Front Cell Infect Microbiol. 2013; 3: 36.
30.
Silaghi C, Woll D, Mahling M, Pfister K, Pfeffer M. Candidatus Neoehrlichia mikurensis in rodents in an area with sympatric existence of the hard ticks Ixodes ricinus and Dermacentor reticulatus, Germany. Parasit Vectors. 2012; 5: 285.
31.
Kjelland V, Paulsen KM, Rollum R, Jenkins A, Stuen S, Soleng A i wsp. Tick-borne encephalitis virus, Borrelia burgdorferi sensu lato, Borrelia miyamotoi, Anaplasma phagocytophilum and Candidatus Neoehrlichia mikurensis in Ixodes ricinus ticks collected from recreational islands in southern Norway. Ticks Tick Borne Dis. 2018; 9(5): 1098–1102.
32.
Larsson C,Hvidsten D, Stuen S, Henningsson AJ, Wilhelmsson P. “Candidatus Neoehrlichia mikurensis” in Ixodes ricinus ticks collected near the Arctic Circle in Norway. Parasit Vectors. 2018; 11: 620.
33.
Welc-Falęciak R, Kowalec M, Karbowiak G, Bajer A, Behnke JM, Siński E. Rickettsiaceae and Anaplasmataceae infections in Ixodes ricinus ticks from urban and natural forested areas of Poland. Parasit Vectors. 2014; 7: 121.
34.
Kowalec M, Szewczyk T, Welc-Falęciak R, Siński E, Karbowiak G, Bajer A. Rickettsiales occurrence and co-occurrence in Ixodes ricinus ticks in natural and urban areas. Microb Ecol. 2019; 77(4): 890–904.
35.
Kalmár Z, Sprong H, Mihalca AD, Gherman CA, Dumitrache MO, Coipan EC i wsp. Borrelia miyamotoi and Candidatus Neoehrlichia mikurensis in Ixodes ricinus ticks, Romania. Emerg Infect Dis. 2016; 22(3): 550–551.
36.
Blaňarová L, Stanko M, Miklisová D, Víchová B, Mošanský L, Kraljik J i wsp. Presence of Candidatus Neoehrlichia mikurensis and Babesia microti in rodents and two tick species (Ixodes ricinus and Ixodes trianguliceps) in Slovakia. Ticks Tick Borne Dis. 2016; 7(2): 319–326.
37.
Oechslin CP, Heutschi D, Lenz N, Tischhauser W, Péter O, Rais O i wsp. Prevalence of tick-borne pathogens in questing Ixodes ricinus ticks in urban and suburban areas of Switzerland. Parasit Vectors. 2017; 10(1): 558.
38.
Andersson M, Bartkova S, Lindestad O, Råberg L. Co-infection with ‘Candidatus Neoehrlichia mikurensis’ and Borrelia afzelii in Ixodes ricinus ticks in Southern Sweden. Vector Borne Zoonotic Dis. 2013; 13(7): 438–442.
39.
Szekeres S, Claudia Coipan E, Rigó K, Majoros G, Jahfari S i wsp. Candidatus Neoehrlichia mikurensis and Anaplasma phagocytophilum in natural rodent and tick communities in Southern Hungary. Ticks Tick Borne Dis. 2015; 6(2): 111–116.
40.
Da Rold G, Ravagnan S, Soppelsa F, Porcellato E, Soppelsa M, Obber F i wsp. Ticks are more suitable than red foxes for monitoring zoonotic tick-borne pathogens in northeastern Italy. Parasit Vectors. 2018; 11(1): 137.
41.
Portillo A, Santibáñez P, Palomar AM, Santibáñez S, Oteo JA. ‘Candidatus Neoehrlichia mikurensis’ in Europe. New Microbes New Infect. 2018; 22: 30–36.
42.
Movila A, Alekseev AN, Dubinina HV, Toderas I. Detection of tick- -borne pathogens in ticks from migratory birds in the Baltic region of Russia. Med Vet Entomol. 2013; 27(1): 113–117.
43.
Wei F, Song M, Liu H, Wang B, Wang S, Wang Z i wsp. Molecular detection and characterization of zoonotic and veterinary pathogens in ticks from Northeastern China. Front Microbiol. 2016; 7: 1913.
44.
Karnath C, Obiegala A, Speck S, Essbauer S, Derschum H, Scholz H i wsp. Detection of Babesia venatorum, Anaplasma phagocytophilum and Candidatus Neoehrlichia mikurensis in Ixodes persulcatus ticks from Mongolia. Ticks Tick Borne Dis. 2016; 7(2): 357–360.
45.
Krücken J, Schreiber C, Maaz D, Kohn M, Demeler J, Beck S i wsp.. A novel high-resolution melt PCR assay discriminates Anaplasma phagocytophilum and “Candidatus Neoehrlichia mikurensis”. J Clin Microbiol. 2013; 51(6): 1958–1961.
46.
Kamani J, Baneth G, Mumcuoglu KY, Waziri NE, Eyal O, Guthmann Y i wsp. Molecular detection and characterization of tick-borne pathogens in dogs and ticks from Nigeria. PLoS Negl Trop Dis. 2013; 7(3): e2108. 47.Burri C, Schumann O, Schumann C, Gern L. Are Apodemus spp. mice and Myodes glareolus reservoirs for Borrelia miyamotoi, Candidatus Neoehrlichia mikurensis, Rickettsia helvetica, R. monacensis and Anaplasma phagocytophilum? Ticks Tick Borne Dis. 2014; 5(3): 245–251.
47.
Obiegala A, Pfeffer M, Pfister K, Tiedemann T, Thiel C, Balling A i wsp. Candidatus Neoehrlichia mikurensis and Anaplasma phagocytophilum: prevalences and investigations on a new transmission path in small mammals and ixodid ticks. Parasit Vectors. 2014; 7: 563.
48.
Svitálková ZH, Haruštiaková D, Mahríková L Mojšová M, Berthová L, Slovák M i wsp. Candidatus Neoehrlichia mikurensis in ticks and rodents from urban and natural habitats of South-Western Slovakia. Parasit Vectors. 2016; 9: 2.
49.
Vayssier-Taussat M, Le Rhun D, Buffet JP, Maaoui N, Galan M, Guivier E. Candidatus Neoehrlichia mikurensis in bank voles, France. Emerg Infect Dis. 2012; 18(12): 2063–2065.
50.
Andersson M, Råberg L. Wild rodents and novel human pathogen Candidatus Neoehrlichia mikurensis, Southern Sweden. Emerg Infect Dis. 2011; 17(9): 1716–1718.
51.
Tabara K, Arai S, Kawabuchi T, Itagaki A, Ishihara C, Satoh H i wsp. Molecular survey of Babesia microti, Ehrlichia species and Candidatus Neoehrlichia mikurensis in wild rodents from Shimane Prefecture, Japan. Microbiol Immunol. 2007; 51(4): 359–367.
52.
Jha P, Kim CM, Kim DM, Yoon NR, Jha B, Park JW i wsp. First detection and identification of Candidatus Neoehrlichia mikurensis in South Korea. PLoS One. 2018; 13(12): e0209685.
53.
Li H, Jiang JF, Liu W, Zheng YC, Huo QB, Tang K i wsp. Human infection with Candidatus Neoehrlichia mikurensis, China. Emerg Infect Dis. 2012; 18(10): 1636–1639.
54.
Beck R, Vlatka CC, Račić I, Šprem N, Vujnović A. Identification of ‘Candidatus Neoehrlichia mikurensis’ and Anaplasma species in wildlife from Croatia. Parasit Vectors. 2014; 7(Suppl 1): O28.
55.
Földvári G, Jahfari S, Rigó K, Jablonszky M, Szekeres S, Majoros G i wsp. Candidatus Neoehrlichia mikurensis and Anaplasma phagocytophilum in urban hedgehogs. Emerg Infect Dis. 2014; 20(3): 496–498.
56.
Hofmann-Lehmann R, Wagmann N, Meli ML, Riond B, Novacco M, Joekel D i wsp. Detection of ‘Candidatus Neoehrlichia mikurensis’ and other Anaplasmataceae and Rickettsiaceae in canidae in Switzerland and Mediterranean countries. Schweiz Arch Tierheilkd. 2016; 158(10): 691–700.
57.
Diniz P, Schulz BS, Hartmann K, Breitschwerdt EB. “Candidatus Neoehrlichia mikurensis” infection in a dog from Germany. J Clin Microbiol. 2011; 49(5): 2059–2062.
58.
Liesner JM, Krücken J, Schaper R, Pachnicke S, Kohn B, Müller E i wsp. Vector-borne pathogens in dogs and red foxes from the federal state of Brandenburg, Germany. Vet Parasitol. 2016; 224: 44–51.
59.
Welinder-Olsson C, Kjellin E, Vaht K, Jacobsson S, Wennerås C. First case of human “Candidatus Neoehrlichia mikurensis” infection in a febrile patient with chronic lymphocyticleukemia. J Clin Microbiol. 2010; 48(5): 1956–1959.
60.
Fehr JS, Bloemberg GV, Ritter C, Hombach M, Lüscher TF, Weber R i wsp. Septicemia caused by tick-borne bacterial pathogen Candidatus Neoehrlichia mikurensis. Emerg Infect Dis. 2010; 16(7): 1127–1129.
61.
von Loewenich FD, Geissdörfer W, Disqué C, Matten J, Schett G, Sakka SG i wsp. Detection of “Candidatus Neoehrlichia mikurensis” in two patients with severe febrile illnesses: evidence for a European sequence variant. J Clin Microbiol. 2010; 48(7): 2630–2635.
62.
Grankvist A, Andersson PO, Mattsson M, Sender M, Vaht K, Höper L i wsp. Infections with the tick-borne bacterium “Candidatus Neoehrlichia mikurensis” mimic noninfectious conditions in patients with B cell malignancies or autoimmune diseases. Clin Infect Dis. 2014; 58(12): 1716–1722.
63.
Maurer FP, Keller PM, Beuret C, Joha C, Achermann Y, Gubler J i wsp. Close geographic association of human neoehrlichiosis and tick populations carrying “Candidatus Neoehrlichia mikurensis” in eastern Switzerland. J Clin Microbiol. 2013; 51(1): 169–176.
64.
Grankvist A, Moore ERB, Stadler LS, Pekova S, Bogdan C, Geißdörfer W i wsp. Multilocus sequence analysis of clinical “Candidatus Neoehrlichia mikurensis” strains from Europe. J Clin Microbiol. 2015; 53(10): 3126–3132.
65.
Quarsten H, Grankvist A, Høyvoll L, Myre IB, Skarpaas T, Kjelland V i wsp. Candidatus Neoehrlichia mikurensis and Borrelia burgdorferi sensu lato detected in the blood of Norwegian patients with erythema migrans. Ticks Tick Borne Dis. 2017; 8(5): 715–720.
66.
Jahfari S, Hofhuis A, Fonville M, van der Giessen J, van Pelt W, Sprong H. Molecular detection of tick-borne pathogens in humans with tick bites and erythema migrans, in the Netherlands. PLoS Negl Trop Dis. 2016; 10(10): e0005042.
67.
Grankvist A, Sandelin LL, Andersson J, Fryland L, Wilhelmsson P, Lindgren PE i wsp. Infections with Candidatus Neoehrlichia mikurensis and cytokine responses in 2 persons bitten by ticks, Sweden. Emerg Infect Dis. 2015; 21(8): 1462–1465.
68.
Welc-Falęciak R, Siński E, Kowalec M, Zajkowska J, Pancewicz SA. Asymptomatic “Candidatus Neoehrlichia mikurensis” infections in immunocompetent humans. J Clin Microbiol. 2014; 52(8): 3072–3074.
69.
Silaghi C, Beck R, Oteo JA, Pfeffer M, Sprong H. Neoehrlichiosis: an emerging tick-borne zoonosis caused by Candidatus Neoehrlichia mikurensis. Exp Appl Acarol. 2016; 68(3): 279–297.
70.
Wass L, Grankvist A, Mattsson M, Gustafsson H, Krogfelt K, Olsen B i wsp. Serological reactivity to Anaplasma phagocytophilum in neoehrlichiosis patients. Eur J Clin Microbiol Infect Dis. 2018; 37(9): 1673–1678.
71.
Wennerås C. Infections with the tick-borne bacterium Candidatus Neoehrlichia mikurensis. Clin Microbiol Infect. 2015; 21: 621–630.
| eISSN: | 2084-4905 |
| ISSN: | 2083-4543 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
