Not only ‘Flinders Island’ spotted fever

Serological Evidence of Exposure to Spotted Fever Group and Typhus Group Rickettsiae in Australian Wildlife Rehabilitators

Rickettsioses are arthropod-borne zoonotic diseases, several of which occur in Australia. This study aimed to assess the exposure levels and risk factors for Rickettsia spp. among Australian wildlife rehabilitators (AWRs) using serology, PCR and a questionnaire. Antibody titres against Spotted Fever Group (SFG), Typhus Group (TG) and Scrub Typhus Group (STG) antigens were determined using an immunofluorescence assay. PCR targeting the gltA gene was performed on DNA extracts from whole blood and serum. Logistic regression was used to identify risk factors associated with seropositivity. Of the 27 (22.1%; 27/122) seropositive participants all were seropositive for SFG, with 5/27 (4.1%) also positive for TG. Of the 27 positive sera, 14.8% (4/27) were further classified as exposure to R. australis, 3.7% (1/27) to R. honei, 3.7% (1/27) to R. felis and 77.8% (21/27) were classified as ‘indeterminate’—most of which (85.7%; 18/21) were indeterminate R. australis/R. honei exposures. Rickettsia DNA was not detected in whole blood or serum. Rehabilitators were more likely to be seropositive if more than one household member rehabilitated wildlife, were older than 50 years or had occupational animal contact. These findings suggest that AWRs are at increased risk of contracting Rickettsia-related illnesses, however the source of the increased seropositivity remains unclear.

Domestic dogs are mammalian reservoirs for the emerging zoonosis flea-borne spotted fever, caused by Rickettsia felis

Rickettsia felis is an obligate intracellular bacterium that is being increasingly recognized as an etiological agent of human rickettsial disease globally. The agent is transmitted through the bite of an infected vector, the cat flea, Ctenocephalides felis, however there is to date, no consensus on the pathogen's vertebrate reservoir, required for the maintenance of this agent in nature. This study for the first time, demonstrates the role of the domestic dog (Canis familiaris) as a vertebrate reservoir of R. felis. The ability of dogs to sustain prolonged periods of rickettsemia, ability to remain asymptomatically infected with normal haematological parameters and ability to act as biological vehicles for the horizontal transmission of R. felis between infected and uninfected fleas provides indication of their status as a mammalian reservoir of this emerging zoonosis.

New and old hotspots for rickettsial spotted fever acquired in Tasmania, 2012-2017

OBJECTIVE

To describe the epidemiology and clinical characteristics of Tasmania-acquired rickettsial disease notified to the Department of Health in Tasmania from 2012 to 2017 inclusive.

METHODS

Data on rickettsiosis cases acquired and notified in Tasmania between 1 January 2012 and 31 December 2017 were analysed descriptively.

RESULTS

Eighteen cases of rickettsial infection notified in Tasmania 2012-17 and likely acquired in the state met one of three case definitions: 12 confirmed (67%), four probable (22%), and two possible (11%). The mean number of cases per year was 3.0 (population rate 0.6 per 100,000 population/year); 60% of cases occurred in November and December. Cases were more commonly older males. Fever, lethargy, and rash were commonly reported symptoms. Thirteen cases were likely acquired on Flinders Island, three around Great Oyster Bay and two in the Midlands.

CONCLUSIONS

This study extends our knowledge of the epidemiology of rickettsial disease in Tasmania. This is the first account including confirmed cases acquired in the Midlands of Tasmania. Implications for public health: Increased knowledge and awareness of epidemiology of rickettsial infection in Tasmania is essential for timely diagnosis and appropriate treatment. These findings bear wider relevance outside Tasmania because visitors may also be at risk.

Laboratory diagnosis of human infections transmitted by ticks, fleas, mites and lice in Australia

A wide range of human pathogens (viruses, bacteria, protozoa) are transmitted by ticks, fleas, mites and lice worldwide. Some of these infections occur in Australia1, whereas others appear to be absent, although they may occur in returned travellers. The key to diagnosis is two-fold: recognition of the possibility of a vector-borne infection by the treating doctor and confirmation of the diagnosis in a diagnostic, microbiology laboratory. Laboratory diagnostic assays include culture (used rarely), nucleic acid amplification (used increasingly) and serology (used often).

Ticks in Australia: endemics; exotics; which ticks bite humans?

At least 71 species of ticks occur in Australia; a further 33 or so species are endemic to its neighbours, New Guinea and New Zealand. The ticks of Australia and other parts of Australasia are phylogenetically distinct. Indeed, there are at least two lineages of ticks that are unique to Australasia: the genus Bothriocroton Klompen, Dobson & Barker, 2002; and the new genus Archaeocroton Barker & Burger, 2018. Two species of ticks that are endemic to Australia are notorious for feeding on humans: (i) Ixodes holocyclus, the eastern paralysis tick, in eastern Australia; and (ii) Amblyomma triguttatum triguttatum, the ornate kangaroo tick, in Western Australia, at one place in South Australia, and in parts of Queensland. Three of the other endemic species of ticks that feed on humans in Australia are also noteworthy: (i) Bothriocroton hydrosauri, the southern reptile tick, which is a vector of Rickettsia honei (Flinders Island spotted fever); (ii) Haemaphysalis novaeguineae, the New Guinea haemaphysalid; and (iii) Ornithodoros capensis, the seabird soft tick. Here, we present images of female Ixodes holocyclus, Amblyomma t. triguttatum, Bothriocroton hydrosauri and Haemaphysalis novaeguineae and our latest maps of the geographic distributions of Ixodes holocyclus, Amblyomma t. triguttatum and Bothriocroton hydrosauri. None of the five exotic species of ticks in Australia typically feed on humans.

Reptile-associated Borrelia species in the goanna tick (Bothriocroton undatum) from Sydney, Australia

BACKGROUND

Knowledge on the capacity of Australian ticks to carry Borrelia species is currently limited or missing. To evaluate the potential of ticks to carry bacterial pathogens and their DNA, it is imperative to have a robust workflow that maximises recovery of bacterial DNA within ticks in order to enable accurate identification. By exploiting the bilateral anatomical symmetry of ticks, we were able to directly compare two DNA extraction methods for 16S rRNA gene diversity profiling and pathogen detection. We aimed to assess which combination of DNA extraction and 16S rRNA hypervariable region enables identification of the greatest bacterial diversity, whilst minimising bias, and providing the greatest capacity for the identification of Borrelia spp.

RESULTS

We collected Australian endemic ticks (Bothriocroton undatum), isolated DNA from equal tick halves using two commercial DNA extraction methods and sequenced samples using V1-V3 and V3-V4 16S rRNA gene diversity profiling assays. Two distinct Borrelia spp. operational taxonomic units (OTUs) were detected using the V1-V3 16S rRNA hypervariable region and matching Borrelia spp. sequences were obtained using a conventional nested-PCR. The tick 16S rRNA gene diversity profile was dominated by Rickettsia spp. (98-99%), while the remaining OTUs belonged to Proteobacteria (51-81%), Actinobacteria (6-30%) and Firmicutes (2-7%). Multiple comparisons tests demonstrated biases in each of the DNA extraction kits towards different bacterial taxa.

CONCLUSIONS

Two distinct Borrelia species belonging to the reptile-associated Borrelia group were identified. Our results show that the method of DNA extraction can promote bias in the final microbiota identified. We determined an optimal DNA extraction method and 16S rRNA gene diversity profile assay that maximises detection of Borrelia species.

Rickettsia gravesii sp. nov.: a novel spotted fever group rickettsia in Western Australian Amblyomma triguttatum triguttatum ticks

A rickettsial organism harboured by Amblyomma triguttatum ticks on Barrow Island, Western Australia, was discovered after reports of possible rickettsiosis among local workers. Subsequent isolation of this rickettsia (strain BWI-1) in cell culture and analysis of its phylogenetic, genotypic and phenotypic relationships with type strains of Rickettsia species with standing in nomenclature suggested that it was sufficiently divergent to warrant its classification as a new species. Multiple gene comparison of strain BWI-1 revealed degrees of sequence similarity with Rickettsia raoultii, its closest relative, of 99.58, 98.89, 97.03, 96.93 and 95.73 % for the 16S rRNA, citrate synthase, ompA, ompB and sca4 genes, respectively. Serotyping in mice also demonstrated that strain BWI-1T was distinct from Rickettsia raoultii. Thus, we propose the naming of a new species, Rickettsia gravesii sp. nov., based on its novel genotypic and phenotypic characteristics. Strain BWI-1T was deposited in the ATCC, CSUR and ARRL collections under reference numbers VR-1664, CSUR R172 and RGBWI-1, respectively.

Tick-borne infectious diseases in Australia

Tick bites in Australia can lead to a variety of illnesses in patients. These include infection, allergies, paralysis, autoimmune disease, post-infection fatigue and Australian multisystem disorder. Rickettsial (Rickettsia spp.) infections (Queensland tick typhus, Flinders Island spotted fever and Australian spotted fever) and Q fever (Coxiella burnetii) are the only systemic bacterial infections that are known to be transmitted by tick bites in Australia. Three species of local ticks transmit bacterial infection following a tick bite: the paralysis tick (Ixodes holocyclus) is endemic on the east coast of Australia and causes Queensland tick typhus due to R. australis and Q fever due to C. burnetii; the ornate kangaroo tick (Amblyomma triguttatum) occurs throughout much of northern, central and western Australia and causes Q fever; and the southern reptile tick (Bothriocroton hydrosauri) is found mainly in south-eastern Australia and causes Flinders Island spotted fever due to R. honei. Much about Australian ticks and the medical outcomes following tick bites remains unknown. Further research is required to increase understanding of these areas.

Rickettsia Detected in the Reptile Tick Bothriocroton hydrosauri from the Lizard Tiliqua rugosa in South Australia

Rickettsiosis is a potentially fatal tick borne disease. It is caused by the obligate intracellular bacteria Rickettsia, which is transferred to humans through salivary excretions of ticks during the biting process. Globally, the incidence of tick-borne diseases is increasing; as such, there is a need for a greater understanding of tick-host interactions to create more informed risk management strategies. Flinders Island spotted fever rickettsioses has been identified throughout Australia (Tasmania, South Australia, Queensland and Torres Strait Islands) with possible identifications in Thailand, Sri Lanka and Italy. Flinders Island spotted fever is thought to be spread through tick bites and the reptile tick Bothriocroton hydrosauri has been implicated as a vector in this transmission. This study used qPCR to assay Bothriocroton hydrosauri ticks collected from Tiliqua rugosa (sleepy lizard) hosts on mainland South Australia near where spotted fever cases have been identified. We report that, although we discovered Rickettsia in all tick samples, it was not Rickettsia honei. This study is the first to use PCR to positively identify Rickettsia from South Australian Bothriocroton hydrosauri ticks collected from Tiliqua rugosa (sleepy lizard) hosts. These findings suggest that B. hydrosauri may be a vector of multiple Rickettsia spp. Also as all 41 tested B. hydrosauri ticks were positive for Rickettsia this indicates an extremely high prevalence within the studied area in South Australia.

Update on tick-borne rickettsioses around the world: a geographic approach

Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia. These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.

Serological prevalence study of exposure of cats and dogs in Launceston, Tasmania, Australia to spotted fever group rickettsiae

A sero-epidemiological study of cats and dogs in the Launceston area of Tasmania, Australia was undertaken to determine the prevalence of antibodies to spotted fever group (SFG) rickettsiae. Results showed that 59% of cats and 57% of dogs were positive for antibodies, but there was no correlation between the animal's health and seropositivity at the time of testing, suggesting that rickettsial exposure is unrelated to ill-health in these two species of domestic animals.

Rickettsioses in Australia

The rickettsial diseases of Australia are described in their chronological order of discovery. The include epidemic typhus (R. prowazekii); murine typhus (R. typhi) found Australia-wide; scrub typhus (O. tsutsugamushi) only in tropical, northen Australia; Q. fever (C. burnetti) found Australia-wide; Queensland tick typhus (R. australis) along the east coast of Australia; Flinders Island spotted fever (R. honei) in southeast Australia; Variant Flinders Island spotted fever (R. honei, strain "marmionii") in eastern Australia; Rickettsia felis, Western Australia; eight new RFG rickettsiae from ticks (of unknown pathogenicity); and two nonhuman pathogens in A. platys (dogs) and A. marginale (cattle).

Three rickettsioses, Darnley Island, Australia

We report 3 rickettsioses on Darnley Island, Australia, in the Torres Strait. In addition to previously described cases of Flinders Island spotted fever (Rickettsia honei strain “marmionii”), we describe 1 case of Queensland tick typhus (R. australis) and 2 cases of scrub typhus caused by a unique strain (Orientia tsutsugamushi).

Flinders Island spotted fever rickettsioses caused by "marmionii" strain of Rickettsia honei, Eastern Australia

We report 7 cases of rickettsiosis caused by a new rickettsial strain.

Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis, with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the “marmionii” strain of R. honei, in honor of Australian physician and scientist Barrie Marmion.

Flinders Island Spotted Fever Rickettsioses Caused by “marmionii” Strain ofRickettsia honei,Eastern Australia

Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the "marmionii" strain of R. honei, in honor of Australian physician and scientist Barrie Marmion.

Rickettsioses in Australia

Australia, an island continent in the southern hemisphere, has a range of rickettsial diseases that include typhus group rickettsiae (Rickettsia typhi), spotted fever group rickettsiae (R. australis, R. honei), scrub typhus group rickettsiae (R. tsutsugamushi), and Q fever (C. burnetii). Our knowledge of Australian rickettsiae is expanding with the recognition of an expanded range of R. honei (Flinders Island spotted fever) to Tasmania and southeastern mainland Australia (not just on Flinders Island), and the detection of a new SFG species (or subspecies), tentatively named "R. marmionii" in the eastern half of Australia. This rickettsia causes both acute disease (7 cases, recognized so far) and is also associated (as a "R. marmionii" bacteriaemia) with patients having a chronic illness. The significance of the latter is under investigation. It may be a marker of autoimmune disease or chronic fatigue in some patients.