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Hsueh YL, Chen HF, Chang MC, Yen TY, Su CL, Chiu HC, Hu HC, Chung YT, Shu PY, Yang SL. Epidemiology of Murine Typhus in Taiwan from 2013 to 2020. Am J Trop Med Hyg 2024; 110:768-778. [PMID: 38471176 PMCID: PMC10993848 DOI: 10.4269/ajtmh.23-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/13/2023] [Indexed: 03/14/2024] Open
Abstract
Murine typhus is a flea-borne disease caused by Rickettsia typhi infection. The disease is a notifiable infectious disease in Taiwan. Specimens from suspected cases are required to be sent to the Taiwan Centers for Disease Control and Prevention for laboratory diagnosis. In this study, 204 cases of murine typhus were identified by bacterial isolation, real-time polymerase chain reaction, or indirect immunofluorescence assay between 2013 and 2020. The average incidence rate was 0.11/100,000 person-years (95% CI: 0.08-0.13). Murine typhus occurred throughout the year, but it was most prevalent in summer (May to August). The majority of patients were males (75%), residents of Kaohsiung city (31%), and worked in agriculture, forestry, fishing, and animal husbandry (27%). Fever was the most common symptom, present in 95.6% of patients, followed by headache (41%), myalgia (33%), and liver dysfunction (33%). Only 13% of patients had a rash. Up to 80% of cases were among hospitalized patients, and 43% of patients developed severe manifestations. Serological assays also indicated coinfection events. Seven patients showed a 4-fold increase in antibody titers against Orientia tsutsugamushi (N = 2), Coxiella burnetii (n = 2), and Leptospira (N = 3). In conclusion, murine typhus is an endemic and important zoonotic rickettsial disease in Taiwan that cannot be ignored. Further epidemiological surveillance and clinical characteristics should be continuously investigated to prevent and control murine typhus.
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Affiliation(s)
- Yeou-Lin Hsueh
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Hsiang-Fei Chen
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Mei-Chun Chang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Tsai-Ying Yen
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Chien-Ling Su
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Hsien-Chun Chiu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Huai-Chin Hu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Ya-Ting Chung
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Su-Lin Yang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
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Minahan NT, Wu WJ, Tsai KH. Rickettsia felis is an emerging human pathogen associated with cat fleas: A review of findings in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:10-19. [PMID: 36585292 DOI: 10.1016/j.jmii.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Rickettsia felis is an emerging rickettsial agent principally associated with cat fleas (Ctenocephalides felis), formerly discovered in 1990. Since then, clinical cases of R. felis infection have been identified globally by specific DNA sequences in patients with undifferentiated febrile illness, including in Taiwan, but such evidence is limited. R. felis rickettsiosis is self-limiting and easily treated with doxycycline, but its diagnosis remains a challenge. Environmental risk factors for R. felis rickettsiosis have yet to be clearly demonstrated, and its transmission biology is incompletely understood. Cat fleas are naturally infected with R. felis at varying rates, and vector competence in the transmission of R. felis has been demonstrated in animal models, including dogs, which may serve as reservoir hosts. In northern Taiwan, despite ∼20% of cat fleas infesting companion animals consistently found to be infected with R. felis, only a few cases of potential R. felis infection have been identified through a retrospective serological investigation, though without molecular confirmation. Ecological studies have identified divergent R. felis-like organisms in different arthropod hosts, but these strains appear to serve as nonpathogenic endosymbionts. Although its association with disease is limited, we believe cat flea-borne R. felis warrants increased recognition in an aging population due to immunosenescence and the proximity of companion animals to the elderly. Adopting a One Health approach involving collaboration and communication between clinicians, veterinarians, public health practitioners, and environmental scientists will improve our knowledge about this neglected pathogen and promote the prevention and control of vector-borne diseases.
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Affiliation(s)
- Nicholas T Minahan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Jer Wu
- Department of Entomology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Entomology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
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First detection and molecular identification of Rickettsia massiliae, a human pathogen, in Rhipicephalus sanguineus ticks collected from Southern Taiwan. PLoS Negl Trop Dis 2022; 16:e0010917. [DOI: 10.1371/journal.pntd.0010917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/23/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
The Rickettsia massiliae was firstly detected and identified in Rhipicephalus sanguineus ticks infested on dogs in Taiwan. A total of 1154 Rh. sanguineus ticks collected from 158 dogs of four districts of Tainan city were examined for Rickettsia infection by nested-PCR assay targeting the citrate synthase (gltA) and outer membrane protein B (ompB) genes of Rickettsia. The Rickettsia infection was detected with a general infection rate of 2.77%, and was detected in male, female and nymphal stage with an infection rate of 2.77%, 3.22% and 1.32%, respectively. Phylogenetic relationships were analyzed by comparing the gltA and ompB sequences obtained from 9 Taiwan strains and 16 other strains representing 13 genospecies of Rickettsia. Results revealed that all Taiwan strains were genetically affiliated to the same clades of R. massiliae (spotted fever group) and R. felis (transitional group), and can be discriminated from other genospecies of Rickettsia. This study provides the first evidence of R. massiliae, a pathogenic spotted fever Rickettsia, identified in Rh. sanguineus ticks and highlight the potential threat for the regional transmission of Rickettsia infection among humans in Taiwan.
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Chao LL, Erazo E, Robinson M, Liang YF, Shih CM. First detection and molecular identification of a pathogenic spotted fever group Rickettsia, R. massiliae, from Rhipicephalus haemaphysaloides ticks infesting dogs in southern Taiwan. Acta Trop 2022; 236:106666. [PMID: 36030046 DOI: 10.1016/j.actatropica.2022.106666] [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: 06/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
Tick-borne Rickettsia pathogens become an emerging zoonotic infection worldwide. The prevalence and genetic identity of Rickettsia infection was determined firstly in Rhipicephalus haemaphysaloides ticks collected from dogs in southern Taiwan. A total of 141 Rh. haemaphysaloides ticks were examined for Rickettsia infection by nested-PCR assay targeting the citrate synthase (gltA) and outer membrane protein B (ompB) genes of Rickettsia. The Rickettsia infection was detected with a general infection rate of 2.84%, and was detected in male and female ticks with an infection rate of 3.13% and 2.60%, respectively. Genetic relationships were analyzed by comparing the gltA and ompB sequences obtained from 4 Taiwan strains and 15 other strains representing 13 genospecies of Rickettsia. Phylogenetic analyses reveal that all Taiwan strains were genetically affiliated with the R. massiliae (spotted fever group) and can be distinguished from other genospecies of Rickettsia. These results demonstrate the epidemiological significance of a human pathogenic Rickettsia species (R. massiliae) detected in Rh. haemaphysaloides ticks. Further study focused on the vector competence of this tick species may help to illustrate the potential threat for human infection in southern Taiwan.
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Affiliation(s)
- Li-Lian Chao
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Esmeralda Erazo
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Melissa Robinson
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - You-Fu Liang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chien-Ming Shih
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
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Banović P, Díaz-Sánchez AA, Simin V, Foucault-Simonin A, Galon C, Wu-Chuang A, Mijatović D, Obregón D, Moutailler S, Cabezas-Cruz A. Clinical Aspects and Detection of Emerging Rickettsial Pathogens: A "One Health" Approach Study in Serbia, 2020. Front Microbiol 2022; 12:797399. [PMID: 35154030 PMCID: PMC8825779 DOI: 10.3389/fmicb.2021.797399] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/24/2021] [Indexed: 01/28/2023] Open
Abstract
Ticks carry numerous pathogens that, if transmitted, can cause disease in susceptible humans and animals. The present study describes our approach on how to investigate clinical presentations following tick bites in humans. To this aim, the occurrence of major tick-borne pathogens (TBPs) in human blood samples (n = 85) and the ticks collected (n = 93) from the same individuals were tested using an unbiased high-throughput pathogen detection microfluidic system. The clinical symptoms were characterized in enrolled patients. In patients with suspected TBP infection, serological assays were conducted to test for the presence of antibodies against specific TBPs. A field study based on One Health tenets was further designed to identify components of a potential chain of infection resulting in Rickettsia felis infection in one of the patients. Ticks species infesting humans were identified as Ixodes ricinus, Rhipicephalus sanguineus sensu lato (s.l.), Dermacentor reticulatus, and Haemaphysalis punctata. Five patients developed local skin lesions at the site of the tick bite including erythema migrans, local non-specific reactions, and cutaneous hypersensitivity reaction. Although Borrelia burgdorferi s.l., Babesia microti, Anaplasma phagocytophilum, and Candidatus Cryptoplasma sp. DNAs were detected in tick samples, different Rickettsia species were the most common TBPs identified in the ticks. The presence of TBPs such as Rickettsia helvetica, Rickettsia monacensis, Borrelia lusitaniae, Borrelia burgdorferi, Borrelia afzelii, A. phagocytophilum, and B. microti in ticks was further confirmed by DNA sequencing. Two of the patients with local skin lesions had IgG reactive against spotted fever group rickettsiae, while IgM specific to B. afzelii, Borrelia garinii, and Borrelia spielmanii were detected in the patient with erythema migrans. Although R. felis infection was detected in one human blood sample, none of the components of the potential chain of infection considered in this study tested positive to this pathogen either using direct pathogen detection in domestic dogs or xenodiagnosis in ticks collected from domestic cats. The combination of high-throughput screening of TBPs and One Health approaches might help characterize chains of infection leading to human infection by TBPs, as well as prevalence of emerging rickettsial pathogens in the Balkan region.
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Affiliation(s)
- Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad, Serbia.,Department of Microbiology With Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | | | - Verica Simin
- Department for Microbiological & Other Diagnostics, Pasteur Institute Novi Sad, Novi Sad, Serbia
| | - Angélique Foucault-Simonin
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Clemence Galon
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Alejandra Wu-Chuang
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Dragana Mijatović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad, Serbia
| | - Dasiel Obregón
- School of Environmental Sciences, University of Guelph, Guelph, ON, Canada
| | - Sara Moutailler
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort, France
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Comparative evaluation of serological tests used for the diagnosis of rickettsial diseases prevalent in the temperate region of North India. Indian J Med Microbiol 2021; 40:294-298. [PMID: 34980488 DOI: 10.1016/j.ijmmb.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/17/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The clinical manifestations of rickettsial diseases mimic other endemic infections with similar presentations thus posing a serious challenge to clinicians for their diagnosis. For the diagnosis of rickettsial disease serological tests like Weil Felix, ELISA and IFA are used. There are limited studies that have evaluated different serological tests for the diagnosis of rickettsial diseases. Therefore, the present study was undertaken to evaluate the ELISA and Weil Felix test for the diagnosis of rickettsial diseases prevalent in this region. METHODS Samples from 281 patients clinically suspected of rickettsial diseases were tested for spotted fever group (SFG), typhus group (TG) and scrub typhus group (STG) by Weil Felix, ELISA and IFA was taken as the gold standard. Baseline titers and cut-off ODs were calculated by taking samples from healthy blood donors. RESULTS The sensitivity, specificity, positive and negative predictive value of Weil Felix test ranged from 30% to 44%, 83.46%-97.86%, 9%-77%, 92-96% respectively. The sensitivity and specificity, positive and negative predictive value of ELISA ranged from 80.77% to 96.15%, 96.33%-98.43%, 70.21%-88.64%, 92.89%-99.60% respectively. Maximum cross-reactions were observed between SFG and STG by the Weil Felix test and between STG and TG by ELISA. CONCLUSIONS ELISA was found to be sensitive and specific for the diagnosis of rickettsial diseases. It is easy to perform, does not require a technical expert for result interpretation and a large number of samples can be processed at a time.
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Shih CM, Chao LL. First detection and genetic identification of Rickettsia infection in Rhipicephalus sanguineus (Acari: Ixodidae) ticks collected from Southern Taiwan. EXPERIMENTAL & APPLIED ACAROLOGY 2021; 85:291-304. [PMID: 34708287 DOI: 10.1007/s10493-021-00669-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
The prevalence and genetic identity of Rickettsia infection in Rhipicephalus sanguineus sensu lato (s.l.) ticks were determined in Taiwan. In total 1153 ticks were examined for Rickettsia infection by PCR assay targeting the citrate synthase gene (gltA) of Rickettsia. The prevalence of Rickettsia infection in R. sanguineus s.l. ticks with a general infection rate of 2.2%, and was detected in nymph, male and female stages of R. sanguineus s.l. ticks with an infection rate of 3.1, 2.0 and 1.1%, respectively. Phylogenetic relationships were analyzed by comparing the gltA sequences obtained from four Taiwan strains and 16 other strains representing 13 genospecies of Rickettsia. Phylogenetic analyses reveal that one Taiwan strain was genetically affiliated with the Japan isolate (GRA-1 strain) which belongs to the spotted fever group (R. parkeri/R. honei) and three Taiwan strains were genetically affiliated with the transitional group of Rickettsia (R. felis). Intra- and inter-species analysis also indicated the genetic distance (GD) of the Taiwan strains with a lower level of GD < 0.011, 0.023 and 0.003 as compared with the type strains of R. parkeri, R. honei and R. felis, respectively. Our findings reveal the first detection of Rickettsia infections (R. parkeri/R. honei and R. felis) in R. sanguineus s.l. ticks of Taiwan. These results also highlight the epidemiological significance of diverse Rickettsia species existed in R. sanguineus s.l. ticks and the potential threat for the geographical transmission of Rickettsia infection in Taiwan.
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Affiliation(s)
- Chien-Ming Shih
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, Republic of China
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| | - Li-Lian Chao
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, Republic of China.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
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Yen TY, Wang HC, Chang YC, Su CL, Chang SF, Shu PY, Tsai KH. Seroepidemiological Study of Spotted Fever Group Rickettsiae and Identification of a Putative New Species, Rickesttsia sp. Da-1, in Gongliao, Northeast Taiwan. Pathogens 2021; 10:pathogens10111434. [PMID: 34832589 PMCID: PMC8617620 DOI: 10.3390/pathogens10111434] [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: 08/24/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Tick-borne spotted fever group (SFG) rickettsioses were neglected in Taiwan. The study reported a seroepidemiological survey of SFG rickettsiae in residents in Gongliao District, Northeast Taiwan. Blood samples were examined for antibodies against SFG rickettsiae by enzyme-linked immunosorbent assay and immunofluorescence assay. Risk factors were assessed using logistic regression. Ticks parasitizing dogs were collected within a 2 km radius from the houses of seropositive participants, and PCR was performed to detect possible tick-borne pathogens. Of 1108 participants, 75 (6.8%) had antibodies against SFG rickettsiae. Residents were more likely to be seropositive if they were older than 65 years, recruited by Dr. Enjoy’s Clinic, or resided in Jilin village. A total of 184 ticks including 5 species (Rhipicephalus sanguineus, Rhipicephalus haemaphysaloides, Dermacentor auratus, Haemaphysalis hystricis, Haemaphysalis ornithophila) were collected. Rickettsia spp. were detected in 6.5% (12/184) of ticks. Rickettsia sp. TwKM01 was found in 6 R. sanguineus and 4 R. haemaphysaloides; while Rickettsia sp. TwKM03 was identified in 1 R. sanguineus. Moreover, gene-based pairwise analysis indicated identification of a putative new species, Rickettsia sp. Da-1, in D. auratus. These findings provided evidence of SFG rickettsiae infection in ticks and suggested SFG rickettsiae exposure in the residents.
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Affiliation(s)
- Tsai-Ying Yen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (T.-Y.Y.); (H.-C.W.)
| | - Hsi-Chieh Wang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (T.-Y.Y.); (H.-C.W.)
| | - Yin-Chao Chang
- Dr. Enjoy’s Clinic, Gong-Liao District, New Taipei City 228003, Taiwan;
| | - Chien-Ling Su
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei 115210, Taiwan; (C.-L.S.); (S.-F.C.)
| | - Shu-Fen Chang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei 115210, Taiwan; (C.-L.S.); (S.-F.C.)
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei 115210, Taiwan; (C.-L.S.); (S.-F.C.)
- Correspondence: (P.-Y.S.); (K.-H.T.); Tel.: +886-2-26531372 (P.-Y.S.); +886-2-33668103 (K.-H.T.)
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (T.-Y.Y.); (H.-C.W.)
- Department of Public Health, College of Public Health, National Taiwan University, Taipei 100025, Taiwan
- Correspondence: (P.-Y.S.); (K.-H.T.); Tel.: +886-2-26531372 (P.-Y.S.); +886-2-33668103 (K.-H.T.)
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Yang WH, Hsu MS, Shu PY, Tsai KH, Fang CT. Neglected human Rickettsia felis infection in Taiwan: A retrospective seroepidemiological survey of patients with suspected rickettsioses. PLoS Negl Trop Dis 2021; 15:e0009355. [PMID: 33872325 PMCID: PMC8084327 DOI: 10.1371/journal.pntd.0009355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/29/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current knowledge on Rickettsia felis infection in humans is based on sporadic case reports. Here we conducted a retrospective seroepidemiological survey of R. felis infection among febrile patients visiting a medical center in Taipei. METHODOLOGY/PRINCIPAL FINDINGS A total of 122 patients with suspected rickettsioses presenting with fever of unknown origin (FUO) but tested negative for scrub typhus, murine typhus, or Q fever were retrospectively identified during 2009 to 2010. The archived serum samples were examined for the presence of antibodies against R. felis, Rickettsia japonica, and Rickettsia typhi using microimmunofluorescence (MIF) assay. Serological evidence of Rickettsia exposure was found in 23 (19%, 23/122) patients. Eight patients had antibodies reactive to R. felis, including four with current infection (a ≥4-fold increase in IgG titer between acute and convalescent sera). The clinical presentations of these four patients included fever, skin rash, lymphadenopathy, as well as more severe conditions such as pancytopenia, hepatomegaly, elevated liver enzymes/bilirubin, and life-threatening acute respiratory distress syndrome. One of the patients died after doxycycline was stopped after being tested negative for scrub typhus, Q fever, and murine typhus. CONCLUSIONS Rickettsia felis is a neglected flea-borne pathogen in Taiwan, and its infection can be life-threatening. Further prospective studies of the prevalence of R. felis among patients with FUO and compatible clinical manifestations are warranted.
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Affiliation(s)
- Wan-Hsiu Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Meng-Shiuan Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, Section of Infectious Disease, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Healthcare Administration, Oriental Institute of Technology, Taipei, Taiwan
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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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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11
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Wang HC, Lee PL, Kuo CC. Fleas of Shrews and Rodents in Rural Lowland Taiwan. JOURNAL OF MEDICAL ENTOMOLOGY 2020; 57:595-600. [PMID: 31693136 DOI: 10.1093/jme/tjz194] [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: 08/10/2019] [Indexed: 06/10/2023]
Abstract
Fleas transmit a variety of pathogens to humans but are relatively understudied in comparison to mosquitoes and ticks, including in Taiwan, where fleas in rural lowlands have never been systematically surveyed. In total, 700 fleas of four species were collected from 1,260 shrews and rodents at nine counties across lowland Taiwan. Nosopsyllus nicanus Jordan (Siphonaptera: Ceratophyllidae) and Xenopsylla cheopis Rothschild (Siphonaptera: Pulicidae) were the most abundant flea species (79.0 and 14.6% of total fleas, respectively); the former was largely limited to the islets, while the latter was restricted to the Taiwan main island. Rattus losea Swinhoe (Rodentia: Muridae) was the most common small mammal species (49.3% of total) and hosted the majority of fleas (88.3% of total). Five Rickettsia spp., including Rickettsia conorii Brumpt (Rickettsiales: Rickettsiaceae), Rickettsia felis Bouyer et al. Rickettsia japonica Uchida, Rickettsia raoultii Mediannikov, and Rickettsia rickettsii Brumpt or closely related species, were identified from 67 individually assayed fleas based on ompB and gltA genes. Rickettsia felis, mainly transmitted by fleas, was detected in one X. cheopis in southern Taiwan where a confirmed human case of infection with R. felis has been reported. The presence of R. felis, along with the other four tick-borne Rickettsia spp., demonstrates that a variety of rickettsiae circulate in rural lowland Taiwan and could pose risks to human health.
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Affiliation(s)
- Hsi-Chieh Wang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Lung Lee
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chi-Chien Kuo
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
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12
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Tsai CT, Lin JN, Lee CH, Sun W, Chang YC, Chen YH, Lai CH. The epidemiology, characteristics and outbreaks of human leptospirosis and the association with animals in Taiwan, 2007-2014: A nationwide database study. Zoonoses Public Health 2020; 67:156-166. [PMID: 31916706 DOI: 10.1111/zph.12667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/05/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leptospirosis (LS) is a neglected tropical zoonosis of global importance. A nationwide investigation of characteristics, epidemiology, risk factors and outbreak is crucial for awareness of this disease. METHODS A nationwide database of reported LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan, was analysed. Geographic information system software was used to map the distribution of confirmed LS cases and pigs. Cross-matching with the databases of Q fever, scrub typhus and murine typhus was conducted to identify possible coinfections. RESULTS A total of 10,917 reported cases of LS were recorded in the database, which included 665 (6.1%) confirmed LS and 10,252 (93.9%) non-confirmed LS cases. The major residences of confirmed LS were the Kaohsiung-Pingtung (248, 37.3%) and Taipei (174, 26.2%) regions. The average annual incidence was 0.4/100,000 people. Compared with non-confirmed LS cases, confirmed LS cases had significantly higher percentages of male gender (83.6% vs. 67.9%, p < .001), high-risk occupations (farmer, animal husbandry or veterinarian) (24.8% vs. 13.7%, p < .001), residence in the Kaohsiung-Pingtung region (37.3% vs. 19.6%, p < .001) and exposure to rats (8.6% vs. 4.9%, p = .001) or pigs (9.4% vs. 1.9%, p < .001) but a lower mean age (47.8 ± 15.1 vs. 51.±18.5 years old). Rat and pig exposure trends were found in the northern and southern regions, respectively. Distribution of LS was consistent with pigs, and one outbreak associated with flooding and pigs occurred in the Pingtung region in 2009. Twenty-three and four patients with LS were coinfected with scrub typhus and Q fever, respectively. CONCLUSIONS LS is an endemic disease in Taiwan, particularly in the Kaohsiung-Pingtung and Taipei regions. High-risk occupations and animal exposure history are important for the clinical presumptive diagnosis of LS, particularly for rats in northern Taiwan and pigs in southern Taiwan. Although uncommon, clinicians should be aware of coinfection of LS with endemic rickettsial diseases.
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Affiliation(s)
- Chia-Ta Tsai
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Department of Infection Control, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jiun-Nong Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wu Sun
- Infection Control Department, Pao-Chien Hospital, Pingtung County, Taiwan
| | - Yi-Chin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan
| | - Chung-Hsu Lai
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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13
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Satjanadumrong J, Robinson MT, Hughes T, Blacksell SD. Distribution and Ecological Drivers of Spotted Fever Group Rickettsia in Asia. ECOHEALTH 2019; 16:611-626. [PMID: 30993545 PMCID: PMC6910891 DOI: 10.1007/s10393-019-01409-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/30/2023]
Abstract
Spotted fever group and related rickettsia (SFGR) are a neglected group of pathogens that belong to the genus Rickettsia. SFGR are zoonotic and are transmitted by arthropod vectors, primarily ticks, fleas and mites to accidental hosts. These emerging and re-emerging infections are widely distributed throughout the world. Land-use change and increasing human-wildlife conflict compound the risk of SFGR infection to local people in endemic areas and travelers to these regions. In this article, we discuss the rickettsial organisms causing spotted fever and related diseases, their arthropod vectors in Asia and the impact of land-use change on their spread.
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Affiliation(s)
- Jaruwan Satjanadumrong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand
| | - Matthew T Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7FZ, UK
| | - Tom Hughes
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand
- EcoHealth Alliance, 460 West 34th Street, 17th Floor, New York, NY, USA
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand.
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7FZ, UK.
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14
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Abstract
Spotted fever group rickettsiae (SFG) are a neglected group of bacteria, belonging to the genus Rickettsia, that represent a large number of new and emerging infectious diseases with a worldwide distribution. The diseases are zoonotic and are transmitted by arthropod vectors, mainly ticks, fleas and mites, to hosts such as wild animals. Domesticated animals and humans are accidental hosts. In Asia, local people in endemic areas as well as travellers to these regions are at high risk of infection. In this review we compare SFG molecular and serological diagnostic methods and discuss their limitations. While there is a large range of molecular diagnostics and serological assays, both approaches have limitations and a positive result is dependent on the timing of sample collection. There is an increasing need for less expensive and easy-to-use diagnostic tests. However, despite many tests being available, their lack of suitability for use in resource-limited regions is of concern, as many require technical expertise, expensive equipment and reagents. In addition, many existing diagnostic tests still require rigorous validation in the regions and populations where these tests may be used, in particular to establish coherent and worthwhile cut-offs. It is likely that the best strategy is to use a real-time quantitative polymerase chain reaction (qPCR) and immunofluorescence assay in tandem. If the specimen is collected early enough in the infection there will be no antibodies but there will be a greater chance of a PCR positive result. Conversely, when there are detectable antibodies it is less likely that there will be a positive PCR result. It is therefore extremely important that a complete medical history is provided especially the number of days of fever prior to sample collection. More effort is required to develop and validate SFG diagnostics and those of other rickettsial infections.
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15
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Minahan NT, Chao CC, Tsai KH. The Re-Emergence and Emergence of Vector-Borne Rickettsioses in Taiwan. Trop Med Infect Dis 2017; 3:E1. [PMID: 30274400 PMCID: PMC6136612 DOI: 10.3390/tropicalmed3010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/17/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Rickettsial diseases, particularly vector-borne rickettsioses (VBR), have a long history in Taiwan, with studies on scrub typhus and murine typhus dating back over a century. The climatic and geographic diversity of Taiwan's main island and its offshore islands provide many ecological niches for the diversification and maintenance of rickettsiae alike. In recent decades, scrub typhus has re-emerged as the most prevalent type of rickettsiosis in Taiwan, particularly in eastern Taiwan and its offshore islands. While murine typhus has also re-emerged on Taiwan's western coast, it remains neglected. Perhaps more alarming than the re-emergence of these rickettsioses is the emergence of newly described VBR. The first case of human infection with Rickettsia felis was confirmed in 2005, and undetermined spotted fever group rickettsioses have recently been detected. Taiwan is at a unique advantage in terms of detecting and characterizing VBR, as it has universal health coverage and a national communicable disease surveillance system; however, these systems have not been fully utilized for this purpose. Here, we review the existing knowledge on the eco-epidemiology of VBR in Taiwan and recommend future courses of action.
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Affiliation(s)
- Nicholas T Minahan
- Institute of Environmental Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan.
| | - Chien-Chung Chao
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Kun-Hsien Tsai
- Institute of Environmental Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan.
- Department of Public Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei 100, Taiwan.
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16
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Kho KL, Koh FX, Hasan LIM, Wong LP, Kisomi MG, Bulgiba A, Nizam QNH, Tay ST. Rickettsial seropositivity in the indigenous community and animal farm workers, and vector surveillance in Peninsular Malaysia. Emerg Microbes Infect 2017; 6:e18. [PMID: 28400593 PMCID: PMC5457682 DOI: 10.1038/emi.2017.4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/13/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
Abstract
Rickettsioses are emerging zoonotic diseases that are often neglected in many countries in Southeast Asia. Rickettsial agents are transmitted to humans through exposure to infected arthropods. Limited data are available on the exposure of indigenous community and animal farm workers to the aetiological agents and arthropod vectors of rickettsioses in Peninsular Malaysia. Serological analysis of Rickettsia conorii and Rickettsia felis was performed for 102 individuals from the indigenous community at six rural villages and 87 workers from eight animal farms in Peninsular Malaysia in a cross-sectional study. The indigenous community had significantly higher seropositivity rates for R. conorii (P<0.001) and R. felis (P<0.001), as compared to blood donors from urban (n=61). Similarly, higher seropositivity rates for R. conorii (P=0.046) and R. felis (P<0.001) were noted for animal farm workers, as compared to urban blood donors. On the basis of the sequence analysis of gltA, ompA and ompB, various spotted fever group rickettsiae closely related to R. raoultii, R. heilongjiangensis, R. felis-like organisms, R. tamurae, Rickettsia sp. TCM1, R. felis, Rickettsia sp. LON13 and R. hulinensis were identified from tick/flea samples in animal farms, indigenous villages and urban areas. This study describes rickettsial seropositivity of the Malaysian indigenous community and animal farm workers, and provides molecular evidence regarding the presence of rickettsial agents in ticks/fleas infesting domestic animals in Peninsular Malaysia.
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Affiliation(s)
- Kai Ling Kho
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fui Xian Koh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Li Ping Wong
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Masoumeh Ghane Kisomi
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Quaza Nizamuddin Hassan Nizam
- Department of Veterinary Services, Ministry of Agriculture and Agro-Based Industry Malaysia, Federal Government Administrative Centre, 62630 Putrajaya, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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17
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Kuo CC, Wardrop N, Chang CT, Wang HC, Atkinson PM. Significance of major international seaports in the distribution of murine typhus in Taiwan. PLoS Negl Trop Dis 2017; 11:e0005430. [PMID: 28264003 PMCID: PMC5354449 DOI: 10.1371/journal.pntd.0005430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/16/2017] [Accepted: 02/23/2017] [Indexed: 11/24/2022] Open
Abstract
Background International seaports are hotspots for disease invasion and pathogens can persist in seaports even after ports are abandoned. Transmitted by fleas infected by Rickettsia typhi, murine typhus, a largely neglected and easily misdiagnosed disease, is known to occur primarily in large seaports. However, the significance of seaports in the occurrence of murine typhus has never been validated quantitatively. Methodology/Principal findings We studied the spatial distribution of murine typhus, a notifiable disease, in Taiwan. We investigated whether risk of infection was correlated with distance to international seaports and a collection of environmental and socioeconomic factors, using a Bayesian negative binomial conditionally autoregressive model, followed with geographically weighted regression. Seaports that are currently in use and those that operated in the 19th century for trade with China, but were later abandoned due to siltation were analyzed. A total of 476 human cases of murine typhus were reported during 2000–2014 in the main island of Taiwan, with spatial clustering in districts in southwest and central-west Taiwan. A higher incidence rate (case/population) was associated with a smaller distance to currently in-use international seaports and lower rainfall and temperature, but was uncorrelated with distance to abandoned ports. Geographically weighted regression revealed a geographic heterogeneity in the importance of distance to in-use seaports near the four international seaports of Taiwan. Conclusions/Significance Our study suggests that murine typhus is associated with international seaports, especially for those with large trading volume. Thus, one of the costs of global trade in Taiwan might be elevated risks of murine typhus. Globalization has accelerated the spread of infectious diseases, but the burden of disease varies geographically, with regions surrounding major international seaports warranting particular surveillance. Globalization has hastened the spread of infectious diseases, with seaports as hotspots for disease invasion. Transmitted by fleas infected with the rickettsia Rickettsia typhi, murine typhus occurs worldwide, but its significance as a common causative agent of illness in tropical regions remains largely neglected. Although it is recognized that murine typhus is prevalent primarily in large seaports, the significance of seaports in the occurrence of murine typhus has never been validated quantitatively. We thus investigated whether distribution of murine typhus in Taiwan was associated with international seaports. Notably, abandoned international seaports (abandoned in the 19th century due to siltation) were also studied to see whether the causative agent of murine typhus might still circulate around the ports even after being abandoned. We found that infection risk of murine typhus was negatively associated with distance to operating seaports but was uncorrelated with nearness to abandoned seaports. In addition, the importance of distance to operating seaports for risk of murine typhus infection varied spatially. Our study highlights elevated disease risk as a cost of international trade and suggests particular surveillance in regions surrounding major international seaports.
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Affiliation(s)
- Chi-Chien Kuo
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
- * E-mail:
| | - Nicola Wardrop
- Geography and Environment, University of Southampton, Southampton, United Kingdom
| | - Chung-Te Chang
- Department of Geography, National Taiwan University, Taipei, Taiwan
| | - Hsi-Chieh Wang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Peter M. Atkinson
- Geography and Environment, University of Southampton, Southampton, United Kingdom
- Faculty of Science and Technology, Lancaster University, Lancaster, United Kingdom
- School of Geography, Archaeology and Palaeoecology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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18
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Lai CH, Sun W, Lee CH, Lin JN, Liao MH, Liu SS, Chang TY, Tsai KF, Chang YC, Lin HH, Chen YH. The Epidemiology and Characteristics of Q fever and Co-infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study. Zoonoses Public Health 2016; 64:517-526. [PMID: 27966835 DOI: 10.1111/zph.12333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 11/29/2022]
Abstract
Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11 109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered.
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Affiliation(s)
- C-H Lai
- Division of Infectious Diseases, Department of Internal Medicine and Division of Infection Control Laboratory, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - W Sun
- Infection Control Department, Pao-Chien Hospital, Pingtung, Taiwan
| | - C-H Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - J-N Lin
- Division of Infectious Diseases, Department of Internal Medicine and Department of Critical Care Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - M-H Liao
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - S-S Liu
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - T-Y Chang
- Division of Infectious Diseases, Pingtung Christian Hospital, Pingtung, Taiwan
| | - K-F Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Y-C Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - H-H Lin
- Division of Infectious Diseases, Department of Internal Medicine and Division of Infection Control Laboratory, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Y-H Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center for Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan
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19
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Kho KL, Koh FX, Singh HKL, Zan HAM, Kukreja A, Ponnampalavanar S, Tay ST. Spotted Fever Group Rickettsioses and Murine Typhus in a Malaysian Teaching Hospital. Am J Trop Med Hyg 2016; 95:765-768. [PMID: 27402519 DOI: 10.4269/ajtmh.16-0199] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/07/2016] [Indexed: 01/06/2023] Open
Abstract
Limited information is available on the etiological agents of rickettsioses in southeast Asia. Herein, we report the molecular investigation of rickettsioses in four patients attending a teaching hospital in Malaysia. DNA of Rickettsia sp. RF2125, Rickettsia typhi, and a rickettsia closely related to Rickettsia raoultii was detected in the blood samples of the patients. Spotted fever group rickettsioses and murine typhus should be considered in the diagnosis of patients with nonspecific febrile illness in this region.
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Affiliation(s)
- Kai Ling Kho
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fui Xian Koh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Anjanna Kukreja
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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20
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Bhengsri S, Baggett HC, Edouard S, Dowell SF, Dasch GA, Fisk TL, Raoult D, Parola P. Sennetsu Neorickettsiosis, Spotted Fever Group, and Typhus Group Rickettsioses in Three Provinces in Thailand. Am J Trop Med Hyg 2016; 95:43-49. [PMID: 27139448 PMCID: PMC4944706 DOI: 10.4269/ajtmh.15-0752] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/24/2016] [Indexed: 12/02/2022] Open
Abstract
We estimated the seroprevalence and determined the frequency of acute infections with Neorickettsia sennetsu, spotted fever group rickettsiae, Rickettsia typhi, and Orientia tsutsugamushi among 2,225 febrile patients presenting to community hospitals in three rural Thailand provinces during 2002–2005. The seroprevalence was 0.2% for sennetsu neorickettsiosis (SN), 0.8% for spotted fever group (SFG) rickettsiae, 4.2% for murine typhus (MT), and 4.2% for scrub typhus (ST). The frequency of acute infections was 0.1% for SN, 0.6% for SFG, 2.2% for MT, and 1.5% for ST. Additional studies to confirm the distribution of these pathogens and to identify animal reservoirs and transmission cycles are needed to understand the risk of infection.
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Affiliation(s)
- Saithip Bhengsri
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Henry C Baggett
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Sophie Edouard
- University Hospital Institute for Infectious Diseases and Tropical Medicine, National Reference Centre for Rickettsioses, Aix-Marseille University, Marseille, France
| | | | - Gregory A Dasch
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tami L Fisk
- Division of Infectious Disease, Emory University, Atlanta, Georgia
| | - Didier Raoult
- University Hospital Institute for Infectious Diseases and Tropical Medicine, National Reference Centre for Rickettsioses, Aix-Marseille University, Marseille, France
| | - Philippe Parola
- University Hospital Institute for Infectious Diseases and Tropical Medicine, National Reference Centre for Rickettsioses, Aix-Marseille University, Marseille, France
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Ferdouse F, Hossain MA, Paul SK, Ahmed S, Mahmud MC, Ahmed R, Haque AKMF, Khan MNAA, Ghosh S, Urushibara N, Kobayashi N. Rickettsia felis Infection among Humans, Bangladesh, 2012-2013. Emerg Infect Dis 2016. [PMID: 26196587 PMCID: PMC4517713 DOI: 10.3201/eid2108.150328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kuo CC, Shu PY, Mu JJ, Lee PL, Wu YW, Chung CK, Wang HC. Widespread Rickettsia spp. Infections in Ticks (Acari: Ixodoidea) in Taiwan. JOURNAL OF MEDICAL ENTOMOLOGY 2015; 52:1096-1102. [PMID: 26336223 DOI: 10.1093/jme/tjv083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/09/2015] [Indexed: 06/05/2023]
Abstract
Ticks are second to mosquitoes as the most important disease vectors, and recent decades have witnessed the emergence of many novel tick-borne rickettsial diseases, but systematic surveys of ticks and tick-borne rickettsioses are generally lacking in Asia. We collected and identified ticks from small mammal hosts between 2006 and 2010 in different parts of Taiwan. Rickettsia spp. infections in ticks were identified by targeting ompB and gltA genes with nested polymerase chain reaction. In total, 2,732 ticks were collected from 1,356 small mammals. Rhipicephalus haemaphysaloides Supino (51.8% of total ticks), Haemaphysalis bandicota Hoogstraal & Kohls (28.0%), and Ixodes granulatus Supino (20.0%) were the most common tick species, and Rattus losea Swinhoe (44.7% of total ticks) and Bandicota indica Bechstein (39.9%) were the primary hosts. The average Rickettsia infective rate in 329 assayed ticks was 31.9% and eight Rickettsia spp. or closely related species were identified. This study shows that rickettsiae-infected ticks are widespread in Taiwan, with a high diversity of Rickettsia spp. circulating in the ticks. Because notifiable rickettsial diseases in Taiwan only include mite-borne scrub typhus and flea-borne murine typhus, more studies are warranted for a better understanding of the real extent of human risks to rickettsioses in Taiwan.
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Affiliation(s)
- Chi-Chien Kuo
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Pei-Yun Shu
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Jung-Jung Mu
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Pei-Lung Lee
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yin-Wen Wu
- Department of Food Science, National Quemoy University, Taiwan
| | - Chien-Kung Chung
- Bureau of Animal and Plant Health Inspection, Kinmen County, Taiwan
| | - Hsi-Chieh Wang
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
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Peter JV, Sudarsan TI, Prakash JAJ, Varghese GM. Severe scrub typhus infection: Clinical features, diagnostic challenges and management. World J Crit Care Med 2015; 4:244-250. [PMID: 26261776 PMCID: PMC4524821 DOI: 10.5492/wjccm.v4.i3.244] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/27/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.
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Reeves WK, Durden LA, Iwakami M, Vince KJ, Paul RR. Rickettsial diseases and ectoparasites from military bases in Japan. J Parasitol 2014; 101:150-5. [PMID: 25548900 DOI: 10.1645/14-662.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ectoparasitic arthropods are often vectors of rickettsiosis. We conducted a survey of ectoparasites on U.S. military facilities throughout Japan with the use of specimens submitted by pest control, public health, and veterinary personnel. Over 1,600 individual ectoparasites were collected. Fifteen species were identified, including several significant vectors of human diseases such as scrub typhus and rickettsial spotted fevers. These ectoparasites included Ctenocephalides felis , Haemaphysalis longicornis, Ixodes persulcatus , Leptotrombidium fuji, Leptotrombidium pallidum, and Rhipicephalus sanguineus . Rickettsial agents were detected by PCR and DNA sequencing. These included Bartonella henselae , Bartonella japonica, a novel Bartonella, Coxiella burnetii , an unnamed Coxiella, Ehrlichia canis , Orientia tsutsugamushi , Rickettsia typhi , and "Rickettsia Rf2125"/"Rickettsia cf1and5".
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Affiliation(s)
- Will K Reeves
- U.S. Air Force School of Aerospace Medicine/PHR, 2510 5th Street, Wright-Patterson Air Force Base 45433
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