1
|
Abstract
Rickettsial diseases, caused by a variety of obligate intracellular, Gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are considered some of the most covert emerging and re-emerging diseases. Scrub typhus, murine flea-borne typhus and Indian tick typhus are commonly being reported and during the last decade. Scrub typhus (ST) has emerged as a serious public health problem in India. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45% with multiple organ dysfunction, if the specific treatment is delayed. Early clinical suspicion, timely diagnosis followed by institution of specific antimicrobial therapy shortens the course of the disease, lowers the risk of complications and reduces morbidity and mortality due to rickettsial diseases. Still there is large gap in our knowledge of Rickettsioses and the vast variability and non-specific presentation of these have often made it difficult to diagnose clinically. The present review describes the epidemiology, clinical manifestations, diagnostic modalities and treatment of Scrub typhus which is a vastly underdiagnosed entity and clinicians should suspect and test for the disease more often.
Collapse
Affiliation(s)
- Ashwani K Sood
- Department of Pediatrics and Adolescent Medicine, Indira Gandhi Medical College, Shimla, India.
| | - Amit Sachdeva
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, India
| |
Collapse
|
2
|
Moraga-Fernández A, Chaligiannis Ι, Cabezas-Cruz A, Papa A, Sotiraki S, de la Fuente J, G Fernández de Mera I. Molecular identification of spotted fever group Rickettsia in ticks collected from dogs and small ruminants in Greece. EXPERIMENTAL & APPLIED ACAROLOGY 2019; 78:421-430. [PMID: 31175472 DOI: 10.1007/s10493-019-00392-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
Spotted fever group (SFG) Rickettsia are zoonotic and emerging pathogens with considerable impact in public and animal health. Greece is an endemic country of diseases caused by SFG Rickettsia. This work aims to evaluate the prevalence of SFG Rickettsia in ticks collected from domestic hosts including sheep, goats and dogs. Several genetic markers for bacterial genes, such as 16S rRNA, ompA, ompB, atpA, gltA, recA, dnaA and dnaK, were amplified and sequenced to accurately classified the rickettsial pathogens in the ticks. Taxonomy and species classification of the Rickettsia was achieved by combining phylogenetic and in silico digestion analysis of the gene sequences obtained. A total of 187 ticks were collected and classified at the species level as Ixodes gibosus, Dermacentor marginatus, Haemaphysalis parva, H. sulcata, H. punctata, Hyalomma scavatum, Rhipicephalus sanguineus, R. bursa and Rhipicephalus sp. The results showed that 7.5% of ticks were infected with at least one SFG Rickettsia including R. massiliae (n = 3), R. slovaca (n = 5), R. raoultii (n = 1) and R. hoogstraalii (n = 5), collected from sheep (n = 4), goats (n = 5) and dogs (n = 3). Molecular analysis revealed the presence of novel genetic variants of R. hoogstraalii (in H. sulcata and H. parva from goat and sheep) and R. raoultii (in D. marginatus from goat). These results proof the presence of SFG Rickettsia in domestic hosts in Greece, and support the need for continued monitoring, surveillance and further analyses of other hosts and study areas.
Collapse
Affiliation(s)
- Alberto Moraga-Fernández
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (CSIC-UCLM-JCCM), Ronda de Toledo, 12, 13005, Ciudad Real, Spain
| | - Ιlias Chaligiannis
- Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001, Thessaloniki, Greece
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alejandro Cabezas-Cruz
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Smaragda Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001, Thessaloniki, Greece
| | - José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (CSIC-UCLM-JCCM), Ronda de Toledo, 12, 13005, Ciudad Real, Spain
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Isabel G Fernández de Mera
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (CSIC-UCLM-JCCM), Ronda de Toledo, 12, 13005, Ciudad Real, Spain.
| |
Collapse
|
3
|
Abstract
Rickettsiae are globally encountered pathogens with foci of endemicity and epidemic exacerbations under circumstances of crowding and decline of sanitation. Diagnosis is often missed due to misconceptions about epidemiology, confusing terminology and nonspecific clinical presentation. Rickettsioses should be considered in children with febrile illnesses exceeding the usual duration of a viral infection, in particular in children with rash, lymphadenopathy and nearly normal first-line laboratory tests, who reside in or return from endemic areas, recall a compatible contact history, have a constellation of symptoms starting after an arthropod bite, live under troubled social circumstances, or are part of a cluster of similar cases.
Collapse
|
4
|
Randomized Trial of Clarithromycin for Mediterranean Spotted Fever. Antimicrob Agents Chemother 2015; 60:1642-5. [PMID: 26711765 DOI: 10.1128/aac.01814-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/15/2015] [Indexed: 01/26/2023] Open
Abstract
The classic antibiotic treatment for Mediterranean spotted fever (MSF) is based on tetracyclines or chloramphenicol, but chloramphenicol's bone marrow toxicity makes tetracyclines the treatment of choice. However, it is convenient to have alternatives available for patients who are allergic to tetracyclines, pregnant women, and children <8 years old. We conducted a randomized clinical trial to compare clarithromycin with doxycycline or josamycin in the treatment of MSF. Forty patients were evaluated (23 male; mean age, 39.87 years); 13 patients were aged <14 years. Seventeen patients received clarithromycin, and 23 received doxycycline or josamycin. The interval between the onset of symptoms and the start of treatment was 4.04 ± 1.70 days in the clarithromycin group versus 4.11 ± 1.60 days in the doxycycline/josamycin group (P = not significant [NS]). Time to the disappearance of fever after treatment was 2.67 ± 1.55 days in the clarithromycin group versus 2.22 ± 1.35 days in the doxycycline/josamycin (P = NS). The symptoms had disappeared at 4.70 ± 2.25 days in the clarithromycin group versus at 4.75 ± 3.08 days in the doxycycline/josamycin (P = NS). There were no adverse reactions to treatment or relapses in either group. In conclusion, clarithromycin is a good alternative to doxycycline or josamycin in the treatment of MSF.
Collapse
|
6
|
Hufnagel M, Schmitt HJ, Nadal D, Christen HJ, Eiffert H, Huppertz HI. Bakterielle Infektionen: Atypische Bakterien. PÄDIATRIE 2014. [PMCID: PMC7193735 DOI: 10.1007/978-3-642-41866-2_99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chlamydophila (früher Chlamydia) pneumoniae ist im Kindesalter ein seltener Erreger respiratorischer Infektionen, vor allem der Pneumonie, wenn die PCR als direkte Nachweismethode herangezogen wird. Die höhere Nachweisrate von Antikörpern gegen C. pneumoniae deutet auf eine hohe Rate asymptomatischer oder unspezifischer Infektionen durch C. pneumoniae hin. Der Mensch ist weltweit das einzige Erregerreservoir. Kranke, seltener auch asymptomatische Ausscheider (Wochen bis 1 Jahr) sind die Ansteckungsquelle. Die Übertragung erfolgt als „Tröpfcheninfektion“ mit respiratorischen Sekreten. Eine epidemische Krankheitshäufung ist beschrieben. In feuchtem Milieu können Chlamydien bis zu 30 h auf unbelebtem Material überleben. Im Erwachsenenalter haben 50–75 % der Bevölkerung Antikörper gegen C. pneumoniae. Die höchsten Titer werden in der Altersklasse der 5- bis 14-Jährigen gefunden – ein Indiz für das Hauptmanifestationsalter der Primärinfektion. Seroprävalenzdaten aus Deutschland decken sich mit den Angaben aus der internationalen Literatur (5 % der unter 10-Jährigen, 64 % der unter 18-Jährigen besitzen Antikörper gegen C. pneumoniae). Ambulant erworbene Pneumonien werden im Kindesalter möglicherweise in bis zu 18 % der Fälle (serologische Diagnose) durch C. pneumoniae verursacht. Untersuchungen mittels PCR hingegen weisen C. pneumoniae nur in sporadischen Fällen nach. Koinfektionen mit Mykoplasmen, aber auch Pneumokokken und Adenoviren sind keine Seltenheit.
Collapse
|