Medical Biochemistry; Clinical Biochemistry with molecular Biology; Molecular Microbiology
RESEARCH INTERESTS
Molecular microbiology, epidemiology, study of antigenic proteins - neglected diseases, infectious diseases, health
82
Scopus Publications
1976
Scholar Citations
25
Scholar h-index
48
Scholar i10-index
Scopus Publications
Risk Communication and Infodemic Misframing in Legionella spp. Environmental Surveillance: An Infodemiology Case Study Antonios Papadakis, Eleftherios Koufakis, Nikolaos Raptakis, George Pitsoulis, Apostolos Kamekis, Dimosthenis Chochlakis, Anna Psaroulaki, Areti Lagiou Microorganisms, 2026 Travel-associated Legionnaires’ disease (TALD) events can generate public concern when environmental surveillance findings are communicated without an adequate explanation of the results. This study examined how surveillance data on Legionella spp. were framed and amplified during a TALD-related investigation in Crete, Greece, from June to July 2025. A mixed infodemiology and environmental surveillance approach was applied, including the analysis of 95 online media items across nine languages, Google Trends search-interest data, and hotel water-system surveillance data from epidemiologically linked facilities. Sampling conducted in a limited number of hotels associated with TALD cases indicated that approximately 50% of the water samples exceeded the laboratory reporting limit of ≥50 CFU/L for Legionella spp., a numerically correct but context-specific finding. Numerical misframing occurred in 83.7%, 41.7%, and 18.2% of Greek, German, and English language items, respectively, with significant differences across language markets (χ2 (8) = 43.75, p < 0.0001; Cramér’s V = 0.679). Public search-interest signals were transient and geographically limited. Environmental surveillance showed no increase in Legionella pneumophila risk, with similar proportions of samples ≥50 CFU/L in the pre-/peri-infodemic (January–July 2025) and post-infodemic (August–November 2025) periods (23.11% [95% CI: 18.21–28.87] vs. 24.45% [19.34–30.41]) and similar exceedance of ≥1000 CFU/L (13.45% [9.69–18.36] vs. 14.41% [10.45–19.55]). Overall, the loss of contextual interpretation of surveillance results and conflation of laboratory reporting limits with regulatory thresholds were associated with inconsistent public risk perception, without evidence of increased environmental hazard.
Spatial aspects of Legionella Dimosthenis Chochlakis, Katerina Tsilipounidaki, Apostolos Ntoukakis, Anna Ntaviglaki, Anna Psaroulaki Health Geography Innovative Geospatial Epidemiology, 2026
Health Geography Health Geography Innovative Geospatial Epidemiology, 2026
Preface Health Geography Innovative Geospatial Epidemiology, 2026
A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases Hari Krishnan Krishnamurthy, Vasanth Jayaraman, Karthik Krishna, Tianhao Wang, Kang Bei, et al. Scientific Reports, 2025 Tick-borne infections are the most common vector-borne diseases in the USA. Ticks harbor and transmit several infections with Lyme disease being the most common tickborne infection in the US and Europe. Lack of awareness about tick populations, specific diagnostic tests, and overlapping signs and symptoms of tick-borne infections can often lead to misdiagnosis affecting treatment and the prevalence data reported especially for non-Lyme tick-borne infections. The diagnostic tests currently available for tick-borne diseases are severely limited in their ability to provide accurate results and cannot detect multiple pathogens in a single run. The multiplex protein microarray developed at Vibrant was designed to detect multiple serological antibodies thereby detecting exposure to multiple pathogens simultaneously. Our microarray in its present form can accommodate 400 antigens (molecules that can bind to specific antibodies) and can multiplex across antigen types, whole cell lysates, recombinant proteins, and peptides. A designed array containing multiple antigens of several microbes including Borrelia burgdorferi, the Lyme disease spirochete, was manufactured and evaluated. The immunoglobulin M (IgM) and G (IgG) responses against several tick-borne microbes and other infectious agents were analyzed for analytical and clinical performance. The microarray improved IgM and IgG sensitivities and specificities of individual microbes when compared with the respective gold standards. The testing was also performed in a single run in comparison to multiple runs needed for comparable testing standards. In summary, our study presents a flexible multiplex microarray platform that can provide quick results with high sensitivity and specificity for evaluating exposure to varied infectious agents especially tick-borne pathogens.
Beyond Microbiological Analysis: The Essential Role of Risk Assessment in Travel-Associated Legionnaires’ Disease Outbreak Investigations Antonios Papadakis, Eleftherios Koufakis, Vasileios Nakoulas, Leonidas Kourentis, Theodore Manouras, Areti Kokkinomagoula, Artemis Ntoula, Maria Malliarou, Kyriazis Gerakoudis, Katerina Tsilipounidaki, Dimosthenis Chochlakis, Anna Psaroulaki Pathogens, 2025 Between April and May 2025, an outbreak of travel-associated Legionnaires’ disease (TALD) occurred, involving six cases at a hotel in Crete, Greece. Including two cases reported in 2023 and two additional cases from 2016 to 2017, ten cases were associated with this accommodation site. All TALD cases were reported by the European Legionnaires’ Disease Surveillance Network (ELDSNet). In compliance with the European Centre for Disease Prevention and Control (ECDC) surveillance and investigation protocols for hotels associated with the patient’s stay, local public health authorities conducted on-site inspections at the hotel by collecting water samples and performing risk assessments, while simultaneously recording the required epidemiological, environmental, and physicochemical data. A total of 181 statistically analyzed water samples showed positive rates for L. pneumophila of 12.71% (95% CI: 7.86–17.56) for (≥50 CFU/L) and 6.08% (95% CI: 2.60–9.56) for (≥1000 CFU/L). Risk assessments identified 18 stagnation points, systemic maintenance deficiencies, and high cumulative structural (30/52) and water (36/71) system risk scores. Low microbiological positivity of water samples does not necessarily equate to low risk, thus necessitating continuous risk assessment, implementation of Water Safety Plans (WSPs), and integrated monitoring by accommodation facilities to prevent LD cases.
Association Between Legionnaires’ Disease Incidence and Meteorological Data by Region and Time on the Island of Crete, Greece Efstathios Koutsostathis, Anna Psaroulaki, Dimosthenis Chochlakis, Chrysovalantis Malesios, Nicos Demiris, Kleomenis Kalogeropoulos, Andreas Tsatsaris Water Switzerland, 2025 Since its first appearance as a human pathogen in 1976, Legionella pneumophila has been identified as a causative agent of community-acquired pneumonia (CAP). It survives in rivers, bays, lakes, and water reservoirs, and it is categorized as the fourth most common causative agent of CAP leading to hospitalization. We aimed to investigate patterns in which environmental, seasonal and regional factors may affect the prevalence of Legionnaires’ disease in Crete during the last two decades (2000–2022).The data used originated from the national surveillance database and included any person reported with travel-associated Legionnaires’ disease (TALD) between January 2000 and December 2022. Meteorological data were collected from the National Weather Service. The meteorological variables included (max) temperature (in °C), cloudiness (in octas), wind speed (in knots), and relative humidity (RH) (%). The statistical analysis was based on a case-crossover design with 1:1 matching characteristic. We revealed both seasonal and regional effects on the incidence of Legionnaires’ disease. Cases are significantly more frequent in autumn, in comparison to the other three seasons, while Rethymnon is the prefecture with fewer cases in comparison to Chania or Heraklion. In addition, our research showed that the majority of cases occurred during the years 2017–2018. TALD in Crete is significantly associated with temperature in °C and wind speed in knots. Our research suggests that temporal and spatial factors significantly influence disease cases. These results are in line with studies from foreign countries. The study results aspire to expand our knowledge regarding the epidemiological characteristics of Legionnaires’ disease in relation to local, geographical and meteorological factors on the island of Crete.
Comparative Risk Assessment of Legionella spp. Colonization in Water Distribution Systems Across Hotels, Passenger Ships, and Healthcare Facilities During the COVID-19 Era Antonios Papadakis, Eleftherios Koufakis, Elias Ath Chaidoutis, Dimosthenis Chochlakis, Anna Psaroulaki Water Switzerland, 2025 The colonization of Legionella spp. in engineered water systems constitutes a major public health threat. In this study, a six-year environmental surveillance (2020–2025) of Legionella colonization in five different types of facilities in Crete, Greece is presented, including hotels, passenger ships, primary healthcare facilities, public hospitals, and private clinics. A total of 1081 water samples were collected and analyzed, and the overall positivity was calculated using culture-based methods. Only 16.46% of the samples exceeded the regulatory limit (>103 CFU/L) in the total sample, with 44.59% overall Legionella positivity. Colonization by facility category showed the highest rates in primary healthcare facilities with 85.96%, followed by public hospitals (46.36%), passenger ships with 36.93%, hotels with 38.08%, and finally private clinics (21.42%). The association of environmental risk factors with Legionella positivity revealed a strong effect at hot water temperatures < 50 °C (RR = 2.05) and free chlorine residuals < 0.2 mg/L (RR = 2.22) (p < 0.0001). Serotyping analysis revealed the overall dominance of Serogroups 2–15 of L. pneumophila; nevertheless, Serogroup 1 was particularly prevalent in hospitals, passenger ships, and hotels. Based on these findings, the requirement for continuous environmental monitoring and risk management plans with preventive thermochemical controls tailored to each facility is highlighted. Finally, operational disruptions, such as those experienced during the COVID-19 pandemic, especially in primary care facilities and marine systems, require special attention.
Challenges on the implementation of wastewater-based epidemiology as a prediction tool: the paradigm of SARS-CoV-2 Dimosthenis Chochlakis, Georgios Tzedakis, Areti Kokkinomagoula, Eleftheria Tzamali, Artemisia Ntoula, Maria Malliarou, Evaggelia Intze, Anastasia Koutsolioutsou, Christina Kotsifaki, Despina Kalisperi, Evangelos Dolapsakis, Krystalia Sifakaki, Emmanouil G. Spanakis, Vangelis Sakkalis, Anna Psaroulaki Science of the Total Environment, 2025
The epidemiological role of wildlife, ticks and environment on coxiella burnetii dissemination Encyclopedia of Bacteriology Research Developments, 2021
Genotyping of Coxiella burnetii in sheep and goat abortion samples Dimosthenis Chochlakis, Ana Sofia Santos, Nektarios D. Giadinis, Dimitrios Papadopoulos, Leonidas Boubaris, Emmanouil Kalaitzakis, Anna Psaroulaki, Spyridon K. Kritas, Evanthia I. Petridou BMC Microbiology, 2018
Canine tick-borne pathogens in Cyprus and a unique canine case of multiple co-infections Charalampos Attipa, Chelsea A.E. Hicks, Emily N. Barker, Vasiliki Christodoulou, Kyriaki Neofytou, Mathios E. Mylonakis, Victoria I. Siarkou, Elpida I. Vingopoulou, Francesca Soutter, Dimosthenis Chochlakis, Anna Psaroulaki, Kostas Papasouliotis, Séverine Tasker Ticks and Tick Borne Diseases, 2017
The epidemiological role of wildlife, ticks and environment on coxiella burnetii dissemination Principles and Practice of Q Fever the One Health Paradigm, 2017
A case of human infection by Rickettsia slovaca in Greece Vasiliki Kostopoulou, Dimosthenis Chochlakis, Chrysoula Kanta, Andromachi Katsanou, Konstantina Rossiou, Aidonis Rammos, Spyridon-Filippos Papadopoulos, Theodora Katsarou, Yannis Tselentis, Anna Psaroulaki, Chrysostomos Boukas Japanese Journal of Infectious Diseases, 2016
Murine typhus in Cyprus: A 9-year survey Anna Psaroulaki, Christos Christou, Dimosthenis Chochlakis, Ioanna Tsiligianni, Vassilios Sandalakis, Leonidas Georgalis, Ioannis Ioannou, Giorgos Giorgalas, Yannis Tselentis Transactions of the Royal Society of Tropical Medicine and Hygiene, 2012
Prevalence of Anaplasma sp. in goats and sheep in Cyprus Dimosthenis Chochlakis, Ioannis Ioannou, Labib Sharif, Sofia Kokkini, Nikos Hristophi, Theodoros Dimitriou, Yannis Tselentis, Anna Psaroulaki Vector Borne and Zoonotic Diseases, 2009
Acute anaplasmosis in humans in Cyprus A. Psaroulaki, D. Chochlakis, I. Ioannou, A. Florentia, A. Gikas, Y. Tselentis Clinical Microbiology and Infection, 2009
Anaplasma phagocytophilum infection in a child Anna Psaroulaki, Maria Koliou, Dimosthenis Chochlakis, Ioannis Ioannou, Stella Mazeri, Yannis Tselentis Pediatric Infectious Disease Journal, 2008
RECENT SCHOLAR PUBLICATIONS
Environmental Investigations of Travel-Associated Legionnaires’ Disease Cases: Timeliness, Outcomes, and Source Attribution A Papadakis, E Koufakis, D Chochlakis, A Psaroulaki Preprints , 2026 2026
A Hybrid Occupational Risk Assessment of Legionella pneumophila in Hotel Water Systems Associated with TALD Cases A Papadakis, V Diamantopoulos, E Koufakis, A Psaroulaki, D Chochlakis Preprints , 2026 2026
Risk Communication and Infodemic Misframing in Legionella spp. Environmental Surveillance: An Infodemiology Case Study A Papadakis, E Koufakis, N Raptakis, G Pitsoulis, A Kamekis, ... Microorganisms 14 (3), 536 , 2026 2026 Citations: 2
Spatial aspects of Legionella D Chochlakis, K Tsilipounidaki, A Ntoukakis, A Ntaviglaki, A Psaroulaki Health Geography, 187-200 , 2026 2026
Legionella surveillance in Crete, Greece: Spatial analysis and implications for public health management E Koutsostathis, A Psaroulaki, N Demiris, D Chochlakis, ... Health Geography, 175-186 , 2026 2026
Beyond Microbiological Analysis: The Essential Role of Risk Assessment in Travel-Associated Legionnaires’ Disease Outbreak Investigations A Papadakis, E Koufakis, V Nakoulas, L Kourentis, T Manouras, ... Pathogens 14 (10), 1059 , 2025 2025 Citations: 3
Association Between Legionnaires’ Disease Incidence and Meteorological Data by Region and Time on the Island of Crete, Greece E Koutsostathis, A Psaroulaki, D Chochlakis, C Malesios, N Demiris, ... Water 17 (15), 2344 , 2025 2025 Citations: 2
Comparative Risk Assessment of Legionella spp. Colonization in Water Distribution Systems Across Hotels, Passenger Ships, and Healthcare Facilities During the … A Papadakis, E Koufakis, EA Chaidoutis, D Chochlakis, A Psaroulaki Water 17 (14), 2149 , 2025 2025 Citations: 5
Challenges on the implementation of wastewater-based epidemiology as a prediction tool: the paradigm of SARS-CoV-2 D Chochlakis, G Tzedakis, A Kokkinomagoula, E Tzamali, A Ntoula, ... Science of The Total Environment 981, 179593 , 2025 2025 Citations: 3
IL-1beta expressing neutrophil extracellular traps in Legionella pneumophila infection M Koutantou, T Konstantinidis, D Chochlakis, E Xingi, A Psaroulaki, ... Frontiers in Immunology 16, 1573151 , 2025 2025 Citations: 2
A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases HK Krishnamurthy, V Jayaraman, K Krishna, T Wang, K Bei, ... Scientific reports 15 (1), 2527 , 2025 2025 Citations: 4
Recreational water safety in hotels: lessons from the COVID-19 Pandemic and the way forward for a safe aquatic environment A Papadakis, D Chochlakis, E Koufakis, V Carayanni, A Psaroulaki Tourism and Hospitality 5 (4), 1167-1181 , 2024 2024 Citations: 10
Hotels Recreational Water Safety: Lessons from COVID-19 Pandemic and Way Forward for a Safe Aquatic Environment A Papadakis, D Chochlakis, E Koufakis, V Carayanni, A Psaroulaki Preprints , 2024 2024
Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete D Chochlakis, V Sandalakis, A Ntoukakis, MO Daskalaki, T Loppinet, ... Frontiers in Cellular and Infection Microbiology 13, 1214717 , 2023 2023 Citations: 3
Acknowledgment to the Reviewers of Tropical Medicine and Infectious Disease in 2022 TropicalMed Editorial Office Tropical Medicine and Infectious Disease 8 (2), 70 , 2023 2023
Serological survey of Chlamydia abortus in Greek dairy sheep flocks EJ Petridou, E Kiossis, D Chochlakis, SQ Lafi, A Psaroulaki, ... Journal of the Hellenic Veterinary Medical Society 73 (3), 4593-4596 , 2022 2022 Citations: 2
Giant cell arteritis associated with acute Q fever–A case report E Sarra, CC Mylonas, G Tsekes, D Chochlakis, A Psaroulaki, M Chini Journal of Infection and Chemotherapy 28 (8), 1177-1179 , 2022 2022 Citations: 1
Swimming pool regulations in the COVID-19 Era: Assessing acceptability and compliance in greek hotels in two consecutive summer touristic periods K Mellou, A Mplougoura, G Mandilara, A Papadakis, D Chochlakis, ... Water 14 (5), 796 , 2022 2022 Citations: 15
Electrochemical antigenic sensor for the diagnosis of chronic Q fever E Mathioudaki, Y Alifragis, M Fouskaki, D Chochlakis, H Xie, A Psaroulaki, ... Current Research in Biotechnology 4, 537-543 , 2022 2022 Citations: 1
Exploring immunogenicity of tick salivary AV422 protein in persons exposed to ticks: prospects for utilization D Mihaljica, D Marković, J Repac, B Božić, Ž Radulović, G Veinović, ... Experimental and Applied Acarology 85 (1), 83-99 , 2021 2021 Citations: 9
MOST CITED SCHOLAR PUBLICATIONS
Human anaplasmosis and Anaplasma ovis variant D Chochlakis, I Ioannou, Y Tselentis, A Psaroulaki Emerging infectious diseases 16 (6), 1031 , 2010 2010 Citations: 205
Analysis of pathogen co-occurrence in host-seeking adult hard ticks from Serbia S Tomanović, D Chochlakis, Ž Radulović, M Milutinović, S Ćakić, ... Experimental and applied acarology 59 (3), 367-376 , 2013 2013 Citations: 107
Carriage of Rickettsia spp., Coxiella burnetii and Anaplasma spp. by endemic and migratory wild birds and their ectoparasites in Cyprus I Ioannou, D Chochlakis, N Kasinis, P Anayiotos, A Lyssandrou, ... Clinical Microbiology and Infection 15, 158-160 , 2009 2009 Citations: 99
Spotted Fever Group Rickettsiae in Ticks in Cyprus D Chochlakis, I Ioannou, V Sandalakis, T Dimitriou, N Kassinis, ... Microbial ecology 63 (2), 314-323 , 2012 2012 Citations: 98
Prevalence of Anaplasma sp. in Goats and Sheep in Cyprus D Chochlakis, I Ioannou, L Sharif, S Kokkini, N Hristophi, T Dimitriou, ... Vector-Borne and Zoonotic Diseases 9 (5), 457-463 , 2009 2009 Citations: 78
Rats as indicators of the presence and dispersal of six zoonotic microbial agents in Cyprus, an island ecosystem: a seroepidemiological study A Psaroulaki, M Antoniou, P Toumazos, A Mazeris, I Ioannou, ... Transactions of the Royal Society of Tropical Medicine and Hygiene 104 (11 … , 2010 2010 Citations: 77
Rickettsia aeschlimannii infection in a man, Greece A Germanakis, D Chochlakis, E Angelakis, Y Tselentis, A Psaroulaki Emerging infectious diseases 19 (7), 1176 , 2013 2013 Citations: 74
Coxiella burnetii in wildlife and ticks in an endemic area A Psaroulaki, D Chochlakis, E Angelakis, I Ioannou, Y Tselentis Transactions of the Royal Society of Tropical Medicine and Hygiene 108 (10 … , 2014 2014 Citations: 64
Rickettsia typhi and Rickettsia felis in Xenopsylla cheopis and Leptopsylla segnis parasitizing rats in Cyprus C Christou, A Psaroulaki, M Antoniou, P Toumazos, I Ioannou, A Mazeris, ... The American journal of tropical medicine and hygiene 83 (6), 1301 , 2010 2010 Citations: 58
Legionella spp. Risk Assessment in Recreational and Garden Areas of Hotels A Papadakis, D Chochlakis, V Sandalakis, M Keramarou, Y Tselentis, ... International journal of environmental research and public health 15 (4), 598 , 2018 2018 Citations: 57
Use of MALDI-TOF mass spectrometry in the battle against bacterial infectious diseases: recent achievements and future perspectives V Sandalakis, I Goniotakis, I Vranakis, D Chochlakis, A Psaroulaki Expert Review of Proteomics 14 (3), 253-267 , 2017 2017 Citations: 52
Tick-borne bacteria in mouflons and their ectoparasites in Cyprus I Ioannou, V Sandalakis, N Kassinis, D Chochlakis, B Papadopoulos, ... The Journal of Wildlife Diseases 47 (2), 300-306 , 2011 2011 Citations: 50
Golden jackals (Canis aureus) as hosts for ticks and tick-borne pathogens in Serbia R Sukara, D Chochlakis, D Ćirović, A Penezić, D Mihaljica, S Ćakić, ... Ticks and tick-borne diseases 9 (5), 1090-1097 , 2018 2018 Citations: 49
Presence of Leishmania and Brucella Species in the Golden Jackal Canis aureus in Serbia D Ćirović, D Chochlakis, S Tomanović, R Sukara, A Penezić, Y Tselentis, ... BioMed Research International 2014 (1), 728516 , 2014 2014 Citations: 48
Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review O Pappa, D Chochlakis, V Sandalakis, C Dioli, A Psaroulaki, A Mavridou International journal of environmental research and public health 17 (16), 5809 , 2020 2020 Citations: 45
Species composition, distribution, ecological preference and host association of ticks in Cyprus A Tsatsaris, D Chochlakis, B Papadopoulos, A Petsa, L Georgalis, ... Experimental and Applied Acarology 70 (4), 523-542 , 2016 2016 Citations: 41
First detection of spotted fever group Rickettsiae in ticks in Serbia Ž Radulović, D Chochlakis, S Tomanović, M Milutinović, Y Tselentis, ... Vector-Borne and Zoonotic Diseases 11 (2), 111-115 , 2011 2011 Citations: 40
Genotyping of Coxiella burnetii in sheep and goat abortion samples D Chochlakis, AS Santos, ND Giadinis, D Papadopoulos, L Boubaris, ... BMC microbiology 18 (1), 204 , 2018 2018 Citations: 39
Presence of Coxiella burnetii in Fleas in Cyprus A Psaroulaki, D Chochlakis, I Ioannou, E Angelakis, Y Tselentis Vector-Borne and Zoonotic Diseases 14 (9), 685-687 , 2014 2014 Citations: 39
Canine tick-borne pathogens in Cyprus and a unique canine case of multiple co-infections C Attipa, CAE Hicks, EN Barker, V Christodoulou, K Neofytou, ... Ticks and tick-borne diseases 8 (3), 341-346 , 2017 2017 Citations: 36
