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Zorilla R, Ching LL, Elisara T, Kramer K, Nerurkar VR. Re-Emerging, Under-Recognized Zoonotic, and Neglected Tropical Diseases in Hawai'i. Jpn J Infect Dis 2024; 77:187-200. [PMID: 38825457 DOI: 10.7883/yoken.jjid.2023.476] [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] [Indexed: 06/04/2024]
Abstract
Hawai'i, the United States' most western geographic state in the Pacific, lies between the North and South American continents and the Indo-Pacific regions, including Japan. The tropical environmental conditions of the Hawaiian Islands provide favorable ecosystems for various infectious pathogens, their vectors, and reservoirs. This creates an environment conducive to the transmission of zoonotic diseases affecting both humans and animals. Hawai'i has experienced an increase in dengue, leptospirosis, and murine typhus outbreaks. Furthermore, toxoplasmosis and neuroangiostrongyliasis cases remain prevalent throughout the state, and the putative presence of autochthonous Zika cases identified in a retrospective study may be of national public health concern. Understanding the factors that affect the transmission and distribution of zoonoses is necessary to identify at-risk locations and populations. The One Health approach seeks to understand, report, and interpret these factors and requires collaboration between private and governmental institutions. One Health should focus on neglected tropical diseases (NTD) and prioritize development of interventions to control and prevent the transmission of diseases that spread between animals and humans. This review focuses on the epidemiological and clinical characteristics of under-recognized zoonotic and NTD affecting Hawai'i, including leptospirosis, murine typhus, neuroangiostrongyliasis, toxoplasmosis, dengue, and Zika.
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Affiliation(s)
- Rodson Zorilla
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Pacific Center for Emerging Infectious Diseases, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Minority Health Research Training Program, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
| | - Lauren Lei Ching
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Pacific Center for Emerging Infectious Diseases, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
| | - Tiana Elisara
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Pacific Center for Emerging Infectious Diseases, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Minority Health Research Training Program, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
| | - Kenton Kramer
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
| | - Vivek Ramchandra Nerurkar
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Pacific Center for Emerging Infectious Diseases, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
- Minority Health Research Training Program, John A Burns School of Medicine, University of Hawai'i at Mānoa, USA
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Rattanakomol P, Khongwichit S, Poovorawan Y. Flea-Borne Rickettsioses and Scrub Typhus in Patients with Suspected Arbovirus Infection in Bangkok, Thailand. Vector Borne Zoonotic Dis 2024. [PMID: 38946645 DOI: 10.1089/vbz.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: In urban Thailand, arboviral infections dominate diagnoses of acute undifferentiated fevers (AUFs) owing to their well-defined epidemiology and characteristic clinical presentations. However, rickettsial diseases, also endemic in this setting, remain under-recognized owing to challenges in early detection. Objective: This study aimed to identify potential rickettsial infections among patients with AUF in Bangkok and vicinity utilizing leftover nucleic acid extracted from serum samples from patients initially suspected of but negative for arbovirus infections. Materials and Methods: A total of 609 nucleic acid samples were screened for rickettsial bacteria using real-time PCR, targeting the 17-kDa common antigen gene of Rickettsia spp. and the 47-kDa gene of Orientia tsutsugamushi. Results: Nine samples were positive for Rickettsia spp. and two were positive for O. tsutsugamushi. DNA sequence and phylogenetic analyses based on partial 17-kDa antigen and citrate synthase (gltA) genes identified the Rickettsia-positive samples as R. typhi in eight cases and R. felis in one case. Analysis of the 56-kDa type-specific antigen gene identified the two O. tsutsugamushi isolates as Gilliam-related genotypes. Although rickettsial diseases typically present with mild symptoms, two patients with R. typhi infection (murine typhus) developed respiratory distress syndrome, highlighting the potential for rare but serious complications. Conclusion: This study underscores the critical importance of differential diagnosis and prompt, effective intervention to prevent complications in suspected cases.
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Affiliation(s)
- Patthaya Rattanakomol
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarawut Khongwichit
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Insyari’ati T, Hamid PH, Rahayu ET, Sugar DL, Rahma NN, Kusumarini S, Kurnianto H, Wardhana AH. Ectoparasites Infestation to Small Ruminants and Practical Attitudes among Farmers toward Acaricides Treatment in Central Region of Java, Indonesia. Vet Sci 2024; 11:162. [PMID: 38668429 PMCID: PMC11053668 DOI: 10.3390/vetsci11040162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/29/2024] Open
Abstract
Ectoparasite infestations are one of the major problems affecting goat and sheep farming. Disease resulting from these infestations can cause changes in physical appearance, such as severe lesions on the skin, and economic consequences in the form of significantly reduced selling prices. This study aimed to determine the prevalence of ectoparasites in the Boyolali district, Central Java, Indonesia. A total of 651 sheep and goats were surveyed in this study. The parasites were collected via skin scraping, twister, or manually from clinically infected goats and sheep in traditional farms. All of the ectoparasites collected were successfully identified. The prevalence of ectoparasites in ruminants in Boyolali was 97.8% (637/651). The species make-up was as follows: Bovicola caprae 97.8% (637/651), Linognathus africanus 39% (254/651), Haemaphysalis bispinosa 3.5% (23/651), Ctenocephalides spp. 0.2% (1/651), and Sarcoptes scabiei 5.2% (34/651). The predilection sites were in the face, ear, and leg areas, and in the axillary, dorsal, abdomen, and scrotum regions of the surveyed animals. An evaluation of farmers' attitudes to ectoparasites was performed using a questionnaire. The findings of this study imply that animals in the investigated area are highly exposed to ectoparasite infestations. Given the importance of ectoparasites in both livestock and human communities, specifically in the health domain, more research into appropriate control strategies is necessary.
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Affiliation(s)
- Titis Insyari’ati
- Department of Animal Science, Sebelas Maret University, Kota Surakarta 57126, Indonesia; (T.I.); (E.T.R.); (D.L.S.); (N.N.R.)
| | - Penny Humaidah Hamid
- Department of Animal Science, Sebelas Maret University, Kota Surakarta 57126, Indonesia; (T.I.); (E.T.R.); (D.L.S.); (N.N.R.)
| | - Endang Tri Rahayu
- Department of Animal Science, Sebelas Maret University, Kota Surakarta 57126, Indonesia; (T.I.); (E.T.R.); (D.L.S.); (N.N.R.)
| | - Diah Lutfiah Sugar
- Department of Animal Science, Sebelas Maret University, Kota Surakarta 57126, Indonesia; (T.I.); (E.T.R.); (D.L.S.); (N.N.R.)
| | - Nadya Nurvita Rahma
- Department of Animal Science, Sebelas Maret University, Kota Surakarta 57126, Indonesia; (T.I.); (E.T.R.); (D.L.S.); (N.N.R.)
| | - Shelly Kusumarini
- Department of Parasitology, Faculty of Veterinary Medicine, Brawijaya University, Kota Malang 65151, Indonesia;
| | - Heri Kurnianto
- National Research and Innovation Agency, Bogor 16122, Indonesia; (H.K.); (A.H.W.)
| | - April Hari Wardhana
- National Research and Innovation Agency, Bogor 16122, Indonesia; (H.K.); (A.H.W.)
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Varadarajan R, Patel AP, Rashidi K, Oh A, Rahman R, Neal R. Flea-Borne Typhus Presenting with Acalculous Cholecystitis and Severe Anemia. Case Rep Infect Dis 2023; 2023:5510295. [PMID: 37954983 PMCID: PMC10637845 DOI: 10.1155/2023/5510295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
Background Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion Albeit uncommon, the presentation of this patient's symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high.
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Affiliation(s)
- Ramya Varadarajan
- Texas A&M College of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ashmi P. Patel
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Keyvon Rashidi
- Texas A&M College of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Albert Oh
- Texas A&M College of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rashmeen Rahman
- Department of Endocrinology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ryan Neal
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
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5
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Blanton LS. Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae. Infect Dis Rep 2023; 15:700-716. [PMID: 37987401 PMCID: PMC10660532 DOI: 10.3390/idr15060063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
Murine typhus is an acute febrile illness caused by Rickettsia typhi, an obligately intracellular Gram-negative coccobacillus. Rats (Rattus species) and their fleas (Xenopsylla cheopis) serve as the reservoir and vector of R. typhi, respectively. Humans become infected when R. typhi-infected flea feces are rubbed into flea bite wounds or onto mucous membranes. The disease is endemic throughout much of the world, especially in tropical and subtropical seaboard regions where rats are common. Murine typhus is reemerging as an important cause of febrile illness in Texas and Southern California, where an alternate transmission cycle likely involves opossums (Didelphis virginiana) and cat fleas (Ctenocephalides felis). Although primarily an undifferentiated febrile illness, a range of neurologic manifestations may occur, especially when treatment is delayed. Serology is the mainstay of diagnostic testing, but confirmation usually requires demonstrating seroconversion or a fourfold increase in antibody titer from acute- and convalescent-phase sera (antibodies are seldom detectable in the first week of illness). Thus, early empiric treatment with doxycycline, the drug of choice, is imperative. The purpose of this review is to highlight murine typhus as an important emerging and reemerging infectious disease, review its neurologic manifestations, and discuss areas in need of further study.
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Affiliation(s)
- Lucas S Blanton
- Department Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA
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Deng YP, Fu YT, Yao C, Shao R, Zhang XL, Duan DY, Liu GH. Emerging bacterial infectious diseases/pathogens vectored by human lice. Travel Med Infect Dis 2023; 55:102630. [PMID: 37567429 DOI: 10.1016/j.tmaid.2023.102630] [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: 05/12/2023] [Revised: 07/02/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
Human lice have always been a major public health concern due to their vector capacity for louse-borne infectious diseases, like trench fever, louse-borne relapsing fever, and epidemic fever, which are caused by Bartonella quintana, Borrelia recurrentis, and Rickettsia prowazekii, respectively. Those diseases are currently re-emerging in the regions of poor hygiene, social poverty, or wars with life-threatening consequences. These louse-borne diseases have also caused outbreaks among populations in jails and refugee camps. In addition, antibodies and DNAs to those pathogens have been steadily detected in homeless populations. Importantly, more bacterial pathogens have been detected in human lice, and some have been transmitted by human lice in laboratories. Here, we provide a comprehensive review and update on louse-borne infectious diseases/bacterial pathogens.
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Affiliation(s)
- Yuan-Ping Deng
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - Yi-Tian Fu
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China; Department of Parasitology, Xiangya School of Basic Medicine, Central South University, Changsha, Hunan, China
| | - Chaoqun Yao
- Department of Biomedical Sciences and One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis.
| | - Renfu Shao
- Centre for Bioinnovation, School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
| | - Xue-Ling Zhang
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - De-Yong Duan
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China
| | - Guo-Hua Liu
- Research Center for Parasites & Vectors, College of Veterinary Medicine, Hunan Agricultural University, Changsha, Hunan, China.
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Alarcón J, Sanosyan A, Contreras ZA, Ngo VP, Carpenter A, Hacker JK, Probert WS, Terashita D, Balter S, Halai UA. Fleaborne Typhus-Associated Deaths - Los Angeles County, California, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:838-843. [PMID: 37535465 PMCID: PMC10414999 DOI: 10.15585/mmwr.mm7231a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June-October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus-associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyperactivation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts.
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Riswari SF, Prodjosoewojo S, Mony SR, Megantara I, Iskandar S, Mayasari W, Heryaman H, de Mast Q, van der Ven A, Kosasih H, Alisjahbana B. Murine typhus is a common cause of acute febrile illness in Bandung, Indonesia. PLoS One 2023; 18:e0283135. [PMID: 37418452 PMCID: PMC10328256 DOI: 10.1371/journal.pone.0283135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/02/2023] [Indexed: 07/09/2023] Open
Abstract
Murine typhus (MT), an infection caused by the gram-negative bacteria Rickettsia typhi (R. typhi), is a significant cause of acute febrile illness (AFI) in Southeast Asia but is rarely reported in Indonesia. The current study aimed to describe the clinical characteristics of MT cases in Bandung, West Java. Non-confirmed AFI cases (n = 176) from a prospective cohort study of whom paired serum samples (acute (T1), midterm (T2), or convalescent (T3)) were available were screened using MT serology. IgG against R. typhi was detected in the T2 or T3 samples using an in-house ELISA. Positive IgG samples were further screened for the presence of IgM. If both IgM and IgG were positive, the endpoint titer of T1, T2, or T3 was determined. In cases with a fourfold increase in titer, real-time PCR of T1 samples was performed to detect R. typhi DNA. In total, 71/176 (40.3%) patients tested positive for IgG antibody, and 26 AFI cases were confirmed as MT (23 cases by PCR, 3 cases by fourfold titer increased IgG or IgM titer). The most common clinical symptoms in the confirmed cases were headache (80%), arthralgia (73%), malaise (69%), and myalgia (54%). In these cases, the presumptive clinical diagnoses were typhoid fever (43.2%), dengue (38.5%), and leptospirosis (19.2%). MT was not considered in any of the patients, and no patients received doxycycline. These findings confirmed that MT is an important cause of AFI in Indonesia. MT should be included in the differential diagnosis of AFI, and empirical treatment with doxycycline should be considered.
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Affiliation(s)
- Silvita Fitri Riswari
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susantina Prodjosoewojo
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Siti Rasnawati Mony
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
| | - Imam Megantara
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
| | - Shelly Iskandar
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Psychiatry, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Wulan Mayasari
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Henhen Heryaman
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Quirijn de Mast
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andre van der Ven
- Department of Internal Medicine and the Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
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9
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Aita T, Sando E, Katoh S, Hamaguchi S, Fujita H, Kurita N. Nonnegligible Seroprevalence and Predictors of Murine Typhus, Japan. Emerg Infect Dis 2023; 29:1438-1442. [PMID: 37347821 PMCID: PMC10310371 DOI: 10.3201/eid2907.230037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
To elucidate the epidemiology of murine typhus, which is infrequently reported in Japan, we conducted a cross-sectional study involving 2,382 residents of rickettsiosis-endemic areas in Honshu Island during August-November 2020. Rickettsia typhi seroprevalence rate was higher than that of Orientia tsutsugamushi, indicating that murine typhus is a neglected disease.
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Qian P, He X, Yang M, Wei L, Zhang L, Xing X. Detection of Severe Murine Typhus by Nanopore Targeted Sequencing, China. Emerg Infect Dis 2023; 29:1275-1277. [PMID: 37209688 DOI: 10.3201/eid2906.221929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
We report a case of murine typhus in China caused by Rickettsia typhi and diagnosed by nanopore targeted sequencing of a bronchoalveolar lavage fluid sample. This case highlights that nanopore targeted sequencing can effectively detect clinically unexplained infections and be especially useful for detecting infections in patients without typical signs and symptoms.
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Warrell CE, Osborne J, Mrcp LN, Gibney B, Carter DP, Warner J, Houlihan CF, Brooks TJG, Rampling T. Imported Rickettsial Infections to the United Kingdom, 2015-2020. J Infect 2023; 86:446-452. [PMID: 36948252 DOI: 10.1016/j.jinf.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The burden of imported rickettsial infection in the UK is not previously described. This retrospective review identifies rickettsial cases diagnosed at the national reference laboratory between 2015-2022. METHODS Samples testing positive for spotted fever group, typhus group and scrub typhus IgG/IgM on acute and convalescent blood samples, and/or PCR on tissue/blood were categorised as suspected, confirmed or past infection. RESULTS 220 patients had rickettsioses, the commonest import was acute spotted fever group infection (61%, 125/205), 54% (62/114) from South Africa. Acute typhus group cases, 60% (40/67) from Southeast Asia. One patient with Rickettsia typhi bacteremia died. Scrub typhus group infections (5%, 10/205) were exclusively from Asia and the Western Pacific regions. Overall, 43% of confirmed cases (39/91) had not received doxycycline prior to results. CONCLUSIONS Rickettsial infections are important and under-recognised causes of imported fever in the UK. Thorough history, examination and timely treatment with doxycycline should be considered if there is suspicion of Rickettsia infection before testing.
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Affiliation(s)
- Clare E Warrell
- Rare and Imported Pathogens Laboratory, Salisbury, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Jane Osborne
- Rare and Imported Pathogens Laboratory, Salisbury, UK
| | | | - Barry Gibney
- Rare and Imported Pathogens Laboratory, Salisbury, UK
| | | | | | - Catherine F Houlihan
- Rare and Imported Pathogens Laboratory, Salisbury, UK; Hospital for Tropical Diseaess, London, UCLH, UK; Department of Clinical Virology UCLH, UK; Infection and Immunity, University College London, United Kingdom
| | | | - Tommy Rampling
- Rare and Imported Pathogens Laboratory, Salisbury, UK; Hospital for Tropical Diseaess, London, UCLH, UK; Infection and Immunity, University College London, United Kingdom
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12
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Blanton LS, Caravedo Martinez MA, Mendell N, Villasante-Tezanos A, Walker DH, Bouyer D. Increased Seroprevalence of Typhus Group Rickettsiosis, Galveston County, Texas, USA. Emerg Infect Dis 2023; 29:212-214. [PMID: 36573645 PMCID: PMC9796186 DOI: 10.3201/eid2901.221206] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Whether increases in typhus group rickettsiosis in Galveston County, Texas, USA, are caused by increased recognition or true reemergence is unclear. We conducted a serosurvey that demonstrated Rickettsia typhi antibodies increased from 1.2% in 2013 to 7.8% in 2021 (p<0.001). These findings support pathogen reemergence rather than enhanced recognition alone.
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13
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Chen K, Ponnusamy L, Mouhamadou CS, Fodjo BK, Sadia GC, Affoue FPK, Deguenon JM, Roe RM. Internal and external microbiota of home-caught Anopheles coluzzii (Diptera: Culicidae) from Côte d'Ivoire, Africa: Mosquitoes are filthy. PLoS One 2022; 17:e0278912. [PMID: 36520830 PMCID: PMC9754230 DOI: 10.1371/journal.pone.0278912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Over the past 10 years, studies using high-throughput 16S rRNA gene sequencing have shown that mosquitoes harbor diverse bacterial communities in their digestive system. However, no previous research has examined the total bacteria community inside versus outside of mosquitoes and whether bacteria found on the outside could represent a potential health threat through mechanical transfer. We examined the bacterial community of the external surface and internal body of female Anopheles coluzzii adults collected from homes in Côte d'Ivoire, Africa, by Illumina sequencing of the V3 to V4 region of 16S rRNA gene. Anopheles coluzzii is in the Anopheles gambiae sensu lato (s.l.) species complex and important in the transmission of malaria. The total 16S rRNA reads were assigned to 34 phyla, 73 orders, 325 families, and 700 genera. At the genus level, the most abundant genera inside and outside combined were Bacillus, Staphylococcus, Enterobacter, Corynebacterium, Kocuria, Providencia, and Sphingomonas. Mosquitoes had a greater diversity of bacterial taxa internally compared to the outside. The internal bacterial communities were similar between homes, while the external body samples were significantly different between homes. The bacteria on the external body were associated with plants, human and animal skin, and human and animal infections. Internally, Rickettsia bellii and Rickettsia typhi were found, potentially of importance, since this genus is associated with human diseases. Based on these findings, further research is warranted to assess the potential mechanical transmission of bacteria by mosquitoes moving into homes and the importance of the internal mosquito microbiota in human health.
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Affiliation(s)
- Kaiying Chen
- Department of Entomology and Plant Pathology, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC, United States of America
- State Key Laboratory for Biology of Plant Diseases and Insect Pests, Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Loganathan Ponnusamy
- Department of Entomology and Plant Pathology, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC, United States of America
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
- * E-mail: (LP); (RMR)
| | - Chouaïbou S. Mouhamadou
- Department of Entomology and Plant Pathology, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC, United States of America
| | - Behi Kouadio Fodjo
- Centre Suisse de Recherches Scientifiques, Abidjan, Cote d’Ivoire, Africa
| | | | | | - Jean M. Deguenon
- Department of Entomology and Plant Pathology, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC, United States of America
| | - R. Michael Roe
- Department of Entomology and Plant Pathology, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC, United States of America
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
- * E-mail: (LP); (RMR)
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14
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Epidemiological Study of the Occurrence of Typhus Group Rickettsia Natural Infection in Domiciliated Dogs from a Rural Community in South-Eastern Mexico. Animals (Basel) 2022; 12:ani12202885. [PMID: 36290270 PMCID: PMC9598504 DOI: 10.3390/ani12202885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Rickettsioses are relevant emergent and reemergent zoonoses in the Americas, including Mexico. Murine typhus caused by typhus group (TG) Rickettsia is prevalent in humans and their companion animals, such as dogs. This study found that 23.9% of the dogs (34/142) were infected by TG Rickettsia in Maxcanú, Yucatan (southeastern Mexico). Statistical analyses showed that reduced outdoor activities, age, sex and previous antiparasitic treatment are associated factors with less risk of TG Rickettsia infection in the sampled dogs. Monitoring and controlling these factors could help to restrict the enzootic transmission risk and prevent the potential zoonotic transmission. Abstract The aim is to describe the Typhus group (TG) Rickettsia infection in dogs and to identify factors associated with this infection. We collected blood samples and gathered exposure and clinical data of 142 dogs from a rural community of Yucatan. The Rickettsia group was determined by semi-nested PCR. Generalized linear models with binomial error distribution were used to model the associated factors from the dog sample for risk ratio (RR) estimation. Thirty-four dogs (23.9%) showed molecular evidence of TG Rickettsia DNA. The multivariate model showed that mixed-breed dogs (RR = 0.06) and dogs that had received antiparasitic treatment (RR = 0.049) had a lower risk of getting infected, taking as reference the purebred group and the non-treated dogs, respectively. Looking at variable interactions, adult dogs without outdoor activities had a lower infection risk than puppies (RR = 0.26). Among dogs with antiparasitic treatment, females had a higher infection risk than male dogs (RR = 26.2). The results showed enzootic TG Rickettsia circulation in dogs of a rural community. The factors outdoor activities, age and previous antiparasitic treatment, as well as the clinical variables signs of hemorrhages and epistaxis, were associated with a less chance of natural infection in the studied dogs. Prevention and control of the enzootic transmission risk of TG Rickettsia should help to reduce the potential zoonotic transmission of this pathogen.
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15
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Murine Typhus-Induced Myocarditis. Am J Med 2022; 135:e397-e398. [PMID: 35576998 DOI: 10.1016/j.amjmed.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
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16
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Juhasz NB, Wilson JM, Haney KN, Clark MH, Davenport AC, Breitschwerdt EB, Qurollo BA. Rickettsia typhi infection in a clinically-ill dog from Houston, Texas. Vet Parasitol Reg Stud Reports 2022; 35:100781. [PMID: 36184113 DOI: 10.1016/j.vprsr.2022.100781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/26/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
In 2020, Rickettsia typhi was diagnosed in a dog from Houston, Texas, USA based upon R. typhi IFA seroreactivity in both acute and convalescent sera, and PCR with DNA sequencing of 4 different gene regions, all of which were 100% identical to R. typhi. The dog was clinically ill with intermittent fever, lethargy, inappetence, and lymphadenopathy. Clinicopathological abnormalities included a mild nonregenerative anemia, neutrophilia, lymphopenia, thrombocytopenia, hypoalbuminemia, and elevated ALP. The dog rapidly recovered with doxycycline administration.
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Affiliation(s)
- Nicholas B Juhasz
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Dr., Raleigh, NC 27607, USA
| | - James M Wilson
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Dr., Raleigh, NC 27607, USA
| | - Kaitlin N Haney
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Dr., Raleigh, NC 27607, USA
| | - Melissa H Clark
- Gulf Coast Veterinary Specialists, 8042 Katy Fwy, Houston, TX 77024, USA
| | - Amy C Davenport
- Gulf Coast Veterinary Specialists, 8042 Katy Fwy, Houston, TX 77024, USA
| | - Edward B Breitschwerdt
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Dr., Raleigh, NC 27607, USA
| | - Barbara A Qurollo
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Dr., Raleigh, NC 27607, USA.
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17
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Dzul-Rosado K, Cámara Herrera R, Miranda-Schaeubinger M, Arias-León J, Peniche-Lara G, Gilman Robert H, Mercado-Saavedra Brandon N, Lugo-Caballero C, López Ávila K, Tello Martín R, Omodior O. Socio-ecological determinants of rickettsial seroprevalence in a rural community of Yucatán, Mexico. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 102:105291. [PMID: 35490957 DOI: 10.1016/j.meegid.2022.105291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
Rickettsial diseases have seen a re-emergence in the Americas in the last few decades, with concerning morbidity, mortality and economic implications that result from loss of productivity, income, curbs in liberal trade agreements, and reduction in agricultural practices. The aim of this study is to determine the socioecological determinants and seroprevalence for Rickettsia typhi and Rickettsia rickettsii among residents of Teabo, a rural community of Yucatán, Mexico. Sociodemographic data and serum samples were obtained from 180 consenting participants. Antibody titers for R. typhi and R. rickettsii were determined by indirect immunofluorescence assay (IFA). Participants also submitted tick samples collected from their residential area. We conducted logistic regression models to evaluate the association between exposure variables and seroprevalence. Rhipicephalus sanguineus s.l. (37%; n = 65), and Amblyomma cajennense Fabricius (17%; n = 29) were the predominant tick species in peri-domestic areas. Out of the 180 participants, there was significantly higher seroprevalence of R. typhi (n = 77; 46%) compared to R. rickettsii [n = 27, 15%, (p < 0.05)]. Pearson's chi-square test of independence revealed significant differences in R. rickettsii seroprevalence by gender (X2 [n = 175, df = 4, (p < 0.001)] = 180.26), level of education, (X2 [n = 180, df = 4, (p < 0.001)] = 44.0), and by tick species found in residential area, (X2 [n = 180, df = 4, (p = 0.050)] = 9.48). After adjusting for other variables in a logistic regression model, for each unit increase in the number of dogs present in the residential area, there was a 27% increase in the odds of human seroprevalence for R. typhi IgG (AOR = 1.27, 95% CI: 1.01-1.63). Compared to study participants living in residential areas with a 'low' height of vegetation, those living in residential areas with a 'medium' height of vegetation had 2.5 times greater odds of human seroprevalence for R. typhi IgG (AOR = 2.51, 95% CI: 1.19-5.40). Potentially modifiable existing factors in the peri-domestic area may constitute a high-risk source of seroprevalence for rickettsial antibodies among residents of the rural community of Teabo, Yucatán, Mexico.
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Affiliation(s)
- K Dzul-Rosado
- Center for Regional Studies Hideyo Noguchi, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - R Cámara Herrera
- Center for Regional Studies Hideyo Noguchi, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - M Miranda-Schaeubinger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Arias-León
- Faculty of Medicine, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - G Peniche-Lara
- Faculty of Medicine, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - H Gilman Robert
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - C Lugo-Caballero
- Center for Regional Studies Hideyo Noguchi, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - K López Ávila
- Center for Regional Studies Hideyo Noguchi, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - R Tello Martín
- Center for Regional Studies Hideyo Noguchi, Autonomous University of Yucatán, Mérida 97000, Yucatán, Mexico
| | - Oghenekaro Omodior
- Department of Health & Wellness Design, School of Public Health Indiana University Bloomington, USA.
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18
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Kato CY, Chung IH, Robinson LK, Eremeeva ME, Dasch GA. Genetic typing of isolates of Rickettsia typhi. PLoS Negl Trop Dis 2022; 16:e0010354. [PMID: 35639778 PMCID: PMC9203007 DOI: 10.1371/journal.pntd.0010354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/16/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Murine typhus, which is caused by Rickettsia typhi, has a wide range of clinical manifestations. It has a low mortality rate but may result in meningoencephalitis and interstitial pneumonia in severe cases. Comparisons of complete genome sequences of R. typhi isolates from North Carolina, USA (Wilmington), Myanmar (B9991PP), and Thailand (TH1527) identified only 26 single nucleotide polymorphism (SNP) and 7 insertion-deletion (INDEL) sites in these highly syntenic genomes. Assays were developed to further define the distribution of these variant sites among 15 additional isolates of R. typhi with different histories from Asia, the USA, and Africa. Mismatch amplification mutation assays (MAMA) were validated for 22 SNP sites, while the 7 INDEL sites were analyzed directly on agarose gels. Six SNP types, 9 INDEL types, 11 total types were identified among these 18 isolates. Replicate DNA samples as well as comparisons of isolates with different passage and source histories gave consistent genetic typing profiles. Comparison of the SNP and INDEL markers to R. typhi’s nearest neighbor Rickettsia prowazekii demonstrated that the majority of the SNPs represent intra-species variation that arose post divergence of these two species while several INDEL sites also exhibited intraspecies variability among the R. prowazekii genomes that have been completely sequenced. The assays for the presence of these SNP and INDEL sites, particularly the latter, comprise a low technology gel method for consistently distinguishing R. typhi and R. prowazekii as well as for differentiating genetic types of R. typhi. Rickettsia typhi is an obligately intracellular bacterium which is most commonly transmitted by rat fleas to humans and can cause the disease murine (endemic) typhus wherever both humans and infected rats are present. However, this agent is also present in a variety of other arthropod species associated with other vertebrate animals. Its closest relative is Rickettsia prowazekii, the etiologic agent of epidemic typhus (human louse-borne) and sylvatic typhus (associated with flying squirrels and its ectoparasites in the Eastern United States). Both classic louse-borne and flea-borne typhus rickettsiae can cause fatal infections and have the potential for use as biothreat agents as they can be grown in large quantities. We investigated the genetic differences that can be found in different stocks of R. typhi. Our work is important for two reasons. We have developed robust and sensitive methods for distinguishing isolates of R. typhi originating from different continents; these new assays require only simple instrumentation which is available in nearly all biology laboratories. Our results also provided new insights confirming the probable origin of R. typhi in Asia and its likely cosmopolitan spread by rats on ships around the world.
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Affiliation(s)
- Cecilia Y. Kato
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Ida H. Chung
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Lauren K. Robinson
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Marina E. Eremeeva
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Gregory A. Dasch
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
- * E-mail:
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19
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Chiang PS, Su SW, Yang SL, Shu PY, Lee WP, Li SY, Teng HJ. Delayed correlation between the incidence rate of indigenous murine typhus in humans and the seropositive rate of Rickettsia typhi infection in small mammals in Taiwan from 2007–2019. PLoS Negl Trop Dis 2022; 16:e0010394. [PMID: 35468137 PMCID: PMC9071160 DOI: 10.1371/journal.pntd.0010394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/05/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022] Open
Abstract
Murine typhus is a flea-borne zoonotic disease with acute febrile illness caused by Rickettsia typhi and is distributed widely throughout the world, particularly in port cities and coastal regions. We observed that murine typhus was an endemic disease (number of annual indigenous cases = 29.23±8.76) with a low incidence rate (0.13±2.03*10−4 per 100,000 person-years) in Taiwan from 2007–2019. Most (45.79%, 174/380) indigenous infections were reported in May, June, and July. The incidence rates in both May and June were statistically higher than those in other months (p<0.05). Correspondingly, sera collected from small mammals (rodents and shrews) trapped in airports and harbors demonstrated anti-R. typhi antibody responses (seropositive rate = 8.24±0.33%). Interestingly, the ports with the highest seropositivity rates in small mammals are all inside/near the areas with the highest incidence rates of indigenous murine typhus. In addition, incidence rates in humans were positively correlated with the 1-month and 2-month prior seropositive rates in small mammals (R = 0.31 and 0.37, respectively). As early treatment with appropriate antibiotics for murine typhus could effectively shorten the duration of illness and reduce the risk of hospitalization and fatality, flea-related exposure experience should be considered in clinics during peak seasons and the months after a rise in seropositivity rates in small mammals. Surveillance in small mammals might be helpful for the development of real-time reporting or even early reminders for physicians of sporadic murine typhus cases based on the delayed correlation observed in this study. Murine typhus is a flea-borne zoonotic disease with acute febrile illness caused by Rickettsia typhi and is distributed widely throughout the world, particularly in port cities and coastal regions. Early treatment with appropriate antibiotics for murine typhus could effectively shorten the duration of illness and reduce the risk of hospitalization and fatality. However, it presents with nonspecific symptoms and is oftentimes misdiagnosed. In Taiwan, murine typhus has been designated a notifiable disease since 2007. Meanwhile, surveillance of R. typhi infection of small mammals was also launched at 25 international airports and harbors. Since then, we observed that indigenous murine typhus patients have been detected in Taiwan annually and sera collected from small mammals trapped in ports also demonstrated anti-R. typhi antibody responses. Correspondingly, the ports with the highest seropositivity are all inside/near the areas with the highest incidence rate of indigenous murine typhus in Taiwan. We further found that incidence rates in humans were positively correlated with the 1-month and 2-month prior seropositive rates in small mammals. Surveillance in small mammals might be helpful for the development of real-time reporting or even early reminders of sporadic murine typhus cases based on the delayed correlation observed in this study.
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Affiliation(s)
- Pai-Shan Chiang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shin-Wei Su
- Division of Quarantine, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Su-Lin Yang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Wang-Ping Lee
- Division of Quarantine, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Ying Li
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Hwa-Jen Teng
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- * E-mail:
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20
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Ngamprasertchai T, Hanboonkunupakarn B, Piyaphanee W. Rickettsiosis in Southeast Asia: Summary for International Travellers during the COVID-19 Pandemic. Trop Med Infect Dis 2022; 7:tropicalmed7020018. [PMID: 35202213 PMCID: PMC8879928 DOI: 10.3390/tropicalmed7020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Rickettsiosis is an important cause of febrile illness among travellers visiting Southeast Asia (SEA). The true incidence of rickettsiosis is underestimated; however, murine typhus and scrub typhus are widely distributed across SEA. Among travellers visiting SEA, scrub typhus was mostly reported from Thailand, whereas murine typhus was frequently found in Indonesia. Although most cases are self-limited or present with mild symptoms, a few cases with severe clinical manifestations have been reported. Doxycycline remains the key treatment of rickettsiosis. Some travellers, such as backpackers, trekkers, or cave explorers, are at a higher risk for rickettsiosis than others. Therefore, in resource-limited conditions, empirical treatment should be considered in these travellers. The coronavirus disease 2019 (COVID-19) pandemic has contributed to difficulty in the diagnosis of rickettsiosis because of the clinical similarities between these diseases. In addition, physical distancing mandated by COVID-19 management guidelines limits accurate physical examination, resulting in misdiagnosis and delayed treatment of rickettsiosis. This review summarises the characteristics of murine typhus and scrub typhus, describes travel-associated rickettsiosis, and discusses the impact of the COVID-19 pandemic on rickettsiosis.
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21
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Xia J, Shrestha S, Saca JC. Murine Typhus Presenting as Septic Acute Cholangitis in a Young Woman From South Texas. Cureus 2021; 13:e19209. [PMID: 34873539 PMCID: PMC8638779 DOI: 10.7759/cureus.19209] [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] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Murine (endemic) typhus is a zoonotic disease spread by fleas carrying Rickettsia typhi bacteria. Typically, murine typhus presents with mild and nonspecific flu-like symptoms. However, it can manifest with severe systemic complications potentially leading to delayed treatment or unnecessary interventions. We present the case of a young woman from South Texas who presented to the emergency department after 10 days of fever, myalgia, headache, nausea, and right-sided abdominal pain. She was found to be febrile, severely hypotensive, suffering from acute liver injury with a predominantly cholestatic pattern, acute kidney injury, severe thrombocytopenia, and hyponatremia. She was initially managed with broad-spectrum antibiotics for undifferentiated septic shock, and doxycycline was added due to suspicion of a Rickettsial infection. Although radiographic findings showed some evidence of biliary involvement, they were not typical for common biliary diseases. However, due to her severe clinical presentation and findings suggesting possible acute cholangitis, she underwent an endoscopic ultrasound with endoscopic retrograde cholangiopancreatography, which revealed no evidence of acute obstructive biliary disease. Without strong evidence to explain her presentation, an extensive chronic liver disease workup was done, which was negative. The patient ultimately clinically improved with antibiotics alone. This case demonstrates an atypical presentation of murine typhus, presenting with septic shock and masquerading as acute cholangitis. With the rising incidence of murine typhus in endemic areas of the United States, this case reinforces the importance of being cognizant of the typical and atypical presentations of murine typhus, which may allow for early appropriate treatment and potentially avoid unnecessary interventions. Additionally, in this study, we conducted a literature review of murine typhus cases associated with acute biliary dysfunction.
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Affiliation(s)
- Jeffrey Xia
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Sabi Shrestha
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James C Saca
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
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22
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Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar. Pathogens 2021; 10:pathogens10111482. [PMID: 34832637 PMCID: PMC8621948 DOI: 10.3390/pathogens10111482] [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: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Rickettsiae may cause febrile infections in humans in tropical and subtropical regions. From Madagascar, no molecular data on the role of rickettsioses in febrile patients are available. Blood samples from patients presenting with fever in the area of the capital Antananarivo were screened for the presence of rickettsial DNA. EDTA (ethylenediaminetetraacetic acid) blood from 1020 patients presenting with pyrexia > 38.5 °C was analyzed by gltA-specific qPCR. Positive samples were confirmed by ompB-specific qPCR. From confirmed samples, the gltA amplicons were sequenced and subjected to phylogenetic analysis. From five gltA-reactive samples, two were confirmed by ompB-specific qPCR. The gltA sequence in the sample taken from a 38-year-old female showed 100% homology with R. typhi. The other sample taken from a 1.5-year-old infant was 100% homologous to R. felis. Tick-borne rickettsiae were not identified. The overall rate of febrile patients with molecular evidence for a rickettsial infection from the Madagascan study site was 0.2% (2/1020 patients). Flea-borne rickettsiosis is a rare but neglected cause of infection in Madagascar. Accurate diagnosis may prompt adequate antimicrobial treatment.
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Toy D, Vo C, Kwan WC, Shavelle DM. Fulminant myocarditis secondary to murine typhus mimicking acute coronary syndrome. J Cardiol Cases 2021; 24:99-101. [PMID: 34466169 DOI: 10.1016/j.jccase.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022] Open
Abstract
Myocarditis is a disease with variable clinical presentation, ranging from an uncomplicated febrile illness to cardiogenic shock. Herein, we report a case of fulminant myocarditis secondary to murine typhus in a 52-year-old male that initially mimicked an acute coronary syndrome. Emergent coronary angiography showed angiographically normal coronary arteries. Left ventriculography showed global hypokinesis with an ejection fraction of 10%. The patient required mechanical support with an intra-aortic balloon pump and fully recovered. <Learning objective:Fulminant myocarditis secondary to murine typhus may occur in urban areas. Clinical complications such as cardiogenic shock and acute heart failure can be overcome with supportive therapy such as an intra-aortic balloon pump and guideline-directed medical therapy.>.
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Affiliation(s)
- Dana Toy
- Department of Medicine, University of Southern California, 2020 Zonal Ave, Suite 620, Los Angeles, CA 90089, USA
| | - Christopher Vo
- Department of Medicine, University of Southern California, 2020 Zonal Ave, Suite 620, Los Angeles, CA 90089, USA
| | - Wilson C Kwan
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, USA
| | - David M Shavelle
- MemorialCare Heart and Vascular Institute, Long Beach Medical Center, Long Beach, CA, USA
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24
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Wachs S, Kuiper B. Liver Failure, Renal Failure, and a Rash: An Unusually Severe Case of Multi-Organ Failure Due to Murine Typhus. Cureus 2021; 13:e16661. [PMID: 34462691 PMCID: PMC8388311 DOI: 10.7759/cureus.16661] [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] [Accepted: 07/26/2021] [Indexed: 11/05/2022] Open
Abstract
Murine typhus is a vector-borne disease transmitted to humans via fleas and typically causes an infection hallmarked by nonspecific, mild symptoms of fever, rash, and headache. More severe diseases, while rare, can occur. We present a complicated case of murine typhus resulting in liver and renal failure. Our patient was a healthy 64-year-old Hispanic gentleman who presented to his local emergency department (ED) in Southwest Texas for fevers, chills, and myalgia progressing to dyspnea, fatigue, and jaundice. He was transferred to a Central Texas transplant hospital given concern for impending liver failure as well as acute kidney injury later requiring hemodialysis. Broad-spectrum antibiotics were narrowed to empiric doxycycline with eventual improvement in his lab values and symptoms. The return of Rickettsia typhi antibody lab values later revealed murine typhus to be the cause of his disease.
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Affiliation(s)
- Stephanie Wachs
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Brandon Kuiper
- Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, USA
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Roberts T, Parker DM, Bulterys PL, Rattanavong S, Elliott I, Phommasone K, Mayxay M, Chansamouth V, Robinson MT, Blacksell SD, Newton PN. A spatio-temporal analysis of scrub typhus and murine typhus in Laos; implications from changing landscapes and climate. PLoS Negl Trop Dis 2021; 15:e0009685. [PMID: 34432800 PMCID: PMC8386877 DOI: 10.1371/journal.pntd.0009685] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Scrub typhus (ST) and murine typhus (MT) are common but poorly understood causes of fever in Laos. We examined the spatial and temporal distribution of ST and MT, with the intent of informing interventions to prevent and control both diseases. METHODOLOGY AND PRINCIPLE FINDINGS This study included samples submitted from 2003 to 2017 to Mahosot Hospital, Vientiane, for ST and MT investigation. Serum samples were tested using IgM rapid diagnostic tests. Patient demographic data along with meteorological and environmental data from Laos were analysed. Approximately 17% of patients were positive for either ST (1,337/8,150 patients tested) or MT (1,283/7,552 patients tested). While both diseases occurred in inhabitants from Vientiane Capital, from the univariable analysis MT was positively and ST negatively associated with residence in Vientiane Capital. ST was highly seasonal, with cases two times more likely to occur during the wet season months of July-September compared to the dry season whilst MT peaked in the dry season. Multivariable regression analysis linked ST incidence to fluctuations in relative humidity whereas MT was linked to variation in temperature. Patients with ST infection were more likely to come from villages with higher levels of surface flooding and vegetation in the 16 days leading up to diagnosis. CONCLUSIONS The data suggest that as cities expand, high risk areas for MT will also expand. With global heating and risks of attendant higher precipitation, these data suggest that the incidence and spatial distribution of both MT and ST will increase.
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Affiliation(s)
- Tamalee Roberts
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Daniel M. Parker
- University of California, Irvine, California, United States of America
| | - Philip L. Bulterys
- Department of Pathology, Stanford University, California, United States of America
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Ivo Elliott
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Vilada Chansamouth
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Matthew T. Robinson
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Stuart D. Blacksell
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford-Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N. Newton
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford-Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Das A, Kim K, Park SG, Choi N, Choo J. SERS-based serodiagnosis of acute febrile diseases using plasmonic nanopopcorn microarray platforms. Biosens Bioelectron 2021; 192:113525. [PMID: 34325318 DOI: 10.1016/j.bios.2021.113525] [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: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
We report a surface-enhanced Raman scattering (SERS)-based immunoassay platform for the rapid diagnosis of scrub typhus and murine typhus, which are the most common acute febrile diseases in South Korea. A microarray device, composed of multiple gold nanopopcorn substrates capable of detecting ultra-sensitive biomarkers, was used as a multiplex SERS-based assay platform. Sequentially diluted titers of Orientia tsutsugamushi and Rickettsia typhi specific human IgG/IgM antibodies, which are biomarkers of two typhus diseases, were analyzed by Raman spectroscopy, and the peak intensity was plotted against the different titer concentration range (0-2048 and 0-1024 for O. tsutsugamushi IgG/IgM and 0-8192 and 0-256 for R. typhi IgG/IgM) to generate calibration curves. The sensitivities and limits of detection (LODs) determined for four different IgG/IgM antibodies were significantly lower than those for the ELISA method. The LODs of titer concentrations for O. tsutsugamushi IgG/IgM and R. typhi IgG/IgM are determined to be 20.4, 7.03, 16.8 and 12.5, respectively. The LOD values were all lower than the cut-off values (256, 16, 128, and 64) used for clinical diagnosis, which means that this assay platform can diagnose two typhus diseases with high sensitivity. When the microarray sensors are combined with portable Raman spectrophotometers, which are commercially available worldwide, it is also possible to directly diagnose a patient in the field without sending their blood sample to a hospital.
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Affiliation(s)
- Anupam Das
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea
| | - Kihyun Kim
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea
| | - Sung-Gyu Park
- Advanced Nano-Surface Department, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Namhyun Choi
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea.
| | - Jaebum Choo
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea.
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27
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Khan SA, Murhekar MV, Bora T, Kumar S, Saikia J, Kamaraj P, Sabarinanthan R. Seroprevalence of Rickettsial Infections in Northeast India: A Population-Based Cross-Sectional Survey. Asia Pac J Public Health 2021; 33:516-522. [PMID: 34018413 DOI: 10.1177/10105395211015864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cross-sectional survey was undertaken to estimate seroprevalence of immunoglobulin G antibodies against scrub typhus, spotted fever group rickettsiae, and typhus group rickettsiae in randomly selected 48 clusters in 12 districts of 3 Northeast states of India: Assam, Meghalaya, and Tripura. Individuals in 3 age groups (5-8, 9-17, and 18-45 years) were selected from each cluster. Sera (N = 2360) tested were collected as part of a national survey on dengue seroprevalence conducted between September 2017 and February 2018. Overall, seroprevalence of 2.5% was detected against rickettsioses, with highest positivity against spotted fever group rickettsiae, followed by scrub typhus and typhus group rickettsiae. Seroprevalence was highest in Tripura (3.7%), followed by Assam (2.6%) and Meghalaya (1.04%). Adults of 18 to 45 years of age were found to be most affected (3.8%). The study findings indicate the need for increasing testing facilities for active case detection at hospital levels. Efforts on implementing effective preventing strategies are suggested to be targeted in disease-specific endemic foci.
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Affiliation(s)
- Siraj A Khan
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Trishna Bora
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - Santhosh Kumar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Jahnabi Saikia
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - P Kamaraj
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - R Sabarinanthan
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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28
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Um J, Nam Y, Lim JN, Kim M, An Y, Hwang SH, Park JS. Seroprevalence of scrub typhus, murine typhus and spotted fever groups in North Korean refugees. Int J Infect Dis 2021; 106:23-28. [DOI: 10.1016/j.ijid.2021.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
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Rees R, Park C, Long B, Spencer S, Sutter D. Murine Typhus Presenting With Mucosal Involvement. J Pediatric Infect Dis Soc 2021; 10:540-542. [PMID: 33269795 DOI: 10.1093/jpids/piaa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/13/2020] [Indexed: 11/14/2022]
Abstract
Lipschutz ulcers (LU) present as painful genital ulcers in nonsexually active females. Associated infections include Epstein Barr virus, Mycoplasma pneumoniae, Cytomegalovirus, and influenza. To our knowledge, this is the first report of LU occurring with murine typhus. Murine typhus is caused by Rickettsia typhi, a Gram-negative, obligate intracellular organism. Rat fleas (Xenopsylla cheopis) are the classic vector, although cat fleas (Ctenocephalides felis) found on cats, dogs, and opossums have been implicated in maintaining the life cycle of R. typhi in suburban areas. Murine typhus can have a nonspecific presentation making a strong index of suspicion crucial to its diagnosis. The most common presenting signs include fever, poor appetite, malaise, and headache. Laboratory abnormalities may include elevated C-reactive protein, elevated erythrocyte sedimentation rate, hypoalbuminemia, elevated transaminases, elevated neutrophil band count, and thrombocytopenia. The treatment of choice for R. typhi is doxycycline.
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Affiliation(s)
- Renuka Rees
- Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, Texas, USA
| | - Christine Park
- Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, Texas, USA
| | - Benjamin Long
- Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, Texas, USA
| | - Steven Spencer
- Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, Texas, USA
| | - Deena Sutter
- Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, Texas, USA
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Describing fine spatiotemporal dynamics of rat fleas in an insular ecosystem enlightens abiotic drivers of murine typhus incidence in humans. PLoS Negl Trop Dis 2021; 15:e0009029. [PMID: 33600454 PMCID: PMC7924756 DOI: 10.1371/journal.pntd.0009029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/02/2021] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Murine typhus is a flea-borne zoonotic disease that has been recently reported on Reunion Island, an oceanic volcanic island located in the Indian Ocean. Five years of survey implemented by the regional public health services have highlighted a strong temporal and spatial structure of the disease in humans, with cases mainly reported during the humid season and restricted to the dry southern and western portions of the island. We explored the environmental component of this zoonosis in an attempt to decipher the drivers of disease transmission. To do so, we used data from a previously published study (599 small mammals and 175 Xenopsylla fleas from 29 sampling sites) in order to model the spatial distribution of rat fleas throughout the island. In addition, we carried out a longitudinal sampling of rats and their ectoparasites over a 12 months period in six study sites (564 rats and 496 Xenopsylla fleas) in order to model the temporal dynamics of flea infestation of rats. Generalized Linear Models and Support Vector Machine classifiers were developed to model the Xenopsylla Genus Flea Index (GFI) from climatic and environmental variables. Results showed that the spatial distribution and the temporal dynamics of fleas, estimated through the GFI variations, are both strongly controlled by abiotic factors: rainfall, temperature and land cover. The models allowed linking flea abundance trends with murine typhus incidence rates. Flea infestation in rats peaked at the end of the dry season, corresponding to hot and dry conditions, before dropping sharply. This peak of maximal flea abundance preceded the annual peak of human murine typhus cases by a few weeks. Altogether, presented data raise novel questions regarding the ecology of rat fleas while developed models contribute to the design of control measures adapted to each micro region of the island with the aim of lowering the incidence of flea-borne diseases. Murine typhus is a neglected zoonotic disease, as the number of human cases is likely underestimated in the absence of specific symptoms. It is caused by Rickettsia typhi, a pathogenic bacterium transmitted by rat fleas (Xenospylla spp). The distribution and dynamics of this disease result from complex interactions involving vectors, reservoirs and humans within a shared environment. In this study, we explored the environmental drivers of rat fleas’ abundance on Reunion Island, where murine typhus has recently emerged. Results showed that i) rat fleas’ abundance is highly dynamic, characterized by a peak at the end of the dry season and ii) among the factors investigated, rainfall, temperature and land cover are the main determinants of rat fleas’ abundance. We modeled a predictive map of flea distribution that strongly correlates with the spatial distribution of human cases on the island. This study highlights the importance of accounting for environmental and climatic characteristics to better understand the spatial and temporal drivers of flea-borne diseases.
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31
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Tanabe MB, Blanton LS, La Rosa M, Webb CM. Murine Typhus Infection in Pregnancy: Case Series and Literature Review. Pathogens 2021; 10:pathogens10020219. [PMID: 33670581 PMCID: PMC7922808 DOI: 10.3390/pathogens10020219] [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: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Murine typhus is a flea-borne disease of worldwide distribution with a recent reemergence in the United States of America. There are limited data about the presentation, treatment, and outcomes in the pregnant population. We report on two cases of murine typhus during pregnancy and review the literature to compile previously reported cases. A comprehensive search was performed via the PubMed database for published articles between 1990 and 2020. Seven articles met the criteria of symptomatic pregnant murine typhus infection. A total of 37 patients were identified. Patients frequently presented with a prolonged duration of fevers prior to presentation, headache, and elevated hepatic transaminases. The diagnosis was predominantly based on serology. Treatment varied. Overall, the pregnancy outcome was favorable. Murine typhus can mimic other pregnancy-related pathologies. More exclusive and large-scale studies are needed to learn more of murine typhus during pregnancy.
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Affiliation(s)
- Melinda B. Tanabe
- Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; (L.S.B.); (C.M.W.)
- Correspondence:
| | - Lucas S. Blanton
- Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; (L.S.B.); (C.M.W.)
| | - Mauricio La Rosa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Camille M. Webb
- Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; (L.S.B.); (C.M.W.)
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Panneerselvam S, Bhat N, Bindiganavile SH, Lee AG. Murine typhus presenting as pseudotumor cerebri. Can J Ophthalmol 2021; 56:e131-e133. [PMID: 33529597 DOI: 10.1016/j.jcjo.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Nita Bhat
- Blanton Eye Institute, Houston Methodist Hospital Houston, Tex
| | | | - Andrew G Lee
- Baylor College of Medicine Houston, Tex; Blanton Eye Institute, Houston Methodist Hospital Houston, Tex; The Houston Methodist Research Institute, Houston Methodist Hospital Houston, Tex; Weill Cornell Medicine New York, NY; Weill Cornell Medicine New York, NY; University of Texas Medical Branch Galveston, Tex; University of Texas MD Anderson Cancer Center Houston, Tex; Texas A and M College of Medicine Bryan, Tex; The University of Iowa Hospitals and Clinics Iowa City, Iowa.
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33
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Anstead GM. History, Rats, Fleas, and Opossums. II. The Decline and Resurgence of Flea-Borne Typhus in the United States, 1945-2019. Trop Med Infect Dis 2020; 6:2. [PMID: 33379251 PMCID: PMC7839051 DOI: 10.3390/tropicalmed6010002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, and diverse organ manifestations that can result in critical illness or death. This is the second part of a two-part series describing the rise, decline, and resurgence of flea-borne typhus (FBT) in the United States over the last century. These studies illustrate the influence of historical events, social conditions, technology, and public health interventions on the prevalence of a vector-borne disease. Flea-borne typhus was an emerging disease, primarily in the Southern USA and California, from 1910 to 1945. The primary reservoirs in this period were the rats Rattus norvegicus and Ra. rattus and the main vector was the Oriental rat flea (Xenopsylla cheopis). The period 1930 to 1945 saw a dramatic rise in the number of reported cases. This was due to conditions favorable to the proliferation of rodents and their fleas during the Depression and World War II years, including: dilapidated, overcrowded housing; poor environmental sanitation; and the difficulty of importing insecticides and rodenticides during wartime. About 42,000 cases were reported between 1931-1946, and the actual number of cases may have been three-fold higher. The number of annual cases of FBT peaked in 1944 at 5401 cases. American involvement in World War II, in the short term, further perpetuated the epidemic of FBT by the increased production of food crops in the American South and by promoting crowded and unsanitary conditions in the Southern cities. However, ultimately, World War II proved to be a powerful catalyst in the control of FBT by improving standards of living and providing the tools for typhus control, such as synthetic insecticides and novel rodenticides. A vigorous program for the control of FBT was conducted by the US Public Health Service from 1945 to 1952, using insecticides, rodenticides, and environmental sanitation and remediation. Government programs and relative economic prosperity in the South also resulted in slum clearance and improved housing, which reduced rodent harborage. By 1956, the number of cases of FBT in the United States had dropped dramatically to only 98. Federally funded projects for rat control continued until the mid-1980s. Effective antibiotics for FBT, such as the tetracyclines, came into clinical practice in the late 1940s. The first diagnostic test for FBT, the Weil-Felix test, was found to have inadequate sensitivity and specificity and was replaced by complement fixation in the 1940s and the indirect fluorescent antibody test in the 1980s. A second organism causing FBT, R. felis, was discovered in 1990. Flea-borne typhus persists in the United States, primarily in South and Central Texas, the Los Angeles area, and Hawaii. In the former two areas, the opossum (Didelphis virginiana) and cats have replaced rats as the primary reservoirs, with the cat flea (Ctenocephalides felis) now as the most important vector. In Hawaii, 73% of cases occur in Maui County because it has lower rainfall than other areas. Despite great successes against FBT in the post-World War II era, it has proved difficult to eliminate because it is now associated with our companion animals, stray pets, opossums, and the cat flea, an abundant and non-selective vector. In the new millennium, cases of FBT are increasing in Texas and California. In 2018-2019, Los Angeles County experienced a resurgence of FBT, with rats as the reservoir.
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Affiliation(s)
- Gregory M Anstead
- Medical Service, South Texas Veterans Health Care System and Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
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Blanton LS, Berman MA, Afrouzian M. Case Report: Renal Failure due to Focal Segmental Glomerulosclerosis in a Patient with Murine Typhus. Am J Trop Med Hyg 2020; 103:1017-1019. [PMID: 32588799 DOI: 10.4269/ajtmh.20-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Murine typhus is a flea-borne rickettsiosis caused by Rickettsia typhi. When severe, endothelial dysfunction can lead to acute kidney injury secondary to prerenal azotemia or acute tubular necrosis. Here, we describe an unusual cause of kidney injury during the course of murine typhus-focal segmental glomerulosclerosis.
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Affiliation(s)
- Lucas S Blanton
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Megan A Berman
- Division of General Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Marjan Afrouzian
- Division of General Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Department of Pathology, University of Texas Medical Branch, Galveston, Texas
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Dougas G, Mavrouli M, Tsakris A, Billinis C, Papaparaskevas J. Serosurvey of IgG Antibodies against Bartonella henselae and Rickettsia typhi in the Population of Attica, Greece. Trop Med Infect Dis 2020; 5:E145. [PMID: 32947795 PMCID: PMC7559870 DOI: 10.3390/tropicalmed5030145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
Rickettsia typhi and Bartonella henselae are the causative agents of murine typhus and cat-scratch disease, respectively. A small-scale survey (N = 202) was conducted in the Attica region, Greece, for determining the prevalence rates of IgG antibodies against B. henselae and R. typhi by indirect fluorescence antibody test. IgG against B. henselae and R. typhi were present in 17.8% (36/202) and 4.5% (9/202) of the participants, respectively; co-occurring IgG against both B. henselae and R. typhi were detected in 3.5% (7/202), whereas only anti-B. henselae IgG in 14.3% (29/202), and only anti-R. typhi IgG in 1.0% (2/202). Titres 1/64, 1/128, 1/256, and 1/512, of anti-B. henselae IgG were identified in 6.4%, 4.5%, 4.5%, and 2.4%, whereas titres 1/40 and 1/80 of anti-R. typhi IgG were detected in 4.0%, and 0.5%, respectively. A positive association of anti-B. henselae IgG prevalence with a coastal area featuring a major seaport (p = 0.009) and with younger age (p = 0.046) was identified. The findings of this survey raise concern for exposure of the population of Attica to B. henselae and R. typhi, which should be considered in the differential diagnosis when compatible symptoms are present. Our results also suggest that seaports may represent high-risk areas for exposure to Bartonella spp.
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Affiliation(s)
- Georgios Dougas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
| | - Maria Mavrouli
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
| | - Charalambos Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece;
| | - Joseph Papaparaskevas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
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36
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Doppler JF, Newton PN. A systematic review of the untreated mortality of murine typhus. PLoS Negl Trop Dis 2020; 14:e0008641. [PMID: 32925913 PMCID: PMC7515178 DOI: 10.1371/journal.pntd.0008641] [Citation(s) in RCA: 11] [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: 01/18/2020] [Revised: 09/24/2020] [Accepted: 07/26/2020] [Indexed: 01/16/2023] Open
Abstract
Murine typhus is an acute febrile, flea-borne disease caused by the bacteria Rickettsia typhi. The disease occurs worldwide but is likely underrecognized due to its non-specific symptoms, causing significant morbidity. A systematic review found disease complications in one-fourth of all patients and a long fever duration in those untreated. Although mortality in treated cases is estimated to be very low, some case series have shown a notably higher mortality in untreated patients. This study aimed to describe the outcomes and estimate the mortality of untreated murine typhus through a comprehensive systematic literature review. We systematically searched the literature for articles describing untreated murine typhus patients, excluding cases with no laboratory assay confirmed diagnosis, those who received efficacious treatment, had incomplete information on primary outcome and articles describing less than 10 patients and performed a narrative synthesis of the study findings. The study protocol followed the PRISMA guidelines and was part of a more extensive protocol registered at PROSPERO (CRD42018101991). Twelve studies including a total of 239 untreated patients matched the eligibility criteria. Only a single study reported one death in 28 patients, giving a patient series mortality of 3.6% and an overall mortality of 0.4% in 239 untreated patients. Complications were reported in 10 of the 12 studies and included involvement of the central nervous system, kidney and lung, with a hospitalisation rate of 70% and ICU admission rate of 27% in one study. The mean duration of fever in untreated patients was 15 days in two and 12.7 days in one study. Although the untreated mortality in this study was low, the sample size was small. Murine typhus caused significant morbidity when untreated, leading to high hospitalisation rates and highlighting the importance of early diagnosis and treatment of this neglected disease to reduce disease burden and health-care related costs. Murine typhus is an acute febrile, flea-borne bacterial disease that has been reported worldwide and continues to cause significant morbidity when untreated. The often self-limiting, non-specific clinical symptoms of the disease resemble that of common viral illnesses, suggesting that the disease is underdiagnosed. While the mortality in treated cases is estimated to be very low, disease complications in one-fourth of all patients and a prolonged duration of fever in untreated cases have been reported. We systematically searched the literature to identify articles describing laboratory diagnostically confirmed clinical cases of untreated murine typhus and summarized disease outcomes, including mortality, of patients in eligible studies. Of the 12 studies containing 239 untreated patients that matched the eligibility criteria, only one study reported a single death amongst 28 untreated patients, resulting in a patient series fatality rate of 3.6% and an overall untreated fatality rate of 0.4%. Disease complications were mentioned in 10 of 12 studies and the mean duration of fever in untreated cases was 15 days in two studies and 12.7 days in one study, demonstrating the significant morbidity caused by untreated murine typhus and highlighting the importance of early diagnosis and treatment of this neglected disease.
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Affiliation(s)
- Johannes F. Doppler
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus, University of Oxford, Oxford, England
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O'Kelly B, Lambert JS. Vector-borne diseases in pregnancy. Ther Adv Infect Dis 2020; 7:2049936120941725. [PMID: 32944240 PMCID: PMC7469740 DOI: 10.1177/2049936120941725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Vector-borne infections cause a significant proportion of world-wide morbidity and mortality and many are increasing in incidence. This is due to a combination of factors, primarily environmental change, encroachment of human habitats from urban to peri-urban areas and rural to previously uninhabited areas, persistence of poverty, malnutrition and resource limitation in geographical areas where these diseases are endemic. Pregnant women represent the single largest ‘at risk’ group, due to immune-modulation and a unique physiological state. Many of these diseases have not benefitted from the same level of drug development as other infectious and medical domains, a factor attributing to the ‘neglected tropical disease’ title many vector-borne diseases hold. Pregnancy compounds this issue as data for safety and efficacy for many drugs is practically non-existent, precluding exposure in pregnancy to many first-line therapeutic agents for ‘fear of the unknown’ or overstated adverse pregnancy-foetal outcomes. In this review, major vector-borne diseases, their impact on pregnancy outcomes, current treatment, vaccination and short-comings of current medical practice for pregnant women will be discussed.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Consultant in Infectious Diseases, Medicine and Sexual Health (GUM), Mater, Rotunda and UCD, Mater Misericordiae University Hospital, Clinic 6, Eccles St, Inns Quay, Dublin, D07 R2WY University College Dublin Rotunda Maternity Hospital
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Situ BA, Streit SJ, Tran TC, Nomura JH, Bababeygy SR, Rodger DC. Two cases of uveitis associated with severe transaminitis during a Rickettsia typhi outbreak in Los Angeles County. Am J Ophthalmol Case Rep 2020; 19:100813. [PMID: 32715155 PMCID: PMC7374180 DOI: 10.1016/j.ajoc.2020.100813] [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: 05/13/2019] [Revised: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the clinical presentation, multimodal imaging, and management of two patients with Rickettsia typhi infection who presented with transaminitis and bilateral uveitis. Observations We report two cases of murine typhus-associated uveitis in the setting of a Rickettsia typhi outbreak in Los Angeles County. In case 1, a 29-year-old Hispanic female presented with scotoma of the right eye and bilateral floaters after 2 weeks of persistent fevers, maculopapular rash, and arthralgia. Clinical examination and optical coherence tomography (OCT) revealed vitreous cell and scattered white spots in both eyes at the level of the inner retina, and a cotton wool spot inferiorly in the left eye. Multiple hyperautofluorescent spots were seen on widefield fundus autofluorescence (FAF). Retinal vascular leakage and optic disc hyperfluorescence were visualized on widefield fluorescein angiography (FA). These findings were concerning for a white dot syndrome (WDS). The patient was started on oral prednisone 30 mg daily. Serologic testing during the convalescent phase returned positive for R. typhi infection and she was started on doxycycline. 3 weeks later, she reported complete resolution of scotoma and significant improvement of bilateral floaters. In the second case, a 42-year-old Hispanic male presented with sudden bilateral increased floaters and blurry vision after 12 days of persistent fever and headache. Clinical examination revealed trace flare with 1+ cell in the anterior chamber, 1+ vitreous cell, and multiple white dots in both eyes at the level of the inner retina. FAF showed scattered hyperautofluorescent spots in both eyes. FA demonstrated late retinal vascular leakage with bilateral hyperfluorescent optic discs. He was started on oral prednisone 40mg, prednisolone acetate 1% drops, and cyclopentolate 1% drops daily. 2 weeks later, serologic titers returned positive for murine typhus and he was started on doxycycline with gradual taper off of steroids. He subsequently had complete resolution of floaters, blurry vision, and the inner retinal white spots. Conclusions and Importance Murine typhus-associated uveitis may present with scotoma and increased floaters in the setting of persistent fevers and transaminitis, with pre- or inner retinal white spots seen on fundus examination. Ophthalmologists may aid in prompt diagnosis and initiation of antibiotic therapy, which can shorten the course of the disease and in turn, reduce the risk of severe complications.
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Affiliation(s)
- Betty A Situ
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, USA
| | - Susan J Streit
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Timothy C Tran
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Jim H Nomura
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Simon R Bababeygy
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Damien C Rodger
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
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Nelder MP, Russell CB, Johnson S, Li Y, Cronin K, Warshawsky B, Brandon N, Patel SN. Assessing human exposure to spotted fever and typhus group rickettsiae in Ontario, Canada (2013-2018): a retrospective, cross-sectional study. BMC Infect Dis 2020; 20:523. [PMID: 32682398 PMCID: PMC7368706 DOI: 10.1186/s12879-020-05244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Assessing the burden of rickettsial infections in Ontario, Canada, is challenging since rickettsial infections are not reportable to public health. In the absence of reportable disease data, we assessed the burden of rickettsial infections by examining patient serological data and clinical information. METHODS Our retrospective, cross-sectional study included patients who had Rickettsia serological testing ordered by their physician, in Ontario, from 2013 to 2018. We tested sera from 2755 non-travel patients for antibodies against spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) using an indirect immunofluorescence assay (IFA) (positive IgG titers ≥1:64). We classified cases using a sensitive surveillance case definition: confirmed (4-fold increase in IgG titers between acute and convalescent sera with clinical evidence of infection), possible (single positive sera with clinical evidence) and previous rickettsial infection (single positive sera without clinical evidence). We classified cases seropositive for both SFGR and TGR as unspecified Rickettsia infections (URIs). RESULTS Less than 5% of all patients had paired acute and convalescent sera tested, and of these, we found a single, laboratory-confirmed SFGR case, with a 4-fold increase in IgG titers and evidence of fever, maculopapular rash and headache. There were 45 possible (19 SFGR, 7 TGR, 19 URI) and 580 previous rickettsial infection (183 SFGR, 89 TGR, 308 URI) cases. The rate of positive tests for SFGR, TGR and URI combined (all case classifications) were 4.4 per 100,000 population. For confirmed and possible cases, the most common signs and symptoms were fever, headache, gastrointestinal complaints and maculopapular rash. The odds of having seropositive patients increased annually by 30% (odds ratio = 1.3, 95% confidence interval: 1.23-1.39). CONCLUSIONS The rates of rickettsial infections in Ontario are difficult to determine. Based on confirmed and possible cases, rates are low, but inclusion of previous rickettsial infection cases would indicate higher rates. We highlight the need for education regarding the importance of testing acute and convalescent sera and consistent completion of the laboratory requisition in confirming rickettsial disease. We suggest further research in Ontario to investigate rickettsial agents in potential vectors and clinical studies employing PCR testing of clinical samples.
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Affiliation(s)
- Mark P Nelder
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada.
| | - Curtis B Russell
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - Steven Johnson
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Ye Li
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Kirby Cronin
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Bryna Warshawsky
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Nicholas Brandon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Eremeeva ME, Capps D, McBride CL, Williams-Newkirk AJ, Dasch GA, Salzer JS, Beati L, Durden LA. Detection of Rickettsia asembonensis in Fleas (Siphonaptera: Pulicidae, Ceratophyllidae) Collected in Five Counties in Georgia, United States. JOURNAL OF MEDICAL ENTOMOLOGY 2020; 57:1246-1253. [PMID: 32123904 DOI: 10.1093/jme/tjaa029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 06/10/2023]
Abstract
We conducted a molecular survey of Rickettsia in fleas collected from opossums, road-killed and live-trapped in peridomestic and rural settings, state parks, and from pet cats and dogs in Georgia, United States during 1992-2014. The cat flea, Ctenocephalides felis (Bouché) was the predominant species collected from cats and among the archival specimens from opossums found in peridomestic settings. Polygenis gwyni (Fox) was more prevalent on opossums and a single cotton rat trapped in sylvatic settings. Trapped animals were infested infrequently with the squirrel flea, Orchopeas howardi (Baker) and C. felis. TaqMan assays targeting the BioB gene of Rickettsia felis and the OmpB gene of Rickettsia typhi were used to test 291 flea DNAs for Rickettsia. A subset of 53 C. felis collected from a cat in 2011 was tested in 18 pools which were all bioB TaqMan positive (34% minimum infection prevalence). Of 238 fleas tested individually, 140 (58.8%, 95% confidence interval [CI]: 52.5-64.9%) DNAs were bioB positive. Detection of bioB was more prevalent in individual C. felis (91%) compared to P. gwyni (13.4%). Twenty-one (7.2%) were ompB TaqMan positive, including 18 C. felis (9.5%) and 3 P. gwyni (3.2%). Most of these fleas were also positive with bioB TaqMan; however, sequencing of gltA amplicons detected only DNA of Rickettsia asembonensis. Furthermore, only the R. asembonensis genotype was identified based on NlaIV restriction analysis of a larger ompB fragment. These findings contribute to understanding the diversity of Rickettsia associated with fleas in Georgia and emphasize the need for development of more specific molecular tools for detection and field research on rickettsial pathogens.
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Affiliation(s)
- Marina E Eremeeva
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA
| | - Danielle Capps
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Cynthia Logan McBride
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA
| | - Amanda J Williams-Newkirk
- Environmental Sciences Department, Emory University, Atlanta, GA
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gregory A Dasch
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Johanna S Salzer
- Environmental Sciences Department, Emory University, Atlanta, GA
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lorenza Beati
- U.S. National Tick Collection, Institute for Coastal Plain Science, Georgia Southern University, Statesboro, GA
| | - Lance A Durden
- College of Science and Mathematics, Georgia Southern University, Statesboro, GA
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Weitzel T, Acosta-Jamett G, Jiang J, Martínez-Valdebenito C, Farris CM, Richards AL, Abarca K. Human seroepidemiology of Rickettsia and Orientia species in Chile - A cross-sectional study in five regions. Ticks Tick Borne Dis 2020; 11:101503. [PMID: 32993924 DOI: 10.1016/j.ttbdis.2020.101503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/19/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Abstract
In recent years, the spectrum and epidemiology of human rickettsioses has become an emerging topic in Chile. This survey aimed to assess the seroprevalence of spotted fever group rickettsiae (SFGR), typhus group rickettsiae (TGR), and scrub typhus group orientiae (STGO) in northern, central, and southern Chile. We performed a cross-sectional study of healthy adults in rural and urban settings of five regions. Participants were chosen by double stratified random sampling in urban and by convenience in rural locations (n = 1302). Serum specimens were analyzed for group-specific IgG antibodies against SFGR, TGR, and STGO by enzyme-linked immunosorbent assays (ELISAs). Overall seroprevalences to SFGR, TGR, and STGO were 5.3 %, 1.2 %, and 0.4 %, respectively. Prevalences showed geographical differences. Statistical analyses revealed an association of older age with seropositivity to SFGR and to TGR and of rural setting and male gender with seropositivity to SFGR. The study indicates that SFGR, TGR, and STGO are endemic in Chile. The very low STGO seroprevalence might indicate an insufficient sensitivity of serological tests using Asian O. tsutsugamushi strains as ELISA antigens for the detection of antibodies against Chilean Orientia species.
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Affiliation(s)
- Thomas Weitzel
- Laboratorio Clínico, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Instituto de Ciencias e Innovación en Medicina (ICIM) Facultad de Medicina Clínica Alemana Universidad del Desarrollo Santiago Chile.
| | - Gerardo Acosta-Jamett
- Instituto de Medicina Preventiva Veterinaria y Programa de Investigación Aplicada en Fauna Silvestre, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile.
| | - Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
| | - Constanza Martínez-Valdebenito
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Christina M Farris
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
| | - Allen L Richards
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Bethesda, MD, USA.
| | - Katia Abarca
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Dhawan S, Robinson MT, Stenos J, Graves SR, Wangrangsimakul T, Newton PN, Day NPJ, Blacksell SD. Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review. Am J Trop Med Hyg 2020; 103:55-63. [PMID: 32274984 PMCID: PMC7356422 DOI: 10.4269/ajtmh.19-0818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the "gold standard" to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: "murine typhus," "rickettsia typhi," "immunofluorescence," "IFA," and "serologic" with restrictions (i.e., "rickettsia typhi" or "murine typhus," and "IFA" or "immunofluorescence," or "serologic*"). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients.
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Affiliation(s)
- Sandhya Dhawan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Matthew T. Robinson
- 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 (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul N. Newton
- 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 (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- 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 (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
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Rodríguez-Alonso B, Almeida H, Alonso-Sardón M, Velasco-Tirado V, Robaina Bordón JM, Carranza Rodríguez C, Pérez Arellano JL, Belhassen-García M. Murine typhus. How does it affect us in the 21st century? The epidemiology of inpatients in Spain (1997–2015). Int J Infect Dis 2020; 96:165-171. [DOI: 10.1016/j.ijid.2020.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022] Open
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Lokida D, Hadi U, Lau CY, Kosasih H, Liang CJ, Rusli M, Sudarmono P, Lukman N, Laras K, Asdie RH, Murniati D, Utama IMS, Mubin RH, Karyana M, Gasem MH, Alisjahbana B. Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results. BMC Infect Dis 2020; 20:364. [PMID: 32448167 PMCID: PMC7245627 DOI: 10.1186/s12879-020-05057-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia. METHODS Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management. RESULTS R. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities. CONCLUSIONS Rickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.
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Affiliation(s)
- Dewi Lokida
- Tangerang District Hospital, Tangerang, Indonesia
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Usman Hadi
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia.
| | - C Jason Liang
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Musofa Rusli
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Kanti Laras
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | | | | | | | | | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | | | - Bachti Alisjahbana
- Hasan Sadikin Hospital - Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Torres‐Castro M, Reyes‐Novelo E, Noh‐Pech H, Tello‐Martín R, Lugo‐Caballero C, Dzul‐Rosado K, Puerto‐Manzano F, Rodríguez‐Vivas RI. Personal and household factors involved in recent
Rickettsia
exposure in a rural population from Yucatán, Mexico. Zoonoses Public Health 2020; 67:506-515. [DOI: 10.1111/zph.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Torres‐Castro
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
- Posgrado Institucional en Ciencias de la Salud Universidad Autónoma de Yucatán Mérida México
| | - Enrique Reyes‐Novelo
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
| | - Henry Noh‐Pech
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
| | - Raúl Tello‐Martín
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
| | - César Lugo‐Caballero
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
| | - Karla Dzul‐Rosado
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
| | - Fernando Puerto‐Manzano
- Centro de Investigaciones Regionales ‘Dr. Hideyo Noguchi’ Universidad Autónoma de Yucatán Mérida México
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Ly TDA, Louni M, Hoang VT, Dao TL, Badiaga S, Brouqui P, Tissot-Dupont H, Raoult D, Fournier PE, Gautret P. Epidemiological serosurvey of vector-borne and zoonotic pathogens among homeless people living in shelters in Marseille: cross-sectional one-day surveys (2005-2015). Eur J Clin Microbiol Infect Dis 2020; 39:1663-1672. [PMID: 32318966 DOI: 10.1007/s10096-020-03889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/30/2020] [Indexed: 10/23/2022]
Abstract
Homeless people are often exposed to unhygienic environments as well as to animals carrying arthropods which both transmit zoonotic infections and human louse-borne pathogens. We attempted to determine the prevalence of antibodies against several vector-borne and zoonotic pathogens among homeless adults living in Marseille. During the 2005-2015 period, we collected sera samples from 821 homeless adults living in shelters. Antibodies against Bartonella quintana, Bartonella henselae, Borrelia recurrentis, Coxiella burnetii, Francisella tularensis (with a cut-off of 1:100), Rickettsia akari, Rickettsia conorii, Rickettsia felis, Rickettsia prowazekii, and Rickettsia typhi (with a cut-off of 1:64) were searched by microimmunofluorescence (MIF). MIF-positive serum samples were confirmed by cross-adsorption to characterise cross-reacting antigens and immunoblotting. Positive sera by Western blot were further tested using qPCR. We evidenced a prevalence of 4.9% seroreactivity to at least one pathogen including phase II C. burnetii (2.1%), B. quintana (1.7%), R. conorii (0.4%), R. prowazekii (0.4%), R. typhi (0.1%), B. recurrentis (0.1%), and F. tularensis (0.1%). No DNA from any pathogens was detected. A comparison with studies conducted prior to the 2000-2003 period showed a decrease in the overall seroprevalence of several vector-borne and zoonotic infections.
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Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Meriem Louni
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Pneumology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Sekene Badiaga
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, Service des urgences CHU Hôpital Nord, Marseille, France
| | - Phillipe Brouqui
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Hervé Tissot-Dupont
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Univ, MEPHI, Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
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Khan SA, Bora T, Saikia J, Shah A, Richards AL, Chattopadhyay S, Kakati S, Rahi M, Kaur H. Seroprevalence of typhus group rickettsial infections in the north-east region of India. Indian J Med Res 2020; 150:203-205. [PMID: 31670277 PMCID: PMC6829774 DOI: 10.4103/ijmr.ijmr_332_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Siraj Ahmed Khan
- Medical Entomology, Arbovirology & Rickettsial Diseases Division, ICMR- Regional Medical Research Centre, Dibrugarh 786 002, Assam, India
| | - Trishna Bora
- Medical Entomology, Arbovirology & Rickettsial Diseases Division, ICMR- Regional Medical Research Centre, Dibrugarh 786 002, Assam, India
| | - Jahnabi Saikia
- Medical Entomology, Arbovirology & Rickettsial Diseases Division, ICMR- Regional Medical Research Centre, Dibrugarh 786 002, Assam, India
| | - Anisha Shah
- Medical Entomology, Arbovirology & Rickettsial Diseases Division, ICMR- Regional Medical Research Centre, Dibrugarh 786 002, Assam, India
| | - Allen L Richards
- Naval Medical Research Centre, Rickettsial Disease Research Unit, Maryland 20910-7500, USA
| | | | - Sanjeeb Kakati
- Department of Medicine, Assam Medical College & Hospital, Dibrugarh 786 002, Assam, India
| | - Manju Rahi
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Harpreet Kaur
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
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48
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Anstead GM. History, Rats, Fleas, and Opossums: The Ascendency of Flea-Borne Typhus in the United States, 1910-1944. Trop Med Infect Dis 2020; 5:E37. [PMID: 32121541 PMCID: PMC7157735 DOI: 10.3390/tropicalmed5010037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/03/2022] Open
Abstract
Flea-borne typhus, due to Rickettsia typhi and Rickettsia felis, is an infection causing fever, headache, rash, hepatitis, thrombocytopenia, and diverse organ manifestations. Although most cases are self-limited, 26%-28% have complications and up to one-third require intensive care. Flea-borne typhus was recognized as an illness similar to epidemic typhus, but having a milder course, in the Southeastern United States and TX from 1913 into the 1920s. Kenneth Maxcy of the US Public Health Service (USPHS) first described the illness in detail and proposed a rodent reservoir and an arthropod vector. Other investigators of the USPHS (Eugene Dyer, Adolph Rumreich, Lucius Badger, Elmer Ceder, William Workman, and George Brigham) determined that the brown and black rats were reservoirs and various species of fleas, especially the Oriental rat flea, were the vectors. The disease was recognized as a health concern in the Southern United States in the 1920s and an increasing number of cases were observed in the 1930s and 1940s, with about 42,000 cases reported between 1931-1946. Attempts to control the disease in the 1930s by fumigation and rat proofing and extermination were unsuccessful. The dramatic increase in the number of cases from 1930 through 1944 was due to: the diversification of Southern agriculture away from cotton; the displacement of the smaller black rat by the larger brown rat in many areas; poor housing conditions during the Great Depression and World War II; and shortages of effective rodenticides and insecticides during World War II.
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Affiliation(s)
- Gregory M. Anstead
- Medical Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA; ; Tel.: +210-567-4666; Fax: +210-567-4670
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Bezerra-Santos MA, Nogueira BCF, Yamatogi RS, Ramos RAN, Galhardo JA, Campos AK. Ticks, fleas and endosymbionts in the ectoparasite fauna of the black-eared opossum Dipelphis aurita in Brazil. EXPERIMENTAL & APPLIED ACAROLOGY 2020; 80:329-338. [PMID: 31927646 DOI: 10.1007/s10493-020-00468-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
Ticks and fleas are essential vectors of pathogens that affect humans and animals, and among their hosts, synanthropic animals such as the black-eared opossum, Didelphis aurita, play a role in public health due to their ability to move between urban centers and forested areas in Brazil. This study aimed to assess the ectoparasite fauna of D. aurita, as well as the presence of pathogens and endosymbionts in ticks and fleas. Opossums (n = 58) captured in Tomahawk livetraps were examined for ectoparasites, and their blood sampled for further analysis. Additionally, spleen samples were collected in individuals found dead. Samples were PCR screened for Rickettsia spp., Borrelia spp., Anaplasmataceae, and Babesia spp. Two tick species were morphologically identified as Ixodes loricatus 24/58 (41.4%) and Amblyomma sculptum 1/58 (1.7%). For fleas, Ctenocephalides felis was detected in 60.3% (35/58) of the animals, and Xenopsylla cheopis in 5.2% (3/58). PCR analysis detected Anaplasmataceae DNA in 34% (16/47) of pooled samples of C. felis, and in 66.7% (2/3) pooled samples of X. cheopis. Sequence analysis revealed Wolbachia pipientis symbiont in all positive samples. Tick, blood and spleen samples were all negative for the microorganisms assessed. These findings suggest that these arthropods circulate among wildlife and urban environments, which may implicate in their participation in the cycle of zoonotic pathogens among opossums, humans and companion animals.
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Affiliation(s)
- Marcos Antônio Bezerra-Santos
- Department of Veterinary Medicine, Federal University of Viçosa, Av. PH Rolfs, s/n, University Campus, Viçosa, MG, 36570-900, Brazil.
| | - Bárbara Cristina Félix Nogueira
- Department of Veterinary Medicine, Federal University of Viçosa, Av. PH Rolfs, s/n, University Campus, Viçosa, MG, 36570-900, Brazil
| | - Ricardo Seiti Yamatogi
- Department of Veterinary Medicine, Federal University of Viçosa, Av. PH Rolfs, s/n, University Campus, Viçosa, MG, 36570-900, Brazil
| | - Rafael Antonio Nascimento Ramos
- Academic Unit of Garanhuns, Federal Rural University of Pernambuco, Av. Bom Pastor, s/n, Boa Vista, Garanhuns, PE, 55292-270, Brazil
| | - Juliana Arena Galhardo
- Faculty of Veterinary Medicine and Animal Science, Federal University of Mato Grosso Do Sul, Av. Senador Filinto Müller, 2443, Jd. Ipiranga, Campo Grande, MS, 79074-460, Brazil
| | - Artur Kanadani Campos
- Department of Veterinary Medicine, Federal University of Viçosa, Av. PH Rolfs, s/n, University Campus, Viçosa, MG, 36570-900, Brazil
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Elliott I, Batty EM, Ming D, Robinson MT, Nawtaisong P, de Cesare M, Newton PN, Bowden R. Oxford Nanopore MinION Sequencing Enables Rapid Whole Genome Assembly of Rickettsia typhi in a Resource-Limited Setting. Am J Trop Med Hyg 2020; 102:408-414. [PMID: 31820709 PMCID: PMC7008338 DOI: 10.4269/ajtmh.19-0383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/25/2019] [Indexed: 01/30/2023] Open
Abstract
The infrastructure challenges and costs of next-generation sequencing have been largely overcome, for many sequencing applications, by Oxford Nanopore Technologies' portable MinION sequencer. However, the question remains open whether MinION-based bacterial whole genome sequencing is by itself sufficient for the accurate assessment of phylogenetic and epidemiological relationships between isolates and whether such tasks can be undertaken in resource-limited settings. To investigate this question, we sequenced the genome of an isolate of Rickettsia typhi, an important and neglected cause of fever across much of the tropics and subtropics, for which only three genomic sequences previously existed. We prepared and sequenced libraries on a MinION in Vientiane, Lao PDR, using v9.5 chemistry, and in parallel, we sequenced the same isolate on the Illumina platform in a genomics laboratory in the United Kingdom. The MinION sequence reads yielded a single contiguous assembly, in which the addition of Illumina data revealed 226 base-substitution and 5,856 indel errors. The combined assembly represents the first complete genome sequence of a human R. typhi isolate collected in the last 50 years and differed from the genomes of existing strains collected over a 90-year time period at very few sites, with no rearrangements. Filtering based on the known error profile of MinION data improved the accuracy of the nanopore-only assembly. However, the frequency of false-positive errors remained greater than true sequence divergence from recorded sequences. Although nanopore-only sequencing cannot yet recover phylogenetic signals in R. typhi, such an approach may be applicable for more diverse organisms.
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Affiliation(s)
- Ivo Elliott
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Elizabeth M. Batty
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Damien Ming
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Matthew T. Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Pruksa Nawtaisong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | | | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rory Bowden
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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