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Vinayaraj EV, Thakur CK, Negi P, Sreenath K, Upadhyay P, Verma N, Das BK, Kabra SK, Wig N, Chaudhry R. Epidemiological, clinical, and laboratory characteristics of human granulocytic anaplasmosis in North India. J Clin Microbiol 2024; 62:e0104823. [PMID: 38329335 PMCID: PMC10935655 DOI: 10.1128/jcm.01048-23] [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: 08/10/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Human granulocytic anaplasmosis (HGA) is an emerging, rickettsial tick-borne disease caused by Anaplasma phagocytophilum. Sero-epidemiological data demonstrate that this pathogen has a worldwide distribution. The diagnosis of HGA requires a high index of clinical suspicion, even in endemic areas. In recent years, HGA has increasingly been reported from Asia and described in China, Japan, and Korea. We serologically and molecularly screened 467 patients with clinical suspicion of Anaplasmosis. The present study describes the epidemiology, clinical, and laboratory details of 6 confirmed and 43 probable cases of human granulocytic anaplasmosis. One of the HGA patients developed secondary invasive opportunistic Aspergillus fumigatus and Acinetobacter baumanii infection during the illness, which resulted in a fatal infection. The HGA patients without severe complications had excellent treatment responses to doxycycline. The emergence of this newly recognized tick-borne zoonotic HGA in North India is a significant concern for public health and is likely underdiagnosed, underreported, and untreated. Hence, it is also essential to establish a well-coordinated system for actively conducting tick surveillance, especially in the forested areas of the country.IMPORTANCEThe results of the present study show the clinical and laboratory evidence of autochthonous cases of Anaplasma phagocytophilum in North India. The results suggest the possibility of underdiagnosis of HGA in this geographical area. One of the HGA patients developed secondary invasive opportunistic Aspergillus fumigatus and Acinetobacter baumanii infection during the illness, which resulted in a fatal infection.
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Affiliation(s)
- E. V. Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Kumar Thakur
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Preeti Negi
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - K. Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Upadhyay
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S. K. Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Gual-Gonzalez L, Self SCW, Meyer M, Cantillo-Barraza O, Torres ME, Nolan MS. Human spotted fever group Rickettsia seroprevalence and associated epidemiologic factors among diverse, marginalized populations in South Carolina. Ticks Tick Borne Dis 2024; 15:102288. [PMID: 38071922 DOI: 10.1016/j.ttbdis.2023.102288] [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: 09/12/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 02/12/2024]
Abstract
Illness caused by spotted fever group Rickettsia (SFGR) is increasing nationally, with affluent, white residents most likely to be diagnosed. The common under-representativeness of marginalized populations in research studies and these vulnerable populations' health inequities make veritable epidemiologic risk factor profiling challenging, which inhibits equitable public health intervention. The current study leveraged 749 banked sera and associated surveys from a cross-sectional minority-represented COVID-19 study to perform an SFGR seroprevalence investigation. SFGR titers (1:64, 1:128, 1:256, 1:512, and 1:1024) were measured using commercially available indirect fluorescent antibody slides-SFGR positive cases were defined as titers ≥1:128. Multivariable logistic regression and Getis-Ord-Gi* hotspot analyses were used to identify seropositivity-associated factors and determine seropositive clusters. Among a mostly minority and lower socioeconomic population, a 3.4 % SFGR seropositivity was noted at the ≥1:128 titer level. Male gender (Odds Ratio (OR): 3.20; adjusted Odds Ratio (aOR)s: 3.73), age (aOR: 1.05), any frequency of tick bite (OR: 2.29), and spending time working outdoors (OR: 5.05) were associated with SFGR IgG seropositivity. Moreover, the geospatial analysis showed clusters of seropositivity in areas where previous case reports occurred, suggesting potential endemic foci.
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Affiliation(s)
- Lídia Gual-Gonzalez
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 327A, Columbia, SC 29201, USA
| | - Stella C W Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 327A, Columbia, SC 29201, USA
| | - Madeleine Meyer
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 327A, Columbia, SC 29201, USA; Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA
| | - Omar Cantillo-Barraza
- Grupo Biología y Control Enfermedades Infecciosas, Universidad de Antioquia, Medellín 050010, Colombia
| | - Myriam E Torres
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 327A, Columbia, SC 29201, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Room 327A, Columbia, SC 29201, USA.
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Karshima SN, Ahmed MI, Mohammed KM, Pam VA, Momoh-Abdullateef H, Gwimi BP. Worldwide meta-analysis on Anaplasma phagocytophilum infections in animal reservoirs: Prevalence, distribution and reservoir diversity. Vet Parasitol Reg Stud Reports 2023; 38:100830. [PMID: 36725159 DOI: 10.1016/j.vprsr.2022.100830] [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: 05/04/2022] [Revised: 12/06/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
A wide range of vertebrate species are competent reservoirs of Anaplasma phagocytophilum, where the pathogen is maintained in the enzootic cycle and transmitted to humans through activities of tick vectors. An insight into the role and diversity of these reservoirs is vital in understanding the epidemiology of this pathogen. Here, we determined the prevalence, distribution and reservoir diversity of A. phagocytophilum using a systematic review and meta-analysis. Data pooling was performed by the random-effects model, heterogeneity was assessed by the Cochran's Q-test and publication bias by Egger's regression test. Eighty-nine studies from 33 countries across 5 continents revealed A. phagocytophilum pooled prevalence of 15.18% (95% CI: 11.64, 19.57). Continental estimates varied significantly (p < 0.0001), with a range of 2.88% (95% CI: 0.25, 26.20) in South America to 19.91% (95% CI: 13.57, 28.24) in Europe. Country-based estimates ranged between 2.93% (95% CI: 1.17, 7.16) in Slovakia and 71.58% (95% CI: 25.91, 94.77) in Norway. Studies on A. phagocytophilum were concentrated in Europe (51.69%; 46/89) by continent and the USA (22.47%; 20/89) by country. Prevalence in wildlife (17.64%; 95% CI: 12.21-28.59) was significantly higher (p < 0.001) than that among domestic animals (10.68%; 95% CI: 6.61-16.83). Diverse species of wildlife, domestic animals and birds were infected by A. phagocytophilum. To curtail the public health, veterinary and economic consequences of A. phagocytophilum infections, we recommend an all-inclusive epidemiological approach that targets the human, animal and environmental components of the disease.
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Affiliation(s)
- Solomon Ngutor Karshima
- Department of Veterinary Public Health and Preventive Medicine, Federal University of Agriculture Zuru, PMB 28 Zuru, Kebbi State, Nigeria.
| | - Musa Isiyaku Ahmed
- Department of Veterinary Parasitology and Entomology, Federal University of Agriculture Zuru, PMB 28 Zuru, Kebbi State, Nigeria
| | - Kaltume Mamman Mohammed
- Department of Veterinary Public Health and Preventive Medicine, Federal University of Agriculture Zuru, PMB 28 Zuru, Kebbi State, Nigeria
| | - Victoria Adamu Pam
- Department of Zoology, Federal University Lafia, Lafia PMB 146, Nasarawa State, Nigeria
| | - Habiba Momoh-Abdullateef
- Department of Animal Health, Federal College of Animal Health and Production Technology, PMB 001, Vom, Plateau State, Nigeria
| | - Bulus Peter Gwimi
- Department of Veterinary Public Health and Preventive Medicine, Federal University of Agriculture Zuru, PMB 28 Zuru, Kebbi State, Nigeria
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Chung MH, Lee JS, Kang JS. Buerger's Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients. Infect Chemother 2022; 54:20-58. [PMID: 35384418 PMCID: PMC8987189 DOI: 10.3947/ic.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Buerger's disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.
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Affiliation(s)
- Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea.
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Khan SA, Bora T, Thangaraj JWV, Murhekar MV. Spotted Fever Group Rickettsiae among Children with Acute Febrile Illness, in Gorakhpur, India. J Trop Pediatr 2021; 67:5865482. [PMID: 32607585 DOI: 10.1093/tropej/fmaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Seasonal outbreaks of acute encephalitis syndrome have been occurring in Gorakhpur division in the Indian state of Uttar Pradesh during monsoon and post-monsoon months. Orientia tsutsugamushi was identified as the major aetiology of these outbreaks. Orientia tsutsugamushi was also identified as one of the important aetiology of febrile illness among children attending peripheral health facilities. The present study was undertaken to detect antibodies against spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) among children with acute febrile illness presenting at peripheral health facilities in Gorakhpur district. Of the 224 blood samples tested, SFGR infection was detected in 13 (6%) patients. None of the samples tested positive for TGR.
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Affiliation(s)
- Siraj A Khan
- Medical Entomology, Arbovirology and Rickettsial Disease Division, Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam 786010, India
| | - Trishna Bora
- Medical Entomology, Arbovirology and Rickettsial Disease Division, Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam 786010, India
| | | | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Sosa-Gutierrez CG, Cervantes-Castillo MA, Laguna-Gonzalez R, Lopez-Echeverria LY, Ojeda-Ramírez D, Oyervides M. Serological and Molecular Evidence of Patients Infected with Anaplasma phagocytophilum in Mexico. Diseases 2021; 9:diseases9020037. [PMID: 34069232 PMCID: PMC8161817 DOI: 10.3390/diseases9020037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/18/2022] Open
Abstract
Human granulocytic Anaplasmosis (HGA), is a tick-borne infectious disease transmitted by ticks, resulting in acute feverish episodes. The etiological agent is the bacteria Anaplasma phagocytophilum; which is spread by ticks of the genus Ixodes spp. to complete its life cycle. In Mexico, there is only one case report. The primary challenge is understanding how other bacteria affect or overlap with the clinical manifestation of the disease. Sample collection occurred over the period September 2017 through October 2019. Blood samples from human subjects were obtained immediately after they signed consent forms. We analyzed for the presence for A. phagocytophilum by serological (IFA IgG two times) and PCR targeting 16SrRNA and groEL genes, followed by DNA sequencing. All patients with a history of travel abroad were dismissed for this project. In total, 1924 patients participated and of these, 1014 samples across the country were analyzed. Of these, 85 (8.38%) had IFA results that ranged from 1:384 to 1:896. Of the positive samples, 7.10% were used for PCR. Significant clinical manifestations included: dizziness, nausea, petechial, epistaxis, enlarged liver and/or spleen and thrombocytopenia. Hospitalization of at least 1.5 days was necessary for 3.2% of patients. None of the cases analyzed were lethal. This is the first clinical manifestations along with serological test results and molecular analysis confirmed the presence of A. phagocytophilum resulting in HGA in patients from Mexico. Health institutions and medical practitioners in general should include diagnostic testing for HGA among high risk populations and should recognize it as a vector-borne emerging infectious disease in Mexico.
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Affiliation(s)
- Carolina Guadalupe Sosa-Gutierrez
- Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Hidalgo 43600, Mexico; (R.L.-G.); (L.Y.L.-E.); (D.O.-R.)
- BioGeneticks and Other Vector Diseases Lab., Tulancingo, Hidalgo 43660, Mexico; (M.A.C.-C.); (M.O.)
- Correspondence: or ; Tel.: +52-1-5517-808-062 or +52-17-757-424-559
| | - Maria Almudena Cervantes-Castillo
- BioGeneticks and Other Vector Diseases Lab., Tulancingo, Hidalgo 43660, Mexico; (M.A.C.-C.); (M.O.)
- Medicina Basada en Evidencia, Hospital Infantil de México “Federico Gómez”, Mexico City 06720, Mexico
| | - Ramon Laguna-Gonzalez
- Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Hidalgo 43600, Mexico; (R.L.-G.); (L.Y.L.-E.); (D.O.-R.)
- BioGeneticks and Other Vector Diseases Lab., Tulancingo, Hidalgo 43660, Mexico; (M.A.C.-C.); (M.O.)
| | - Laura Yareli Lopez-Echeverria
- Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Hidalgo 43600, Mexico; (R.L.-G.); (L.Y.L.-E.); (D.O.-R.)
- BioGeneticks and Other Vector Diseases Lab., Tulancingo, Hidalgo 43660, Mexico; (M.A.C.-C.); (M.O.)
| | - Deyanira Ojeda-Ramírez
- Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Tulancingo, Hidalgo 43600, Mexico; (R.L.-G.); (L.Y.L.-E.); (D.O.-R.)
| | - Mayra Oyervides
- BioGeneticks and Other Vector Diseases Lab., Tulancingo, Hidalgo 43660, Mexico; (M.A.C.-C.); (M.O.)
- Departament of Biology, Schreiner University, Kerrville, TX 78028, USA
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Straily A, Stuck S, Singleton J, Brennan S, Marcum S, Condit M, Lee C, Kato C, Tonnetti L, Stramer SL, Paddock CD. Antibody Titers Reactive With Rickettsia rickettsii in Blood Donors and Implications for Surveillance of Spotted Fever Rickettsiosis in the United States. J Infect Dis 2021; 221:1371-1378. [PMID: 31267128 DOI: 10.1093/infdis/jiz316] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2000, the reported prevalence of tick-borne spotted fever rickettsiosis has increased considerably. We compared the level of antibody reactivity among healthy blood donors from 2 widely separated regions of the United States and evaluated the impact of antibody prevalence on public health surveillance in one of these regions. METHODS Donor serum samples were evaluated by indirect immunofluorescence antibody assay to identify immunoglobulin G (IgG) antibodies reactive with Rickettsia rickettsii. The Georgia Department of Public Health (GDPH) analyzed characteristics of cases from 2016 surveillance data to evaluate the utility of laboratory surveillance for case assessment. RESULTS Of the Georgia donors (n = 1493), 11.1% demonstrated antibody titers reactive with R. rickettsii at titers ≥64, whereas 6.3% of donors from Oregon and Washington (n = 1511) were seropositive. Most seropositive donors had a titer of 64; only 3.1% (n = 93) of all donors had titers ≥128. During 2016, GDPH interviewed 243 seropositive case patients; only 28% (n = 69) met inclusion criteria in the national case definition for spotted fever rickettsiosis. CONCLUSIONS These findings suggest that a single IgG antibody titer is an unreliable measure of diagnosis and could inaccurately affect surveillance estimates that define magnitude and clinical characteristics of Rocky Mountain spotted fever and other spotted fever rickettsioses.
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Affiliation(s)
- Anne Straily
- Epidemic Intelligence Service, Atlanta.,Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | | | - Joseph Singleton
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | | | - Stephanie Marcum
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | - Marah Condit
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | - Christopher Lee
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | - Cecilia Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
| | - Laura Tonnetti
- American Red Cross, Rockville and Gaithersburg, Maryland
| | | | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta
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Alugubelly N, Stokes JV, Cross CE, Ross AML, Crawford AE, Fiihr GF, Varela-Stokes AS. Beyond the IFA: Revisiting the ELISA as a More Sensitive, Objective, and Quantitative Evaluation of Spotted Fever Group Rickettsia Exposure. Pathogens 2021; 10:pathogens10020088. [PMID: 33498380 PMCID: PMC7909427 DOI: 10.3390/pathogens10020088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/04/2022] Open
Abstract
Based on limited serological studies, at least 10% of the US population has been exposed to spotted fever group Rickettsia (SFGR) species. The immunofluorescence antibody assay (IFA) has been the gold standard for the serodiagnosis of rickettsial infections such as spotted fever rickettsiosis (SFR). However, the IFA is semi-quantitative and subjective, requiring a high level of expertise to interpret it correctly. Here, we developed an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of Rickettsia parkeri infection in the guinea pig. Our ELISA is an objective, quantitative, and high-throughput assay that shows greater sensitivity and resolution in observed titers than the IFA. We methodically optimized relevant parameters in sequence for optimal signal-to-noise ratio and low coefficient of variation% values. We used a guinea pig model as it is a part of our overall research efforts to understand the immunological and clinical response to SFGR species after tick transmission. Guinea pigs are a useful model to study SFR and show clinical signs of SFR, such as fever and eschars. We anticipate that this assay will be easily adapted to other hosts, including humans and other SFGR species.
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Elders PND, Swe MMM, Phyo AP, McLean ARD, Lin HN, Soe K, Htay WYA, Tanganuchitcharnchai A, Hla TK, Tun NN, Nwe TT, Moe MM, Thein WM, Zaw NN, Kyaw WM, Linn H, Htwe YY, Smithuis FM, Blacksell SD, Ashley EA. Serological evidence indicates widespread distribution of rickettsioses in Myanmar. Int J Infect Dis 2020; 103:494-501. [PMID: 33310022 PMCID: PMC7862081 DOI: 10.1016/j.ijid.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
Diagnosis of rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study, the distribution of rickettsioses in Myanmar was not known. This serosurvey shows that rickettsioses are widespread in Myanmar. Particularly high prevalence of scrub typhus was found in central and northern regions.
Background Little research has been published on the prevalence of rickettsial infections in Myanmar. This study determined the seroprevalence of immunoglobulin G (IgG) antibodies to rickettsial species in different regions of Myanmar. Methods Seven hundred leftover blood samples from patients of all ages in primary care clinics and hospitals in seven regions of Myanmar were collected. Samples were screened for scrub typhus group (STG), typhus group (TG) and spotted fever group (SFG) IgG antibodies using enzyme-linked immunosorbent assays (ELISA). Immunofluorescence assays were performed for the same rickettsial groups to confirm seropositivity if ELISA optical density ≥0.5. Results Overall IgG seroprevalence was 19% [95% confidence interval (CI) 16–22%] for STG, 5% (95% CI 3–7%) for TG and 3% (95% CI: 2–5%) for SFG. The seroprevalence of STG was particularly high in northern and central Myanmar (59% and 19–33%, respectively). Increasing age was associated with higher odds of STG and TG seropositivity [per 10-year increase, adjusted odds ratio estimate 1.68 (p < 0.01) and 1.24 (p = 0.03), respectively]. Conclusion Rickettsial infections are widespread in Myanmar, with particularly high seroprevalence of STG IgG antibodies in central and northern regions. Healthcare workers should consider rickettsial infections as common causes of fever in Myanmar.
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Affiliation(s)
| | | | | | - Alistair R D McLean
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Kyaw Soe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | - Ampai Tanganuchitcharnchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thel K Hla
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - Ni Ni Tun
- Medical Action Myanmar, Yangon, Myanmar
| | - Thin Thin Nwe
- Magway General Hospital and University of Medicine, Magway, Myanmar; University of Medicine 2, Yangon, Myanmar
| | - Myat Myat Moe
- Magway General Hospital and University of Medicine, Magway, Myanmar
| | - Win May Thein
- Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
| | - Ni Ni Zaw
- Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
| | | | - Htun Linn
- Monywa General Hospital, Monywa, Myanmar
| | | | - Frank M Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Medical Action Myanmar, Yangon, Myanmar
| | - Stuart D Blacksell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao Democratic People's Republic.
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10
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Salmon-Mulanovich G, Simons MP, Flores-Mendoza C, Loyola S, Silva M, Kasper M, Rázuri HR, Canal LE, Leguia M, Bausch DG, Richards AL. Seroprevalence and Risk Factors for Rickettsia and Leptospira Infection in Four Ecologically Distinct Regions of Peru. Am J Trop Med Hyg 2020; 100:1391-1400. [PMID: 30938281 DOI: 10.4269/ajtmh.18-0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Rickettsia and Leptospira spp. are under-recognized causes of acute febrile disease worldwide. Rickettsia species are often placed into the spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR). We explored the antibody prevalence among humans for these two groups of rickettsiae in four regions of Peru (Lima, Cusco, Puerto Maldonado, and Tumbes) and for Leptospira spp. in Puerto Maldonado and Tumbes. We also assessed risk factors for seropositivity and collected serum samples and ectoparasites from peri-domestic animals from households in sites with high human seroprevalence. In total, we tested 2,165 human sera for antibodies (IgG) against SFGR and TGR by ELISA and for antibodies against Leptospira by a microscopic agglutination test. Overall, human antibody prevalence across the four sites was 10.6% for SFGR (ranging from 6.2% to 14.0%, highest in Tumbes) and 3.3% for TGR (ranging from 2.6% to 6.4%, highest in Puerto Maldonado). Factors associated with seroreactivity against SFGR were male gender, older age, contact with backyard birds, and working in agriculture or with livestock. However, exposure to any kind of animal within the household decreased the odds ratio by half. Age was the only variable associated with higher TGR seroprevalence. The prevalence of Leptospira was 11.3% in Puerto Maldonado and 5.8% in Tumbes, with a borderline association with keeping animals in the household. We tested animal sera for Leptospira and conducted polymerase chain reaction (PCR) to detect Rickettsia species among ectoparasites collected from domestic animals in 63 households of seropositive participants and controls. We did not find any association between animal infection and human serostatus.
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Affiliation(s)
| | - Mark P Simons
- U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | | | - Steev Loyola
- U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | - María Silva
- U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | - Matthew Kasper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland
| | - Hugo R Rázuri
- U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | | | | | - Daniel G Bausch
- U.S. Naval Medical Research Unit No. 6, Callao, Peru.,Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Allen L Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland
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11
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Trung NV, Hoi LT, Dien VM, Huong DT, Hoa TM, Lien VN, Van Luan P, Lewycka SO, Choisy M, Bryant JE, Nadjm B, Rogier van Doorn H, Richards AL, Van Kinh N. Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015-2017. Emerg Infect Dis 2019; 25. [PMID: 30882318 PMCID: PMC6433017 DOI: 10.3201/eid2504.180691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Scrub typhus was the predominant rickettsial disease diagnosed among hospitalized patients with acute undifferentiated fever in northern Vietnam. Rickettsioses are endemic to Vietnam; however, only a limited number of clinical studies have been performed on these vectorborne bacteria. We conducted a prospective hospital-based study at 2 national referral hospitals in Hanoi to describe the clinical characteristics of scrub typhus and murine typhus in northern Vietnam and to assess the diagnostic applicability of quantitative real-time PCR assays to diagnose rickettsial diseases. We enrolled 302 patients with acute undifferentiated fever and clinically suspected rickettsiosis during March 2015–March 2017. We used a standardized case report form to collect clinical information and laboratory results at the time of admission and during treatment. We confirmed scrub typhus in 103 (34.1%) patients and murine typhus in 12 (3.3%) patients. These results highlight the need for increased emphasis on training for healthcare providers for earlier recognition, prevention, and treatment of rickettsial diseases in Vietnam.
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12
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Heitman KN, Drexler NA, Cherry-Brown D, Peterson AE, Armstrong PA, Kersh GJ. National Surveillance Data Show Increase in Spotted Fever Rickettsiosis: United States, 2016-2017. Am J Public Health 2019; 109:719-721. [PMID: 30969821 DOI: 10.2105/ajph.2019.305038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kristen Nichols Heitman
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Naomi A Drexler
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dena Cherry-Brown
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amy E Peterson
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paige A Armstrong
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gilbert J Kersh
- All of the authors are with the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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13
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Tsai KH, Chung LH, Chien CH, Tung YJ, Wei HY, Yen TY, Shu PY, Wang HC. Human granulocytic anaplasmosis in Kinmen, an offshore island of Taiwan. PLoS Negl Trop Dis 2019; 13:e0007728. [PMID: 31539395 PMCID: PMC6774531 DOI: 10.1371/journal.pntd.0007728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/02/2019] [Accepted: 08/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background Human granulocytic anaplasmosis, a tick-borne infection caused by Anaplasma phagocytophilum, has received scant attention, while scrub typhus, a mite-transmitted disease caused by Orientia tsutsugamushi, is the most common rickettsiosis in Taiwan. The clinical presentations of both diseases are characterized by undifferentiated fever, headache and malaise. Moreover, both pathogens have been detected in small mammals that serve as hosts for chiggers and ticks in the wild. The objective of the present study was to investigate whether human granulocytic anaplasmosis occurs in Taiwan. Methodology/Principal findings Blood samples from 274 patients suspected of having scrub typhus in Kinmen, an offshore island of Taiwan, in 2011 and 2012 were retrospectively examined by immunofluorescence assays. IgG antibodies reactive with Anaplasma phagocytophilum was found in 31.8% (87/274) of the patients. Paired serology identified 3 patients with human granulocytic anaplasmosis and 8 patients with coinfection with O. tsutsugamushi and A. phagocytophilum. Laboratory tests showed that elevated serum ALT/AST, creatinine, and BUN levels were observed in patients with anaplasmosis and coinfection, but elevated serum CRP levels, thrombocytopenia, and anemia were only observed in coinfected patients. PCR detected A. phagocytophilum 16S rDNA and p44/msp2 in 2 patients. The phylogenetic analysis suggested that the replicons of the 16S rDNA shared high sequence similarity with the reference sequences in the Korea, USA, Japan, and China. The amplicons of p44/msp2 were close to those of the human variants identified in the USA and Japan. Conclusions Our findings indicated that A. phagocytophilum infection was prevalent but unrecognized in Taiwan. Human granulocytic anaplasmosis is a tick-borne rickettsial infection caused by Anaplasma phagocytophilum. Although most cases resolve readily, life-threatening complications can occur without prompt antibiotic treatment. The major difficulty in diagnosing human granulocytic anaplasmosis is due to the nonspecific nature of the symptoms. Given that scrub typhus is the most frequently reported rickettsial disease in Taiwan and shares similar early clinical signs with anaplasmosis, we retrospectively examined blood samples from patients with suspected diagnoses of scrub typhus in 2011 and 2012. While serological evidence of potential past exposure was found in as many as 31.8% (87/274) of the patients, current or recent anaplasmosis was supported by seroconversion in 11 patients, including 8 patients coinfected with scrub typhus. Anaplasma phagocytophilum DNA was detected in acute phase samples, and the amplified fragments were phylogenetically close to those of variants in the Korea, the USA, Japan, and China. Herein, for the first time, we confirmed the presence of human granulocytic anaplasmosis in Taiwan. By reporting coinfections with anaplasmosis and scrub typhus, the study further highlighted the health risk of increasing contact with wild rodents.
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Affiliation(s)
- Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lo-Hsuan Chung
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Hao Chien
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yu-Jung Tung
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
| | - Hsin-Yi Wei
- Taipei Regional Center, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Tsai-Ying Yen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- * E-mail: (PYS); (HCW)
| | - Hsi-Chieh Wang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- * E-mail: (PYS); (HCW)
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14
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Binder AM, Nichols Heitman K, Drexler NA. Diagnostic Methods Used to Classify Confirmed and Probable Cases of Spotted Fever Rickettsioses - United States, 2010-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:243-246. [PMID: 30870409 PMCID: PMC6421962 DOI: 10.15585/mmwr.mm6810a3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alison M Binder
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Kristen Nichols Heitman
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Naomi A Drexler
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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15
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Mullins KE, Maina AN, Krueger L, Jiang J, Cummings R, Drusys A, Williams G, Dhillon M, Richards AL. Rickettsial Infections among Cats and Cat Fleas in Riverside County, California. Am J Trop Med Hyg 2018; 99:291-296. [PMID: 29869607 DOI: 10.4269/ajtmh.17-0706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Presently, few studies have investigated the role of domestic cats (Felis catus) in the recrudescence of flea-borne rickettsioses in California and the southern United States. In this study, we aimed to investigate the presence of Rickettsia typhi or Rickettisa felis in domestic cats (F. catus) and the fleas (primarily Ctenocephalides felis, the cat flea) associated with these cats in Riverside County, California. Thirty cats and 64 pools of fleas collected from these cats were investigated for rickettsial infections. Three cats and 17 flea pools (from 10 cats) tested positive for rickettsial infections. polymerase chain reaction and DNA sequencing indicated that one of the cats was positive for R. felis infections, whereas two were positive for Candidatus Rickettsia senegalensis infection. In addition, 12 of the flea pools were positive for R. felis, whereas five were positive for Ca. R. senegalensis. By contrast, no cats or their associated fleas tested positive for R. typhi. Finally, eight sera from these cats contained spotted fever group Rickettsia (SFGR) antibodies. The detection of R. felis and SFGR antibodies and the lack of R. typhi and TGR antibodies support R. felis as the main rickettsial species infecting cat fleas. The detection of Ca. R. senegalensis in both fleas and cats also provides additional evidence that cats and their associated fleas are infected with other R. felis-like organisms highlighting the potential risk for human infections with R. felis or R. felis-like organisms.
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Affiliation(s)
- Kristin E Mullins
- Naval Medical Research Center, Silver Spring, Maryland.,University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice N Maina
- Naval Medical Research Center, Silver Spring, Maryland
| | - Laura Krueger
- Orange County Mosquito and Vector Control District, Garden Grove, California
| | - Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland
| | - Robert Cummings
- Orange County Mosquito and Vector Control District, Garden Grove, California
| | - Allan Drusys
- Riverside County Department of Animal Services, Riverside, California
| | - Greg Williams
- Northwest Mosquito and Vector Control District, Corona, California
| | - Major Dhillon
- Northwest Mosquito and Vector Control District, Corona, California
| | - Allen L Richards
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Naval Medical Research Center, Silver Spring, Maryland
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16
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Kobayashi KJ, Weil AA, Branda JA. Case 16-2018: A 45-Year-Old Man with Fever, Thrombocytopenia, and Elevated Aminotransferase Levels. N Engl J Med 2018; 378:2023-2029. [PMID: 29791814 DOI: 10.1056/nejmcpc1712227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kimiyoshi J Kobayashi
- From the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - Ana A Weil
- From the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - John A Branda
- From the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.J.K., A.A.W.) and Pathology (J.A.B.), Harvard Medical School - both in Boston
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17
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Nelson K, Maina AN, Brisco A, Foo C, Croker C, Ngo V, Civen R, Richards AL, Fujioka K, Wekesa JW. A 2015 outbreak of flea-borne rickettsiosis in San Gabriel Valley, Los Angeles County, California. PLoS Negl Trop Dis 2018; 12:e0006385. [PMID: 29677221 PMCID: PMC5931684 DOI: 10.1371/journal.pntd.0006385] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 05/02/2018] [Accepted: 03/12/2018] [Indexed: 11/23/2022] Open
Abstract
Although flea-borne rickettsiosis is endemic in Los Angeles County, outbreaks are rare. In the spring of 2015 three human cases of flea-borne rickettsiosis among residents of a mobile home community (MHC) prompted an investigation. Fleas were ubiquitous in common areas due to presence of flea-infested opossums and overabundant outdoor cats and dogs. The MHC was summarily abated in June 2015, and within five months, flea control and removal of animals significantly reduced the flea population. Two additional epidemiologically-linked human cases of flea-borne rickettsiosis detected at the MHC were suspected to have occurred before control efforts began. Molecular testing of 106 individual and 85 pooled cat fleas, blood and ear tissue samples from three opossums and thirteen feral cats using PCR amplification and DNA sequencing detected rickettsial DNA in 18.8% of the fleas. Seventeen percent of these cat fleas tested positive for R. felis-specific DNA compared to under two (<2) percent for Candidatus R. senegalensis-specific DNA. In addition, serological testing of 13 cats using a group-specific IgG-ELISA detected antibodies against typhus group rickettsiae and spotted fever group rickettsiae in six (46.2%) and one (7.7%) cat, respectively. These results indicate that cats and their fleas may have played an active role in the epidemiology of the typhus group and/or spotted fever group rickettsial disease(s) in this outbreak. Outbreaks of flea-borne rickettsiosis are rare despite the endemic status in Los Angeles County. In the spring of 2015 three human cases of flea-borne rickettsiosis among residents of a mobile home community (MHC) prompted an investigation. Fleas were found in all common areas at the MHC due to presence of flea-infested opossums and overabundant outdoor cats and dogs. The MHC was summarily abated in June 2015, and within five months, flea control and removal of animals significantly reduced the flea population. Two additional epidemiologically-linked human cases detected at the MHC were considered to have occurred before control efforts began. Molecular testing of cat fleas, immunological testing of opossums and feral cats collected at the site indicated active transmission of flea-borne rickettsiosis. This study represents the first flea-borne rickettsial outbreak that summary abatement approach was used to reduce its intensity.
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Affiliation(s)
- Kimberly Nelson
- San Gabriel Valley Mosquito and Vector Control District, West Covina, California, United States of America
| | - Alice N. Maina
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Angela Brisco
- San Gabriel Valley Mosquito and Vector Control District, West Covina, California, United States of America
| | - Chelsea Foo
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
- CDC/CSTE Applied Epidemiology Fellowship Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Curtis Croker
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Van Ngo
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Rachel Civen
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
- Community Health Services Program, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Allen L. Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Kenn Fujioka
- San Gabriel Valley Mosquito and Vector Control District, West Covina, California, United States of America
| | - J. Wakoli Wekesa
- San Gabriel Valley Mosquito and Vector Control District, West Covina, California, United States of America
- * E-mail:
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18
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Trung NV, Hoi LT, Thuong NTH, Toan TK, Huong TTK, Hoa TM, Fox A, van Kinh N, van Doorn HR, Wertheim HFL, Bryant JE, Nadjm B. Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever Among Rural and Urban Populations of Northern Vietnam. Am J Trop Med Hyg 2017; 96:1084-1087. [PMID: 28500808 PMCID: PMC5417199 DOI: 10.4269/ajtmh.16-0399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/17/2017] [Indexed: 12/02/2022] Open
Abstract
AbstractRickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG positive) was surprisingly low, with 9.14% (83/908) testing positive to the three major rickettsial serogroups thought to circulate in the region. Prevalence of typhus group rickettsiae (TG)-specific antibodies (6.5%, 58/908) was significantly greater than scrub typhus group orientiae (STG)- or spotted fever group rickettsiae (SFG)-specific antibodies (P < 0.05). The majority of TG seropositives were observed among urban rather than rural residents (P < 0.05). In contrast, overall antibody prevalence to STG and SFG were both very low (1.1%, 10/908 for STG; 1.7%, 15/908 for SFG), with no significant differences between rural and urban residents. These results provide data on baseline population characteristics that may help inform development of Rickettsia serological testing criteria in future clinical studies.
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Affiliation(s)
| | - Le Thi Hoi
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Nguyen Thi Hong Thuong
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | | | - Tran Thi Kieu Huong
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Tran Mai Hoa
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Annette Fox
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | | | - H. Rogier van Doorn
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Heiman F. L. Wertheim
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medical Microbiology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juliet E. Bryant
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Behzad Nadjm
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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19
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Molecular and serological evidence of flea-associated typhus group and spotted fever group rickettsial infections in Madagascar. Parasit Vectors 2017; 10:125. [PMID: 28259176 PMCID: PMC5336680 DOI: 10.1186/s13071-017-2061-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/24/2017] [Indexed: 12/25/2022] Open
Abstract
Background Rickettsiae are obligate intracellular bacteria responsible for many febrile syndromes around the world, including in sub-Saharan Africa. Vectors of these pathogens include ticks, lice, mites and fleas. In order to assess exposure to flea-associated Rickettsia species in Madagascar, human and small mammal samples from an urban and a rural area, and their associated fleas were tested. Results Anti-typhus group (TGR)- and anti-spotted fever group rickettsiae (SFGR)-specific IgG were detected in 24 (39%) and 21 (34%) of 62 human serum samples, respectively, using indirect ELISAs, with six individuals seropositive for both. Only two (2%) Rattus rattus out of 86 small mammals presented antibodies against TGR. Out of 117 fleas collected from small mammals, Rickettsia typhi, a TGR, was detected in 26 Xenopsylla cheopis (24%) collected from rodents of an urban area (n = 107), while two of these urban X. cheopis (2%) were positive for Rickettsia felis, a SFGR. R. felis DNA was also detected in eight (31%) out of 26 Pulex irritans fleas. Conclusions The general population in Madagascar are exposed to rickettsiae, and two flea-associated Rickettsia pathogens, R. typhi and R. felis, are present near or in homes. Although our results are from a single district, they demonstrate that rickettsiae should be considered as potential agents of undifferentiated fever in Madagascar.
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20
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Maina AN, Farris CM, Odhiambo A, Jiang J, Laktabai J, Armstrong J, Holland T, Richards AL, O'Meara WP. Q Fever, Scrub Typhus, and Rickettsial Diseases in Children, Kenya, 2011-2012. Emerg Infect Dis 2016; 22:883-6. [PMID: 27088502 PMCID: PMC4861507 DOI: 10.3201/eid2205.150953] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To increase knowledge of undifferentiated fevers in Kenya, we tested paired serum samples from febrile children in western Kenya for antibodies against pathogens increasingly recognized to cause febrile illness in Africa. Of patients assessed, 8.9%, 22.4%, 1.1%, and 3.6% had enhanced seroreactivity to Coxiella burnetii, spotted fever group rickettsiae, typhus group rickettsiae, and scrub typhus group orientiae, respectively.
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21
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Khan SA, Bora T, Chattopadhyay S, Jiang J, Richards AL, Dutta P. Seroepidemiology of rickettsial infections in Northeast India. Trans R Soc Trop Med Hyg 2016; 110:487-94. [PMID: 27618917 DOI: 10.1093/trstmh/trw052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Resurgence of scrub typhus was reported in Northeast India in 2010 after a gap of 67 years since World War II. However, the presence of other rickettsial infections remained unknown from this region. A seroepidemiological investigation was undertaken in the scrub typhus affected areas from 2013-2015 in Assam, Arunachal Pradesh and Nagaland to assess the exposure to other rickettsial diseases besides scrub typhus. METHODS Samples were collected from people residing in scrub typhus reporting areas. Serology was performed by an indirect ELISA for the three rickettsial agents' viz., scrub typhus group orientiae (STGO), spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR). A sample with total net absorbance ≥1.000 was considered as positive. An entomological survey was also carried out in the affected areas. RESULTS Overall, 1265 human blood samples were collected, of which 30.8% (n=390), 13.8% (175) and 4.2% (53) had antibodies against STGO, SFGR and TGR respectively. Presence of antibodies against more than one of the rickettsial groups was also detected. Among the arthropods collected, chiggers of Leptotrombidium deleinse, fleas belonging to Ctenocephalides felis and Pulex irritans, ticks belonging to Rhipicephalus microplus, Haemaphysalis spp. were predominant. Candidatus Rickettsia senegalensis was detected in C. felis. CONCLUSIONS Our findings confirm wide circulation of rickettsial infections and their probable vectors in the northeast region of India.Accession numbers: KU163367, KU163368, KU499847, KU499848.
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Affiliation(s)
- Siraj Ahmed Khan
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | - Trishna Bora
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | | | - Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Allen L Richards
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Prafulla Dutta
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
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22
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Maina AN, Jiang J, Omulo SA, Cutler SJ, Ade F, Ogola E, Feikin DR, Njenga MK, Cleaveland S, Mpoke S, Ng'ang'a Z, Breiman RF, Knobel DL, Richards AL. High prevalence of Rickettsia africae variants in Amblyomma variegatum ticks from domestic mammals in rural western Kenya: implications for human health. Vector Borne Zoonotic Dis 2016; 14:693-702. [PMID: 25325312 DOI: 10.1089/vbz.2014.1578] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tick-borne spotted fever group (SFG) rickettsioses are emerging human diseases caused by obligate intracellular Gram-negative bacteria of the genus Rickettsia. Despite being important causes of systemic febrile illnesses in travelers returning from sub-Saharan Africa, little is known about the reservoir hosts of these pathogens. We conducted surveys for rickettsiae in domestic animals and ticks in a rural setting in western Kenya. Of the 100 serum specimens tested from each species of domestic ruminant 43% of goats, 23% of sheep, and 1% of cattle had immunoglobulin G (IgG) antibodies to the SFG rickettsiae. None of these sera were positive for IgG against typhus group rickettsiae. We detected Rickettsia africae-genotype DNA in 92.6% of adult Amblyomma variegatum ticks collected from domestic ruminants, but found no evidence of the pathogen in blood specimens from cattle, goats, or sheep. Sequencing of a subset of 21 rickettsia-positive ticks revealed R. africae variants in 95.2% (20/21) of ticks tested. Our findings show a high prevalence of R. africae variants in A. variegatum ticks in western Kenya, which may represent a low disease risk for humans. This may provide a possible explanation for the lack of African tick-bite fever cases among febrile patients in Kenya.
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Affiliation(s)
- Alice N Maina
- 1 Jomo Kenyatta University of Agriculture and Technology , Nairobi, Kenya
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Maina AN, Fogarty C, Krueger L, Macaluso KR, Odhiambo A, Nguyen K, Farris CM, Luce-Fedrow A, Bennett S, Jiang J, Sun S, Cummings RF, Richards AL. Rickettsial Infections among Ctenocephalides felis and Host Animals during a Flea-Borne Rickettsioses Outbreak in Orange County, California. PLoS One 2016; 11:e0160604. [PMID: 27537367 PMCID: PMC4990410 DOI: 10.1371/journal.pone.0160604] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/21/2016] [Indexed: 11/23/2022] Open
Abstract
Due to a resurgence of flea-borne rickettsioses in Orange County, California, we investigated the etiologies of rickettsial infections of Ctenocephalides felis, the predominant fleas species obtained from opossums (Didelphis virginiana) and domestic cats (Felis catus), collected from case exposure sites and other areas in Orange County. In addition, we assessed the prevalence of IgG antibodies against spotted fever group (SFGR) and typhus group (TGR) rickettsiae in opossum sera. Of the 597 flea specimens collected from opossums and cats, 37.2% tested positive for Rickettsia. PCR and sequencing of rickettsial genes obtained from C. felis flea DNA preparations revealed the presence of R. typhi (1.3%), R. felis (28.0%) and R. felis-like organisms (7.5%). Sera from opossums contained TGR-specific (40.84%), but not SFGR-specific antibodies. The detection of R. felis and R. typhi in the C. felis fleas in Orange County highlights the potential risk for human infection with either of these pathogens, and underscores the need for further investigations incorporating specimens from humans, animal hosts, and invertebrate vectors in endemic areas. Such studies will be essential for establishing a link in the ongoing flea-borne rickettsioses outbreaks.
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Affiliation(s)
- Alice N. Maina
- Naval Medical Research Center, Silver Spring, MD, United States of America
- * E-mail:
| | - Carrie Fogarty
- Orange County Mosquito and Vector Control District, Garden Grove, CA, United States of America
| | - Laura Krueger
- Orange County Mosquito and Vector Control District, Garden Grove, CA, United States of America
| | - Kevin R. Macaluso
- Louisiana State University, Baton Rouge, LA, United States of America
| | - Antony Odhiambo
- Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Kiet Nguyen
- Orange County Mosquito and Vector Control District, Garden Grove, CA, United States of America
| | | | - Alison Luce-Fedrow
- Naval Medical Research Center, Silver Spring, MD, United States of America
- Shippensburg University, Shippensburg, PA, United States of America
| | - Stephen Bennett
- Orange County Mosquito and Vector Control District, Garden Grove, CA, United States of America
| | - Ju Jiang
- Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Sokanary Sun
- West Valley Mosquito and Vector Control District, Ontario, CA, United States of America
| | - Robert F. Cummings
- Orange County Mosquito and Vector Control District, Garden Grove, CA, United States of America
| | - Allen L. Richards
- Naval Medical Research Center, Silver Spring, MD, United States of America
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Elhamiani Khatat S, Sahibi H, Hing M, Alaoui Moustain I, El Amri H, Benajiba M, Kachani M, Duchateau L, Daminet S. Human Exposure to Anaplasma phagocytophilum in Two Cities of Northwestern Morocco. PLoS One 2016; 11:e0160880. [PMID: 27532208 PMCID: PMC4988626 DOI: 10.1371/journal.pone.0160880] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022] Open
Abstract
Anaplasma phagocytophilum is an emerging tick-borne zoonosis with extensive increased interest. Epidemiological data are available in several regions of the USA, Europe and Asia in contrast to other parts of the world such as North Africa. Blood samples of 261 healthy individuals divided in two groups i.e., dog handlers and blood donors were analysed. Indirect immunofluorescent assay using a commercial kit was performed to detect specific A. phagocytophilum IgG. Two dilutions were used to assess the prevalence of seroreactive samples. Demographic variables were assessed as potential risk factors using exact logistic regression. Seropositivity rates reached 37% and 27% in dog handlers and 36% and 22% in blood donors. No statistically significant differences were found in the prevalence rates between the two groups. Analysis of risk factors such as gender, age groups, outdoor activities, self-reported previous exposure to ticks, or contact with domestic animals (dogs, cats, ruminants and horses) did not shown any significant difference. A. phagocytophilum exposure was common in both high-risk population and blood donors in Morocco.
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Affiliation(s)
- Sarah Elhamiani Khatat
- Department of Pathology and Veterinary Public Heath, Institut Agronomique et Vétérinaire Hassan II, Rabat, Morocco
- Department of Companion Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- * E-mail:
| | - Hamid Sahibi
- Department of Pathology and Veterinary Public Heath, Institut Agronomique et Vétérinaire Hassan II, Rabat, Morocco
| | - Mony Hing
- National Reference Laboratory for Anaplasma phagocytophilum, Laboratory of Clinical Biology, Queen Astrid Military Hospital, Brussels, Belgium
| | | | | | | | - Malika Kachani
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, United States of America
| | - Luc Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sylvie Daminet
- Department of Companion Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Kocher C, Morrison AC, Leguia M, Loyola S, Castillo RM, Galvez HA, Astete H, Flores-Mendoza C, Ampuero JS, Bausch DG, Halsey ES, Cespedes M, Zevallos K, Jiang J, Richards AL. Rickettsial Disease in the Peruvian Amazon Basin. PLoS Negl Trop Dis 2016; 10:e0004843. [PMID: 27416029 PMCID: PMC4944934 DOI: 10.1371/journal.pntd.0004843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
Using a large, passive, clinic-based surveillance program in Iquitos, Peru, we characterized the prevalence of rickettsial infections among undifferentiated febrile cases and obtained evidence of pathogen transmission in potential domestic reservoir contacts and their ectoparasites. Blood specimens from humans and animals were assayed for spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) by ELISA and/or PCR; ectoparasites were screened by PCR. Logistic regression was used to determine associations between patient history, demographic characteristics of participants and symptoms, clinical findings and outcome of rickettsial infection. Of the 2,054 enrolled participants, almost 2% showed evidence of seroconversion or a 4-fold rise in antibody titers specific for rickettsiae between acute and convalescent blood samples. Of 190 fleas (Ctenocephalides felis) and 60 ticks (Rhipicephalus sanguineus) tested, 185 (97.4%) and 3 (5%), respectively, were positive for Rickettsia spp. Candidatus Rickettsia asemboensis was identified in 100% and 33% of the fleas and ticks tested, respectively. Collectively, our serologic data indicates that human pathogenic SFGR are present in the Peruvian Amazon and pose a significant risk of infection to individuals exposed to wild, domestic and peri-domestic animals and their ectoparasites. Rickettsial infection remains relatively unexplored in South America compared to other regions of the world. For most regions of Peru (including the Amazon Basin), nothing more than broad serological characterization is available about circulating rickettsiae. Even less is known about the animal reservoirs and insect vectors involved in disease transmission. With this study we aimed to better characterize the circulating species of Rickettsia in humans in the Amazon Basin, as well as investigate their domestic animal reservoir and arthropod vectors. Out of 2054 fever patients enrolled we identified 38 individuals with serologic evidence for acute rickettsial infection. Their homes were visited in order to draw blood samples and collect ectoparasites from their domestic animals. Serology and molecular methods were used to test the animal blood samples as well as the ectoparasites. The information collected contributes to the understanding of the transmission dynamics of rickettsial diseases in Iquitos and leads to a better understanding of the exposure risk to rickettsial infection and it will guide approaches for prevention.
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Affiliation(s)
- Claudine Kocher
- Kantonsspital Baden, Baden, Switzerland
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
- * E-mail:
| | - Amy C. Morrison
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Mariana Leguia
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Steev Loyola
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | - Hugo A. Galvez
- Instituto Veterinario de Investigaciones Tropicales y de Altura, Iquitos, Peru
| | - Helvio Astete
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | | | | | - Eric S. Halsey
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | - Karine Zevallos
- Laboratorio de Investigacion y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ju Jiang
- U.S. Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Allen L. Richards
- U.S. Naval Medical Research Center, Silver Spring, Maryland, United States of America
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26
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Delisle J, Mendell NL, Stull-Lane A, Bloch KC, Bouyer DH, Moncayo AC. Human Infections by Multiple Spotted Fever Group Rickettsiae in Tennessee. Am J Trop Med Hyg 2016; 94:1212-7. [PMID: 27022147 DOI: 10.4269/ajtmh.15-0372] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 01/13/2016] [Indexed: 11/07/2022] Open
Abstract
Rocky Mountain spotted fever is the most common tick-borne disease in Tennessee. However, Rickettsia rickettsii has rarely been isolated from endemic ticks, suggesting rickettsioses may be caused by other species. A total of 56 human serum samples that were serologically positive for exposure to Rickettsia were obtained from commercial laboratories in 2010 and 2011. In addition, 20 paired sera from patients with encephalitis and positive Rickettsia serology were obtained from the Tennessee Unexplained Encephalitis Surveillance (TUES) study. Using an immunofluorescence assay, reactivity of the sera to R. rickettsii, Rickettsia montanensis, Rickettsia parkeri, and Rickettsia amblyommii was tested, and a comparison of endpoint titers was used to determine the probable antigen that stimulated the antibody response. Cross-absorption was conducted for 94.8% (N = 91) of the samples due to serologic cross-reactivity. Of the commercial laboratory samples, 55.4% (N = 31) had specific reactivity to R. amblyommii and 44.6% (N = 25) were indeterminate. Of the paired TUES samples, 20% (N = 4) had specific reactivity to R. amblyommii, 5% (N = 1) to R. montanensis, and 5% (N = 1) to R. parkeri Patients with specific reactivity to R. amblyommii experienced fever (75%), headache (68%) and myalgia (58%). Rash (36%) and thrombocytopenia (40%) were less common. To our knowledge, this is the first time R. amblyommii has been reported as a possible causative agent of rickettsioses in Tennessee.
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Affiliation(s)
- Josie Delisle
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nicole L Mendell
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Annica Stull-Lane
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karen C Bloch
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Donald H Bouyer
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Abelardo C Moncayo
- Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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27
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Wallace JW, Nicholson WL, Perniciaro JL, Vaughn MF, Funkhouser S, Juliano JJ, Lee S, Kakumanu ML, Ponnusamy L, Apperson CS, Meshnick SR. Incident Tick-Borne Infections in a Cohort of North Carolina Outdoor Workers. Vector Borne Zoonotic Dis 2016; 16:302-8. [PMID: 27008102 DOI: 10.1089/vbz.2015.1887] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tick-borne diseases cause substantial morbidity throughout the United States, and North Carolina has a high incidence of spotted fever rickettsioses and ehrlichiosis, with sporadic cases of Lyme disease. The occupational risk of tick-borne infections among outdoor workers is high, particularly those working on publicly managed lands. This study identified incident tick-borne infections and examined seroconversion risk factors among a cohort of North Carolina outdoor workers. Workers from the North Carolina State Divisions of Forestry, Parks and Recreation, and Wildlife (n = 159) were followed for 2 years in a randomized controlled trial evaluating the effectiveness of long-lasting permethrin-impregnated clothing. Antibody titers against Rickettsia parkeri, Rickettsia rickettsii, "Rickettsia amblyommii," and Ehrlichia chaffeensis were measured at baseline (n = 130), after 1 year (n = 82), and after 2 years (n = 73). Titers against Borrelia burgdorferi were measured at baseline and after 2 years (n = 90). Baseline seroprevalence, defined as indirect immunofluorescence antibody titers of 1/128 or greater, was R. parkeri (24%), R. rickettsii (19%), "R. amblyommii" (12%), and E. chaffeensis (4%). Incident infection was defined as a fourfold increase in titer over a 1-year period. There were 40 total seroconversions to at least one pathogen, including R. parkeri (n = 19), "R. amblyommii" (n = 14), R. rickettsii (n = 9), and E. chaffeensis (n = 8). There were no subjects whose sera were reactive to B. burgdorferi C6 antigen. Thirty-eight of the 40 incident infections were subclinical. The overall risk of infection by any pathogen during the study period was 0.26, and the risk among the NC Division of Forest Resources workers was 1.73 times that of workers in other divisions (95% confidence interval [CI]: 1.02, 2.92). The risk of infection was lower in subjects wearing permethrin-impregnated clothing, but not significantly (risk ratio = 0.81; 95% CI: 0.47, 1.39). In summary, outdoor workers in North Carolina are at high risk of incident tick-borne infections, most of which appear to be asymptomatic.
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Affiliation(s)
- John W Wallace
- 1 Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - William L Nicholson
- 2 Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Jamie L Perniciaro
- 2 Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Meagan F Vaughn
- 1 Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - Sheana Funkhouser
- 1 Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - Jonathan J Juliano
- 3 Division of Infectious Diseases, University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - Sangmi Lee
- 4 Department of Entomology, North Carolina State University , Raleigh, North Carolina
| | - Madhavi L Kakumanu
- 4 Department of Entomology, North Carolina State University , Raleigh, North Carolina
| | - Loganathan Ponnusamy
- 4 Department of Entomology, North Carolina State University , Raleigh, North Carolina
| | - Charles S Apperson
- 4 Department of Entomology, North Carolina State University , Raleigh, North Carolina
| | - Steven R Meshnick
- 1 Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health , Chapel Hill, North Carolina
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28
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Luce-Fedrow A, Mullins K, Kostik AP, St John HK, Jiang J, Richards AL. Strategies for detecting rickettsiae and diagnosing rickettsial diseases. Future Microbiol 2016; 10:537-64. [PMID: 25865193 DOI: 10.2217/fmb.14.141] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Rickettsial diseases and scrub typhus constitute a group of the oldest known vector-borne diseases. The cosmopolitan distribution of the vectors that transmit rickettsiae and orientiae leads to a worldwide prevalence of these diseases. Despite their significant historical status, detection and diagnosis of these diseases are still evolving today. Serological methods remain among the most prevalent techniques used for the detection/diagnosis of rickettsial diseases and scrub typhus. Molecular techniques have been instrumental in increasing the sensitivity/specificity of diagnosis, identifying new Rickettsia and Orientia species and have enhanced epidemiological capabilities when used in combination with serological methods. In this review, we discuss these techniques and their associated pros and cons.
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Affiliation(s)
- Alison Luce-Fedrow
- Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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29
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Jiang J, Myers TE, Rozmajzl PJ, Graf PCF, Chretien JP, Gaydos JC, Richards AL. Seroconversions to Rickettsiae in US Military Personnel in South Korea. Emerg Infect Dis 2015; 21:1073-4. [PMID: 25989279 PMCID: PMC4451913 DOI: 10.3201/eid2106.141487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Markowicz M, Schötta AM, Wijnveld M, Stanek G. Human granulocytic anaplasmosis acquired in Connecticut, USA, diagnosed in Vienna, Austria, 2015. Diagn Microbiol Infect Dis 2015; 84:347-9. [PMID: 26778486 DOI: 10.1016/j.diagmicrobio.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
Abstract
Human granulocytic anaplasmosis (HGA) is caused by Anaplasma phagocytophilum, an intracellular pathogen transmitted by hard ticks. We report a patient who had acquired the infection in Connecticut, USA, and was diagnosed in Vienna, Austria, using PCR methods. Imported HGA from the United States to Austria is a rare event.
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Affiliation(s)
- Mateusz Markowicz
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Anna-Margarita Schötta
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Michiel Wijnveld
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Gerold Stanek
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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31
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Thiga JW, Mutai BK, Eyako WK, Ng'ang'a Z, Jiang J, Richards AL, Waitumbi JN. High seroprevalence of antibodies against spotted fever and scrub typhus bacteria in patients with febrile Illness, Kenya. Emerg Infect Dis 2015; 21:688-91. [PMID: 25811219 PMCID: PMC4378494 DOI: 10.3201/eid2104.141387] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Serum samples from patients in Kenya with febrile illnesses were screened for antibodies against bacteria that cause spotted fever, typhus, and scrub typhus. Seroprevalence was 10% for spotted fever group, <1% for typhus group, and 5% for scrub typhus group. Results should help clinicians expand their list of differential diagnoses for undifferentiated fevers.
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32
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Jiao XY, Fan ZC, Li YZ, Tang YT, Ke CW. Clinical and laboratory features parameters of human granulocytic anaplasmosis (HGA) in patients admitted to hospital in Guangdong Province, China. Trop Doct 2015; 45:209-13. [PMID: 25873582 DOI: 10.1177/0049475515579772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Human granulocytic anaplasmosis (HGA) is an acute tick-borne infectious disease with increasing morbidity and mortality, but is rarely considered in clinical practice. Because human-to-human transfusion or nosocomial transmission can occur, diagnosis is difficult when the history of tick bites is not clear. METHODS We present clinical features and laboratory data of HGA patients who had no clear tick bite history. RESULTS All patients in the study presented with a high fever, petechiae, purpura, nose bleeding and leukopenia, and patients had abnormally high levels of serum ferritin and C-reactive protein. Morulae in leukocytes were observed in three patients. Foamy histiocytes and slight erythrophagocytic activity were only found in severely ill patients. CONCLUSION In patients with fever and thrombocytopenia in whom no other diagnosis is evident on clinical assessment, HGA should be considered in the differential diagnosis, and tested for serologically if possible. For patients in whom the diagnosis of HGA is possible, and to whom tetracyclines can safely be given, it is apparent that these drugs hasten recovery and improve the prognosis.
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Affiliation(s)
- Xiao-yang Jiao
- PhD, Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong Province, PR China
| | - Zhi-chen Fan
- MS, Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong Province, PR China
| | - Ya-zhen Li
- MS, Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong Province, PR China
| | - Yue-ting Tang
- PhD, Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong Province, PR China
| | - Chang-wen Ke
- PhD, Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong Province, PR China Professor, Department of Cell Biology and Genetics, Shantou University Medical College, Shantuo, Guangdong Province, PR China; Institute of Microbiology, Center for Diseases Control and Prevention of Guangdong Province, PR China
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33
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Banajee KH, Embers ME, Langohr IM, Doyle LA, Hasenkampf NR, Macaluso KR. Amblyomma maculatum Feeding Augments Rickettsia parkeri Infection in a Rhesus Macaque Model: A Pilot Study. PLoS One 2015; 10:e0135175. [PMID: 26244337 PMCID: PMC4526656 DOI: 10.1371/journal.pone.0135175] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/17/2015] [Indexed: 11/19/2022] Open
Abstract
Rickettsia parkeri is an emerging eschar-causing human pathogen in the spotted fever group of Rickettsia and is transmitted by the Gulf coast tick, Amblyomma maculatum. Tick saliva has been shown to alter both the cellular and humoral components of the innate and adaptive immune systems. However, the effect of this immunomodulation on Rickettsia transmission and pathology in an immunocompetent vertebrate host has not been fully examined. We hypothesize that, by modifying the host immune response, tick feeding enhances infection and pathology of pathogenic spotted fever group Rickettsia sp. In order to assess this interaction in vivo, a pilot study was conducted using five rhesus macaques that were divided into three groups. One group was intradermally inoculated with low passage R. parkeri (Portsmouth strain) alone (n = 2) and another group was inoculated during infestation by adult, R. parkeri-free A. maculatum (n = 2). The final macaque was infested with ticks alone (tick feeding control group). Blood, lymph node and skin biopsies were collected at several time points post-inoculation/infestation to assess pathology and quantify rickettsial DNA. As opposed to the tick-only animal, all Rickettsia-inoculated macaques developed inflammatory leukograms, elevated C-reactive protein concentrations, and elevated TH1 (interferon-γ, interleukin-15) and acute phase inflammatory cytokines (interleukin-6) post-inoculation, with greater neutrophilia and interleukin-6 concentrations in the tick plus R. parkeri group. While eschars formed at all R. parkeri inoculation sites, larger and slower healing eschars were observed in the tick feeding plus R. parkeri group. Furthermore, dissemination of R. parkeri to draining lymph nodes early in infection and increased persistence at the inoculation site were observed in the tick plus R. parkeri group. This study indicates that rhesus macaques can be used to model R. parkeri rickettsiosis, and suggests that immunomodulatory factors introduced during tick feeding may enhance the pathogenicity of spotted fever group Rickettsia.
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Affiliation(s)
- Kaikhushroo H. Banajee
- Vector-borne Disease Laboratories, Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, 70803, United States of America
| | - Monica E. Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, Louisiana, United States of America
| | - Ingeborg M. Langohr
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Lara A. Doyle
- Division of Veterinary Medicine, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, United States of America
| | - Nicole R. Hasenkampf
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, Louisiana, United States of America
| | - Kevin R. Macaluso
- Vector-borne Disease Laboratories, Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, 70803, United States of America
- * E-mail:
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34
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Immunoproteomic profiling of Rickettsia parkeri and Rickettsia amblyommii. Ticks Tick Borne Dis 2015; 6:829-35. [PMID: 26234571 DOI: 10.1016/j.ttbdis.2015.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/22/2022]
Abstract
Rickettsia parkeri is an Amblyomma-associated, spotted fever group Rickettsia species that causes an eschar-associated, febrile illness in multiple countries throughout the Western Hemisphere. Many other rickettsial species of known or uncertain pathogenicity have been detected in Amblyomma spp. ticks in the Americas, including Rickettsia amblyommii, "Candidatus Rickettsia andeanae" and Rickettsia rickettsii. In this study, we utilized an immunoproteomic approach to compare antigenic profiles of low-passage isolates of R. parkeri and R. amblyommii with serum specimens from patients with PCR- and culture-confirmed infections with R. parkeri. Five immunoreactive proteins of R. amblyommii and nine immunoreactive proteins of R. parkeri were identified by matrix-assisted laser desorption ionization tandem time-of-flight mass spectrometry. Four of these, including the outer membrane protein (Omp) A, OmpB, translation initiation factor IF-2, and cell division protein FtsZ, were antigens common to both rickettsiae. Serum specimens from patients with R. parkeri rickettsiosis reacted specifically with cysteinyl-tRNA synthetase, DNA-directed RNA polymerase subunit alpha, putative sigma (54) modulation protein, chaperonin GroEL, and elongation factor Tu of R. parkeri which have been reported as virulence factors in other bacterial species. Unique antigens identified in this study may be useful for further development of the better serological assays for diagnosing infection caused by R. parkeri.
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Hagedorn P, Imhoff M, Fischer C, Domingo C, Niedrig M. Human granulocytic anaplasmosis acquired in Scotland, 2013. Emerg Infect Dis 2015; 20:1079-81. [PMID: 24857681 PMCID: PMC4036789 DOI: 10.3201/eid2006.131849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Seroepidemiologic study of human infections with spotted fever group Rickettsiae in North Carolina. J Clin Microbiol 2014; 52:3960-6. [PMID: 25187639 DOI: 10.1128/jcm.01733-14] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Increasing entomologic and epidemiologic evidence suggests that spotted fever group rickettsiae (SFGR) other than Rickettsia rickettsii are responsible for spotted fever rickettsioses in the United States. A retrospective seroepidemiologic study was conducted on stored acute- and convalescent-phase sera that had been submitted for Rocky Mountain spotted fever testing to the North Carolina State Laboratory of Public Health. We evaluated the serologic reactivity of the paired sera to R. rickettsii, Rickettsia parkeri, and Rickettsia amblyommii antigens. Of the 106 eligible pairs tested, 21 patients seroconverted to one or more antigens. Cross-reactivity to multiple antigens was observed in 10 patients, and seroconversions to single antigens occurred in 11 patients, including 1 against R. rickettsii, 4 against R. parkeri, and 6 against R. amblyommii. Cross-absorption of cross-reactive sera and/or Western blots identified two presumptive cases of infection with R. parkeri, two presumptive cases of infection with R. rickettsii, and one presumptive case of infection with R. amblyommii. These findings suggest that species of SFGR other than R. rickettsii are associated with illness among North Carolina residents and that serologic testing using R. rickettsii antigen may miss cases of spotted fever rickettsioses caused by other species of SFGR.
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Jin H, Wei F, Liu Q, Qian J. Epidemiology and Control of Human Granulocytic Anaplasmosis: A Systematic Review. Vector Borne Zoonotic Dis 2012; 12:269-74. [DOI: 10.1089/vbz.2011.0753] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hongtao Jin
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary, Academy of Military Medical Sciences, Changchun, Jilin Province, People's Republic of China
| | - Feng Wei
- College of Life Science, Jilin Agricultural University, Changchun, Jilin Province, People's Republic of China
| | - Quan Liu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary, Academy of Military Medical Sciences, Changchun, Jilin Province, People's Republic of China
| | - Jun Qian
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary, Academy of Military Medical Sciences, Changchun, Jilin Province, People's Republic of China
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Kasper MR, Blair PJ, Touch S, Sokhal B, Yasuda CY, Williams M, Richards AL, Burgess TH, Wierzba TF, Putnam SD. Infectious etiologies of acute febrile illness among patients seeking health care in south-central Cambodia. Am J Trop Med Hyg 2012; 86:246-253. [PMID: 22302857 PMCID: PMC3269275 DOI: 10.4269/ajtmh.2012.11-0409] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations.
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Affiliation(s)
- Matthew R. Kasper
- *Address correspondence to Matthew R. Kasper, Department of Bacteriology, U.S. Naval Medical Research Unit 6, Lima, Peru, Unit 3230, DPO, AA 34031. E-mail:
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Weil AA, Baron EL, Brown CM, Drapkin MS. Clinical findings and diagnosis in human granulocytic anaplasmosis: a case series from Massachusetts. Mayo Clin Proc 2012; 87:233-9. [PMID: 22386178 PMCID: PMC3498394 DOI: 10.1016/j.mayocp.2011.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/03/2011] [Accepted: 09/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe clinical findings and the use of a tick-associated pathogen panel in a series of patients with human granulocytic anaplasmosis (HGA) at a suburban Boston hospital. PATIENTS AND METHODS Medical records were reviewed for inpatients and outpatients at Newton-Wellesley Hospital with a positive polymerase chain reaction (PCR) result for Anaplasma phagocytophilum during the study period March 1 through November 30, 2009. A PCR panel was used to test for tick-borne pathogens. Postal ZIP code data from the patients' areas of residence were used to estimate the area of disease transmission. RESULTS Thirty-three cases were confirmed during the 2009 transmission season, and 14 of these patients (42%) required hospitalization. Thrombocytopenia and/or leukopenia were observed at the time of presentation in 25 of 30 patients (86%) in whom both white blood cell and platelet counts were determined, and 28 of 33 patients (85%) reported fever. Rash occurred in only 2 of the 33 patients (6%), and 25 (76%) reported one or more respiratory or gastrointestinal symptom. Cases were geographically distributed diffusely throughout the hospital catchment area, with one possible focus of infection identified in Weston, MA. Due to a lack of clinical data reporting to the Massachusetts Department of Public Health, only 20 of 32 HGA cases (63%) fulfilled the case confirmation criteria. CONCLUSION Diagnosis of HGA requires a high suspicion for infection even in endemic areas. Use of a tick-associated pathogen panel that includes PCR assays for several organisms could improve detection of underrecognized tick-borne diseases in endemic areas. Lack of epidemiological follow-up to confirm corroborating clinical findings prevents accurate case reporting and assessment of the true HGA burden.
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Affiliation(s)
- Ana A Weil
- Department of Medicine, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114, USA.
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Jiang J, Stromdahl EY, Richards AL. Detection of Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Gulf Coast ticks collected from humans in the United States. Vector Borne Zoonotic Dis 2011; 12:175-82. [PMID: 22022815 DOI: 10.1089/vbz.2011.0614] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rickettsia parkeri, a spotted fever group (SFG) rickettsia recently found to be pathogenic to humans, causes an eschar-associated febrile illness. The R. parkeri rickettsiosis, Tidewater spotted fever, has been misdiagnosed as Rocky Mountain spotted fever due to serologic cross reactivity and the lack of specific diagnostic methods. Candidatus Rickettsia andeanae, also a SFG rickettsia, is a recently described agent of unknown pathogenicity originally identified in ticks collected from domestic animals during a fever outbreak investigation in northern Peru. Among 37 Amblyomma maculatum (collected from humans (n=35) and questing (n=2)) obtained from the southern United States during 2000-2009, nine and four A. maculatum nucleic acid preparations were found positive for R. parkeri and Candidatus R. andeanae, respectively, by newly developed genus- and species-specific quantitative real-time polymerase chain reaction assays. In addition Rickettsia felis was found in two A. maculatum nucleic acid preparations.
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Affiliation(s)
- Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland, USA
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Openshaw JJ, Swerdlow DL, Krebs JW, Holman RC, Mandel E, Harvey A, Haberling D, Massung RF, McQuiston JH. Rocky mountain spotted fever in the United States, 2000-2007: interpreting contemporary increases in incidence. Am J Trop Med Hyg 2010; 83:174-82. [PMID: 20595498 PMCID: PMC2912596 DOI: 10.4269/ajtmh.2010.09-0752] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/15/2010] [Indexed: 11/07/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF), a potentially fatal tick-borne infection caused by Rickettsia rickettsii, is considered a notifiable condition in the United States. During 2000 to 2007, the annual reported incidence of RMSF increased from 1.7 to 7 cases per million persons from 2000 to 2007, the highest rate ever recorded. American Indians had a significantly higher incidence than other race groups. Children 5-9 years of age appeared at highest risk for fatal outcome. Enzyme-linked immunosorbent assays became more widely available beginning in 2004 and were used to diagnose 38% of cases during 2005-2007. The proportion of cases classified as confirmed RMSF decreased from 15% in 2000 to 4% in 2007. Concomitantly, case fatality decreased from 2.2% to 0.3%. The decreasing proportion of confirmed cases and cases with fatal outcome suggests that changes in diagnostic and surveillance practices may be influencing the observed increase in reported incidence rates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jennifer H. McQuiston
- Division of Viral and Rickettsial Diseases, National Center of Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jiang J, Yarina T, Miller MK, Stromdahl EY, Richards AL. Molecular Detection ofRickettsia amblyommiiinAmblyomma americanumParasitizing Humans. Vector Borne Zoonotic Dis 2010; 10:329-40. [DOI: 10.1089/vbz.2009.0061] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Tamasin Yarina
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Melissa K. Miller
- U.S. Center for Health Promotion and Preventive Medicine–North, Fort Meade, Maryland
| | - Ellen Y. Stromdahl
- U.S. Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Maryland
| | - Allen L. Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
As newly recognized rickettsial diseases and rickettsial pathogens increase in scope and magnitude, several elements related to the concept of emerging rickettsioses deserve consideration. Newly identified rickettsiae may be mildly pathogenic, or perhaps even nonpathogenic, and have little direct impact on human or animal health, yet nonetheless wield considerable influence on the epidemiology and ecology of historically recognized diseases. In this context "new" rickettsioses provide a lens through which "old" rickettsioses are more accurately represented. Predicting pathogen from nonpathogen is not an exact science, particularly as so few rickettsiae have been broadly accepted as nonpathogenic by contemporary rickettsiologists. However, various factors relating to specific physiologic requirements and molecular machinery of the particular rickettsia, as well as characteristics of its invertebrate host that either position or exclude the rickettsia from infecting a human host, must be considered. Close inspection of mild or atypical forms of historically recognized rickettsioses and a greater emphasis on culture- and molecular-based diagnostic techniques are the keys to identifying future rickettsial agents of disease.
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Affiliation(s)
- Christopher D Paddock
- Infectious Disease Pathology Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Paddock C, Finley R, Wright C, Robinson H, Schrodt B, Lane C, Ekenna O, Blass M, Tamminga C, Ohl C, McLellan S, Goddard J, Holman R, Openshaw J, Sumner J, Zaki S, Eremeeva M. Rickettsia parkeriRickettsiosis and Its Clinical Distinction from Rocky Mountain Spotted Fever. Clin Infect Dis 2008; 47:1188-96. [DOI: 10.1086/592254] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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