Epidemiology of rickettsioses in North Africa

Emerging bacterial infectious diseases/pathogens vectored by human lice

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.

Manifestations and Management of Flea-Borne Rickettsioses

Murine typhus and flea-borne spotted fever are undifferentiated febrile illnesses caused by Rickettsia typhi and Rickettsia felis, respectively. These organisms are small obligately intracellular bacteria and are transmitted to humans by fleas. Murine typhus is endemic to coastal areas of the tropics and subtropics (especially port cities), where rats are the primary mammalian host and rat fleas (Xenopsylla cheopis) are the vector. In the United States, a cycle of transmission involving opossums and cat fleas (Ctenocephalides felis) are the presumed reservoir and vector, respectively. The incidence and distribution of murine typhus appear to be increasing in endemic areas of the US. Rickettsia felis has also been reported throughout the world and is found within the ubiquitous cat flea. Flea-borne rickettsioses manifest as an undifferentiated febrile illness. Headache, malaise, and myalgia are frequent symptoms that accompany fever. The incidence of rash is variable, so its absence should not dissuade the clinician to consider a rickettsial illness as part of the differential diagnosis. When present, the rash is usually macular or papular. Although not a feature of murine typhus, eschar has been found in 12% of those with flea-borne spotted fever. Confirmatory laboratory diagnosis is usually obtained by serology; the indirect immunofluorescence assay is the serologic test of choice. Antibodies are seldom present during the first few days of illness. Thus, the diagnosis requires acute- and convalescent-phase specimens to document seroconversion or a four-fold increase in antibody titer. Since laboratory diagnosis is usually retrospective, when a flea-borne rickettsiosis is considered, empiric treatment should be initiated. The treatment of choice for both children and adults is doxycycline, which results in a swift and effective response. The following review is aimed to summarize the key clinical, epidemiological, ecological, diagnostic, and treatment aspects of flea-borne rickettsioses.

Molecular evidence of Borrelia burgdorferi sensu stricto and Rickettsia massiliae in ticks collected from a domestic-wild carnivore interface in Chihuahua, Mexico

Sixty-five wild carnivores and twenty free-roaming dogs from the Janos Biosphere Reserve (JBR), northwestern Chihuahua, Mexico, were inspected for ticks which were tested by molecular assays to identify Borrelia and Rickettsia infections. Overall, 45 ticks belonging to five taxa, including Dermacentor parumapertus, Ixodes hearlei, Ixodes kingi, Rhipicephalus sanguineus s.l., and Ornithodoros sp. were collected from 9.2% of the wild carnivores and 60% of the free-roaming dogs. Borrelia burgdorferi s.s. DNA was detected in an I. kingi tick collected from a kit fox (Vulpes macrotis), while Rickettsia massiliae was detected in two (6.5%) of the 31 Rh. sanguineus s.l. collected from free-roaming dogs. Our results revealed host associations between free-roaming dogs and wild carnivore hosts and their ticks in the JBR. The presence of the etiological agents of Lyme disease and spotted fever rickettsiosis in ticks raises the potential risk of tick-borne diseases at the human-domestic-wildlife interface in northwestern Mexico.

ESCCAR international congress on Rickettsia and other intracellular bacteria

The European Society for the study of Chlamydia, Coxiella, Anaplasma and Rickettsia (ESCCAR) held his triennial international meeting in Lausanne. This meeting gathered 165 scientists from 28 countries and all 5 continents, allowing efficient networking and major scientific exchanges. Topics covered include molecular and cellular microbiology, genomics, as well as epidemiology, veterinary and human medicine. Several breakthroughs have been revealed at the meeting, such as (i) the presence of CRISPR (the "prokaryotic immune system") in chlamydiae, (ii) an Anaplasma effector involved in host chromatin remodelling, (iii) the polarity of the type III secretion system of chlamydiae during the entry process revealed by cryo-electron tomography. Moreover, the ESCCAR meeting was a unique opportunity to be exposed to cutting-edge science and to listen to comprehensive talks on current hot topics.

Detection of Rickettsia in Rhipicephalus sanguineus ticks and Ctenocephalides felis fleas from southeastern Tunisia by reverse line blot assay

Ticks (n = 663) and fleas (n = 470) collected from domestic animals from southeastern Tunisia were screened for Rickettsia infection using reverse line blot assay. Evidence of spotted fever group Rickettsia was obtained. We detected Rickettsia felis in fleas, Rickettsia massiliae Bar 29 and the Rickettsia conorii Israeli spotted fever strain in ticks, and Rickettsia conorii subsp. conorii and Rickettsia spp. in both arthropods. The sensitivity of the adopted technique allowed the identification of a new association between fleas and R. conorii subsp. conorii species. The presence of these vector-borne Rickettsia infections should be considered when diagnosing this disease in humans in Tunisia.

Seroprevalence of tick-borne infections in military working dogs in the Republic of Korea

In this study we endeavored to determine the seroprevalence of tick-borne infections in the military working dog (MWD) population in the Republic of Korea (ROK). Our sample population consisted of 182 serum samples from MWDs for 3 different years (1996, 2002, and 2007). In addition, 63 whole blood samples from 2007 were available for polymerase chain reaction (PCR). Serum samples were evaluated by a commercially available enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assay (IFA) for Ehrlichia canis and Anaplasma phagocytophilum, and by ELISA only for Borrelia burgdorferi. PCR amplification of DNA was performed to screen for Ehrlichia canis, E. chaffeensis, E. ewingii, Anaplasma phagocytophilum, A. platys, Borrelia burgdorferi, and Rickettsia rickettsii, as well as Babesia and Theileria species using previously published primers and probes. A total of 56 (30.8%) MWDs were positive by at least one serologic test. Seroprevalences for Anaplasma and Ehrlichia were 4.4% and 0.6% based on the ELISA, and 24.7% and 22.5% based on the IFA, respectively. ELISA testing for Borrelia yielded 2 (1.1%) positive results. In parallel testing using both the ELISA and IFA tests, the percentages of dogs with one or more positive results were 34.1%, 25.9%, and 28.4%, for 1996, 2002, and 2007, respectively. There was no significant differences in seroprevalence based on location, year, breed, or sex of the MWD. There was poor agreement between IFA and ELISA test results. No MWD sample had a positive PCR result. MWDs stationed in Korea had serologic evidence of exposure to several tick-borne pathogens, but PCR testing did not identify any active infections.

Cross-protection among Rickettsia species and subspecies in a guinea pig model of cutaneous infection

Pathogenic rickettsiae of the spotted fever group (SFG) induce skin lesions called "eschars" at the sites of arthropod bites. We recently described a guinea pig model based on eschar formation to predict the eventual pathogenicity of new Rickettsia species, and in this study, we used the model to study cross-protection among SFG Rickettsia species and subspecies. We showed that the intradermal inoculation of guinea pigs with Rickettsia conorii subsp. conorii significantly reduced, but not completely prevented, the number of eschars after sub-challenges with the same pathogen (P=0.0004). The same effect was also observed for other subspecies of the R. conorii complex. Additionally, the bacterial load in the eschars was significantly lower in immunized animals than in naïve animals. No protection was observed when sub-challenges were performed with other Rickettsia species, such as R. africae, R. sibirica subsp. mongolitimonae, R. aeschlimannii and R. massiliae. Our data suggest that patients may experience several episodes of infection with related or with the same species of Rickettsia. Moreover, the absence of cross-protection between Rickettsia species may explain the co-existence of two or more tick-borne rickettsioses in the same geographic areas.

Spotted fever group rickettsiae in ticks collected from wild animals in Israel

We report molecular evidence for the presence of spotted fever group rickettsiae (SFGR) in ticks collected from roe deer, addax, red foxes, and wild boars in Israel. Rickettsia aeschlimannii was detected in Hyalomma marginatum and Hyalomma detritum while Rickettsia massiliae was present in Rhipicephalus turanicus ticks. Furthermore, a novel uncultured SFGR was detected in Haemaphysalis adleri and Haemaphysalis parva ticks from golden jackals. The pathogenicity of the novel SFGR for humans is unknown; however, the presence of multiple SFGR agents should be considered when serological surveillance data from Israel are interpreted because of significant antigenic cross-reactivity among Rickettsia. The epidemiology and ecology of SFGR in Israel appear to be more complicated than was previously believed.

Murine typhus in the homeless

Homeless populations are particularly exposed to many vector-borne diseases because of their poor living conditions. We tested sera from 299 homeless people recruited in 2010 and 2011 in Marseilles, France for antibodies to Rickettsia typhi by microimmunofluorescence using a titer of 1:25 as a cut-off titer, and we confirmed the results by Western blot and cross-adsorption studies. Sixty-three persons (22%) had antibodies against R. typhi. The murine typhus seroprevalence rates have significantly increased in homeless populations between the 2000-2003 and 2010-2011 periods. These findings indicate that the homeless are increasingly exposed to flea-borne murine typhus in Marseilles. One might suggest that multiple strikes of sanitation workers resulting in the increase of waste and construction sites combined with the poor living conditions of the homeless expose this population to rodents and their fleas. Further annual studies are necessary to follow rodent-associated diseases among homeless people in Marseille.

Epidemiological study of rickettsial infections in patients with hypertransaminemia in Madrid (Spain)

A retrospective analysis was performed to detect anti-rickettsial antibodies in the serum of patients with hypertransaminemia of unknown etiology, and in that of healthy members of the general population of Madrid (Spain). Among 143 patients 16 (11.2%) were positive for anti-R. conorii IgG antibodies and 7% for R. typhi. PCR analysis was performed in patients with IgM antibodies. Among 143 healthy subjects from the general population, seven (4.9%) were positive for anti-R. conorii IgG antibodies, and 2.8% for R. typhi. These results show that anti-rickettsial antibodies are more commonly detected in patients with hypertransaminemia than in healthy people.

Mediterranean-spotted fever: clinical and laboratory characteristics of 34 children in Oran (Algeria)

INTRODUCTION

Mediterranean-spotted fever (MSF) is endemic in the Mediterranean basin. The aim of our study is to describe clinical and laboratory characteristics of MSF in Algeria.

METHODS

Retrospective study of 34 children suffering from MSF hospitalized from 2002 to 2005. Diagnosis and outcome data were abstracted from patient medical reports. The serological confirmation was obtained by immunofluorescent antibody.

RESULTS

All the children were hospitalized during summer time. The median age was 4.5 years. The sex ratio in the children was 0.76. Clinical features were high fever, maculopapulous rash and black eschar. Among analytical findings, leucocyte count was decreased in 50% of children during the first week of illness. The indirect immunofluorescence for Rickettsia conorii was positive in 70% of cases in the second determination. All received antimicrobial therapy. All children cured without complications.

CONCLUSION

MSF is a mild rickettsial disease in Algeria.