1
|
Paskey AC, Schully KL, Voegtly LJ, Arnold CE, Cer RZ, Frey KG, Blair PW, Clark DV, Ge H, Richards AL, Farris CM, Bishop-Lilly KA. A proof of concept for a targeted enrichment approach to the simultaneous detection and characterization of rickettsial pathogens from clinical specimens. Front Microbiol 2024; 15:1387208. [PMID: 38659991 PMCID: PMC11039911 DOI: 10.3389/fmicb.2024.1387208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Infection with either Rickettsia prowazekii or Orientia tsutsugamushi is common, yet diagnostic capabilities are limited due to the short window for positive identification. Until now, although targeted enrichment had been applied to increase sensitivity of sequencing-based detection for various microorganisms, it had not been applied to sequencing of R. prowazekii in clinical samples. Additionally, hybridization-based targeted enrichment strategies had only scarcely been applied to qPCR of any pathogens in clinical samples. Therefore, we tested a targeted enrichment technique as a proof of concept and found that it dramatically reduced the limits of detection of these organisms by both qPCR and high throughput sequencing. The enrichment methodology was first tested in contrived clinical samples with known spiked-in concentrations of R. prowazekii and O. tsutsugamushi DNA. This method was also evaluated using clinical samples, resulting in the simultaneous identification and characterization of O. tsutsugamushi directly from clinical specimens taken from sepsis patients. We demonstrated that the targeted enrichment technique is helpful by lowering the limit of detection, not only when applied to sequencing, but also when applied to qPCR, suggesting the technique could be applied more broadly to include other assays and/or microbes for which there are limited diagnostic or detection modalities.
Collapse
Affiliation(s)
- Adrian C. Paskey
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
- Leidos, Reston, VA, United States
| | - Kevin L. Schully
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
| | - Logan J. Voegtly
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
- Leidos, Reston, VA, United States
| | - Catherine E. Arnold
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
- Defense Threat Reduction Agency, Fort Belvoir, VA, United States
| | - Regina Z. Cer
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
| | - Kenneth G. Frey
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
| | - Paul W. Blair
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Danielle V. Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Hong Ge
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Command, Silver Spring, MD, United States
| | - Allen L. Richards
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Command, Silver Spring, MD, United States
| | - Christina M. Farris
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Command, Silver Spring, MD, United States
| | - Kimberly A. Bishop-Lilly
- Genomics and Bioinformatics Department, Biological Defense Research Directorate, Naval Medical Research Command, Frederick, MD, United States
| |
Collapse
|
2
|
Abou Abdallah R, Million M, Delerce J, Anani H, Diop A, Caputo A, Zgheib R, Rousset E, Sidi Boumedine K, Raoult D, Fournier PE. Pangenomic analysis of Coxiella burnetii unveils new traits in genome architecture. Front Microbiol 2022; 13:1022356. [PMID: 36478861 PMCID: PMC9721466 DOI: 10.3389/fmicb.2022.1022356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 08/25/2023] Open
Abstract
Coxiella burnetii is the etiological agent of Q fever, a worldwide zoonosis able to cause large outbreaks. The disease is polymorphic. Symptomatic primary infection is named acute Q fever and is associated with hepatitis, pneumonia, fever, and auto-immune complications while persistent focalized infections, mainly endocarditis, and vascular infections, occur in a minority of patients but are potentially lethal. In order to evaluate the genomic features, genetic diversity, evolution, as well as genetic determinants of antibiotic resistance, pathogenicity, and ability to cause outbreaks of Q fever, we performed a pangenomic analysis and genomic comparison of 75 C. burnetii strains including 63 newly sequenced genomes. Our analysis demonstrated that C. burnetii has an open pangenome, unique genes being found in many strains. In addition, pathogenicity islands were detected in all genomes. In consequence C. burnetii has a high genomic plasticity, higher than that of other intracellular bacteria. The core- and pan-genomes are made of 1,211 and 4,501 genes, respectively (ratio 0.27). The core gene-based phylogenetic analysis matched that obtained from multi-spacer typing and the distribution of plasmid types. Genomic characteristics were associated to clinical and epidemiological features. Some genotypes were associated to specific clinical forms and countries. MST1 genotype strains were associated to acute Q fever. A significant association was also found between clinical forms and plasmids. Strains harboring the QpRS plasmid were never found in acute Q fever and were only associated to persistent focalized infections. The QpDV and QpH1 plasmids were associated to acute Q fever. In addition, the Guyanese strain CB175, the most virulent strain to date, exhibited a unique MST genotype, a distinct COG profile and an important variation in gene number that may explain its unique pathogenesis. Therefore, strain-specific factors play an important role in determining the epidemiological and clinical manifestations of Q fever alongside with host-specific factors (valvular and vascular defects notably).
Collapse
Affiliation(s)
- Rita Abou Abdallah
- Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Jeremy Delerce
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Hussein Anani
- Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Awa Diop
- Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Aurelia Caputo
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Rita Zgheib
- Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Elodie Rousset
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
| | - Karim Sidi Boumedine
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), UMR Microbes Evolution Phylogeny and Infections (MEPHI), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Service de Santé des Armées, AP-HM, UMR Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| |
Collapse
|
3
|
Condit ME, Jones E, Biggerstaff BJ, Kato CY. Procedure for spotted fever group Rickettsia isolation from limited clinical blood specimens. PLoS Negl Trop Dis 2022; 16:e0010781. [PMID: 36240222 PMCID: PMC9605293 DOI: 10.1371/journal.pntd.0010781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 10/26/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Current isolation techniques for spotted fever group Rickettsia from clinical samples are laborious and are limited to tissue, blood and blood derivatives with volumes ideally greater than 1 mL. We validated the use of simplified methodologies for spotted fever group Rickettsia culture isolation that overcome sample volume limitations and provide utility in clinical diagnostics and research studies. METHODOLOGY/PRINCIPAL FINDINGS A modified cell culture method is evaluated for the isolation of Rickettsia ssp. from human diagnostic samples. Culture sampling method, culture platform, and growth phase analysis were evaluated to determine best practices for optimal culture isolation conditions. Rickettsial isolates (R. conorii, R. rickettsii, and R. parkeri) were grown in Vero E6 cells over a course of 5 to 7 days at low inoculum treatments (~40 bacterial copies) to standardize the sampling strategy at a copy number reflective of the bacteremia in acute diagnostic samples. This methodology was verified using small volumes (50 μL) of 25 unprocessed clinical whole blood, plasma, and serum samples from acute samples of patients suspected of having Rocky Mountain Spotted Fever, of which 10 were previously confirmed positive via the PanR8 qPCR assay, 13 had no detectable Rickettsia DNA by the PanR8 qPCR assay, and 2 were not previously tested; these samples resulted in the cultivation of 7 new R. rickettsii isolates. CONCLUSIONS/SIGNIFICANCE We observed that rickettsial isolate growth in culture is reproducibly identified by real-time PCR testing of culture media within 72 hours after inoculation. Additionally, specimen sedimentation prior to isolation to remove red blood cells was found to decrease the amount of total organism available in the inoculum. A small volume culture method was established focusing on comparative qPCR detection rather than bacterial visualization, taking significantly shorter time to detect, and requiring less manipulation compared to traditional clinical isolate culture methods.
Collapse
Affiliation(s)
- Marah E. Condit
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emma Jones
- Office of the Director, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Brad J. Biggerstaff
- Office of the Director, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Cecilia Y. Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America,* E-mail:
| |
Collapse
|
4
|
Lyu Y, Shen Y, Hu CY, Xu PP, Qin W, Gong L, Zhou Y, Gong TQ, Sun J, Chen BL, Sun Y, Xie SY, Li KC, Chang HW. The first reported outbreak of an undetermined species of human infection with spotted fever group Rickettsia in Lu'an, China. Acta Trop 2021; 223:106072. [PMID: 34358513 DOI: 10.1016/j.actatropica.2021.106072] [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: 10/15/2019] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE On May 2, 2017, an outbreak of unexplained fever with rashes was reported in Lu'an, China. In this study, we aimed to identify the possible pathogens, epidemiological characteristics, and risk factors of this outbreak. METHODS We conducted descriptive field epidemiological studies. Blood samples were tested using an indirect immunofluorescence assay for Rickettsia rickettsii antibody, and nested polymerase chain reaction and gene sequencing assays were performed. RESULTS We recruited 39 cases who had symptomatic onset from April 20 to June 8, 2017. Among these, 9 were suspected cases, 18 were probable cases, and 12 were confirmed cases. No one died. The main clinical manifestations were fever (100%), rash (100%), fatigue (97.3%), myalgia (83.8%), and anorexia (83.8%). None of the patients died. Thirty-seven patients who were treated with antibiotics during hospitalization showed significant improvement. The cases were distributed across 14 townships in 2 counties. The median age was 59 (43.0-81.0) years, of which 93.3% had a history of tea picking (28/30), and 77.3% (17/22) had a history of tick bites. The mean incubation period was 5.0 days (2.0-13.0 days). Serum IgG titers were higher in convalescent patients than in the general population (p = 0.016). Phylogenetic analysis revealed that the ompA sequences of Rickettsia sp. Lu'an-2018 had an 86.8%-99.0% sequence identity with the 23 strains of Rickettsia found worldwide. CONCLUSIONS This was the first reported outbreak of an undetermined species of a human infection with the spotted fever group of Rickettsia in China, which might be caused by ticks biting local residents when picking tea.
Collapse
Affiliation(s)
- Yong Lyu
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Yong Shen
- Emergency Department, Lu 'an affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Cheng-Yang Hu
- School of Humanistic Medicine, Anhui Medical University, Hefei, China
| | - Peng-Peng Xu
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Wei Qin
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Lei Gong
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yu Zhou
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Tian-Qi Gong
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Jie Sun
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Bei-Lei Chen
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Yong Sun
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Shao-Yu Xie
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Kai-Chun Li
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Hong-Wei Chang
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China.
| |
Collapse
|
5
|
Mediterranean Spotted Fever: Current Knowledge and Recent Advances. Trop Med Infect Dis 2021; 6:tropicalmed6040172. [PMID: 34698275 PMCID: PMC8544691 DOI: 10.3390/tropicalmed6040172] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Mediterranean spotted fever (MSF) is an emerging tick-borne rickettsiosis of the spotted fever group (SFG), endemic in the Mediterranean basin. By virtue of technological innovations in molecular genetics, it has been determined that the causative agent of MSF is Rickettsia conorii subspecies conorii. The arthropod vector of this bacterium is the brown dog tick Rhipicephalus sanguineus. The true nature of the reservoir of R. conorii conorii has not been completely deciphered yet, although many authors theorize that the canine population, other mammals, and the ticks themselves could potentially contribute as reservoirs. Typical symptoms of MSF include fever, maculopapular rash, and a characteristic eschar (“tache noire”). Atypical clinical features and severe multi-organ complications may also be present. All of these manifestations arise from the disseminated infection of the endothelium by R. conorii conorii. Several methods exist for the diagnosis of MSF. Serological tests are widely used and molecular techniques have become increasingly available. Doxycycline remains the treatment of choice, while preventive measures are focused on modification of human behavior and vector control strategies. The purpose of this review is to summarize the current knowledge on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of MSF.
Collapse
|
6
|
Sunbathing, a possible risk factor of murine typhus infection in Greece. PLoS Negl Trop Dis 2021; 15:e0009186. [PMID: 33711035 PMCID: PMC7990230 DOI: 10.1371/journal.pntd.0009186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 03/24/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There are few studies about the presence of murine typhus in Greece. Our objective was to conduct a large scale retrospective investigation to determine the clinical and epidemiological features of patients diagnosed with murine typhus in Greece. METHODOLOGY/PRINCIPAL FINDINGS From 2012 to 2019 serum samples from hospitalized patients and outpatients throughout Greece suspected for murine typhus infection were tested by immunofluorescence assay for Rickettsia typhi. Immunofluorescence positive samples obtained since 2016 were also tested by qPCR targeting R. typhi. Clinical and epidemiological data were retrospectively collected for the patients with confirmed murine typhus. Overall, we tested 5,365 different patients and, in total, 174 patients from all geographic regions of Greece were diagnosed with murine typhus. The most frequently reported sign or symptom was fever (89%), followed by headache (84%) and rash (81%). The classical triad of fever, headache, and rash was present in 72% of patients during their illness. Severe infections with complications including acute renal failure or septic shock were not recorded. The majority of cases (81%) occurred during May-October and peaked in June and September. Most of patients (81%) infected in Athens, recalled that their only activity the last weeks before symptoms onset was swimming on the beach and 59% of them also reported an insect bite while sunbathing. CONCLUSIONS/SIGNIFICANCE Our results may reflect the reemergence of murine typhus in Greece and we highlight the importance of awareness of this difficult-to-recognize undifferentiated febrile illness.
Collapse
|
7
|
Piotrowski M, Rymaszewska A. Expansion of Tick-Borne Rickettsioses in the World. Microorganisms 2020; 8:E1906. [PMID: 33266186 PMCID: PMC7760173 DOI: 10.3390/microorganisms8121906] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/30/2020] [Accepted: 11/25/2020] [Indexed: 12/28/2022] Open
Abstract
Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia. These infections are among the oldest known diseases transmitted by vectors. In the last three decades there has been a rapid increase in the recognition of this disease complex. This unusual expansion of information was mainly caused by the development of molecular diagnostic techniques that have facilitated the identification of new and previously recognized rickettsiae. A lot of currently known bacteria of the genus Rickettsia have been considered nonpathogenic for years, and moreover, many new species have been identified with unknown pathogenicity. The genus Rickettsia is distributed all over the world. Many Rickettsia species are present on several continents. The geographical distribution of rickettsiae is related to their vectors. New cases of rickettsioses and new locations, where the presence of these bacteria is recognized, are still being identified. The variety and rapid evolution of the distribution and density of ticks and diseases which they transmit shows us the scale of the problem. This review article presents a comparison of the current understanding of the geographic distribution of pathogenic Rickettsia species to that of the beginning of the century.
Collapse
|
8
|
Chaudhry R, Kokkayil P, Ghosh A, Bahadur T, Kant K, Sagar T, Kabra SK, Lodha R, Dey AB, Menon V. Bartonella henselae infection in diverse clinical conditions in a tertiary care hospital in north India. Indian J Med Res 2018; 147:189-194. [PMID: 29806608 PMCID: PMC5991118 DOI: 10.4103/ijmr.ijmr_1932_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background & objectives: Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India. Methods: A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2 with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA). Results: IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive. Interpretation & conclusions: The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider Bartonella infection in the differential diagnosis of febrile illnesses and chronic diseases.
Collapse
Affiliation(s)
- Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Arnab Ghosh
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Tej Bahadur
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamala Kant
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vimala Menon
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Torpiano P, Pace D. Clinically-diagnosed Mediterranean Spotted Fever in Malta. Travel Med Infect Dis 2018; 26:16-24. [PMID: 29462726 DOI: 10.1016/j.tmaid.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mediterranean Spotted Fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii which is endemic in Malta, an island in the South Mediterranean that is a popular tourist destination. Diagnosis is frequently based on clinical manifestations as laboratory results are often limited to a retrospective diagnosis. We describe the clinical presentation, diagnosis and treatment of children <16 years who presented with MSF from 2011 to 2016. METHOD The demographics, clinical findings, laboratory results, management and outcome of all children hospitalised with suspected MSF based on the presence of fever and an eschar, were retrieved from their case notes. RESULTS Over the five-year study period six children, aged between 17 months and 15 years, were diagnosed with MSF. All children had contact with ticks and the majority presented in summer. Laboratory results were non-specific and included elevated inflammatory markers, lymphocytosis/lymphopenia and hyponatraemia. Serological and molecular techniques were used for diagnosis. Response to clarithromycin or doxycycline was immediate. CONCLUSION MSF should be included in the differential diagnosis of fever, rash and an eschar in children who travel to Malta. Despite advances in molecular diagnostics, clinical diagnosis remains important in the management of children with suspected MSF.
Collapse
Affiliation(s)
- Paul Torpiano
- Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta.
| | - David Pace
- Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta
| |
Collapse
|
10
|
Chochlakis D, Germanakis A, Chaliotis G, Kapetanaki S, Kalogeraki L, Gkika E, Partalis N, Polymili G, Tselentis Y, Psaroulaki A. Potential exposure of humans to Rickettsia felis in Greece. Acta Trop 2018; 178:40-45. [PMID: 29079185 DOI: 10.1016/j.actatropica.2017.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
Rickettsia felis is a flea-transmitted pathogen however, in Greece, much work has been done on another flea-borne pathogen, R. typhi; human cases have been described and high-risk areas have been characterized. Nevertheless, little is known about human infections caused by R. felis in the country since human cases are not routinely tested for antibodies against this pathogen. During the past seven years, we have set up a protocol at the National Reference Centre in order to improve the testing of tick-borne diseases in Greece. Based on this protocol, R. conorii, R. typhi R. slovaca, R. felis, and R. mongolotimonae have been added into the routine analysis; during these last years, eight (8) cases of potential exposure to R. felis were identified by serology. On an environmental investigation carried out at the residences of the patients, the pathogen was detected in C. felis only. The demonstration of R. felis potential presence highlights the need for better testing and surveillance of the pathogen.
Collapse
|
11
|
Nouchi A, Monsel G, Jaspard M, Jannic A, Angelakis E, Caumes E. Rickettsia sibirica mongolitimonae infection in a woman travelling from Cameroon: a case report and review of the literature. J Travel Med 2018; 25:4780169. [PMID: 29394384 DOI: 10.1093/jtm/tax074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/13/2017] [Indexed: 11/12/2022]
Abstract
Rickettsia sibirica mongolitimonae is now a well-known cause of human rickettsial infection, with 52 reported cases, including 47 in southern Europe and one in South Africa. We report the first case of R. sibirica mongolitimonae in Central Africa, likely a sentinel case for a more common disease than originally suspected.
Collapse
Affiliation(s)
- Agathe Nouchi
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gentiane Monsel
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Jaspard
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Arnaud Jannic
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalo-Universitaire Méditerranée Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Eric Caumes
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| |
Collapse
|
12
|
Abou Abdallah R, Raoult D, Fournier PE. A concise overview on tick-borne human infections in Europe: a focus on Lyme borreliosis and tick-borne Rickettsia spp. MICROBIOLOGY AUSTRALIA 2018. [DOI: 10.1071/ma18065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ticks are blood-feeding external parasites of mammals. Almost all ticks belong to one of two major families, the Ixodidae or hard ticks, and the Argasidae or soft ticks. Ticks are responsible of transmitting many diseases called ‘tick-borne diseases'. Borrelia and Rickettsia spp., are the most important tick-transmitted bacterial pathogens circulating in Europe. In this review we will focus on the two tick-borne diseases caused by these bacterial pathogens, their vector, epidemiology, clinical diagnosis and symptoms.
Collapse
|
13
|
Guimard T, Amrane S, Elsa Prudent, El Karkouri K, Raoult D, Angelakis E. Case Report: Scalp Eschar and Neck Lymphadenopathy Associated with Bacteremia due to Coxiella-Like Bacteria. Am J Trop Med Hyg 2017; 97:1319-1322. [PMID: 28820698 DOI: 10.4269/ajtmh.17-0251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Coxiella-like bacteria have been recently proposed as human pathogens. Using molecular techniques, we detected Coxiella-like bacteria in the blood and serum samples of a patient with a scalp eschar, neck lymphadenopathy, severe urticaria, edema, fever, and arthralgia indicating that this organism can provide systemic complications.
Collapse
Affiliation(s)
- Thomas Guimard
- Centre Hospitalier Départemental Vendée, Service de Maladies Infectieuses, La Roche sur Yon, France
| | - Sophie Amrane
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France
| | - Elsa Prudent
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France
| | - Khalid El Karkouri
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France
| | - Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix-Marseille Université, Marseille, France
| |
Collapse
|
14
|
Portillo A, de Sousa R, Santibáñez S, Duarte A, Edouard S, Fonseca IP, Marques C, Novakova M, Palomar AM, Santos M, Silaghi C, Tomassone L, Zúquete S, Oteo JA. Guidelines for the Detection of Rickettsia spp. Vector Borne Zoonotic Dis 2017; 17:23-32. [PMID: 28055574 DOI: 10.1089/vbz.2016.1966] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The genus Rickettsia (Rickettsiales: Rickettsiaceae) includes Gram-negative, small, obligate intracellular, nonmotile, pleomorphic coccobacilli bacteria transmitted by arthropods. Some of them cause human and probably also animal disease (life threatening in some patients). In these guidelines, we give clinical practice advices (microscopy, serology, molecular tools, and culture) for the microbiological study of these microorganisms in clinical samples. Since in our environment rickettsioses are mainly transmitted by ticks, practical information for the identification of these arthropods and for the study of Rickettsia infections in ticks has also been added.
Collapse
Affiliation(s)
- Aránzazu Portillo
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Rita de Sousa
- 2 National Institute of Health Dr. Ricardo Jorge , Águas de Moura, Portugal
| | - Sonia Santibáñez
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Ana Duarte
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Sophie Edouard
- 4 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalo-Universitaire Méditerranée-Infection , Marseille, France
| | - Isabel P Fonseca
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Cátia Marques
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Marketa Novakova
- 5 Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno , Brno, Czech Republic .,6 CEITEC VFU, University of Veterinary and Pharmaceutical Sciences Brno , Brno, Czech Republic
| | - Ana M Palomar
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| | - Marcos Santos
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - Cornelia Silaghi
- 7 National Centre for Vector Entomology, Institute of Parasitology, University of Zurich , Zurich, Switzerland
| | - Laura Tomassone
- 8 Department of Veterinary Sciences, University of Torino , Grugliasco, Italy
| | - Sara Zúquete
- 3 Center for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon , Lisbon, Portugal
| | - José A Oteo
- 1 Center of Rickettsiosis and Arthropod-Borne Diseases , Hospital San Pedro-CIBIR, Logroño, Spain
| |
Collapse
|
15
|
Sul H, Kim DM. Present state and future of tick-borne infectious diseases in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.6.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyoung Sul
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| |
Collapse
|
16
|
Abstract
To further characterize human infections caused by Rickettsia sibirica mongolitimonae, we tested skin biopsy and swab samples and analyzed clinical, epidemiologic, and diagnostic characteristics of patients with a rickettsiosis. The most common (38%) indigenous species was R. sibirica mongolitimonae. Significantly more cases of R. sibirica mongolitimonae infection occurred during spring and summer.
Collapse
|
17
|
Kocher C, Morrison AC, Leguia M, Loyola S, Castillo RM, Galvez HA, Astete H, Flores-Mendoza C, Ampuero JS, Bausch DG, Halsey ES, Cespedes M, Zevallos K, Jiang J, Richards AL. Rickettsial Disease in the Peruvian Amazon Basin. PLoS Negl Trop Dis 2016; 10:e0004843. [PMID: 27416029 PMCID: PMC4944934 DOI: 10.1371/journal.pntd.0004843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
Using a large, passive, clinic-based surveillance program in Iquitos, Peru, we characterized the prevalence of rickettsial infections among undifferentiated febrile cases and obtained evidence of pathogen transmission in potential domestic reservoir contacts and their ectoparasites. Blood specimens from humans and animals were assayed for spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) by ELISA and/or PCR; ectoparasites were screened by PCR. Logistic regression was used to determine associations between patient history, demographic characteristics of participants and symptoms, clinical findings and outcome of rickettsial infection. Of the 2,054 enrolled participants, almost 2% showed evidence of seroconversion or a 4-fold rise in antibody titers specific for rickettsiae between acute and convalescent blood samples. Of 190 fleas (Ctenocephalides felis) and 60 ticks (Rhipicephalus sanguineus) tested, 185 (97.4%) and 3 (5%), respectively, were positive for Rickettsia spp. Candidatus Rickettsia asemboensis was identified in 100% and 33% of the fleas and ticks tested, respectively. Collectively, our serologic data indicates that human pathogenic SFGR are present in the Peruvian Amazon and pose a significant risk of infection to individuals exposed to wild, domestic and peri-domestic animals and their ectoparasites. Rickettsial infection remains relatively unexplored in South America compared to other regions of the world. For most regions of Peru (including the Amazon Basin), nothing more than broad serological characterization is available about circulating rickettsiae. Even less is known about the animal reservoirs and insect vectors involved in disease transmission. With this study we aimed to better characterize the circulating species of Rickettsia in humans in the Amazon Basin, as well as investigate their domestic animal reservoir and arthropod vectors. Out of 2054 fever patients enrolled we identified 38 individuals with serologic evidence for acute rickettsial infection. Their homes were visited in order to draw blood samples and collect ectoparasites from their domestic animals. Serology and molecular methods were used to test the animal blood samples as well as the ectoparasites. The information collected contributes to the understanding of the transmission dynamics of rickettsial diseases in Iquitos and leads to a better understanding of the exposure risk to rickettsial infection and it will guide approaches for prevention.
Collapse
Affiliation(s)
- Claudine Kocher
- Kantonsspital Baden, Baden, Switzerland
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
- * E-mail:
| | - Amy C. Morrison
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Mariana Leguia
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Steev Loyola
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | - Hugo A. Galvez
- Instituto Veterinario de Investigaciones Tropicales y de Altura, Iquitos, Peru
| | - Helvio Astete
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | | | | | - Eric S. Halsey
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | | | - Karine Zevallos
- Laboratorio de Investigacion y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ju Jiang
- U.S. Naval Medical Research Center, Silver Spring, Maryland, United States of America
| | - Allen L. Richards
- U.S. Naval Medical Research Center, Silver Spring, Maryland, United States of America
| |
Collapse
|
18
|
Biggs HM, Behravesh CB, Bradley KK, Dahlgren FS, Drexler NA, Dumler JS, Folk SM, Kato CY, Lash RR, Levin ML, Massung RF, Nadelman RB, Nicholson WL, Paddock CD, Pritt BS, Traeger MS. Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States. MMWR Recomm Rep 2016; 65:1-44. [PMID: 27172113 DOI: 10.15585/mmwr.rr6502a1] [Citation(s) in RCA: 303] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.
Collapse
Affiliation(s)
- Holly M Biggs
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Angelakis E, Mediannikov O, Parola P, Raoult D. Rickettsia felis: The Complex Journey of an Emergent Human Pathogen. Trends Parasitol 2016; 32:554-564. [PMID: 27155905 DOI: 10.1016/j.pt.2016.04.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
Rickettsia felis is an obligate intracellular bacterium that is different from other officially recognized rickettsial species. It has multiple genes of different origins, an incubation temperature of less than 32°C, and a conjugative plasmid. This Rickettsia is commonly detected in febrile patients in sub-Saharan Africa. R. felis is frequently detected in cat fleas, but recently mosquitoes have been suspected to be able to transmit the bacterium. However, many aspects of the ecology and epidemiology of R. felis are not completely understood and remain to be uncovered. We aim here to give an update of the current knowledge about this fascinating organism.
Collapse
Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France.
| | - Oleg Mediannikov
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Philippe Parola
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| |
Collapse
|
20
|
Luce-Fedrow A, Mullins K, Kostik AP, St John HK, Jiang J, Richards AL. Strategies for detecting rickettsiae and diagnosing rickettsial diseases. Future Microbiol 2016; 10:537-64. [PMID: 25865193 DOI: 10.2217/fmb.14.141] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Rickettsial diseases and scrub typhus constitute a group of the oldest known vector-borne diseases. The cosmopolitan distribution of the vectors that transmit rickettsiae and orientiae leads to a worldwide prevalence of these diseases. Despite their significant historical status, detection and diagnosis of these diseases are still evolving today. Serological methods remain among the most prevalent techniques used for the detection/diagnosis of rickettsial diseases and scrub typhus. Molecular techniques have been instrumental in increasing the sensitivity/specificity of diagnosis, identifying new Rickettsia and Orientia species and have enhanced epidemiological capabilities when used in combination with serological methods. In this review, we discuss these techniques and their associated pros and cons.
Collapse
Affiliation(s)
- Alison Luce-Fedrow
- Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | | | | | | | | | | |
Collapse
|
21
|
Znazen A, Sellami H, Elleuch E, Hattab Z, Ben Sassi L, Khrouf F, Dammak H, Letaief A, Ben Jemaa M, Hammami A. Comparison of two quantitative real time PCR assays for Rickettsia detection in patients from Tunisia. PLoS Negl Trop Dis 2015; 9:e0003487. [PMID: 25706392 PMCID: PMC4338037 DOI: 10.1371/journal.pntd.0003487] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Quantitative real time PCR (qPCR) offers rapid diagnosis of rickettsial infections. Thus, successful treatment could be initiated to avoid unfavorable outcome. Our aim was to compare two qPCR assays for Rickettsia detection and to evaluate their contribution in early diagnosis of rickettsial infection in Tunisian patients. Patients and methods Included patients were hospitalized in different hospitals in Tunisia from 2007 to 2012. Serology was performed by microimmunofluorescence assay using R. conorii and R. typhi antigens. Two duplex qPCRs, previously reported, were performed on collected skin biopsies and whole blood samples. The first duplex amplified all Rickettsia species (PanRick) and Rickettsia typhi DNA (Rtt). The second duplex detected spotted fever group Rickettsiae (RC00338) and typhus group Rickettsiae DNA (Rp278). Results Diagnosis of rickettsiosis was confirmed in 82 cases (57.7%). Among 44 skin biopsies obtained from patients with confirmed diagnosis, the first duplex was positive in 24 samples (54.5%), with three patients positive by Rtt qPCR. Using the second duplex, positivity was noted in 21 samples (47.7%), with two patients positive by Rp278 qPCR. Among79 whole blood samples obtained from patients with confirmed diagnosis, panRick qPCR was positive in 5 cases (6.3%) among which two were positive by Rtt qPCR. Using the second set of qPCRs, positivity was noted in four cases (5%) with one sample positive by Rp278 qPCR. Positivity rates of the two duplex qPCRs were significantly higher among patients presenting with negative first serum than those with already detectable antibodies. Conclusions Using qPCR offers a rapid diagnosis. The PanRick qPCR showed a higher sensitivity. Our study showed that this qPCR could offer a prompt diagnosis at the early stage of the disease. However, its implementation in routine needs cost/effectiveness evaluation. Rickettsial diagnosis is challenging in routine laboratory. Serology offers only retrospective diagnosis. We aimed to introduce molecular methods in routine diagnosis of these infections. The lack of standardized methods led us to compare real time PCR assays previously reported in order to implement a clear strategies for diagnosis of these infections in our laboratory. Real time PCR proposed by Renvoisé et al includes two PCRs, one to detect spotted fever group and another to detect typhus group Rickettsiae. The real time PCR proposed by Giullieri et al includes a first PCR detecting 16rDNA of all Rickettsiae and if it is positive a second PCR detecting R. typhi should be performed. This second Real time PCR was shown to offer a slight higher sensitivity with a lower cost in our study. Skin biopsy specimens were more likely to show positive results than whole blood samples. Finally, positivity rates were higher among patients presenting at the first stage of the disease, essentially with negative serology.
Collapse
Affiliation(s)
- Abir Znazen
- Laboratory of Microbiology, Research Laboratory “MPH”, Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia
- * E-mail:
| | - Hanen Sellami
- Laboratory of Microbiology, Research Laboratory “MPH”, Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia
| | - Emna Elleuch
- Infectious diseases department, Hedi Chaker University Hospital of Sfax, Sfax University, Sfax, Tunisia
| | - Zouhour Hattab
- Infectious diseases department, Farhat Hached University Hospital of Sousse, Sousse, Tunisia
| | | | - Fatma Khrouf
- Laboratory of entomology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hassen Dammak
- Intensive care unit, Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia
| | - Amel Letaief
- Infectious diseases department, Farhat Hached University Hospital of Sousse, Sousse, Tunisia
| | - Mounir Ben Jemaa
- Infectious diseases department, Hedi Chaker University Hospital of Sfax, Sfax University, Sfax, Tunisia
| | - Adnene Hammami
- Laboratory of Microbiology, Research Laboratory “MPH”, Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia
| |
Collapse
|
22
|
Angelakis E, Johani S, Ahsan A, Memish Z, Raoult D. Q fever endocarditis and new Coxiella burnetii genotype, Saudi Arabia. Emerg Infect Dis 2014; 20:726-8. [PMID: 24655815 PMCID: PMC3966385 DOI: 10.3201/eid2004.131603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
23
|
Draft Genome Sequence of Coxiella burnetii Strain Cb196, an Agent of Endocarditis in Saudi Arabia. GENOME ANNOUNCEMENTS 2014; 2:2/6/e01180-14. [PMID: 25428964 PMCID: PMC4246156 DOI: 10.1128/genomea.01180-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Coxiella burnetii Cb196, with a 2,006,415-bp genome, is a strain isolated from a 45-year-old man in Saudi Arabia with endocarditis. It belongs to the genotype MST51, which was detected for the first time only in this country. Cb196 shows more similarity to C. burnetii CbuK_Q154, belonging to genotype 8, which was phylogenetically close to MST51.
Collapse
|
24
|
Angelakis E, Mediannikov O, Socolovschi C, Mouffok N, Bassene H, Tall A, Niangaly H, Doumbo O, Znazen A, Sarih M, Sokhna C, Raoult D. Coxiella burnetii-positive PCR in febrile patients in rural and urban Africa. Int J Infect Dis 2014; 28:107-10. [PMID: 25245003 DOI: 10.1016/j.ijid.2014.05.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Q fever has been reported throughout the African continent. The objective of this study was to detect the presence of Coxiella burnetii in febrile patients from Africa. METHODS Blood samples from febrile and non-febrile patients from six African countries and from France were investigated retrospectively for Q fever infection by molecular assays targeting the IS1111 and IS30A spacers. RESULTS We tested 1888 febrile patients from Senegal, Mali, Tunisia, Algeria, Gabon, and Morocco and found one male adult patient (0.3%) infected with C. burnetii in Algeria and six positive patients (0.5%) in Senegal. For one patient from Senegal we determined that the infection was caused by C. burnetii genotype 35. In Senegal, more patients were infected with C. burnetii in Keur Momar Sarr (p=0.002) than in the other locations. Blood samples taken from 500 (51% males) non-febrile people from Senegal and France were all negative. CONCLUSIONS The installation of point-of-care laboratories in rural Africa can be a very effective tool for studying the epidemiology of many infectious diseases.
Collapse
Affiliation(s)
| | - Oleg Mediannikov
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | | | - Nadjet Mouffok
- Service des Maladies Infectieuses, Centre Hospitalo-Universitaire d'Oran, Oran, Algeria
| | - Hubert Bassene
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | - Adama Tall
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Hamidou Niangaly
- Malaria Research and Training Centre, Faculty of Medicine, University of Sciences Techniques and Technology, Bamako, Bamako, Mali
| | - Ogobara Doumbo
- Malaria Research and Training Centre, Faculty of Medicine, University of Sciences Techniques and Technology, Bamako, Bamako, Mali
| | - Abir Znazen
- Laboratory of Microbiology and Laboratory of Research 'MPH', Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mhammed Sarih
- Laboratoire des Maladies Vectorielles, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Cheikh Sokhna
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| |
Collapse
|
25
|
Merhej V, Angelakis E, Socolovschi C, Raoult D. Genotyping, evolution and epidemiological findings of Rickettsia species. INFECTION GENETICS AND EVOLUTION 2014; 25:122-37. [DOI: 10.1016/j.meegid.2014.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 01/12/2023]
|
26
|
Bacterial lymphadenitis at a major referral hospital in France from 2008 to 2012. J Clin Microbiol 2014; 52:1161-7. [PMID: 24478415 DOI: 10.1128/jcm.03491-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lymph node enlargement is a common medical problem, and in a large number of patients, the causes of lymphadenopathy remain undiagnosed. We report a thorough microbiological analysis of 1,688 lymph node biopsy specimens collected in our bartonellosis reference center. We studied lymph node biopsy samples from patients with suspected regional infectious lymph node enlargement from January 2008 to December 2012. To evaluate a useful strategy for the diagnosis of infectious lymphadenitis, specimens were cultured and subjected to molecular assays. Histologic analysis was done when possible. A total of 642 (38%) biopsy specimens were infected with a bacterial agent, and quantitative PCR (qPCR) was significantly better than 16S rRNA gene PCR (rrs) for the detection of Bartonella henselae (P = 0.05), Mycobacterium tuberculosis (P = 0.05), and Mycobacterium avium (P = 0.007). Molecular assays were significantly better than bacterial cultures for the diagnosis of Francisella tularensis (P = 0.017) but were less effective for detecting M. tuberculosis (P = 0.004) and M. avium (P = 0.001). Histologic analysis was done for 412 lymph nodes, and 20% of these were compatible with an infectious lymphadenitis, whereas a neoplasm was found in 29% of these lymph nodes. M. tuberculosis was detected significantly more in female than in male patients (P = 0.01), and patients with cat scratch disease (CSD) were younger than patients with M. tuberculosis, Tropheryma whipplei, and F. tularensis. Negative rrs PCR does not exclude the diagnosis of infectious lymphadenitis. Histologic analysis of lymph node biopsy specimens is critical, as a diagnosis of infectious lymphadenitis does not preclude other concurrent diseases.
Collapse
|
27
|
Psotta-Schachtner C, Elsharkawi-Welt K, Härter G, Scharffetter-Kochanek K. [Papulovesicular exanthem after a safari in South Africa]. Hautarzt 2014; 65:229-33. [PMID: 24419477 DOI: 10.1007/s00105-013-2739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 68-year-old man presented with a papulovesicular exanthem, fever and malaise after a safari in South Africa. Based on the history, the typical clinical picture with an exanthema and eschar as well as the detection of antibodies against rickettsioses of the spotted fever group, we diagnosed African tick-bite fever which is due to R. africae. During treatment with doxycycline 200 mg/d, all symptoms resolved completely within 11 days. Rickettsioses should always be considered in patients presenting with exanthema, fever and malaise. Particularly the presence of one or multiple eschars on the skin manifesting as erythematous plaques with central necrosis is a pathognomic sign. The serological detection of antibodies against rickettsia species of the spotted fever group is the established diagnostic standard. Due to extensive cross-reactions it is not possible to distinguish between the members of one rickettsial group. Furthermore antibody titers rise late in the disease, frequently 2 or 3 weeks after the onset of symptoms. This underscores the importance of the clinical diagnosis.
Collapse
Affiliation(s)
- C Psotta-Schachtner
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland,
| | | | | | | |
Collapse
|
28
|
Abstract
Osteoarticular infection is an uncommon presentation of Q fever. Positron emission tomography (PET) scanning is a valuable tool for the diagnosis of Coxiella burnetii graft prosthesis infection and endocarditis. Our objective was to test a series of culture-negative osteoarticular samples using molecular assays for Coxiella burnetii. We tested for C. burnetii by molecular assays targeting the IS1111 and the IS30A spacer regions, using culture-negative osteoarticular samples obtained in our laboratory between January 2011 and December 2012. We examine a total of 1,410 osteoarticular samples, and we observed two cases of arthritis and subacromial bursitis caused by C. burnetii. The infections were localized using PET scanning, and the diagnosis was confirmed through serology. For one, a C. burnetii strain with a multispacer sequence type 8 genotype was isolated from synovial fluid culture. Q fever articular infections could be undiagnosed because of the long evolution of articular attack, and patients with high antibody titers against C. burnetii should be tested using PET scanning to localize the site of infection.
Collapse
|
29
|
Germanakis A, Chochlakis D, Angelakis E, Tselentis Y, Psaroulaki A. Rickettsia aeschlimannii infection in a man, Greece. Emerg Infect Dis 2014; 19:1176-7. [PMID: 23764167 PMCID: PMC3713992 DOI: 10.3201/eid1907.130232] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
30
|
Angelakis E, Mediannikov O, Stein A, Bassene H, Sokhna C, Raoult D. Throat swab samples for diagnosis of Q fever. Am J Trop Med Hyg 2013; 90:147-8. [PMID: 24166041 DOI: 10.4269/ajtmh.13-0490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Oropharyngeal swabs collected from patients with Q fever from France and from febrile patients from Senegal were tested by molecular assays for Coxiella burnetii. One positive result (0.08%) occurred for only one patient with acute Q fever. Throat swabs cannot replace blood serum samples as diagnostic tools for Q fever.
Collapse
Affiliation(s)
- Emmanouil Angelakis
- Faculte de Medecine, Aix Marseille Université, Marseille 13385, France; URMITE, UMR, IRD 198, Dakar, Senegal
| | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Parola P, Paddock CD, Socolovschi C, Labruna MB, Mediannikov O, Kernif T, Abdad MY, Stenos J, Bitam I, Fournier PE, Raoult D. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 2013; 26:657-702. [PMID: 24092850 PMCID: PMC3811236 DOI: 10.1128/cmr.00032-13] [Citation(s) in RCA: 910] [Impact Index Per Article: 82.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia. These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.
Collapse
Affiliation(s)
- Philippe Parola
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | | | - Cristina Socolovschi
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Marcelo B. Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia Universidade de São Paulo, Cidade Universitária, São Paulo, SP, Brazil
| | - Oleg Mediannikov
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Tahar Kernif
- Service d'Ecologie des Systèmes Vectoriels, Institut Pasteur d'Algérie, Algiers, Algeria
| | - Mohammad Yazid Abdad
- Division of Veterinary and Biomedical Science, Murdoch University, Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - John Stenos
- Division of Veterinary and Biomedical Science, Murdoch University, Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - Idir Bitam
- University of Boumerdes, Boumerdes, Algeria
| | - Pierre-Edouard Fournier
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| | - Didier Raoult
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, Marseille, France
| |
Collapse
|
33
|
« Lymphangitis-associated rickettsiosis » due à Rickettsia sibirica mongolitimonae. Ann Dermatol Venereol 2013; 140:521-7. [DOI: 10.1016/j.annder.2013.04.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/21/2022]
|
34
|
Hii SF, Abdad MY, Kopp SR, Stenos J, Rees RL, Traub RJ. Seroprevalence and risk factors for Rickettsia felis exposure in dogs from Southeast Queensland and the Northern Territory, Australia. Parasit Vectors 2013; 6:159. [PMID: 23731951 PMCID: PMC3679791 DOI: 10.1186/1756-3305-6-159] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background The recent detection of Rickettsia felis DNA in dogs in Australia suggests that dogs are potential mammalian reservoir hosts for this emerging rickettsia. To date, there is no published report addressing the seroprevalence of R. felis in dogs in Australia. Methods Antigens for R. felis were produced by inoculating confluent XTC-2 monolayer cell cultures with three pools of cat flea (Ctenocephalides felis) homogenates. Infection was confirmed by real-time (qPCR), conventional or nested PCRs targeting the ompB, gltA, 17 kDa and ompA genes. Two hundred and ninety-two dogs from Southeast Queensland and the Northern Territory were tested for the presence of R. felis antibodies using a microimmunofluorescence (IF) test and the seroprevalence and associated risk factors for exposure were determined using both uni- and multi-variate analyses. Results Rickettsia felis was successfully isolated in cell culture from all three cat-flea pools. One hundred and forty-eight dogs (50.7%) showed seropositivity with titres ≥64 and 54 (18.5%) with titres ≥128. At antibody titres ≥64, dogs with active ectoparasite control were less likely to be seropositive to R. felis (OR: 2.60; 95% CI: 1.20 - 5.56). Conclusions This first reported isolation of R. felis in cell culture in Australia allowed for the production of antigen for serological testing of dogs. Results of this serological testing reflects the ubiquitous exposure of dogs to R. felis and advocate for owner vigilance with regards to ectoparasite control on domestic pets.
Collapse
Affiliation(s)
- Sze-Fui Hii
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
| | | | | | | | | | | |
Collapse
|