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McGowan D, Kermani A, Sheagren J. Investigating and Summarizing Information Resources Related to the Clinical Presentation and Diagnosis of Cutaneous Manifestations of Infectious Diseases in Patients With Skin of Color. Open Forum Infect Dis 2024; 11:ofad692. [PMID: 38390461 PMCID: PMC10883730 DOI: 10.1093/ofid/ofad692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024] Open
Abstract
Patients with skin of color (SOC) present diseases differently in many circumstances, yet there is a lack of information regarding the presentation and diagnosis of cutaneous manifestations in such patients experiencing infectious diseases. Therefore, we conducted a scoping review to investigate and summarize information pertaining to the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with SOC focusing on the following viral, bacterial, toxin-mediated, and infestation diseases and fungal infections: human immunodeficiency virus, shingles, impetigo, scarlet fever, Lyme disease, toxic shock syndrome, scabies, rickettsioses, and cutaneous fungal infections. This scoping review identified literature gaps regarding cutaneous manifestations of infectious diseases in patients with SOC such as a lack of visual examples and more precise descriptions of common infectious diseases. The lack of better-quality literature and educational resources describing cutaneous manifestations of infectious diseases in patients with SOC may contribute to care barriers; therefore, more research and collaboration are needed in the specialties of both infectious diseases and dermatology.
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Affiliation(s)
- Dorothea McGowan
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Anosh Kermani
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - John Sheagren
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Dzul-Rosado K, Lavín-Sánchez DG, Hernández GÁ, Gómez-Carro S, Puerto-Manzano FI. Rickettsia rickettsii and Rickettsia typhi in hospitalized children diagnosed with Pediatric Multisystemic Inflammatory Syndrome in Merida, Yucatan. Braz J Infect Dis 2024; 28:103707. [PMID: 38070540 PMCID: PMC10826168 DOI: 10.1016/j.bjid.2023.103707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WHO.
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Affiliation(s)
- Karla Dzul-Rosado
- Hideyo Noguchi Regional Investigation Center, Faculty of Medicine, Autonomous University of Yucatan, Mérida, México.
| | | | | | - Salvador Gómez-Carro
- Agustín O' Horan General Hospital, Department of Health, Mérida, Yucatán, México
| | - Fernando I Puerto-Manzano
- Hideyo Noguchi Regional Investigation Center, Faculty of Medicine, Autonomous University of Yucatan, Mérida, México
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Li SA, Zhang L, Li Z, Song HN, Que ZW, Zhao SY, Li YY, Guo YL, Wu JY. Detection of Rickettsia spp. and Anaplasma ovis in Melophagus ovinus from southern Xinjiang, China. MEDICAL AND VETERINARY ENTOMOLOGY 2023; 37:865-870. [PMID: 37341627 DOI: 10.1111/mve.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
Melophagus ovinus is a hematophagous insect that is distributed worldwide and plays a crucial role in transmitting disease-causing pathogens. From June 2021 to March 2022, a total of 370 M. ovinus were collected from 11 sampling points in southern Xinjiang, China. The specimens were identified using morphological and molecular analyses. Rickettsia spp. and Anaplasma ovis were detected from all the samples using seven Rickettsia-specific genetic markers and the msp-4 gene of A. ovis. Approximately 11% of the M. ovinus specimens were positive for Rickettsia spp., and Candidatus Rickettsia barbariae was the most predominant species (35/41; 85.4%), while R. massiliae was least prevalent (6/41; 14.6%). Approximately 10.5% (39/370) of the M. ovinus specimens were positive for A. ovis of genotype III, which was co-detected with Candidatus R. barbariae in M. ovinus (3/370; 0.8%). To the best of our knowledge, this is the first report of the detection of R. massiliae and Candidatus R. barbariae in M. ovinus globally. The detection and control of insect-borne diseases originating from M. ovinus should be strengthened in southern Xinjiang, an area important to animal husbandry and production.
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Affiliation(s)
- Si-Ang Li
- College of Animal Science and Technology, Tarim University, Xinjiang, China
- Engineering Laboratory of Tarim Animal Diseases Diagnosis and Control, Xinjiang Production & Construction Corps, Xinjiang, China
| | - Liu Zhang
- College of Animal Science and Technology, Tarim University, Xinjiang, China
- Engineering Laboratory of Tarim Animal Diseases Diagnosis and Control, Xinjiang Production & Construction Corps, Xinjiang, China
| | - Zheng Li
- College of Animal Science and Technology, Tarim University, Xinjiang, China
- Engineering Laboratory of Tarim Animal Diseases Diagnosis and Control, Xinjiang Production & Construction Corps, Xinjiang, China
| | - Hao-Nan Song
- College of Animal Science and Technology, Tarim University, Xinjiang, China
- Engineering Laboratory of Tarim Animal Diseases Diagnosis and Control, Xinjiang Production & Construction Corps, Xinjiang, China
| | - Ze-Wei Que
- Key Laboratory of Tarim Animal Husbandry Science and Technology of Xinjiang Production & Construction Corps, Xinjiang, China
| | - Si-Yu Zhao
- Key Laboratory of Tarim Animal Husbandry Science and Technology of Xinjiang Production & Construction Corps, Xinjiang, China
| | - Ying-Ying Li
- Key Laboratory of Tarim Animal Husbandry Science and Technology of Xinjiang Production & Construction Corps, Xinjiang, China
| | - Yu-Ling Guo
- Key Laboratory of Tarim Animal Husbandry Science and Technology of Xinjiang Production & Construction Corps, Xinjiang, China
| | - Jun-Yuan Wu
- College of Animal Science and Technology, Tarim University, Xinjiang, China
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Stegmüller S, Qi W, Torgerson PR, Fraefel C, Kubacki J. Hazard potential of Swiss Ixodes ricinus ticks: Virome composition and presence of selected bacterial and protozoan pathogens. PLoS One 2023; 18:e0290942. [PMID: 37956168 PMCID: PMC10642849 DOI: 10.1371/journal.pone.0290942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Ticks play an important role in transmitting many different emerging zoonotic pathogens that pose a significant threat to human and animal health. In Switzerland and abroad, the number of tick-borne diseases, in particular tick-borne encephalitis (TBE), has been increasing over the last few years. Thus, it remains essential to investigate the pathogen spectrum of ticks to rapidly detect emerging pathogens and initiate the necessary measures. To assess the risk of tick-borne diseases in different regions of Switzerland, we collected a total of 10'286 ticks from rural and urban areas in ten cantons in 2021 and 2022. Ticks were pooled according to species, developmental stage, gender, and collection site, and analyzed using next generation sequencing (NGS) and quantitative polymerase chain reaction (qPCR). The metagenomic analysis revealed for the first time the presence of Alongshan virus (ALSV) in Swiss ticks. Interestingly, the pool-prevalence of ALSV was higher than that of tick-borne encephalitis virus (TBEV). Furthermore, several TBEV foci have been identified and pool prevalence of selected non-viral pathogens determined.
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Affiliation(s)
- Stefanie Stegmüller
- Institute of Virology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Weihong Qi
- Functional Genomics Center Zurich, Zurich, Switzerland
| | - Paul R. Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Cornel Fraefel
- Institute of Virology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jakub Kubacki
- Institute of Virology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Institute of Virology and Immunology, Mittelhäusern, Switzerland
- Department of Infectious Diseases and Pathobiology (DIP), Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Lionello FCP, Rotundo S, Bruno G, Marino G, Morrone HL, Fusco P, Costa C, Russo A, Trecarichi EM, Beltrame A, Torti C. Touching Base with Some Mediterranean Diseases of Interest from Paradigmatic Cases at the "Magna Graecia" University Unit of Infectious Diseases: A Didascalic Review. Diagnostics (Basel) 2023; 13:2832. [PMID: 37685370 PMCID: PMC10486464 DOI: 10.3390/diagnostics13172832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Among infectious diseases, zoonoses are increasing in importance worldwide, especially in the Mediterranean region. We report herein some clinical cases from a third-level hospital in Calabria region (Southern Italy) and provide a narrative review of the most relevant features of these diseases from epidemiological and clinical perspectives. Further, the pathogenic mechanisms involved in zoonotic diseases are reviewed, focusing on the mechanisms used by pathogens to elude the immune system of the host. These topics are of particular concern for individuals with primary or acquired immunodeficiency (e.g., people living with HIV, transplant recipients, patients taking immunosuppressive drugs). From the present review, it appears that diagnostic innovations and the availability of more accurate methods, together with better monitoring of the incidence and prevalence of these infections, are urgently needed to improve interventions for better preparedness and response.
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Affiliation(s)
- Ferdinando Carmelo Pio Lionello
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Salvatore Rotundo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriele Bruno
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriella Marino
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Helen Linda Morrone
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Paolo Fusco
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Chiara Costa
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Anna Beltrame
- College of Public Health, University of South Florida, Gainesville, FL 33620, USA;
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
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Zhang X, Chen H, Han D, Wu W. Clinical usefulness of metagenomic next-generation sequencing for Rickettsia and Coxiella burnetii diagnosis. Eur J Clin Microbiol Infect Dis 2023; 42:681-689. [PMID: 36997767 PMCID: PMC10172222 DOI: 10.1007/s10096-023-04586-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/07/2023] [Indexed: 04/01/2023]
Abstract
Rickettsia and Coxiella burnetii are zoonotic tick-borne pathogens that cause febrile illnesses in humans. Metagenomic next-generation sequencing (mNGS) is a new technology used to diagnose infectious diseases. However, clinical experience with applying the test to rickettsioses and Q fever is relatively limited. Therefore, this study aimed to explore the diagnostic performance of mNGS in detecting Rickettsia and C. burnetii. We retrospectively studied patients with rickettsioses or Q fever between August 2021 and July 2022. Peripheral blood mNGS and polymerase chain reaction (PCR) were performed for all patients. Clinical data were retrieved for analysis. Thirteen patients were included in this study (eleven confirmed cases and two suspected cases). Signs and symptoms included fever (13, 100%), rash (7, 53.8%), muscle soreness (5, 38.5%), headache (4, 30.8%), skin eschar (3, 23.1%), and disturbance of consciousness (2, 15.4%). In addition, eight patients (61.6%) had thrombocytopenia, ten (76.9%) had liver function impairment, and two (15.4%) had renal function impairment. The results of mNGS revealed seven patients with R. japonica (53.8%), five with C. burneti (38.5%), two with R. heilongjiangensis (15.4%), and one with R. honei (7.7%). PCR results were positive in 11 patients (84.6%). After receiving doxycycline-based treatment, 12 (92.3%) patients returned to a normal temperature within 72 h. All patients were discharged in better health. Therefore, mNGS can help diagnose Rickettsia and C. burnetii and shorten the diagnosis time, especially for patients with atypical clinical manifestations and unclear epidemiologic evidence of a tick bite or exposure.
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Affiliation(s)
- Xuan Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Huixin Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Dongsheng Han
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China.
| | - Wei Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Rodrigues AC, de Castro MB, Labruna MB, Szabó MPJ. The inoculation eschar of Rickettsia parkeri rickettsiosis in Brazil: Importance and cautions. Ticks Tick Borne Dis 2023; 14:102127. [PMID: 36693294 DOI: 10.1016/j.ttbdis.2023.102127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Two well characterized tick-borne rickettsioses occur in Brazil. Rickettsia rickettsii caused spotted-fever, transmitted by Amblyomma sculptum and Amblyomma aureolatum, is a severe disease with a high case-fatality rate in the southeastern region of the country. Rickettsia parkeri strain Atlantic rainforest infections transmitted by adult Amblyomma ovale ticks cause a milder non-lethal febrile disease with an eschar (necrosis) at the tick bite site. Clinical diagnosis of rickettsiosis is challenging, particularly during the early stages of the illness when signs and symptoms are non-specific. Since eschar at the tick bite site has emerged as the main clinical feature of mild R. parkeri infections and used to differentiate it from severe R. rickettsii infection, its proper recognition, distinction from other tick bite lesions, and boundaries as a clinical tool must be highlighted. Of importance, eschars induced by Rickettsia must be differentiated from dermatoses caused by other tick-borne skin infections as well from lesions caused by the tick bite itself. We herein highlight information on eschar in rickettsial diseases in Brazil and discuss the need for further research on its clinical relevance and application in the diagnosis of spotted fever caused by R. parkeri strain Atlantic rainforest. In particular, we draw attention to diagnosis of other febrile diseases in the presence of concomitant tick bites.
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Affiliation(s)
- Alessandra Castro Rodrigues
- Laboratório de Ixodologia, Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Pará, 1720/Campus Umuarama-Bloco 2T, CEP 38400-902, Uberlândia, Minas Gerais, Brazil
| | - Márcio Botelho de Castro
- Laboratório de Patologia Veterinária, Universidade de Brasília, Av. L4 Norte, Hospital Veterinário - Campus Universitário Darcy Ribeiro, CP. 4508, Asa Norte, CEP 70910-970, Brasília, Distrito Federal, Brazil
| | - Marcelo Bahia Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva, 87, Cidade Universitária, CEP 05508-270, São Paulo, São Paulo, Brazil
| | - Matias Pablo Juan Szabó
- Laboratório de Ixodologia, Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Pará, 1720/Campus Umuarama-Bloco 2T, CEP 38400-902, Uberlândia, Minas Gerais, Brazil.
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Arroyo-Andrés J, Ferreiro López D, Oteo Revuelta JA, Zarco C. First reported case of imported scrub typhus in Spain: A disease to consider in travellers. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:132-134. [PMID: 36759052 DOI: 10.1016/j.eimce.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Jorge Arroyo-Andrés
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Daniel Ferreiro López
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Carlos Zarco
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Investigation of Rickettsia conorii in Patients Suspected of Having Crimean-Congo Hemorrhagic Fever. Pathogens 2022; 11:pathogens11090973. [PMID: 36145405 PMCID: PMC9502110 DOI: 10.3390/pathogens11090973] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Rickettsia conorii is the causative agent of Mediterranean spotted fever (MSF). Misdiagnosis of MSF may occur with febrile syndromes associated with rash and thrombocytopenia, such as Crimean-Congo hemorrhagic fever (CCHF). This study aimed to determine the prevalence of R. conorii among serum samples obtained from 260 suspected CCHF patients with features of MSF in Iran (2018–2020). The quantitative polymerase chain reaction (qPCR) method detected three (1.15%) positive 16S rDNA Rickettsia spp. samples that were classified as R. conorii subsp. conorii, R. conorii subsp. Israelensis, and R. helvetica using the sequencing of gltA, ompA, and 17kDa genes. Furthermore, R. conorii IgM antibodies presented in 38 (14.62%) patients by the enzyme-linked immunosorbent assay (ELISA) method. Out of 97 MSF patients with available paired serum samples, IgM seroconversion and a four-fold increase were observed in 14 (14.43%) and 12 (12.37%) patients, respectively. We concluded that rickettsial agents are present in Iran and may be misdiagnosed with other febrile syndromes.
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Arroyo-Andrés J, Ferreiro López D, Oteo Revuelta JA, Zarco C. First reported case of imported scrub typhus in Spain: A disease to consider in travellers. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Santibáñez S, Portillo A, Ibarra V, Santibáñez P, Metola L, García-García C, Palomar AM, Cervera-Acedo C, Alba J, Blanco JR, Oteo JA. Epidemiological, Clinical, and Microbiological Characteristics in a Large Series of Patients Affected by Dermacentor-Borne-Necrosis-Erythema-Lymphadenopathy from a Unique Centre from Spain. Pathogens 2022; 11:528. [PMID: 35631049 PMCID: PMC9146834 DOI: 10.3390/pathogens11050528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
During recent decades, a tick-borne rickettsial syndrome, characterized by eschar and painful lymphadenopathy after Dermacentor marginatus-bite, has been described as an emerging rickettsiosis in Europe. Our group named it DEBONEL (Dermacentor-borne-necrosis-erythema-lymphadenopathy), regarding the vector and the main infection signs. Other groups called it TIBOLA (tick-borne-lymphadenophathy) and, later, SENLAT (scalp-eschar-and-neck-lymphadenopathy-after-tick-bite), expanding, in the latter, the etiological spectrum to other pathogens. Objective: To investigate the etiology of DEBONEL agents in our area, and to compare their epidemiological/clinical/microbiological characteristics. During 2001-2020, 216 patients clinically diagnosed of DEBONEL (the largest series from one center) in La Rioja (northern Spain) were examined. Rickettsia spp. were amplified in 14/104 (13.46%) blood samples, 69/142 (48.59%) eschar swabs, 7/7 (100%) biopsies, and 71/71 (100%) D. marginatus from patients. For samples in which Rickettsia was undetected, no other microorganisms were found. 'Candidatus Rickettsia rioja', Rickettsia slovaca, Rickettsia raoultii, and Rickettsia DmS1 genotype were detected in 91, 66, 4, and 3 patients, respectively. DEBONEL should be considered in patients with clinical manifestations herein described in areas associated to Dermacentor. The most frequently involved agent in our environment is 'Ca. R. rioja'. The finding of Rickettsia sp. DmS1 in ticks attached to DEBONEL patients suggests the implication of other rickettsia genotypes.
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Affiliation(s)
| | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Infectious Diseases Department, San Pedro University Hospital-Center for Biomedical Research from La Rioja (CIBIR), 26006 Logroño, Spain; (S.S.); (V.I.); (P.S.); (L.M.); (C.G.-G.); (A.M.P.); (C.C.-A.); (J.A.); (J.R.B.); (J.A.O.)
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Vázquez-Pérez Á, Rodríguez-Granger J, Calatrava-Hernández E, Santos-Pérez JL. Pediatric tubular acute lymphangitis caused by Rickettsia sibirica mongolitimonae: Case report and literature review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:218-219. [PMID: 35473997 DOI: 10.1016/j.eimce.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/01/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Álvaro Vázquez-Pérez
- Department of Pediatrics, Virgen de las Nieves Children's Hospital, Granada, Spain.
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Vázquez-Pérez Á, Rodríguez-Granger J, Calatrava-Hernández E, Santos-Pérez JL. Pediatric tubular acute lymphangitis caused by Rickettsia sibirica mongolitimonae: Case report and literature review. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Silva-Ramos CR, Faccini-Martínez ÁA. Clinical, epidemiological, and laboratory features of Rickettsia africae infection, African tick-bite fever: A systematic review. LE INFEZIONI IN MEDICINA 2022; 29:366-377. [PMID: 35146341 DOI: 10.53854/liim-2903-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
African tick-bite fever (ATBF), caused by Rickettsia africae, is the main tick-borne rickettsiosis and the second most frequent cause of fever after malaria in travelers returning from sub-Saharan Africa. General descriptions on ATBF were made in the first two decades after recognized as a new infectious entity, and since then, many authors have contributed to the knowledge of the disease by reporting clinical cases in scientific literature. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of confirmed R. africae rickettsiosis cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. A total of 48 scientific publications (108 confirmed cases) were analyzed in order to extract data for developing this review. Overall, our results show that R. africae rickettsiosis is more frequent in males in the age group of 18-64 years, more than 80% of the cases occurred in European travelers, South Africa was the country where most infections were acquired, and almost 40% of cases occurred in clusters. Clinically, more than 80% of the cases had fever and eschar (55% developed multiple eschars), rash was present in less than the half of cases, and lymphangitis was not a common sign (11%). Headache, myalgia and regional lymphadenopathy were predominant nonspecific clinical manifestation (mean of 60%, 49% and 51%, respectively). Our results show that at least 70% of R. africae cases had altered laboratory parameters, most often showing an increase in transaminases and C-reactive protein. Tetracycline-class antibiotics, as monotherapy, were used in most (>90%) of the patients. Overall, only 4% of cases had complications, 12% required hospitalization, and there was a 100% rate of clinical recovery.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro A Faccini-Martínez
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.,Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia
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Salazar Alarcón E, Guillén-Martín S, Callejas-Caballero I, Valero-Arenas A. Clinical case report: Not all rickettsiosis are mediterranean spotted fever. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:44-45. [PMID: 34732342 DOI: 10.1016/j.eimce.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | - Ana Valero-Arenas
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
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16
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Drago F, Ciccarese G, Merlo G, Trave I, Javor S, Rebora A, Parodi A. Oral and cutaneous manifestations of viral and bacterial infections: Not only COVID-19 disease. Clin Dermatol 2021; 39:384-404. [PMID: 34517997 PMCID: PMC7849469 DOI: 10.1016/j.clindermatol.2021.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy.
| | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, Alessandria, Italy
| | - Ilaria Trave
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Sanja Javor
- Dermatology Unit, Galliera Hospital, Via Mura delle Cappuccine 14, Genoa, Italy
| | - Alfredo Rebora
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
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17
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D E, S P, K G, W R, V P V, Pp AK, Jaj P, Js D. Spotted fever diagnosis: Experience from a South Indian center. Pathog Glob Health 2021; 115:300-306. [PMID: 34493177 DOI: 10.1080/20477724.2021.1934293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Spotted fever (SF) is an important treatable cause of acute febrile illness (AFI) with rash and has reemerged in India. A prospective AFI with rash study was undertaken at a South Indian hospital to correlate specific clinical findings with laboratory confirmation of spotted fever. During the study period (December 2017 to May 2019), 175 patients with fever and rash were suspected to have spotted fever. Molecular assays for scrub typhus and spotted fever (47 kDa and ompA qPCR) and serology (IgM ELISA) was performed on the 96 individuals recruited. Laboratory confirmed SF cases (ompA qPCR positive) were 21, whereas laboratory supported SF cases (ompA negative but sero-positive by SF IgM ELISA) were 27. Among the 48 spotted fever (SF) cases, 70% of had maculopapular rash, 12.5% had macular rash, purpuric/petechial rash (severe rash) was seen in 8 patients (16.7%). Presence of rash on the palms and soles was associated with a relative risk (RR) of 4.36 (95% CI: 2.67-7.10; p < 0.001). Our study suggests that ompA qPCR though useful for confirming the diagnosis of spotted fever is not always positive. A positive SF IgM ELISA in febrile individuals with palmo-plantar rash supports the diagnosis of spotted fever especially when other causes of febrile rash have been excluded. Multi-centric prospective studies employing the serological reference standard, IFA (immunofluorescence assay) in addition to the assays used in this study are needed to validate these findings.
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Affiliation(s)
- Elangovan D
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Perumalla S
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Gunasekaran K
- Department of General Medicine, Christian Medical College, Vellore, India
| | - Rose W
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Verghese V P
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Abhilash K Pp
- Department of Emergency Medicine, Christian Medical College, Vellore, India
| | - Prakash Jaj
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Dumler Js
- Department of Pathology, Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Luciano E, Fluixá Carrascosa C. [Mediterranean spotted fever in immunosuppressed patients]. Semergen 2021; 47:e31-e32. [PMID: 34155977 DOI: 10.1016/j.semerg.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E Luciano
- Servicio de Medicina Preventiva, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - C Fluixá Carrascosa
- Medicina Familiar y Comunitaria, Centro de Salud Valencia Alfahuir. Departamento Valencia Clínico Malvarrosa, Valencia, España
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Silva-Ramos CR, Hidalgo M, Faccini-Martínez ÁA. Clinical, epidemiological, and laboratory features of Rickettsia parkeri rickettsiosis: A systematic review. Ticks Tick Borne Dis 2021; 12:101734. [PMID: 33989945 DOI: 10.1016/j.ttbdis.2021.101734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 04/05/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
Rickettsia parkeri rickettsiosis is recognized as the second most prevalent tick-borne disease caused by spotted fever group rickettsiae in the Americas, where two pathogenic strains (R. parkeri sensu stricto and R. parkeri strain Atlantic rainforest) have been related to human infections and transmitted by Amblyomma spp. ticks. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of R. parkeri rickettsiosis, including confirmed and probable cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. We excluded papers that contained missing information of some variables and publications in which it was not possible to separate data for confirmed and probable cases. A total of 77 clinical cases (32 confirmed cases and 45 probable cases) were considered for this review. Overall, our results show that R. parkeri rickettsiosis is more frequent in males in the age group of 18-64 years and that a history of tick exposure was frequent (>90%). Cases were described in the United States, Argentina, Brazil, Uruguay and Colombia. Clinically, more than 60% of the cases had fever (mean of 93%), eschar (mean of 87%), and rash (mean of 68%). Headache and myalgia were predominant nonspecific symptoms (mean of 67% and 61%, respectively). Our results show that at least 60% of R. parkeri cases had altered laboratory parameters, most often showing an increase in transaminases and leukopenia. Tetracyclines-class antibiotics were used in most (>85%) of the patients. Overall, only 9% of cases required hospitalization and there was a 100% rate of clinical recovery in all of cases.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro A Faccini-Martínez
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA; Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia.
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20
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Belhajsalah N, Brahim MB, Daada S, Brahim HB, Hammemi S. Concomitant Mediterranean spotted fever and systemic lupus erythematosus: a rare case report. Pan Afr Med J 2021; 38:377. [PMID: 34367456 PMCID: PMC8308997 DOI: 10.11604/pamj.2021.38.377.28762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Infections are an important cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE). Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. This infection is endemic in Tunisia with summer seasonality. Herein, the case of a 45 years old woman, admitted to hospital with fever and erythema nodosum. On examination, she had a diffuse skin rash, malar rash, and polyarthritis. Serology demonstrated Rickettsia Conoriiinfection. The diagnosis of MSF was made and the patient had a course of doxycycline for 5 days with a prompt improvement of the fever, the skin lesions but she had a persistent malar rash, polyarthritis, and lymphopenia. The immunological profile was positive for antinuclear antibodies (ANA), anti-DNA antibodies, anti-nucleosomes antibodies, and anti-citrullinated protein antibodies (ACPA). The diagnosis of SLE was established. We report the first case of SLE associated with MSF and with erythema nodosum as the initial presentation.
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Affiliation(s)
- Nada Belhajsalah
- Department of Infectious Disease, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Marwa Ben Brahim
- Department of Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Syrine Daada
- Department of Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.,Laboratory LR12ES05, Lab-NAFS 'Nutrition - Functional Food and Vascular Health', Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hajer Ben Brahim
- Department of Infectious Disease, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sonia Hammemi
- Department of Internal Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.,Laboratory LR12ES05, Lab-NAFS 'Nutrition - Functional Food and Vascular Health', Faculty of Medicine, University of Monastir, Monastir, Tunisia
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21
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Baltadzhiev I, Zaprianov Z, Baltadjiev A. Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data. Med Princ Pract 2021; 30:369-375. [PMID: 33780958 PMCID: PMC8436609 DOI: 10.1159/000516167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Mediterranean spotted fever (MSF) is a tick-borne rickettsial infection endemic to the Mediterranean coastline countries. As a result of growing tourism, imported cases have been registered in many nonendemic countries and regions. We present clinical laboratory parameters and histopathological data on renal impairment in patients with MSF. The study meets our goal of identifying kidney involvement and detecting renal damage in people with MSF. SUBJECTS AND METHODS Three hundred fifty patients with MSF with a diagnosis confirmed by immunofluorescence analysis were tested for serum urea, creatinine, and albumin. Fifty-five patients with malignant form of MSF were divided into 2 groups: 19 fatalities and 36 survivors. The percentage of patients with acute renal failure (ARF) was compared in both groups. RESULTS Subjects with elevated urea and creatinine levels increased from 5.21 to 3.47% in mild to 48.78 and 29.26% in severe MSF, respectively. Loss of serum albumin also increased from mild to severe MSF. Renal impairment comprised 60% of the cohort of 55 patients with malignant MSF: 89.4% in the group of deaths and almost twice less in the survivors. ARF developed in 84.2% of fatal cases and was >2 times less in survivors. Postmortem light microscopy of renal samples of 9 fatal cases revealed perivascular mononuclear inflammatory infiltrates, vasculitis with fibrinoid necrosis, acute tubular necrosis, interstitial edema, hemorrhage, and thrombosis. CONCLUSION Renal pathology associated with MSF rickettsial infection consists of systemic small vessel vasculitis and vascular injury, leading to ARF in the most severe cases.
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Affiliation(s)
- Ivan Baltadzhiev
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University and Infectious Disease Clinic, University Hospital St. George, Plovdiv, Bulgaria
| | - Zaprian Zaprianov
- Department of General and Clinical Pathology, Faculty of Medicine, Medical University and General and Clinical Pathology Clinic, University Hospital St. George, Plovdiv, Bulgaria
| | - Atanas Baltadjiev
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
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22
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Salazar Alarcón E, Guillén-Martín S, Callejas-Caballero I, Valero-Arenas A. Clinical case report: Not all rickettsiosis are mediterranean spotted fever. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00015-X. [PMID: 33618852 DOI: 10.1016/j.eimc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Ana Valero-Arenas
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, España
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23
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Abstract
Scrub typhus and other rickettsial infections contribute to 25 - 50% of acute undifferentiated febrile illnesses in endemic regions. Delayed recognition and therapy increase the morbidity and mortality. The constellation of fever with eschar or rash and multisystem involvement should facilitate the diagnosis and initiation of appropriate therapy. The pathological hallmark of rickettsial infections is endothelial infection and inflammation causing vasculitis. Endothelial inflammation results in microvascular dysfunction and increased vascular permeability. Immune and endothelial activation may worsen microvascular dysfunction, predisposing to multi-organ failure. Serology is the mainstay of diagnosis, although false negatives occur early in the disease. Point-of-care rapid diagnostic tests and molecular techniques, such as quantitative polymerase chain reaction (qPCR), can hasten diagnostic processes. Intravenous doxycycline with a loading dose is the most widely used antibiotic in critically ill patients, with azithromycin as a suitable alternative. Early appropriate treatment and organ support can decrease the duration of illness and be life-saving. How to cite this article: Gunasekaran K, Bal D, Varghese GM, et al. Scrub Typhus and Other Rickettsial Infections. Indian J Crit Care Med 2021;25(Suppl 2):S138-S143.
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Affiliation(s)
- Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepti Bal
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Miguélez Ferreiro S, Navalpotro Rodríguez D. Linfangitis aguda tubular por Rickettsia sibirica mongolitimonae. Enferm Infecc Microbiol Clin 2020; 38:506-507. [DOI: 10.1016/j.eimc.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/02/2020] [Accepted: 03/08/2020] [Indexed: 11/16/2022]
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Fisher J, Card G, Soong L. Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses. PLoS Negl Trop Dis 2020; 14:e0008675. [PMID: 33091013 PMCID: PMC7580963 DOI: 10.1371/journal.pntd.0008675] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Scrub typhus and spotted fever rickettsioses (SFR) are understudied, vector-borne diseases of global significance. Over 1 billion individuals are at risk for scrub typhus alone in an endemic region, spanning across eastern and southern Asia to Northern Australia. While highly treatable, diagnostic challenges make timely antibiotic intervention difficult for these diseases. Delayed therapy may lead to severe outcomes affecting multiple organs, including the central nervous system (CNS), where infection and associated neuroinflammation may be lethal or lead to lasting sequelae. Meningitis and encephalitis are prevalent in both scrub typhus and SFR. Additionally, case reports detailing focal neurological deficits have come to light, with attention to both acute and chronic sequelae of infection. Despite the increasing number of clinical reports outlining neurologic consequences of these diseases, relatively little research has examined underlying mechanisms of neuroinflammation. Animal models of scrub typhus have identified cerebral T-cell infiltration and vascular damage associated with endothelial infection and neuropathogenesis. Differential gene expression analysis of brain tissues during murine scrub typhus have revealed selective increases in CXCR3 ligands, proinflammatory and type-1 cytokines and chemokines, and cytotoxicity molecules, as well as alterations in the complement pathway. In SFR, microglial expansion and macrophage infiltration contribute to neurological disease progression. This narrative Review highlights clinical neurologic features of scrub typhus and SFR and evaluates our current understanding of basic research into neuroinflammation for both diseases in animal models. Further investigation into key mediators of neuropathogenesis may yield prognostic markers and treatment regimens for severe patients.
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Affiliation(s)
- James Fisher
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Galen Card
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
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Weck B, Krawczak FS, Costa FB, Dall'Agnol B, Marcili A, Reck J, Labruna MB. Rickettsia parkeri in the Pampa biome of southern Brazil: Isolation, molecular characterization, and serological evidence of canine infection. Vet Parasitol Reg Stud Reports 2020; 22:100448. [PMID: 33308714 DOI: 10.1016/j.vprsr.2020.100448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 11/18/2022]
Abstract
In this work we performed a field study in a spotted fever-endemic area of the Pampa biome in Rio Grande do Sul, the southernmost state of Brazil (Rosário do Sul municipality), with the aim to evaluate the serological status of dogs for spotted fever group (SFG) rickettsiae, to attempt the isolation rickettsiae from A. tigrinum ticks, and to further perform a multi-genic molecular characterization of the rickettsial isolate. For this purpose, we collected blood serum samples and ticks from 18 rural dogs during 2016-2017. By immunofluorescence assay, all 18 dogs (100%) reacted serologically to SFG rickettsiae, with highest endpoint titers to R. parkeri, suggesting that at least part of these dogs have been infected by R. parkeri. Among 23 ticks collected from the dogs (13 A. tigrinum and 10 Rhipicephalus sanguineus sensu stricto), 46% (6/13) A. tigrinum contained DNA of R. parkeri, which was successfully isolated in Vero cell culture from one of these ticks. Partial sequences of five genes (gltA, ompA, virB4, dnaA, dnaK) and 3 intergenic spacers (mppA-purC, rrl-rrf-ITS, rpmE-tRNAfMet) were generated from this rickettsial isolate, and were all 100% identical to corresponding sequences of R. parkeri s.s. We provide the first report of a viable isolate of R. parkeri from A. tigrinum, confirming that this isolate belongs to the strain R. parkeri s.s., as it has already been demonstrated for other two tick species of the Amblyomma maculatum species complex (A. maculatum and Amblyomma triste).
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Affiliation(s)
- Bárbara Weck
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa em Saúde Animal, Instituto de Pesquisas Veterinárias Desidério Finamor (IPVDF), Eldorado do Sul, Rio Grande do Sul, Brazil.
| | - Felipe S Krawczak
- Setor de Medicina Veterinária Preventiva, Escola de Veterinária e Zootecnia, Universidade Federal de Goiás, Goiânia, Brazil
| | - Francisco B Costa
- Departamento de Patologia, Medicina Veterinária, Universidade Estadual do Maranhão, São Luís, Maranhão, Brazil
| | - Bruno Dall'Agnol
- Centro de Pesquisa em Saúde Animal, Instituto de Pesquisas Veterinárias Desidério Finamor (IPVDF), Eldorado do Sul, Rio Grande do Sul, Brazil
| | - Arlei Marcili
- Mestrado em Medicina e Bem-Estar Animal, Universidade Santo Amaro, São Paulo, SP, Brazil
| | - Jose Reck
- Centro de Pesquisa em Saúde Animal, Instituto de Pesquisas Veterinárias Desidério Finamor (IPVDF), Eldorado do Sul, Rio Grande do Sul, Brazil
| | - Marcelo B Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
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Nelder MP, Russell CB, Johnson S, Li Y, Cronin K, Warshawsky B, Brandon N, Patel SN. Assessing human exposure to spotted fever and typhus group rickettsiae in Ontario, Canada (2013-2018): a retrospective, cross-sectional study. BMC Infect Dis 2020; 20:523. [PMID: 32682398 PMCID: PMC7368706 DOI: 10.1186/s12879-020-05244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Assessing the burden of rickettsial infections in Ontario, Canada, is challenging since rickettsial infections are not reportable to public health. In the absence of reportable disease data, we assessed the burden of rickettsial infections by examining patient serological data and clinical information. METHODS Our retrospective, cross-sectional study included patients who had Rickettsia serological testing ordered by their physician, in Ontario, from 2013 to 2018. We tested sera from 2755 non-travel patients for antibodies against spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) using an indirect immunofluorescence assay (IFA) (positive IgG titers ≥1:64). We classified cases using a sensitive surveillance case definition: confirmed (4-fold increase in IgG titers between acute and convalescent sera with clinical evidence of infection), possible (single positive sera with clinical evidence) and previous rickettsial infection (single positive sera without clinical evidence). We classified cases seropositive for both SFGR and TGR as unspecified Rickettsia infections (URIs). RESULTS Less than 5% of all patients had paired acute and convalescent sera tested, and of these, we found a single, laboratory-confirmed SFGR case, with a 4-fold increase in IgG titers and evidence of fever, maculopapular rash and headache. There were 45 possible (19 SFGR, 7 TGR, 19 URI) and 580 previous rickettsial infection (183 SFGR, 89 TGR, 308 URI) cases. The rate of positive tests for SFGR, TGR and URI combined (all case classifications) were 4.4 per 100,000 population. For confirmed and possible cases, the most common signs and symptoms were fever, headache, gastrointestinal complaints and maculopapular rash. The odds of having seropositive patients increased annually by 30% (odds ratio = 1.3, 95% confidence interval: 1.23-1.39). CONCLUSIONS The rates of rickettsial infections in Ontario are difficult to determine. Based on confirmed and possible cases, rates are low, but inclusion of previous rickettsial infection cases would indicate higher rates. We highlight the need for education regarding the importance of testing acute and convalescent sera and consistent completion of the laboratory requisition in confirming rickettsial disease. We suggest further research in Ontario to investigate rickettsial agents in potential vectors and clinical studies employing PCR testing of clinical samples.
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Affiliation(s)
- Mark P Nelder
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada.
| | - Curtis B Russell
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - Steven Johnson
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Ye Li
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Kirby Cronin
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Bryna Warshawsky
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Nicholas Brandon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Lokida D, Hadi U, Lau CY, Kosasih H, Liang CJ, Rusli M, Sudarmono P, Lukman N, Laras K, Asdie RH, Murniati D, Utama IMS, Mubin RH, Karyana M, Gasem MH, Alisjahbana B. Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results. BMC Infect Dis 2020; 20:364. [PMID: 32448167 PMCID: PMC7245627 DOI: 10.1186/s12879-020-05057-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia. METHODS Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management. RESULTS R. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities. CONCLUSIONS Rickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.
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Affiliation(s)
- Dewi Lokida
- Tangerang District Hospital, Tangerang, Indonesia
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Usman Hadi
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia.
| | - C Jason Liang
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Musofa Rusli
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Kanti Laras
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | | | | | | | | | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | | | - Bachti Alisjahbana
- Hasan Sadikin Hospital - Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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29
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Špitalská E, Kraljik J, Miklisová D, Boldišová E, Sparagano OAE, Stanko M. Circulation of Rickettsia species and rickettsial endosymbionts among small mammals and their ectoparasites in Eastern Slovakia. Parasitol Res 2020; 119:2047-2057. [PMID: 32382991 DOI: 10.1007/s00436-020-06701-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
Bacteria belonging to the genus Rickettsia are known as causative agents of vector-borne zoonotic diseases, such as spotted fevers, epidemic typhus and endemic typhus. Different species of ticks, mites and fleas could act as reservoirs and arthropod vectors of different pathogenic Rickettsia species. The aim of this work was to establish active surveillance of Rickettsia spp. in mites, ticks and fleas collected from small mammals (rodents and shrews) in Eastern Slovakia. A total of 964 animal ear biopsies, 871 mites, 667 ticks and 743 fleas were collected from small mammals in the Košice region, Eastern Slovakia. All specimens were identified using specialized taxonomic keys, and were conserved in ethanol until DNA extraction was performed. After DNA extraction, identification of Rickettsia species was performed by PCR-based methods. The total prevalence of rickettsiae from ear biopsies was 4.6% (95% CI, 3.2-5.9), in tested mites 9.3% (95% CI, 7.4-11.2), 17.2% (95% CI, 14.3-20.1) in I. ricinus ticks and 3.5% (95% CI, 2.2-4.8) in fleas. Sequence analysis of the partial gltA gene and Rickettsia helvetica-, Rickettsia slovaca-, Rickettsia raoultii- species specific real-time PCR tests revealed the presence of R. helvetica, R. slovaca, unidentified Rickettsia and rickettsial endosymbionts. These pathogenic and symbiotic species were confirmed in the following ectoparasite species-Laelaps jettmari, Haemogamasus nidi, Laelaps agilis and Eulaelaps stabularis mites, Ixodes ricinus ticks, Ctenophthalmus solutus, C. assimilis and Megabothris turbidus fleas infesting host-Apodemus agrarius, A. flavicollis, Microtus arvalis and Myodes glareolus small mammals. These results confirm the circulation of R. helvetica, R. slovaca, unidentified Rickettsia and rickettsial endosymbionts in mites, ticks and fleas collected on small mammals in the Košice region, Eastern Slovakia.
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Affiliation(s)
- Eva Špitalská
- Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05, Bratislava, Slovak Republic.
| | - Jasna Kraljik
- Institute of Zoology Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovak Republic
| | - Dana Miklisová
- Institute of Parasitology Slovak Academy of Sciences, Hlinkova 3, 040 01, Košice, Slovak Republic
| | - Eva Boldišová
- Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05, Bratislava, Slovak Republic
| | - Olivier A E Sparagano
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, Kowloon, Hong Kong SAR
| | - Michal Stanko
- Institute of Zoology Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovak Republic
- Institute of Parasitology Slovak Academy of Sciences, Hlinkova 3, 040 01, Košice, Slovak Republic
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Balážová A, Baláž V, Ondruš J, Široký P. Duplex qPCR assay for detection and quantification of Anaplasma phagocytophilum and Rickettsia spp. Ticks Tick Borne Dis 2020; 11:101462. [PMID: 32723653 DOI: 10.1016/j.ttbdis.2020.101462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022]
Abstract
Anaplasma phagocytophilum and Rickettsia spp. are vector-borne zoonotic bacteria, which are clinically important especially in immunocompromised patients. There are large gaps in the current knowledge of their geographic distribution and prevalence in both their vectors and hosts. Our aim was to develop reliable and easy detection method for both these pathogens. We made a new hydrolysis probe based duplex Real-Time PCR assay based on previous studies. We optimized the assays and tested them to provide reliable recommended procedures with a sensitivity to a minimum of 10 target DNA copies per sample. The assays were designed to be specific for A. phagocytophilum and in the same reaction detect multiple species of rickettsiae. We designed gBlock quantification standards that provide the option to identify differences in pathogen load among different samples in subsequent studies.
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Affiliation(s)
- Alena Balážová
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Vojtech Baláž
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Jaroslav Ondruš
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic; CEITEC - Central European Institute of Technology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Pavel Široký
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic; CEITEC - Central European Institute of Technology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic.
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Chochlakis D, Cutler S, Giadinis N, Psaroulaki A. Bartonella vinsonii subsp. arupensis infection in animals of veterinary importance, ticks and biopsy samples. New Microbes New Infect 2020; 34:100652. [PMID: 32071727 PMCID: PMC7013009 DOI: 10.1016/j.nmni.2020.100652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Testing for vector-borne pathogens in livestock is largely reliant upon blood and tissue. The role of biopsy samples remains poorly explored for detecting tick-borne bacteria in animals. In a 2-year survey, animals of veterinary importance from farms throughout the northern part of Greece were routinely checked for the presence of biopsy samples. Where detected, either a portion or a biopsy was collected together with whole blood samples and any ticks at the site of the biopsy sample. Molecular testing was carried out by real-time PCR targeting the internal transcribed spacer gene of Bartonella species. A total of 68 samples (28 blood samples, 28 biopsy samples and 12 ticks (nine Rhipicephalus bursa and three Rhipicephalus turanicus)) were collected from goats (64 samples) and cattle (four samples). Eight (11.8%) of the 68 samples were positive for Bartonella species. Of the biopsy and whole blood samples, four (14.3%) of each type were positive for Bartonella species. None of the ticks tested positive for Bartonella species. All pairs of positive biopsy samples/whole blood samples originated from the same animals. Positive samples were identified as Bartonella vinsonii subsp. arupensis. Although many more samples from a much wider spectrum of animal species is required before concluding upon the merit of biopsy samples in the study of tick-borne diseases, the significance of our finding warrants further study, both for clinical consequences in small ruminants and for those humans who are farming infected animals.
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Affiliation(s)
- D. Chochlakis
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Voutes – Staurakia, 71110, Heraklion, Crete, Greece
| | - S. Cutler
- School of Health, Sports & Bioscience, University of East London, London, UK
| | - N.D. Giadinis
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - A. Psaroulaki
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Voutes – Staurakia, 71110, Heraklion, Crete, Greece
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Rogozin E, Lazarovitch T, Weinberger M. High Morbidity Due to Murine Typhus Upsurge in Urban Neighborhoods in Central Israel. Am J Trop Med Hyg 2020; 100:952-956. [PMID: 30761983 DOI: 10.4269/ajtmh.18-0076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The incidence of murine typhus in Israel has decreased substantially since 1950 to a low of 0.04/100,000 population in 2010. We present the experience of a single university medical center in central Israel. Hospitalized patients serologically positive for Rickettsia typhi by indirect immunofluorescence antibody assay during 2006-2016 were retrospectively identified. Clinical and laboratory data from patients' charts were used to analyze disease trends and distribution. Seventy-eight patients were studied (mean age: 27.9 years), mostly of Arab ethnicity (68, 87.2%). Seventy-one (91%) patients resided in two large mixed Jewish-Arab cities-Lod and Ramla. The incidence of murine typhus among the Arab population in Lod increased 8.4-fold from 6.4/100,000 in 2006 to a peak of 53.4/100,000 in 2013. The average annual incidence among Arabs in Ramla was 10.1/100,000. Among Jews, incidences were 0.8/100,000 in Lod and 0.4/100,000 in Ramla. The classical triad of fever, headache, and rash was noted in 20.8% patients. Substantial morbidity included prolonged fever before hospitalization and hospital stay (mean of 8.4 and 5.1 days, respectively), and severe complications in six patients, including pneumonitis in three patients, and splenic infarctions, pericardial effusion, and retinitis, each in one. One previously healthy patient died of multiorgan failure. The study describes a high incidence of murine typhus with a recent upsurge in an urban setting in central Israel. High morbidity and a single fatal outcome challenge the concept of murine typhus being a mild disease. The study calls for better rodent control and sanitation measures in the affected neighborhoods.
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Affiliation(s)
- Evgeny Rogozin
- Department of Medicine B, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Tsilia Lazarovitch
- The Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Miriam Weinberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin, Israel
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33
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New Spotted Fever Group Rickettsia Isolate, Identified by Sequence Analysis of Conserved Genomic Regions. Pathogens 2019; 9:pathogens9010011. [PMID: 31861899 PMCID: PMC7168670 DOI: 10.3390/pathogens9010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
The clinical features of spotted fever group (SFG) Rickettsia induced disease range from a mild to severe illness. The clinical complexity is even greater due to the fact that the disease can be caused by different species with varying degrees of virulence. Current knowledge asserts that the Israeli SFG (ISF) strain Rickettsia conorii israelensis is the only human pathogenic SFG member in Israel. Current diagnostic procedures distinguish between SFG and the typhus group rickettsiosis, assuming all SFG-positive clinical samples positive for ISF. Molecular studies on questing ticks over the past decade have uncovered the existence of other SFG strains besides ISF in Israel and the region. This study describes the first documented analysis of SFG-positive samples from Israeli patients with the goal of distinguishing between ISF and non-ISF SFG strains. We managed to identify a new Rickettsia isolate from three independent clinical samples in Israel which was shown to be an as-yet unknown SFG member, showing no absolute identity with any known Rickettsia species present in the NCBI database.
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da Paixão Sevá A, Martins TF, Muñoz-Leal S, Rodrigues AC, Pinter A, Luz HR, Angerami RN, Labruna MB. A human case of spotted fever caused by Rickettsia parkeri strain Atlantic rainforest and its association to the tick Amblyomma ovale. Parasit Vectors 2019; 12:471. [PMID: 31604442 PMCID: PMC6790035 DOI: 10.1186/s13071-019-3730-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rickettsia parkeri strain Atlantic rainforest has emerged in Brazil during the last 10 years, with three laboratory-confirmed human cases. While these cases were epidemiologically associated with the tick Amblyomma ovale, in none of them the tick specimens that bit the patients could be identified. RESULTS We report a clinical case of spotted fever rickettsiosis that was acquired in an Atlantic forest area in Bahia state, northeast Brazil. The case was determined to be caused by R. parkeri strain Atlantic rainforest, based on molecular analysis of the crust removed from the tick bite site (inoculation eschar) of the patients' skin. DNA extracted from the crust yielded partial sequences of three rickettsial genes (gltA, ompA and ompB), which were 99-100% identical to R. parkeri strain Atlantic rainforest. The tick specimen that was attached to patient skin was identified as a female of A. ovale. CONCLUSIONS We report the fourth confirmed case of spotted fever rickettsiosis caused by R. parkeri strain Atlantic rainforest, providing to our knowledge for the first time, direct evidence of R. parkeri strain Atlantic rainforest transmission by A. ovale.
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Affiliation(s)
| | - Thiago Fernandes Martins
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sebastián Muñoz-Leal
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Carla Rodrigues
- Universidade do Estado de Mato Grosso, Campus Nova Xavantina, Nova Xavantina, MT, Brazil
| | - Adriano Pinter
- Superintendência de Controle de Endemias do Estado de São Paulo, São Paulo, SP, Brazil
| | - Hermes R Luz
- Departamento de Patologia, RENORBIO, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Rodrigo N Angerami
- Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marcelo B Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil.
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Two for the price of one: Co-infection with Rickettsia bellii and spotted fever group Rickettsia in Amblyomma (Acari: Ixodidae) ticks recovered from wild birds in Brazil. Ticks Tick Borne Dis 2019; 10:101266. [PMID: 31402227 DOI: 10.1016/j.ttbdis.2019.101266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
The bacterium Rickettsia bellii has been detected in 25 species of ticks in the American continents, but its pathogenic potential is considered as undetermined. A possible role for this species in the phenomenon of transovarial exclusion of pathogenic members of the spotted fever group (SFG) of Rickettsia has been suggested and co-infections with pathogenic species have been reported infrequently in both North and South America. Traditional methods for the molecular detection of rickettsial agents in ticks focus largely on the identification of sequences found in SFG Rickettsia, an approach that may overlook the presence of co-infections with R. bellii. Two novel, species-specific polymerase chain reaction (PCR) assays, targeting the genes encoding the surface cell antigen (Sca), autotransporter proteins sca9 and sca14, were developed and validated for the detection of R. bellii using 150 Amblyomma ticks collected from wild birds in Brazil. Co-infection of R. bellii infected ticks was evaluated using a novel PCR assay targeting the ompA sequence characteristic of SFG Rickettsia. Preliminary species-level identification was achieved by restriction fragment length polymorphism (RFLP) analysis and subsequently confirmed by sequencing of amplicons. Nine out of seventy-three Amblyomma longirostre and one of two Amblyomma calcaratum ticks were shown to be co-infected with R. bellii and Rickettsia amblyommatis, while two out of sixty-seven Amblyomma sp. haplotype Nazaré ticks were recorded as co-infected with R. bellii and the Rickettsia parkeri-like bacterium, strain ApPR. Interestingly, our data represent the first records of R. bellii in association with A. calcaratum and Amblyomma sp. haplotype Nazaré. The novel PCR-RFLP systems reported herein, provide an alternative, rapid and cost-efficient (relative to strategies based on sequencing or real-time PCR), approach to evaluate rickettsial co-infection of ticks, a potentially significant phenomenon that has most likely been underestimated to date.
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An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil's Disease. Case Rep Infect Dis 2019; 2019:9620245. [PMID: 31360559 PMCID: PMC6644265 DOI: 10.1155/2019/9620245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
A 65-year-old previously healthy male presented to us on the fourth day of a febrile illness with headache, arthralgia, myalgia, nausea, cough, chest pain, sore throat, and passing of watery stools and dark urine with a history of exposure to leptospirosis during a dengue outbreak. On examination, there was dehydration and hypovolemia, and an ultrasound scan revealed capillary leakage. His liver transaminases, serum creatine, blood urea, C-reactive protein, and neutrophil percentage were high, and thrombocytopenia was present. Moreover, myocarditis has been detected too. Supportive therapy with intravenous ceftriaxone was administered, considering possible Weil's disease or dengue hemorrhagic fever with secondary bacterial infection. Serological tests, performed later, diagnosed him with a Rickettsia conorii infection and excluded dengue, leptospirosis, and hantavirus infections. Repeat 2D echocardiograms showed mild improvement of his cardiac failure after one month and a more improvement after eight months. Clinical features of the rickettsial spotted fever group (SFG) and leptospirosis overlap. Leptospirosis is common; thus, the risk of overlooking SFG and diagnosing leptospirosis is likely. Tests for differentiation are unavailable in Sri Lankan hospitals and in many other developing countries. Empirical doxycycline in suspected cases of SFG infections in areas where rickettsioses are prevalent can save lives as in this case.
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Peckle M, Luz HR, Labruna MB, Serpa MCA, Lima S, Maturano R, Faccini JLH, McIntosh D. Multi-locus phylogenetic analysis groups the New World bacterium Rickettsia sp. strain ApPR with the Old World species R. africae; proposal of "Candidatus Rickettsia paranaensis". Ticks Tick Borne Dis 2019; 10:101261. [PMID: 31337544 DOI: 10.1016/j.ttbdis.2019.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
Rickettsia parkeri sensu stricto (s.s.) is an emerging human pathogen in the Americas. Comprehension of the etiology of R. parkeri infections in South America is complicated by the existence of genetic variants (Atlantic rainforest, NOD and Parvitarsum) of this species that are associated with specific groups of Amblyomma ticks. The rickettsial bacterium strain ApPR was first reported in Amblyomma parkeri ticks in Southern Brazil in 2012 and was considered, based on sequencing of fragments of the gltA, htrA, ompA and ompB genes, to represent yet another genetic variant of R. parkeri. In the current work, a multi-locus phylogenetic analysis employing additional genes and intragenic regions was performed using DNA extracted from (a) larvae of A. parkeri and Amblyomma species haplotype Nazaré ticks collected from wild birds, (b) a nymph of Amblyomma sp. haplotype Nazaré recovered from a monkey (Callicebus nigrifons), representing the first report of that tick parasitizing a non-human primate and (c) from a cultured isolate of ApPR, isolated from colony-reared adults of Amblyomma geayi. Phylogenetic inference performed using Maximum-likelihood (ML), Maximum Parsimony (MP) and Bayesian (B) methods, consistently placed strain ApPR outside the New World R. parkeri complex and instead grouped it in proximity to the Old World species Rickettsia africae and Rickettsia sibirica. Estimates of evolutionary divergence provided additional support for the inferred phylogenetic relationship. Given the clear evolutionary distance between strain ApPR and R. parkeri we propose the recognition of "Candidatus Rickettsia paranaensis".
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Affiliation(s)
- Maristela Peckle
- Departamento de Parasitologia Animal, Universidade Federal Rural do Rio de Janeiro, UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Hermes R Luz
- Programa de Pós-Graduação em Biotecnologia do RENORBIO, Ponto Focal Maranhão, Universidade Federal do Maranhão, Brazil.
| | - Marcelo B Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Maria Carolina A Serpa
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Stanley Lima
- Departamento de Parasitologia Animal, Universidade Federal Rural do Rio de Janeiro, UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Ralph Maturano
- Departamento de Zoologia, Universidade Federal de Juiz de For a - UFJF, Juiz de Fora, Minas Gerais, Brazil
| | - João L H Faccini
- Departamento de Parasitologia Animal, Universidade Federal Rural do Rio de Janeiro, UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Douglas McIntosh
- Departamento de Parasitologia Animal, Universidade Federal Rural do Rio de Janeiro, UFRRJ, Seropédica, Rio de Janeiro, Brazil
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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.
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Jiang J, Choi YJ, Kim J, Kim HC, Klein TA, Chong ST, Richards AL, Park HJ, Shin SH, Song D, Park KH, Jang WJ. Distribution of Rickettsia spp. in Ticks from Northwestern and Southwestern Provinces, Republic of Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:161-166. [PMID: 31104408 PMCID: PMC6526208 DOI: 10.3347/kjp.2019.57.2.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/23/2018] [Indexed: 11/30/2022]
Abstract
This study was done to characterize distribution of Rickettsia spp. in ticks in the northwestern and southwestern provinces in the Republic of Korea. A total of 2,814 ticks were collected between May and September 2009. After pooling, 284 tick DNA samples were screened for a gene of Rickettsia-specific 17-kDa protein using nested PCR (nPCR), and produced 88 nPCR positive samples. Of these positives, 75% contained 190-kDa outer membrane protein gene (ompA), 50% 120-kDa outer membrane protein gene (ompB), and 64.7% gene D (sca4). The nPCR products of ompA, ompB, and sca4 genes revealed close relatedness to Rickettsia japonica, R. heilongjiangensis, and R. monacensis. Most Rickettsia species were detected in Haemaphysalis longicornis. This tick was found a dominant vector of rickettsiae in the study regions in the Republic of Korea.
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Affiliation(s)
- Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910-7500, USA
| | - Yeon-Joo Choi
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Jeoungyeon Kim
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Heung-Chul Kim
- Force Health Protection and Preventive Medicine, Medical Department Activity-Korea/65th Medical Brigade, Unit 15281, APO AP 96271-5281, USA
| | - Terry A Klein
- Force Health Protection and Preventive Medicine, Medical Department Activity-Korea/65th Medical Brigade, Unit 15281, APO AP 96271-5281, USA
| | - Sung-Tae Chong
- Force Health Protection and Preventive Medicine, Medical Department Activity-Korea/65th Medical Brigade, Unit 15281, APO AP 96271-5281, USA
| | - Allen L Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910-7500, USA
| | - Hye-Jin Park
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Sun-Hye Shin
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Dayoung Song
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Kyung-Hee Park
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Won-Jong Jang
- Department of Microbiology, Konkuk University School of Medicine, Seoul 05029, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
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Pawełczyk A, Bednarska M, Kowalska JD, Uszyńska-Kałuża B, Radkowski M, Welc-Falęciak R. Seroprevalence of six pathogens transmitted by the Ixodes ricinus ticks in asymptomatic individuals with HIV infection and in blood donors. Sci Rep 2019; 9:2117. [PMID: 30765826 PMCID: PMC6376038 DOI: 10.1038/s41598-019-38755-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
The objective of our study was to estimate the seroprevalence of six pathogens transmitted by ticks in HIV-infected persons and blood donors in Poland (B. burgdorferi s.l., A. phagocytophilum, Ehrlichia spp., Babesia spp., Rickettsia spp. Bartonella henselae) to assess the frequency of exposure to such microorganisms in immunocompetent and immunocompromised individuals in endemic regions for I. ricinus ticks. Serum samples were collected from 227 HIV-infected patients and 199 blood donors. All samples were analyzed for antibodies against six tick-borne pathogens and seroprevalence rates were statistically compared between two tested group as well as age, sex and lymphocyte T CD4+ level in HIV infected patients. The seroprevalence of tick-borne infections in HIV-infected patients is higher than that of the healthy population in Poland, although no association between serological status of patients and lymphocyte CD4+ T cell level has been observed. The frequency of tick-borne coinfections and doubtful results of serological tests were significantly higher in HIV-positive individuals. In Poland, the possibility of tick-borne diseases transmission with blood is rather negligible.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, 3C Pawińskiego Street, 02-106, Warsaw, Poland.,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland
| | - Małgorzata Bednarska
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland.,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 37 Wolska Street, 01-201, Warsaw, Poland
| | - Beata Uszyńska-Kałuża
- Blood Center of the Ministry of Internal Affairs and Administration, 137 Wołoska Street, 02-507, Warsaw, Poland
| | - Marek Radkowski
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, 3C Pawińskiego Street, 02-106, Warsaw, Poland
| | - Renata Welc-Falęciak
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland. .,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland.
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Abdeljelil M, Sakly H, Kooli I, Marrakchi W, Aouam A, Loussaief C, Toumi A, Ben Brahim H, Chakroun M. Mediterranean spotted fever as a cause of septic shock. IDCases 2019; 15:e00528. [PMID: 30976518 PMCID: PMC6441820 DOI: 10.1016/j.idcr.2019.e00528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022] Open
Abstract
Mediterranean spotted fever presents with various non‐specific symptoms. There is no reliable test to diagnose the infection in its early stages. Doxycycline should be used upon suspicion of MSF, without awaiting laboratory confirmation.
Mediterranean spotted fever is a generally benign disease but with the potential of serious manifestations. We report a case of Mediterranean spotted fever in a 56-year–old woman, with pet dog exposure, who presented with a septic shock pattern. Based on clinical symptoms, history, and laboratory results, the diagnosis of Mediterranean spotted fever was suspected and the outcome was favorable with doxycycline treatment. Although rickettsiae remain an uncommon cause of the sepsis syndrome, it is important to consider it, especially as people are now traveling to endemic areas more frequently.
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Le-Viet N, Le VN, Chung H, Phan DT, Phan QD, Cao TV, Abat C, Raoult D, Parola P. Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam. Emerg Microbes Infect 2019; 8:339-352. [PMID: 30866787 PMCID: PMC6455186 DOI: 10.1080/22221751.2019.1580539] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 01/15/2023]
Abstract
Acute undifferentiated fever (AUF) is frequently observed in tropical settings, but diagnosing the cause of AUF is often a challenge for local physicians and the physicians treating returning travellers. We conducted a case-control study in central Vietnam in 2016. A total of 378 febrile adult patients (AUFs) with a fever for ≤21 days, no evidence of localized infection and negative screening tests for dengue and malaria, and 384 afebrile adult patients (Controls) were prospectively enrolled. Whole blood, plasma, eschar swab, throat swab and urine specimens were collected and analysed. Quantitative PCR and RT-PCR were used to test for 55 bacteria, viruses and their subtypes. Serological tests were also used to test for rickettsial agents. The most common aetiology was influenza virus (20.9% in AUFs vs. 0% in Controls), followed by rickettsial agents (mainly Orientia tsutsugamushi and Rickettsia typhi) (10.8% vs. 0.3%), dengue virus (7.7% vs. 0.5%), Leptospira (4.8% vs. 0.8%), adenovirus (4.8% vs. 1.0%), and enterovirus (2.1% vs. 0%) (p < .05). The real proportion of dengue in AUF cases was underestimated because patients with dengue-positive rapid diagnosis tests were excluded from the study. The emerging agent Rickettsia felis, which had not been previously observed in Vietnam, was detected in this study. In total, 216 patients (57.1%) were given causative diagnoses, comprising 143 (66.2%) monoinfections and 73 (33.8%) coinfections. The infections caused by these agents should be considered in clinical practice and further studies. Additionally, agents susceptible to doxycycline were detected in 15.6% of AUFs; thus, this drug should be included in the panel used to treat AUF patients.
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Affiliation(s)
- Nhiem Le-Viet
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- Department of Tropical Medicine, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Viet-Nho Le
- School of Medicine and Pharmacy, Danang University, Danang, Vietnam
| | - Hai Chung
- Department of Tropical Medicine, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Duc-Tuan Phan
- Department of Internal Medicine II, Quang Nam Northern Mountainous Region General Hospital, Quang Nam, Vietnam
| | - Quang-Duong Phan
- Department of Internal Medicine B, Quang Nam Regional General Hospital, Quang Nam, Vietnam
| | - Thanh-Van Cao
- Department of Tropical Medicine, Quang Nam Provincial General Hospital, Quang Nam, Vietnam
| | - Cédric Abat
- IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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Quintero Vélez JC, Aguirre-Acevedo DC, Rodas JD, Arboleda M, Troyo A, Vega Aguilar F, Osorio Quintero L, Rojas Arbeláez C. Epidemiological characterization of incident cases of Rickettsia infection in rural areas of Urabá region, Colombia. PLoS Negl Trop Dis 2018; 12:e0006911. [PMID: 30379820 PMCID: PMC6242695 DOI: 10.1371/journal.pntd.0006911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/19/2018] [Accepted: 10/09/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Most of the studies related to rickettsial infection in Colombia are cross-sectional because of the challenge in conducting prospective studies on infectious disease that may have a difficult diagnosis. Although cross-sectional studies are essential to detect people exposed to rickettsiae, they are not suited to demonstrate the recent circulation of this pathogen in areas at risk of transmission. Objective To characterize the epidemiology of incident cases of Spotted fever group (SFG) rickettsial infection in humans and equines from rural areas of Urabá region in Colombia where outbreaks of rickettsiae previously occurred. Materials and methods A prospective study was conducted in the Alto de Mulatos and Las Changas in the Urabá region. Serum samples and socio-ecological information were collected from 597 people enrolled in 2015, and a second sample was collected from 273 people a year later. Indirect immune-fluorescence assays for detection of IgG antibody against rickettsiae were done using slides with Rickettsia rickettsii antigens. A titer ≥128 was considered positive. Incident cases were defined as (i) serological conversion of IgG titers from seronegative to seropositive or (ii) at least a four-fold increase in IgG end point titers in the second sample. Results The cumulative incidence of rickettsial infection was 6.23% (95%CI 3.67–9.78) in humans and 32.31% (21/65) of incident cases in equines. Incident cases were mostly females (82.35%), the median age of cases was 41.02 years (IQR 18.62–54.1), and 29.41% reported tick bites during the study period. Results from multivariate analysis showed that removal of ticks after working outdoors is a protective factor for rickettsial infection (RR 0.26, 95%CI 0.08–0.84) and that a higher incidence of infection occurred in people who reported fever in the last year (RR 4.26, 95%CI 1.15–9.31). Conclusions These results showed recent circulation of SFG rickettsiae in areas where previous lethal outbreaks have been reported, supporting the implementation of preventive measures to halt rickettsial transmission in the studied communities. On the northwestern coast of Colombia three lethal outbreaks of rickettsioses caused by the species Rickettsia rickettsii have been reported. The lack of an active epidemiological surveillance system in these areas makes difficult the detection and the timely treatment of the disease prompting a worse prognosis. In this study, new cases of rickettsial infection were detected in people and horses living in areas where outbreaks of the disease occurred in the previous decade. In addition, the results showed that nonspecific febrile syndromes are associated to rickettsial infection and protective measures such as tick removal from the body decrease the risk of infection. The design, evaluation and implementation of a surveillance program of emerging and re-emerging infectious diseases, such as rickettsioses, should be a priority in the country, especially in areas where such infections have proved to be lethal.
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Affiliation(s)
- Juan Carlos Quintero Vélez
- Grupo de Investigación Ciencias Veterinarias Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
- * E-mail:
| | | | - Juan David Rodas
- Grupo de Investigación Ciencias Veterinarias Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
| | - Margarita Arboleda
- Instituto Colombiano de Medicina Tropical- CES, Apartadó, Antioquia, Colombia
| | - Adriana Troyo
- Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Francisco Vega Aguilar
- Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Lisardo Osorio Quintero
- Grupo Salud y Ambiente, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Rojas Arbeláez
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
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Welc-Falęciak R, Kowalska JD, Bednarska M, Szatan M, Pawełczyk A. Molecular identification of tick-borne pathogens in asymptomatic individuals with human immunodeficiency virus type 1 (HIV-1) infection: a retrospective study. BMC Infect Dis 2018; 18:227. [PMID: 29776392 PMCID: PMC5960136 DOI: 10.1186/s12879-018-3140-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background The studies on the occurrence and diversity of tick-borne infections in HIV-infected individuals have been few, and the subject has been relatively neglected when compared with other common infections associated with HIV. In HIV-positive patients in whom a serological diagnostics is complicated due to reduced positive predictive value, a method where the microorganism is detected directly is of great value. Therefore, we performed a molecular study to ascertain the prevalence and incidence of tick-borne infections in HIV-infected persons in Poland, an endemic area for Ixodes ricinus ticks. Methods Genomic DNA was isolated from whole blood of tested patients. Detection of tick-borne pathogens was performed by amplification and sequencing of different loci. Molecular and phylogenetic analyses of obtained nucleotide sequences were performed. Serum samples were analyzed for antibodies against tick-borne pathogens by using commercial tests in all patients. Results Among 148 studied blood samples from HIV-infected patients, two cases (1.4%) of infection with tick-borne pathogen were reported. No symptoms of tick-borne infection were observed in these cases. In one case a patient was infected with Anaplasma phagocytophilum – the agent of human granulocytic anaplasmosis (HGA) and in the other with Borrelia garinii. Conclusions Our study revealed the first case of HIV positive patient infected with A. phagocytophilum. Asymptomatic tick-borne infection can occur in HIV-positive patients. The detailed history of tick bites, especially in endemic tick areas, should be considered as part of anamnesis in routine clinical care of HIV-positive patients.
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Affiliation(s)
- Renata Welc-Falęciak
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland. .,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland.
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 37 Wolska Street, 01-201, Warsaw, Poland
| | - Małgorzata Bednarska
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland.,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland
| | - Magdalena Szatan
- AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland
| | - Agnieszka Pawełczyk
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, 3C Pawińskiego Street, 02-106, Warsaw, Poland.,AmerLab Ltd. Diagnostic Laboratory of Parasitic Diseases and Zoonotic Infections, Biological and Chemical Research Centre, 101 Żwirki and Wigury Street, 02-089, Warsaw, Poland
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Rodríguez Y, Rojas M, Gershwin ME, Anaya JM. Tick-borne diseases and autoimmunity: A comprehensive review. J Autoimmun 2018; 88:21-42. [DOI: 10.1016/j.jaut.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
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Suspected and Confirmed Vector-Borne Rickettsioses of North America Associated with Human Diseases. Trop Med Infect Dis 2018; 3:tropicalmed3010002. [PMID: 30274401 PMCID: PMC6136625 DOI: 10.3390/tropicalmed3010002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/27/2022] Open
Abstract
The identification of pathogenic rickettsial agents has expanded over the last two decades. In North America, the majority of human cases are caused by tick-borne rickettsioses but rickettsiae transmitted by lice, fleas, mites and other arthropods are also responsible for clinical disease. Symptoms are generally nonspecific or mimic other infectious diseases; therefore, diagnosis and treatment may be delayed. While infection with most rickettsioses is relatively mild, delayed diagnosis and treatment may lead to increased morbidity and mortality. This review will discuss the ecology, epidemiology and public health importance of suspected and confirmed vector-transmitted Rickettsia species of North America associated with human diseases.
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Faccini-Martínez ÁA, Ramírez-Hernández A, Barreto C, Forero-Becerra E, Millán D, Valbuena E, Sánchez-Alfonso AC, Imbacuán-Pantoja WO, Cortés-Vecino JA, Polo-Terán LJ, Yaya-Lancheros N, Jácome J, Palomar AM, Santibáñez S, Portillo A, Oteo JA, Hidalgo M. Epidemiology of Spotted Fever Group Rickettsioses and Acute Undifferentiated Febrile Illness in Villeta, Colombia. Am J Trop Med Hyg 2017; 97:782-788. [PMID: 28722568 PMCID: PMC5590559 DOI: 10.4269/ajtmh.16-0442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/18/2016] [Indexed: 11/07/2022] Open
Abstract
Etiology of acute undifferentiated febrile syndrome (AUFS) is often unknown, leading to inaccurate diagnosis and treatment. Villeta town has been identified as an endemic area for spotted fever group (SFG) rickettsioses but little is known about possible amplifier hosts and other Rickettsia species different from Rickettsia rickettsii. Besides, few studies have approached other AUFS etiologies in the region. We investigated the role of dengue, leptospirosis, rickettsioses, human anaplasmosis, and Q fever as possible causes of AUFS in patients from Villeta. Sera specimens and ticks from animals as well as ticks from vegetation were studied for the presence of different Rickettsia spp. Among 104 sera from patients with AUFS, 16.4%, 24.0%, and 2.9% patients seroconverted to dengue, Leptospira, and SFG Rickettsia, respectively, with a case of probable coinfection or cross-reaction with Anaplasma phagocytophilum. None of the samples were reactive for Coxiella burnetii. Sera samples from 74 horses, 118 dogs, and 62 bovines were collected and showed 33.8%, 14.4%, and 50.0% of seroprevalence for SFG Rickettsia, respectively. A total of 1,287 ixodid ticks were collected from animals/vegetation and processed in pools for polymerase chain reaction. Among them, 1.7% was positive for Rickettsia genes, and Rickettsia amblyommii, R. rickettsii, and Rickettsia spp. were found. These results confirm the circulation of dengue, different SFG Rickettsia species and the relevance of other etiologies like leptospirosis and human anaplasmosis. Further studies must identify different epidemiological variables to establish proper surveillance and control programs.
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Affiliation(s)
- Álvaro A. Faccini-Martínez
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
- Programa de Pós-Graduação em Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Alejandro Ramírez-Hernández
- Grupo Parasitología Veterinaria, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Christian Barreto
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin Forero-Becerra
- Departamento de Medicina Veterinária, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Diego Millán
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin Valbuena
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrea C. Sánchez-Alfonso
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Wilson O. Imbacuán-Pantoja
- Grupo Parasitología Veterinaria, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jesús A. Cortés-Vecino
- Grupo Parasitología Veterinaria, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luis J. Polo-Terán
- Grupo Parasitología Veterinaria, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo Salud Pública Veterinaria, Departamento Salud Animal, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Néstor Yaya-Lancheros
- Grupo Salud Pública Veterinaria, Departamento Salud Animal, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge Jácome
- Departamento de Biología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana M. Palomar
- Departamento de Enfermedades Infecciosas, Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Hospital San Pedro–CIBIR, Logroño, Spain
| | - Sonia Santibáñez
- Departamento de Enfermedades Infecciosas, Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Hospital San Pedro–CIBIR, Logroño, Spain
| | - Aránzazu Portillo
- Departamento de Enfermedades Infecciosas, Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Hospital San Pedro–CIBIR, Logroño, Spain
| | - José A. Oteo
- Departamento de Enfermedades Infecciosas, Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Hospital San Pedro–CIBIR, Logroño, Spain
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
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Portillo A, de Sousa R, Santibáñez S, Duarte A, Edouard S, Fonseca IP, Marques C, Novakova M, Palomar AM, Santos M, Silaghi C, Tomassone L, Zúquete S, Oteo JA. Guidelines for the Detection of Rickettsia spp. Vector Borne Zoonotic Dis 2017; 17:23-32. [PMID: 28055574 DOI: 10.1089/vbz.2016.1966] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The genus Rickettsia (Rickettsiales: Rickettsiaceae) includes Gram-negative, small, obligate intracellular, nonmotile, pleomorphic coccobacilli bacteria transmitted by arthropods. Some of them cause human and probably also animal disease (life threatening in some patients). In these guidelines, we give clinical practice advices (microscopy, serology, molecular tools, and culture) for the microbiological study of these microorganisms in clinical samples. Since in our environment rickettsioses are mainly transmitted by ticks, practical information for the identification of these arthropods and for the study of Rickettsia infections in ticks has also been added.
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Affiliation(s)
- Aránzazu Portillo
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Rita de Sousa
- 2 National Institute of Health Dr. Ricardo Jorge , Águas de Moura, Portugal
| | - Sonia Santibáñez
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Ana Duarte
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Sophie Edouard
- 4 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalo-Universitaire Méditerranée-Infection , Marseille, France
| | - Isabel P Fonseca
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Cátia Marques
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Marketa Novakova
- 5 Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno , Brno, Czech Republic .,6 CEITEC VFU, University of Veterinary and Pharmaceutical Sciences Brno , Brno, Czech Republic
| | - Ana M Palomar
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Marcos Santos
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Cornelia Silaghi
- 7 National Centre for Vector Entomology, Institute of Parasitology, University of Zurich , Zurich, Switzerland
| | - Laura Tomassone
- 8 Department of Veterinary Sciences, University of Torino , Grugliasco, Italy
| | - Sara Zúquete
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - José A Oteo
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
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Carvalho R, Vazquez D, Silveira P, Lencastre L. Rickettsiosis: a rare challenge in ICU. Intensive Care Med 2017; 43:1514-1515. [PMID: 28668974 DOI: 10.1007/s00134-017-4876-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Rosa Carvalho
- Internal Medicine Department, Hospital de Braga, Braga, Portugal.
| | - Dolores Vazquez
- Internal Medicine Department, Centro Hospitalar da Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal
| | - Pedro Silveira
- Emergency Department, Hospital de Braga, Braga, Portugal
| | - Luís Lencastre
- Emergency Department, Hospital de Braga, Braga, Portugal
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50
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Koka H, Sang R, Kutima HL, Musila L. The Detection of Spotted Fever Group Rickettsia DNA in Tick Samples From Pastoral Communities in Kenya. JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:774-780. [PMID: 28073909 PMCID: PMC5850802 DOI: 10.1093/jme/tjw238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
In this study, ticks from pastoral communities in Kenya were tested for Rickettsia spp. infections in geographical regions where the presence of tick-borne arboviruses had previously been reported. Rickettsial and arbovirus infections have similar clinical features which makes differential diagnosis challenging when both diseases occur. The tick samples were tested for Rickettsia spp. by conventional PCR using three primer sets targeting the gltA, ompA, and ompB genes followed by amplicon sequencing. Of the tick pools screened, 25% (95/380) were positive for Rickettsia spp. DNA using the gltA primer set. Of the tick-positive pools, 60% were ticks collected from camels. Rickettsia aeschlimannii and R. africae were the main Rickettsia spp. detected in the tick pools sequenced. The findings of this study indicate that multiple Rickettsia species are circulating in ticks from pastoral communities in Kenya and could contribute to the etiology of febrile illness in these areas. Diagnosis and treatment of rickettsial infections should be a public health priority in these regions.
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Affiliation(s)
- Hellen Koka
- Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya ( ; )
- US Army Medical Research Directorate - Kenya, P. O. Box 606-00621, Nairobi, Kenya ( )
| | - Rosemary Sang
- Kenya Medical Research Institute, Centre for Virus Research, P. O. Box 54628-00200, Nairobi, Kenya ( )
- International Centre for Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya
| | - Helen Lydia Kutima
- Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya (; )
| | - Lillian Musila
- US Army Medical Research Directorate - Kenya, P. O. Box 606-00621, Nairobi, Kenya
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