1
|
Gunasekaran K, Elangovan D, Perumalla S, Abhilash KPP, Prakash JAJ. Purpura Fulminans and Spotted Fever: A Case Series from South India. J Glob Infect Dis 2022; 14:162-164. [PMID: 36636298 PMCID: PMC9831211 DOI: 10.4103/jgid.jgid_297_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/03/2022] [Accepted: 06/03/2022] [Indexed: 12/12/2022] Open
Abstract
Purpura fulminans (PF) is associated with acute infections such as meningococcal, staphylococcal, streptococcal, and rickettsial infections. However, there are only a few reports of association of PF with rickettsial fever from India. In this case series of seven adults with PF, four were definitive cases of spotted fever as the ompA real-time polymerase chain reaction was positive. The other three adults were probable cases of spotted fever, as they were positive by immunoglobulin M enzyme-linked immunosorbent assay, and their fever subsided within 72 h of rickettsia-specific therapy. Three of the seven patients had peripheral gangrene. These patients, despite presenting with severe spotted fever, had a favorable outcome. This is attributed to the high index of suspicion and early treatment supported by diagnostic assays.
Collapse
Affiliation(s)
- Karthik Gunasekaran
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Susmitha Perumalla
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kundavaram Paul Prabhakar Abhilash
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence: Dr. Kundavaram Paul Prabhakar Abhilash, Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India. E-mail:
| | | |
Collapse
|
2
|
Khan SA, Saikia J, Bora T, Khamo V, Rahi M. Rickettsiae in fleas infesting domestic pets of eastern Himalayan terrains of India. Trans R Soc Trop Med Hyg 2022; 116:595-598. [DOI: 10.1093/trstmh/trab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Flea-borne rickettsioses have been limitedly explored in the Indian sub-Himalayan belt, including the North Eastern Region (NER) of India. This study investigates the presence of rickettsiae hosts and their probable pathogens in the disease-endemic hilly state of the NER of India.
Methods
Entomological surveys were carried out in disease-reporting localities in a hilly state in India. Fleas collected from domesticated animals were processed for detection of a Rickettsia-specific 17-kDa gene.
Results
Sequence analysis revealed Rickettsia felis in six flea pools (40%), Candidatus Rickettsia senegalensis in two pools (13.3%) and Rickettsia asembonensis in one pool (6.6%).
Conclusions
Our findings suggest Ctenocephalides felis, Ctenocephalides canis and Pulex irritans as potential carriers of R. felis and R. felis–like organisms in India.
Collapse
Affiliation(s)
- Siraj A Khan
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Jahnabi Saikia
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Trishna Bora
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Vinotsole Khamo
- Health Care and Research laboratory, Naga Hospital Authority , Kohima 797001, Nagaland, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research , Ansari Nagar New Delhi 110029, India
| |
Collapse
|
3
|
Dasch GA, Eremeeva ME, Zambrano ML, Premaratna R, Kularatne SAM, Jayanthe Rajapakse RPV. Molecular Characterization of Rickettsial Agents in Ticks (Acari: Ixodidae) from Sri Lanka. Am J Trop Med Hyg 2022; 106:tpmd210995. [PMID: 35405644 PMCID: PMC9209928 DOI: 10.4269/ajtmh.21-0995] [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: 09/16/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Because the majority of spotted fever group rickettsiae are transmitted to humans by tick bites, it is important to understand which ticks might play a role in transmission of rickettsial pathogens in Sri Lanka. The purpose of our study was to conduct molecular surveillance of 847 ticks collected in different locations in central Sri Lanka to determine which were infected with Rickettsia and Anaplasmataceae. Molecular methods were used to identify the ticks and the agents detected. Most ticks (Amblyomma, Haemaphysalis, and Rhipicephalus) were collected by flagging, and lower number was collected from dogs, cattle, pigs, a pangolin, and tortoises. Five spotted fever genotypes were identified: a Rickettsia africae-like agent in Amblyomma larvae, Rhipicephalus massiliae and a related genotype identified in association with the tropical type of Rhipicephalus sanguineus from dogs and Rhipicephalus haemaphysaloides from dogs and cattle, and Candidatus R. kellyi and another novel genotype (SL94) in R. haemaphysaloides. Twenty-three ticks were positive for Anaplasmataceae, including one Anaplasma and two Ehrlichia genotypes. Because the sequence database for both ticks and rickettsial agents from Sri Lanka and southern India is not extensive, additional molecular characterization of the tick species of Sri Lanka and their rickettsial agents is required to understand their pathogenic potential more completely. However, several of the agents we identified in this survey may well be pathogenic for humans and domestic animals, and should be considered as a part of epidemiological surveillance and patient management.
Collapse
Affiliation(s)
- Gregory A. Dasch
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marina E. Eremeeva
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
| | - Maria L. Zambrano
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | |
Collapse
|
4
|
Schmidt WP, Devamani CS, Elangovan D, Alexander N, Rose W, Prakash JAJ. Clinical characteristics of and antibody response to spotted fever group rickettsial infections in South India: Case series and serological cohort study. Trop Med Int Health 2021; 26:1616-1623. [PMID: 34597443 DOI: 10.1111/tmi.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The clinical and serological characteristics of spotted fever group rickettsial (SFGR) infections in South Asia are poorly understood. We studied the clinical presentation and the IgM/IgG response in cases enrolled at two health care centres in South India. METHOD We enrolled 77 patients. Fifty-seven of these patients were recruited at a tertiary care centre, the remaining 20 at a community hospital (secondary care level). Diagnostic tests included IgM and IgG enzyme-linked immunosorbent assay and polymerase chain reaction. Over a period of 1 year, 41 cases were followed up for repeated sero-analysis. RESULTS Median age was 9 years (range 1-79). A rash was present in 74% of cases (57/77). In cases aged <15 years, rash was present in 94% (44/47) vs. 43% (13/30) in cases aged ≥15 years. An eschar was found in two cases (3%). Severe infection or complications occurred in 10 cases (13%). These included central nervous system infection (6/77, 8%), kidney injury (3/77, 4%), shock (3/77, 4%), lung involvement (2/77, 3%) and peripheral gangrene (2/77, 3%). IgM antibody levels increased faster after fever onset than IgG antibodies, peaking at 50 and 60 days, respectively. After the peak, IgM and IgG levels showed a slow decline over one year with less than 50% of cases showing persistent IgG antibody levels. CONCLUSION Spotted fever group rickettsial infections in South India may be under-diagnosed, as many cases may not develop a rash. The proportion of cases developing severe infection seems lower than for scrub typhus in this region. IgG seroprevalence may substantially underestimate the proportion in a population with past SFGR infection.
Collapse
Affiliation(s)
- Wolf-Peter Schmidt
- Department of Emergency Medicine, Christian Medical College, Vellore, India.,Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Carol S Devamani
- Rural Unit for Health & Social Affairs, Christian Medical College, Vellore, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Winsley Rose
- Department of Pediatrics and Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - John A J Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| |
Collapse
|
5
|
D E, S P, K G, W R, V P V, Pp AK, Jaj P, Js D. Spotted fever diagnosis: Experience from a South Indian center. Pathog Glob Health 2021; 115:300-306. [PMID: 34493177 DOI: 10.1080/20477724.2021.1934293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Spotted fever (SF) is an important treatable cause of acute febrile illness (AFI) with rash and has reemerged in India. A prospective AFI with rash study was undertaken at a South Indian hospital to correlate specific clinical findings with laboratory confirmation of spotted fever. During the study period (December 2017 to May 2019), 175 patients with fever and rash were suspected to have spotted fever. Molecular assays for scrub typhus and spotted fever (47 kDa and ompA qPCR) and serology (IgM ELISA) was performed on the 96 individuals recruited. Laboratory confirmed SF cases (ompA qPCR positive) were 21, whereas laboratory supported SF cases (ompA negative but sero-positive by SF IgM ELISA) were 27. Among the 48 spotted fever (SF) cases, 70% of had maculopapular rash, 12.5% had macular rash, purpuric/petechial rash (severe rash) was seen in 8 patients (16.7%). Presence of rash on the palms and soles was associated with a relative risk (RR) of 4.36 (95% CI: 2.67-7.10; p < 0.001). Our study suggests that ompA qPCR though useful for confirming the diagnosis of spotted fever is not always positive. A positive SF IgM ELISA in febrile individuals with palmo-plantar rash supports the diagnosis of spotted fever especially when other causes of febrile rash have been excluded. Multi-centric prospective studies employing the serological reference standard, IFA (immunofluorescence assay) in addition to the assays used in this study are needed to validate these findings.
Collapse
Affiliation(s)
- Elangovan D
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Perumalla S
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Gunasekaran K
- Department of General Medicine, Christian Medical College, Vellore, India
| | - Rose W
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Verghese V P
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Abhilash K Pp
- Department of Emergency Medicine, Christian Medical College, Vellore, India
| | - Prakash Jaj
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Dumler Js
- Department of Pathology, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| |
Collapse
|
6
|
Denison AM, Leitgeb B, Obadiah JM, Schwindt A, Ladd-Wilson SG, Paddock CD, Matkovic E. Rickettsia honei Infection in a Traveler Returning From India. Open Forum Infect Dis 2020; 8:ofaa636. [PMID: 33575421 DOI: 10.1093/ofid/ofaa636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022] Open
Abstract
We report a case of Rickettsia honei infection in a US tourist returning from India and the Himalayas. This case highlights a need for awareness of various Rickettsia species endemic to India and the importance for physicians to consider rickettsial diseases in returning travelers with eschar or rash-associated febrile illnesses.
Collapse
Affiliation(s)
- Amy M Denison
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke Leitgeb
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Anne Schwindt
- Multnomah County Health Department, Portland, Oregon, USA
| | | | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eduard Matkovic
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Nataraj N, Muthuraman K, Sundaram D, Ayyanar E, Ashokkumar M, Kasinathan G, Devaraju P. Molecular detection of Candidatus Rickettsia asembonensis in fleas collected from pets and domestic animals in Puducherry, India. MEDICAL AND VETERINARY ENTOMOLOGY 2020; 34:498-502. [PMID: 32432803 DOI: 10.1111/mve.12449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/14/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Rickettsia are obligate intracellular pathogens transmitted by arthropod vectors. The re-emergence of several rickettsioses imposes severe global health burden. In addition to the well-established rickettsial pathogens, newer rickettsial species and their pathogenic potentials are being uncovered. There are many reports of spotted and typhus fever caused by rickettsiae in India. Hence, in this study we screened the ectoparasites of pet and domestic animals for the presence of rickettsia using polymerase chain reaction. Nine cat flea samples (Ctenocephalides felis felis), that tested positive for the presence of rickettsia were subjected to Multi Locus Sequence Typing. Nucleotide sequencing and Phylogenetic analysis of gltA, ompB and 16rrs genes revealed that the rickettsiae detected in cat fleas was Rickettsia asembonensis. Further studies are required to assess Rickettsia asembonensis pathogenic potential to human and its enzootic maintenance of in various hosts and vectors.
Collapse
Affiliation(s)
- N Nataraj
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - K Muthuraman
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - D Sundaram
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - E Ayyanar
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - M Ashokkumar
- Division of Microbiology & Molecular Biology, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - G Kasinathan
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| | - P Devaraju
- Division of Vector Biology and Control, ICMR-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, India
| |
Collapse
|
8
|
Oren A, Garrity GM, Parker CT, Chuvochina M, Trujillo ME. Lists of names of prokaryotic Candidatus taxa. Int J Syst Evol Microbiol 2020; 70:3956-4042. [DOI: 10.1099/ijsem.0.003789] [Citation(s) in RCA: 782] [Impact Index Per Article: 195.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We here present annotated lists of names of Candidatus taxa of prokaryotes with ranks between subspecies and class, proposed between the mid-1990s, when the provisional status of Candidatus taxa was first established, and the end of 2018. Where necessary, corrected names are proposed that comply with the current provisions of the International Code of Nomenclature of Prokaryotes and its Orthography appendix. These lists, as well as updated lists of newly published names of Candidatus taxa with additions and corrections to the current lists to be published periodically in the International Journal of Systematic and Evolutionary Microbiology, may serve as the basis for the valid publication of the Candidatus names if and when the current proposals to expand the type material for naming of prokaryotes to also include gene sequences of yet-uncultivated taxa is accepted by the International Committee on Systematics of Prokaryotes.
Collapse
Affiliation(s)
- Aharon Oren
- The Institute of Life Sciences, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, 9190401 Jerusalem, Israel
| | - George M. Garrity
- NamesforLife, LLC, PO Box 769, Okemos MI 48805-0769, USA
- Department of Microbiology & Molecular Genetics, Biomedical Physical Sciences, Michigan State University, East Lansing, MI 48824-4320, USA
| | | | - Maria Chuvochina
- Australian Centre for Ecogenomics, University of Queensland, St. Lucia QLD 4072, Brisbane, Australia
| | - Martha E. Trujillo
- Departamento de Microbiología y Genética, Campus Miguel de Unamuno, Universidad de Salamanca, 37007, Salamanca, Spain
| |
Collapse
|
9
|
Biswal M, Zaman K, Suri V, Gopi S, Kumar A, Gopi T, Vig S, Sharma N, Bhalla A. Molecular confirmation & characterization of Rickettsia conorii in north India: A report of three cases. Indian J Med Res 2020; 151:59-64. [PMID: 32134015 PMCID: PMC7055166 DOI: 10.4103/ijmr.ijmr_92_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives In India, spotted fever group rickettsiae (SFGR) are an underdiagnosed cause of acute febrile illness (AFI). The non-specific Weil-Felix test is the first diagnostic modality for the diagnosis of SFGR in many laboratories due to the lack of advanced diagnostic facilities in developing countries. The aim of this study was to detect SFGR using molecular methods in the patients, presenting with AFI in a tertiary care centre in north India. Methods Consecutive patients (>14 yr of age) with AFI were enrolled over a six month period. Standard investigations for common pathogens causing AFI in India (malaria, dengue, scrub typhus, leptospirosis and enteric fever) were carried out. In patients who were negative for all of the above investigations, blood was subjected to polymerase chain reaction (PCR) targeting outer membrane protein A (ompA) gene of Rickettsia. Results Of the 51 patients with an undiagnosed aetiology, three were positive by ompA PCR. Two of the PCR products produced good sequences and BLAST identification confirmed them as Rickettsia conorii. The sequences of R. conorii reported from south India clustered with two previously reported novel rickettsial genotypes. The study sequences clustered in a group different from that of Rickettsia spp. of the south Indian sequences reported earlier. Interpretation & conclusions This study showed the existence of R. conorii in north India. Testing for SFGR may be included in the diagnostic workup of AFI for better disease management.
Collapse
Affiliation(s)
- Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kamran Zaman
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Srikanth Gopi
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Abhay Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - T Gopi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shashi Vig
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
10
|
Paras ML, Hyle EP, Foreman RK, Coffey KC. Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia, and Uveitis. N Engl J Med 2018; 378:1825-1833. [PMID: 29742372 DOI: 10.1056/nejmcpc1800337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Molly L Paras
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - Emily P Hyle
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - Ruth K Foreman
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - K C Coffey
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| |
Collapse
|
11
|
Tomassone L, Portillo A, Nováková M, de Sousa R, Oteo JA. Neglected aspects of tick-borne rickettsioses. Parasit Vectors 2018; 11:263. [PMID: 29690900 PMCID: PMC5937841 DOI: 10.1186/s13071-018-2856-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/18/2018] [Indexed: 11/26/2022] Open
Abstract
Rickettsioses are among the oldest known infectious diseases. In spite of this, and of the extensive research carried out, many aspects of the biology and epidemiology of tick-borne rickettsiae are far from being completely understood. Their association with arthropod vectors, the importance of vertebrates as reservoirs, the rarity of clinical signs in animals, or the interactions of pathogenic species with rickettsial endosymbionts and with the host intracellular environment, are only some examples. Moreover, new rickettsiae are continuously being discovered. In this review, we focus on the ‘neglected’ aspects of tick-borne rickettsioses and on the gaps in knowledge, which could help to explain why these infections are still emerging and re-emerging threats worldwide.
Collapse
Affiliation(s)
- Laura Tomassone
- Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095, Grugliasco (Torino), Italy.
| | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital San Pedro-CIBIR, C/ Piqueras 98, 26006, Logroño, Spain
| | - Markéta Nováková
- Department of Biology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Palackého 1946/1, 612 42, Brno, Czech Republic
| | - Rita de Sousa
- National Institute of Health Dr. Ricardo Jorge, Av. da Liberdade 5, 2965-575, Aguas de Moura, Portugal
| | - José Antonio Oteo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital San Pedro-CIBIR, C/ Piqueras 98, 26006, Logroño, Spain
| |
Collapse
|
12
|
Takajo I, Sekizuka T, Fujita H, Kawano A, Kawaguchi T, Matsuda M, Kubo K, Miyauchi S, Umekita K, Nagatomo Y, Kuroda M, Takasaki T, Okayama A, Ando S. Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India. Emerg Infect Dis 2018; 22:1079-82. [PMID: 27192498 PMCID: PMC4880103 DOI: 10.3201/eid2206.151985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 60-year-old woman experienced fever, headache, rash, and altered vision after
returning to Japan from India. Testing detected elevated antibody titers to spotted
fever group rickettsia; PCR on blood yielded positive results for the rickettsial
outer membrane protein A gene. We isolated a unique rickettsial
agent and performed a full-genome analysis.
Collapse
|
13
|
Khan SA, Bora T, Chattopadhyay S, Jiang J, Richards AL, Dutta P. Seroepidemiology of rickettsial infections in Northeast India. Trans R Soc Trop Med Hyg 2016; 110:487-94. [PMID: 27618917 DOI: 10.1093/trstmh/trw052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Resurgence of scrub typhus was reported in Northeast India in 2010 after a gap of 67 years since World War II. However, the presence of other rickettsial infections remained unknown from this region. A seroepidemiological investigation was undertaken in the scrub typhus affected areas from 2013-2015 in Assam, Arunachal Pradesh and Nagaland to assess the exposure to other rickettsial diseases besides scrub typhus. METHODS Samples were collected from people residing in scrub typhus reporting areas. Serology was performed by an indirect ELISA for the three rickettsial agents' viz., scrub typhus group orientiae (STGO), spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR). A sample with total net absorbance ≥1.000 was considered as positive. An entomological survey was also carried out in the affected areas. RESULTS Overall, 1265 human blood samples were collected, of which 30.8% (n=390), 13.8% (175) and 4.2% (53) had antibodies against STGO, SFGR and TGR respectively. Presence of antibodies against more than one of the rickettsial groups was also detected. Among the arthropods collected, chiggers of Leptotrombidium deleinse, fleas belonging to Ctenocephalides felis and Pulex irritans, ticks belonging to Rhipicephalus microplus, Haemaphysalis spp. were predominant. Candidatus Rickettsia senegalensis was detected in C. felis. CONCLUSIONS Our findings confirm wide circulation of rickettsial infections and their probable vectors in the northeast region of India.Accession numbers: KU163367, KU163368, KU499847, KU499848.
Collapse
Affiliation(s)
- Siraj Ahmed Khan
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | - Trishna Bora
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | | | - Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Allen L Richards
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Prafulla Dutta
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| |
Collapse
|
14
|
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
|
15
|
Molecular evidence of spotted fever group rickettsiae and Anaplasmataceae from ticks and stray dogs in Bangladesh. Parasitol Res 2015; 115:949-55. [DOI: 10.1007/s00436-015-4819-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/03/2015] [Indexed: 11/26/2022]
|
16
|
Hii SF, Lawrence AL, Cuttell L, Tynas R, Abd Rani PAM, Šlapeta J, Traub RJ. Evidence for a specific host-endosymbiont relationship between 'Rickettsia sp. genotype RF2125' and Ctenocephalides felis orientis infesting dogs in India. Parasit Vectors 2015; 8:169. [PMID: 25884425 PMCID: PMC4369868 DOI: 10.1186/s13071-015-0781-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Fleas of the genus Ctenocephalides serve as vectors for a number of rickettsial zoonoses, including Rickettsia felis. There are currently no published reports of the presence and distribution of R. felis in India, however, the ubiquitous distribution of its vector Ctenocephalides felis, makes it possible that the pathogen is endemic to the region. This study investigates the occurrence of Rickettsia spp. infection in various subspecies of C. felis infesting dogs from urban areas of Mumbai, Delhi and Rajasthan in India. Methods Individual fleas collected off 77 stray dogs from Mumbai, Delhi and Rajasthan were screened for Rickettsia spp. by a conventional PCR targeting the ompB gene. Further genetic characterisation of Rickettsia-positive fleas was carried out using nested PCR and phylogenetic analysis of partial DNA sequences of the gltA and ompA genes. Ctenocephalides spp. were morphologically and genetically identified by PCR targeting a fragment of cox1 gene. Results Overall, 56/77 fleas (72.7%), including 22/24 (91.7%) from Delhi, 32/44 (72.7%) from Mumbai and 2/9 (22.2%) from Rajasthan were positive for Rickettsia DNA at the ompB gene. Sequences of gltA fragments confirmed the amplification of Rickettsia sp. genotype RF2125. The ompA gene of Rickettsia sp. genotype RF2125 was characterised for the first time and shown 96% identical to R. felis. Three species of Ctenocephalides were identified, with the Ctenocephalides felis orientis being the dominant flea species (69/77; 89.6%) in India, followed by Ctenocephalides felis felis (8/77; 10.4%). Conclusions High occurrence of Rickettsia sp. genotype RF2125 in C. felis orientis and the absence of R. felis suggests a specific vector-endosymbiont adaptation and coevolution of the Rickettsia felis-like sp. within subspecies of C. felis.
Collapse
Affiliation(s)
- Sze-Fui Hii
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia. .,Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia.
| | - Andrea L Lawrence
- Faculty of Veterinary Science, The University of Sydney, New South Wales, 2006, Australia.
| | - Leigh Cuttell
- Safe Food Production Queensland, PO Box 440, Spring Hill, Queensland, 4004, Australia.
| | - Rebecca Tynas
- School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, 6009, Australia.
| | | | - Jan Šlapeta
- Faculty of Veterinary Science, The University of Sydney, New South Wales, 2006, Australia.
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia.
| |
Collapse
|
17
|
Faccini-Martínez ÁA, García-Álvarez L, Hidalgo M, Oteo JA. Syndromic classification of rickettsioses: an approach for clinical practice. Int J Infect Dis 2014; 28:126-39. [PMID: 25242696 DOI: 10.1016/j.ijid.2014.05.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/23/2014] [Accepted: 05/24/2014] [Indexed: 10/24/2022] Open
Abstract
Rickettsioses share common clinical manifestations, such as fever, malaise, exanthema, the presence or absence of an inoculation eschar, and lymphadenopathy. Some of these manifestations can be suggestive of certain species of Rickettsia infection. Nevertheless none of these manifestations are pathognomonic, and direct diagnostic methods to confirm the involved species are always required. A syndrome is a set of signs and symptoms that characterizes a disease with many etiologies or causes. This situation is applicable to rickettsioses, where different species can cause similar clinical presentations. We propose a syndromic classification for these diseases: exanthematic rickettsiosis syndrome with a low probability of inoculation eschar and rickettsiosis syndrome with a probability of inoculation eschar and their variants. In doing so, we take into account the clinical manifestations, the geographic origin, and the possible vector involved, in order to provide a guide for physicians of the most probable etiological agent.
Collapse
Affiliation(s)
| | - Lara García-Álvarez
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain
| | - Marylin Hidalgo
- Microbiology Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José A Oteo
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain.
| |
Collapse
|
18
|
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: 908] [Impact Index Per Article: 82.5] [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
|
19
|
Abstract
The field of rickettsiology is rapidly evolving. Rickettsiae are small Gram-negative bacteria that can be transmitted to humans by arthropods. In most cases they are transmitted transovarially in the arthropod; human beings are incidental hosts. In recent years the use of cell culture and molecular biology has profoundly changed our knowledge of rickettsiae and has led to the description of several new species. New rickettsial diseases have been found in three main situations: firstly, in places where no new species have been identified, typical rickettsial symptoms have been observed (Japan, China); secondly, typical rickettsioses have been found to be caused by different organisms - in such cases a new Rickettsia species has been misdiagnosed as a previously identified bacterium (for example, R. parkeri was confused with R. rickettsii); thirdly, atypical clinical symptoms have been found to be caused by rickettsial organisms such as R. slovaca. These findings challenge the old dogma that only one tick-borne rickettsiosis is prevalent in one geographical area. Many Rickettsia spp. have been identified in ticks, but have not yet been implicated in human pathology. These rickettsiae should be considered as potential pathogens. All known or suspected rickettsial diseases should be treated (including in children) with doxycycline.
Collapse
Affiliation(s)
- Aurélie Renvoisé
- Unité des Rickettsies, CNRS-IRD UMR6236-198, Université de la Méditerranée, Faculté de Médecine, 27 bd Jean Moulin, 13385 Marseille cedex 5, France
| | | | | |
Collapse
|
20
|
Prakash JAJ, Sohan Lal T, Rosemol V, Verghese VP, Pulimood SA, Reller M, Dumler JS. Molecular detection and analysis of spotted fever group Rickettsia in patients with fever and rash at a tertiary care centre in Tamil Nadu, India. Pathog Glob Health 2012; 106:40-5. [PMID: 22595273 DOI: 10.1179/2047773212y.0000000001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Detection of specific targets by PCR is used to confirm a diagnosis of spotted fever, but serological tests are still widely used. In this prospective study, nested PCR was performed on skin biopsy specimens to confirm the diagnosis of spotted fever. METHODS In 58 clinically suspected cases of spotted fever, nested PCR, to detect gltA, 17 kDa lipoprotein antigen gene (17 kDa), ompA and ompB, from skin biopsy of the rash was performed. Sequencing was carried on amplicons representing the four targets to confirm specificity of amplification. This was followed by phylogenetic analysis using MEGA version 4.0 software. RESULTS The gltA, 17 kDa, ompA, and ompB genes were detected from skin biopsy specimens in 38, 23, 27, and 22 individuals. Sequence analysis revealed that the gltA, 17 kDa, ompA, and ompB sequences belonged to spotted fever group (SFG) rickettsia. Of the six partial ompA gene sequences, only one was dissimilar to the previously reported 'Candidatus Rickettsia kellyi'. CONCLUSION Further evidence indicates that SFG rickettsiae resembling 'Candidatus Rickettsia kellyi' cause fever and rash in southern India. More detailed phylogenetic analysis following isolation of rickettsia in culture is required for providing irrefutable proof for the occurrence of novel spotted fever rickettsiae in this region.
Collapse
|
21
|
Zou Y, Wang Q, Fu Z, Liu P, Jin H, Yang H, Gao H, Xi Z, Liu Q, Chen L. Detection of spotted fever group Rickettsia in Haemaphysalis longicornis from Hebei Province, China. J Parasitol 2011; 97:960-2. [PMID: 21506802 DOI: 10.1645/ge-2751.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
DNA samples from 737 tick pools, representing 6,850 Haemaphysalis longicornis and 51 Dermacentor nuttalli collected from Hebei Province, China, were analyzed by polymerase chain reaction (PCR) for the presence of spotted fever group Rickettsia. Fifty (6.9%) of 724 H. longicornis in the tick pool were positive, but no positive samples were found in 13 D. nuttalli. Sequence analysis of the partial outer membrane protein A (ompA) genes from the 10 positive samples showed 97.4-99.8% identity, but were different from the homologous sequence of Rickettsia previously deposited in GenBank. Phylogenetic analysis of ompA genes indicated that the Rickettsia detected in this study belonged to a novel haplotype, and formed a clade distinct from Rickettsia heilongjiangii, Rickettsia sibirica, and Rickettsia hulinii in China. The new strain, named Candidatus Rickettsia hebeiii, appears to represent a distinct lineage and could constitute a new species with a minimum prevalence of about 0.7% in H. longicornis from Hebei Province, China.
Collapse
Affiliation(s)
- Yaxue Zou
- Key Laboratory of Preventive Veterinary Medicine in Hebei Province, Hebei Normal University of Science & Techology, 360 Hebei Street, Qinhuangdao, 066000, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Renvoisé A, Raoult D. L’actualité des rickettsioses. Med Mal Infect 2009; 39:71-81. [DOI: 10.1016/j.medmal.2008.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 11/13/2008] [Indexed: 11/28/2022]
|