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Muco E, Karruli A, Dajlani A, Zerja A, Bego A. Severe murine typhus complicated by multiple organ dysfunctions: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:188-192. [PMID: 38463928 PMCID: PMC10921100 DOI: 10.22088/cjim.15.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 10/15/2022] [Indexed: 03/12/2024]
Abstract
Background Rickettsioses are infectious diseases which are caused by intracellular bacteria which belong to the family Rickettsiaceae. This zoonosis endemically prefers tropical and subtropical regions of which the Mediterranean is included. Murine typhus is a type of rickettsial disease that commonly presents with undulating fever, headache rash, chills, malaise, and myalgias. It can lead to complications such as multi-organ failure and has a lethality rate of <5% in such cases. Case Presentation A 70-year-old male was hospitalized at the Unit of Infectious Diseases, Mother Teresa Hospital, Tirana, Albania in a comatose condition. He had a seven-day history of fever up to 39-40°C, headache, fatigue, anorexia, vomiting, cough, and myalgia. He was a farmer and had contact with animals. Upon admission, he had scleral hemorrhages, hepatosplenomegaly, jaundice, maculopapular rash over the trunk, abdomen, and palms of his hands as well as severe acidosis, depressed bicarbonate levels, alteration in liver, kidney, and pancreas function tests. He was urgently transferred to the Intensive care unit of the Infectious Diseases Department. He was hemodynamically unstable and was put immediately on vasoactive agents and mechanical ventilation. ELISA Rickettsia typhi IgM resulted positive. Supportive treatment along with antibiotics Levofloxacin and Ceftriaxone was initiated. However, the patient died on the 4th day of hospitalization and the 11th of the disease onset. Conclusion Murine typhus should be included in the investigation of possible causes when dealing with patients presenting with fever and maculopapular rash complicated by multi-organ failure and coming from a typhus-endemic area, especially in the summer season.
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Affiliation(s)
- Ermira Muco
- Department of Infectious Diseases, Hospital University Center “Mother Teresa”, Tirana, Albania
| | - Arta Karruli
- Department of Infectious Diseases, Hospital University Center “Mother Teresa”, Tirana, Albania
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Anjeza Dajlani
- Unit of Infectious Disease, Hospital of Elbasan, Albania
| | - Arjana Zerja
- Department of Infectious Diseases, Hospital University Center “Mother Teresa”, Tirana, Albania
| | - Artan Bego
- Institute of Public Health, Tirana, Albania
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Oludele J, Alho P, Chongo I, Maholela P, Magaia V, Muianga A, Melchior B, Isaías T, Gatambire A, Zimba E, Nhavoto E, Notiço P, Inguana P, Cantoria J, António V, Monteiro V, Ali S, Inlamea O, Samo Gudo E. Emerging Zoonotic Diseases among Pastoral Communities of Caia and Búzi Districts, Sofala, Mozambique: Evidence of Antibodies against Brucella, Leptospira, Rickettsia, and Crimean-Congo Hemorrhagic Fever Virus. Viruses 2023; 15:2379. [PMID: 38140620 PMCID: PMC10748219 DOI: 10.3390/v15122379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Emerging zoonotic diseases are an increasing threat to public health. There is little data on the seroprevalence of zoonotic diseases among pastoralists in the country. We aim to carry out a cross-sectional study on the prevalence of major zoonotic diseases among pastoral communities in the Caia and Búzi districts. METHODS Between January and December 2018, a questionnaire was used to solicit socio-demographic data from consenting pastoralists with the collection of blood samples in the Caia and Búzi districts of the Sofala province. All samples were tested using ELISA commercial reagents for the detection of IgM antibodies against Brucella and Leptospira. Likewise, IgM and IgG antibodies against Rickettsia and CCHFV were determined using ELISA kits. RESULTS A total of 218 samples were tested, of which 43.5% (95/218) were from the district of Caia and 56.4% (123/218) from the Búzi district. Results from both districts showed that the seroprevalence of IgM antibodies against Brucella and Leptospira was 2.7% (6/218) and 30.3% (67/218), respectively. Positivity rates for IgM and IgG anti-Rickettsia and CCHFV were 8.7% (19/218), 2.7% (6/218), 4.1% (9/218), and 0.9% (2/218), respectively. CONCLUSIONS Results from our study showed evidence of antibodies due to exposure to Brucella, Leptospira, Rickettsia, and CCHFV with antibodies against Leptospira and Rickettsia being the most prevalent. Hence, laboratory diagnosis of zoonotic diseases is essential in the early detection of outbreaks, the identification of silent transmission, and the etiology of non-febrile illness in a pastoral community. There is a need to develop public health interventions that will reduce the risk of transmission.
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Affiliation(s)
- John Oludele
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pascoal Alho
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Inocêncio Chongo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Plácida Maholela
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vlademiro Magaia
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique;
| | - Argentina Muianga
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Bibiana Melchior
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Telma Isaías
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Aline Gatambire
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Edna Zimba
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Emídio Nhavoto
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Paulo Notiço
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pedro Inguana
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Juma Cantoria
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Virgílio António
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vanessa Monteiro
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Sádia Ali
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, Ludwig Maximilian University of Munich, 80802 München, Germany
| | - Osvaldo Inlamea
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
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Kigozi BK, Kharod GA, Bukenya H, Shadomy SV, Haberling DL, Stoddard RA, Galloway RL, Tushabe P, Nankya A, Nsibambi T, Mbidde EK, Lutwama JJ, Perniciaro JL, Nicholson WL, Bower WA, Bwogi J, Blaney DD. Investigating the etiology of acute febrile illness: a prospective clinic-based study in Uganda. BMC Infect Dis 2023; 23:411. [PMID: 37328808 PMCID: PMC10276394 DOI: 10.1186/s12879-023-08335-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Historically, malaria has been the predominant cause of acute febrile illness (AFI) in sub-Saharan Africa. However, during the last two decades, malaria incidence has declined due to concerted public health control efforts, including the widespread use of rapid diagnostic tests leading to increased recognition of non-malarial AFI etiologies. Our understanding of non-malarial AFI is limited due to lack of laboratory diagnostic capacity. We aimed to determine the etiology of AFI in three distinct regions of Uganda. METHODS A prospective clinic-based study that enrolled participants from April 2011 to January 2013 using standard diagnostic tests. Participant recruitment was from St. Paul's Health Centre (HC) IV, Ndejje HC IV, and Adumi HC IV in the western, central and northern regions, which differ by climate, environment, and population density. A Pearson's chi-square test was used to evaluate categorical variables, while a two-sample t-test and Krukalis-Wallis test were used for continuous variables. RESULTS Of the 1281 participants, 450 (35.1%), 382 (29.8%), and 449 (35.1%) were recruited from the western, central, and northern regions, respectively. The median age (range) was 18 (2-93) years; 717 (56%) of the participants were female. At least one AFI pathogen was identified in 1054 (82.3%) participants; one or more non-malarial AFI pathogens were identified in 894 (69.8%) participants. The non-malarial AFI pathogens identified were chikungunya virus, 716 (55.9%); Spotted Fever Group rickettsia (SFGR), 336 (26.2%) and Typhus Group rickettsia (TGR), 97 (7.6%); typhoid fever (TF), 74 (5.8%); West Nile virus, 7 (0.5%); dengue virus, 10 (0.8%) and leptospirosis, 2 (0.2%) cases. No cases of brucellosis were identified. Malaria was diagnosed either concurrently or alone in 404 (31.5%) and 160 (12.5%) participants, respectively. In 227 (17.7%) participants, no cause of infection was identified. There were statistically significant differences in the occurrence and distribution of TF, TGR and SFGR, with TF and TGR observed more frequently in the western region (p = 0.001; p < 0.001) while SFGR in the northern region (p < 0.001). CONCLUSION Malaria, arboviral infections, and rickettsioses are major causes of AFI in Uganda. Development of a Multiplexed Point-of-Care test would help identify the etiology of non-malarial AFI in regions with high AFI rates.
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Affiliation(s)
- Brian K Kigozi
- Uganda Virus Research Institute, Entebbe, Uganda.
- College of Health Sciences, Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.
| | - Grishma A Kharod
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - Sean V Shadomy
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Dana L Haberling
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Robyn A Stoddard
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Renee L Galloway
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - Annet Nankya
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Thomas Nsibambi
- Uganda Virus Research Institute, Entebbe, Uganda
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | | | | | - William A Bower
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - David D Blaney
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
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Kato CY, Chung IH, Robinson LK, Eremeeva ME, Dasch GA. Genetic typing of isolates of Rickettsia typhi. PLoS Negl Trop Dis 2022; 16:e0010354. [PMID: 35639778 PMCID: PMC9203007 DOI: 10.1371/journal.pntd.0010354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/16/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Murine typhus, which is caused by Rickettsia typhi, has a wide range of clinical manifestations. It has a low mortality rate but may result in meningoencephalitis and interstitial pneumonia in severe cases. Comparisons of complete genome sequences of R. typhi isolates from North Carolina, USA (Wilmington), Myanmar (B9991PP), and Thailand (TH1527) identified only 26 single nucleotide polymorphism (SNP) and 7 insertion-deletion (INDEL) sites in these highly syntenic genomes. Assays were developed to further define the distribution of these variant sites among 15 additional isolates of R. typhi with different histories from Asia, the USA, and Africa. Mismatch amplification mutation assays (MAMA) were validated for 22 SNP sites, while the 7 INDEL sites were analyzed directly on agarose gels. Six SNP types, 9 INDEL types, 11 total types were identified among these 18 isolates. Replicate DNA samples as well as comparisons of isolates with different passage and source histories gave consistent genetic typing profiles. Comparison of the SNP and INDEL markers to R. typhi’s nearest neighbor Rickettsia prowazekii demonstrated that the majority of the SNPs represent intra-species variation that arose post divergence of these two species while several INDEL sites also exhibited intraspecies variability among the R. prowazekii genomes that have been completely sequenced. The assays for the presence of these SNP and INDEL sites, particularly the latter, comprise a low technology gel method for consistently distinguishing R. typhi and R. prowazekii as well as for differentiating genetic types of R. typhi. Rickettsia typhi is an obligately intracellular bacterium which is most commonly transmitted by rat fleas to humans and can cause the disease murine (endemic) typhus wherever both humans and infected rats are present. However, this agent is also present in a variety of other arthropod species associated with other vertebrate animals. Its closest relative is Rickettsia prowazekii, the etiologic agent of epidemic typhus (human louse-borne) and sylvatic typhus (associated with flying squirrels and its ectoparasites in the Eastern United States). Both classic louse-borne and flea-borne typhus rickettsiae can cause fatal infections and have the potential for use as biothreat agents as they can be grown in large quantities. We investigated the genetic differences that can be found in different stocks of R. typhi. Our work is important for two reasons. We have developed robust and sensitive methods for distinguishing isolates of R. typhi originating from different continents; these new assays require only simple instrumentation which is available in nearly all biology laboratories. Our results also provided new insights confirming the probable origin of R. typhi in Asia and its likely cosmopolitan spread by rats on ships around the world.
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Affiliation(s)
- Cecilia Y. Kato
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Ida H. Chung
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Lauren K. Robinson
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Marina E. Eremeeva
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Gregory A. Dasch
- Rickettsial Zoonoses Branch, Centers for Disease Control, Atlanta, Georgia, United States of America
- * E-mail:
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Ectoparasite load of small mammals in the Serengeti Ecosystem: effects of land use, season, host species, age, sex and breeding status. Parasitol Res 2022; 121:823-838. [PMID: 35122139 PMCID: PMC8858283 DOI: 10.1007/s00436-022-07439-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
Abstract
Ectoparasite load in small mammals can be influenced by both environmental conditions and host species characteristics. However, the nature of these influences is poorly understood in many ecosystems. We used zero-inflated negative binomial (ZINB) regression models with a log link function to assess variation in ectoparasite load among 19 small mammal host species across different land uses (protection in a park, pastoralism and agriculture), habitat types, seasons, age classes, sexes and breeding statuses. We collected 4258 ectoparasites from 612 individual belonging to 19 different species of small mammals. The average ectoparasite load per individual was higher in the pastoral and agricultural lands than in the National Park. Ectoparasite load varied among species and was the highest for the four common and generalist small mammal species (Aethomys sp., Arvicanthis niloticus, Mastomys natalensis, and Gerbilliscus vicinus), most notably in the disturbed pastoral and agricultural lands. It was also higher in the dry than the wet season and for adult males than adult females. These patterns partly reflect the greater mobility of small mammals in the drier conditions; in addition the large body size and home range of males increase the likelihood of encountering parasites. Human disturbance was associated with elevated ectoparasitic load among the small mammals and hence elevated risk of transmission of ectoparasites to humans. As a result, understanding the effect of habitat disturbance on ectoparasite load and its link to zoonotic disease risk should be an important conservation goal and public health priority. Moreover, effective pest control strategies should consider variation in ectoparasite load with land use, habitat type, season and species characteristics.
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Rauch J, Barton J, Kwiatkowski M, Wunderlich M, Steffen P, Moderzynski K, Papp S, Höhn K, Schwanke H, Witt S, Richardt U, Mehlhoop U, Schlüter H, Pianka V, Fleischer B, Tappe D, Osterloh A. GroEL is an immunodominant surface-exposed antigen of Rickettsia typhi. PLoS One 2021; 16:e0253084. [PMID: 34111210 PMCID: PMC8191997 DOI: 10.1371/journal.pone.0253084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022] Open
Abstract
Rickettsioses are neglected and emerging potentially fatal febrile diseases that are caused by obligate intracellular bacteria, rickettsiae. Rickettsia (R.) typhi and R. prowazekii constitute the typhus group (TG) of rickettsiae and are the causative agents of endemic and epidemic typhus, respectively. We recently generated a monoclonal antibody (BNI52) against R. typhi. Characterization of BNI52 revealed that it specifically recognizes TG rickettsiae but not the members of the spotted fever group (SFG) rickettsiae. We further show that BNI52 binds to protein fragments of ±30 kDa that are exposed on the bacterial surface and also present in the periplasmic space. These protein fragments apparently derive from the cytosolic GroEL protein of R. typhi and are also recognized by antibodies in the sera from patients and infected mice. Furthermore, BNI52 opsonizes the bacteria for the uptake by antigen presenting cells (APC), indicating a contribution of GroEL-specific antibodies to protective immunity. Finally, it is interesting that the GroEL protein belongs to 32 proteins that are differentially downregulated by R. typhi after passage through immunodeficient BALB/c CB17 SCID mice. This could be a hint that the rickettsia GroEL protein may have immunomodulatory properties as shown for the homologous protein from several other bacteria, too. Overall, the results of this study provide evidence that GroEL represents an immunodominant antigen of TG rickettsiae that is recognized by the humoral immune response against these pathogens and that may be interesting as a vaccine candidate. Apart from that, the BNI52 antibody represents a new tool for specific detection of TG rickettsiae in various diagnostic and experimental setups.
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Affiliation(s)
- Jessica Rauch
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Barton
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Malte Wunderlich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Pascal Steffen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Stefanie Papp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Katharina Höhn
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hella Schwanke
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Susanne Witt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ute Mehlhoop
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Verena Pianka
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Anke Osterloh
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Abstract
Over the last decades, rickettsioses are emerging worldwide. These diseases are caused by intracellular bacteria. Although rickettsioses can be treated with antibiotics, a vaccine against rickettsiae is highly desired for several reasons. Rickettsioses are highly prevalent, especially in poor countries, and there are indications of the development of antibiotic resistance. In addition, some rickettsiae can persist and cause recurrent disease. The development of a vaccine requires the understanding of the immune mechanisms that are involved in protection as well as in immunopathology. Knowledge about these immune responses is accumulating, and efforts have been undertaken to identify antigenic components of rickettsiae that may be useful as a vaccine. This review provides an overview on current knowledge of adaptive immunity against rickettsiae, which is essential for defense, rickettsial antigens that have been identified so far, and on vaccination strategies that have been used in animal models of rickettsial infections.
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8
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Osterloh A. Immune response against rickettsiae: lessons from murine infection models. Med Microbiol Immunol 2017; 206:403-417. [PMID: 28770333 PMCID: PMC5664416 DOI: 10.1007/s00430-017-0514-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 12/19/2022]
Abstract
Rickettsiae are small intracellular bacteria that can cause life-threatening febrile diseases. Rickettsioses occur worldwide with increasing incidence. Therefore, a vaccine is highly desired. A prerequisite for the development of a vaccine is the knowledge of the immune response against these bacteria, in particular protective immunity. In recent years murine models of rickettsial infections have been established, and the study of immune response against rickettsiae in mice provided many new insights into protective and pathological immune reactions. This review summarizes the current knowledge about immune mechanisms in protection and pathology in rickettsial infections.
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Affiliation(s)
- Anke Osterloh
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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Cytotoxic effector functions of T cells are not required for protective immunity against fatal Rickettsia typhi infection in a murine model of infection: Role of TH1 and TH17 cytokines in protection and pathology. PLoS Negl Trop Dis 2017; 11:e0005404. [PMID: 28222146 PMCID: PMC5336310 DOI: 10.1371/journal.pntd.0005404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/03/2017] [Accepted: 02/12/2017] [Indexed: 01/05/2023] Open
Abstract
Endemic typhus caused by Rickettsia (R.) typhi is an emerging febrile disease that can be fatal due to multiple organ pathology. Here we analyzed the requirements for protection against R. typhi by T cells in the CB17 SCID model of infection. BALB/c wild-type mice generate CD4+ TH1 and cytotoxic CD8+ T cells both of which are sporadically reactivated in persistent infection. Either adoptively transferred CD8+ or CD4+ T cells protected R. typhi-infected CB17 SCID mice from death and provided long-term control. CD8+ T cells lacking either IFNγ or Perforin were still protective, demonstrating that the cytotoxic function of CD8+ T cells is not essential for protection. Immune wild-type CD4+ T cells produced high amounts of IFNγ, induced the release of nitric oxide in R. typhi-infected macrophages and inhibited bacterial growth in vitro via IFNγ and TNFα. However, adoptive transfer of CD4+IFNγ-/- T cells still protected 30-90% of R. typhi-infected CB17 SCID mice. These cells acquired a TH17 phenotype, producing high amounts of IL-17A and IL-22 in addition to TNFα, and inhibited bacterial growth in vitro. Surprisingly, the neutralization of either TNFα or IL-17A in CD4+IFNγ-/- T cell recipient mice did not alter bacterial elimination by these cells in vivo, led to faster recovery and enhanced survival compared to isotype-treated animals. Thus, collectively these data show that although CD4+ TH1 cells are clearly efficient in protection against R. typhi, CD4+ TH17 cells are similarly protective if the harmful effects of combined production of TNFα and IL-17A can be inhibited.
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Moderzynski K, Papp S, Rauch J, Heine L, Kuehl S, Richardt U, Fleischer B, Osterloh A. CD4+ T Cells Are as Protective as CD8+ T Cells against Rickettsia typhi Infection by Activating Macrophage Bactericidal Activity. PLoS Negl Trop Dis 2016; 10:e0005089. [PMID: 27875529 PMCID: PMC5119731 DOI: 10.1371/journal.pntd.0005089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/02/2016] [Indexed: 01/07/2023] Open
Abstract
Rickettsia typhi is an intracellular bacterium that causes endemic typhus, a febrile disease that can be fatal due to complications including pneumonia, hepatitis and meningoencephalitis, the latter being a regular outcome in T and B cell-deficient C57BL/6 RAG1-/- mice upon Rickettsia typhi infection. Here, we show that CD4+ TH1 cells that are generated in C57BL/6 mice upon R. typhi infection are as protective as cytotoxic CD8+ T cells. CD4+- as well as CD8+-deficient C57BL/6 survived the infection without showing symptoms of disease at any point in time. Moreover, adoptively transferred CD8+ and CD4+ immune T cells entered the CNS of C57BL/6 RAG1-/- mice with advanced infection and both eradicated the bacteria. However, immune CD4+ T cells protected only approximately 60% of the animals from death. They induced the expression of iNOS in infiltrating macrophages as well as in resident microglia in the CNS which can contribute to bacterial killing but also accelerate pathology. In vitro immune CD4+ T cells inhibited bacterial growth in infected macrophages which was in part mediated by the release of IFNγ. Collectively, our data demonstrate that CD4+ T cells are as protective as CD8+ T cells against R. typhi, provided that CD4+ TH1 effector cells are present in time to support bactericidal activity of phagocytes via the release of IFNγ and other factors. With regard to vaccination against TG Rickettsiae, our findings suggest that the induction of CD4+ TH1 effector cells is sufficient for protection. Endemic typhus caused by Rickettsia typhi usually is a relatively mild disease. However, CNS inflammation and neurological symptoms are complications that can occur in severe cases. This outcome of disease is regularly observed in T and B cell-deficient C57BL/6 RAG1-/- mice upon infection with R. typhi. We show here that CD4+ T cells are as protective as cytotoxic CD8+ T cells against R. typhi as long as they are present in time. This is evidenced by the fact that neither CD8+ nor CD4+ T cell-deficient C57BL/6 mice develop disease which is also true for R. typhi-infected C57BL/6 RAG1-/- mice that receive immune CD8+ or CD4+ at an early point in time. Moreover, adoptive transfer of immune CD4+ T cells still protects approximately 60% of C57BL/6 RAG1-/- mice when applied later in advanced infection when the bacteria start to rise. Although CD8+ T cells are faster and more efficient in bacterial elimination, R. typhi is not detectable in CD4+ T cell recipients anymore. We further show that immune CD4+ T cells activate bactericidal functions of microglia and macrophages in the CNS in vivo and inhibit bacterial growth in infected macrophages in vitro which is in part mediated by the release of IFNγ. Collectively, we demonstrate for the first time that CD4+ T cells alone are sufficient to protect against R. typhi infection. With regard to vaccination our findings suggest that the induction of R. typhi-specific CD4+ TH1 effector T cells may be as effective as the much more difficult targeting of cytotoxic CD8+ T cells.
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Affiliation(s)
- Kristin Moderzynski
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stefanie Papp
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Rauch
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Liza Heine
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Svenja Kuehl
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bernhard Fleischer
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Osterloh
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- * E-mail:
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Papp S, Rauch J, Kuehl S, Richardt U, Keller C, Osterloh A. Comparative evaluation of two Rickettsia typhi-specific quantitative real-time PCRs for research and diagnostic purposes. Med Microbiol Immunol 2016; 206:41-51. [PMID: 27696011 DOI: 10.1007/s00430-016-0480-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 01/03/2023]
Abstract
Rickettsioses are caused by intracellular bacteria of the family of Rickettsiaceae. Rickettsia (R.) typhi is the causative agent of endemic typhus. The disease occurs worldwide and is one of the most prevalent rickettsioses. Rickettsial diseases, however, are generally underdiagnosed which is mainly due to the lack of sensitive and specific methods. In addition, methods for quantitative detection of the bacteria for research purposes are rare. We established two qPCRs for the detection of R. typhi by amplification of the outer membrane protein B (ompB) and parvulin-type PPIase (prsA) genes. Both qPCRs are specific and exclusively recognize R. typhi but no other rickettsiae including the closest relative, R. prowazekii. The prsA-based qPCR revealed to be much more sensitive than the amplification of ompB and provided highly reproducible results in the detection of R. typhi in organs of infected mice. Furthermore, as a nested PCR the prsA qPCR was applicable for the detection of R. typhi in human blood samples. Collectively, the prsA-based qPCR represents a reliable method for the quantitative detection of R. typhi for research purposes and is a promising candidate for differential diagnosis.
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Affiliation(s)
- Stefanie Papp
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany
| | - Jessica Rauch
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany
| | - Svenja Kuehl
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany
| | - Ulricke Richardt
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany
| | - Christian Keller
- Institute for Virology, University Medical Center Gießen and Marburg, 35032, Marburg, Germany
| | - Anke Osterloh
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, 20359, Hamburg, Germany.
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Papp S, Moderzynski K, Rauch J, Heine L, Kuehl S, Richardt U, Mueller H, Fleischer B, Osterloh A. Liver Necrosis and Lethal Systemic Inflammation in a Murine Model of Rickettsia typhi Infection: Role of Neutrophils, Macrophages and NK Cells. PLoS Negl Trop Dis 2016; 10:e0004935. [PMID: 27548618 PMCID: PMC4993389 DOI: 10.1371/journal.pntd.0004935] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/31/2016] [Indexed: 12/31/2022] Open
Abstract
Rickettsia (R.) typhi is the causative agent of endemic typhus, an emerging febrile disease that is associated with complications such as pneumonia, encephalitis and liver dysfunction. To elucidate how innate immune mechanisms contribute to defense and pathology we here analyzed R. typhi infection of CB17 SCID mice that are congenic to BALB/c mice but lack adaptive immunity. CB17 SCID mice succumbed to R. typhi infection within 21 days and showed high bacterial load in spleen, brain, lung, and liver. Most evident pathological changes in R. typhi-infected CB17 SCID mice were massive liver necrosis and splenomegaly due to the disproportionate accumulation of neutrophils and macrophages (MΦ). Both neutrophils and MΦ infiltrated the liver and harbored R. typhi. Both cell populations expressed iNOS and produced reactive oxygen species (ROS) and, thus, exhibited an inflammatory and bactericidal phenotype. Surprisingly, depletion of neutrophils completely prevented liver necrosis but neither altered bacterial load nor protected CB17 SCID mice from death. Furthermore, the absence of neutrophils had no impact on the overwhelming systemic inflammatory response in these mice. This response was predominantly driven by activated MΦ and NK cells both of which expressed IFNγ and is considered as the reason of death. Finally, we observed that iNOS expression by MΦ and neutrophils did not correlate with R. typhi uptake in vivo. Moreover, we demonstrate that MΦ hardly respond to R. typhi in vitro. These findings indicate that R. typhi enters MΦ and also neutrophils unrecognized and that activation of these cells is mediated by other mechanisms in the context of tissue damage in vivo.
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Affiliation(s)
- Stefanie Papp
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Kristin Moderzynski
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Rauch
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Liza Heine
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Svenja Kuehl
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Heidelinde Mueller
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bernhard Fleischer
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Osterloh
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Umulisa I, Omolo J, Muldoon KA, Condo J, Habiyaremye F, Uwimana JM, Muhimpundu MA, Galgalo T, Rwunganira S, Dahourou AG, Tongren E, Koama JB, McQuiston J, Raghunathan PL, Massung R, Gatei W, Boer K, Nyatanyi T, Mills EJ, Binagwaho A. A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012. Am J Trop Med Hyg 2016; 95:452-6. [PMID: 27352876 DOI: 10.4269/ajtmh.15-0643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/05/2016] [Indexed: 11/07/2022] Open
Abstract
In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.
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Affiliation(s)
- Irenee Umulisa
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.
| | - Jared Omolo
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Katherine A Muldoon
- University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada
| | - Jeanine Condo
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Francois Habiyaremye
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Jean Marie Uwimana
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda
| | | | - Tura Galgalo
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Samuel Rwunganira
- Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Anicet G Dahourou
- CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eric Tongren
- Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Jean Baptiste Koama
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Jennifer McQuiston
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pratima L Raghunathan
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Robert Massung
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wangeci Gatei
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Kimberly Boer
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Thierry Nyatanyi
- Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Edward J Mills
- University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada. Stanford University, Stanford, California
| | - Agnes Binagwaho
- Ministry of Health Rwanda, Kigali, Rwanda. Harvard Medical School, Boston, Massachusetts. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Persisting Rickettsia typhi Causes Fatal Central Nervous System Inflammation. Infect Immun 2016; 84:1615-1632. [PMID: 26975992 DOI: 10.1128/iai.00034-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/06/2016] [Indexed: 01/03/2023] Open
Abstract
Rickettsioses are emerging febrile diseases caused by obligate intracellular bacteria belonging to the family Rickettsiaceae. Rickettsia typhi belongs to the typhus group (TG) of this family and is the causative agent of endemic typhus, a disease that can be fatal. In the present study, we analyzed the course of R. typhi infection in C57BL/6 RAG1(-/-) mice. Although these mice lack adaptive immunity, they developed only mild and temporary symptoms of disease and survived R. typhi infection for a long period of time. To our surprise, 3 to 4 months after infection, C57BL/6 RAG1(-/-) mice suddenly developed lethal neurological disorders. Analysis of these mice at the time of death revealed high bacterial loads, predominantly in the brain. This was accompanied by a massive expansion of microglia and by neuronal cell death. Furthermore, high numbers of infiltrating CD11b(+) macrophages were detectable in the brain. In contrast to the microglia, these cells harbored R. typhi and showed an inflammatory phenotype, as indicated by inducible nitric oxide synthase (iNOS) expression, which was not observed in the periphery. Having shown that R. typhi persists in immunocompromised mice, we finally asked whether the bacteria are also able to persist in resistant C57BL/6 and BALB/c wild-type mice. Indeed, R. typhi could be recultivated from lung, spleen, and brain tissues from both strains even up to 1 year after infection. This is the first report demonstrating persistence and reappearance of R. typhi, mainly restricted to the central nervous system in immunocompromised mice.
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Froeschl G, Ntinginya NE, Sangare A, Lawala P, Mangu C, Dobler G, Heinrich N, Flach B, Nsojo A, Lennemann T. Integrating Local, National, and International Stakeholders in Outbreak Preparedness in Developing Countries: Conclusions from a Conference in Mbeya, Tanzania. Health Secur 2016; 14:29-34. [PMID: 26836445 DOI: 10.1089/hs.2015.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A conference called "Outbreaks in Tanzania-Are We Prepared?" was held in Mbeya, Tanzania, on September 14 and 15, 2015, accompanied by a training workshop on infection prevention and control for local stakeholders from September 16 to 18, 2015. The objective of the conference was to revisit past disease epidemics and to reflect on the current status of surveillance and outbreak preparedness in Tanzania, including an overview of agents relevant to biosecurity. The conference brought together national authorities of Tanzania, regional public health representatives, people from research and academic institutions, and international stakeholders. Key findings of the event were: (1) although national frameworks for surveillance and preparedness exist, their implementation presents challenges, and local health structures need support in implementation; (2) the ability to identify and properly manage infectious diseases of public health concern is crucial in empowering the local health workforce to contribute to surveillance measures, which in turn allows for realistic risk assessments and management algorithms; and (3) in settings of limited resources, research activities acquire an additional responsibility toward national surveillance and capacity building and should be integrated into national epidemic preparedness plans. This event was the first of its kind in Tanzania, facilitating direct discussion among regional, zonal, national, and international stakeholders on surveillance and outbreak preparedness. The conference's conclusions are relevant to strengthening health systems in other low- and middle-income countries.
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High seroprevalence for spotted fever group rickettsiae, is associated with higher temperatures and rural environment in Mbeya region, Southwestern Tanzania. PLoS Negl Trop Dis 2015; 9:e0003626. [PMID: 25849718 PMCID: PMC4388512 DOI: 10.1371/journal.pntd.0003626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 02/18/2015] [Indexed: 12/03/2022] Open
Abstract
Background Rickettsioses are endemic in sub-Sahara Africa. Burden of disease, risk factors and transmission are hitherto sparsely described. Methods From the EMINI (Evaluating and Monitoring the Impact of New Interventions) population cohort, we randomly selected 1,228 persons above the age of 5 years from the nine participating communities in Mbeya region, Southwestern Tanzania, stratified by age, altitude of residence and ownership of domestic mammals, to conduct a cross-sectional seroprevalence study in. The aim was to estimate the seroprevalence of IgG antibodies against Spotted Fever Group (SFG) rickettsiae and to assess socioeconomic and environmental risk factors. Serology (indirect immunofluorescence) was performed at a dilution of 1:64. Results SFG-seropositivity in the cohort was found to be 67.9% (range among nine sites: 42.8–91.4%). Multivariable analysis revealed an association with age (prevalence ratio, PR per 10 years: 1.08; 95% CI 1.06–1.10), warmer temperatures (PR per °C: 1.38; 1.11–1.71), male gender (PR 1.08; 1.00–1.16), and low population density (PR per 1.000 persons/km²increase 0.96; 0.94–0.99). At higher elevations, higher cattle density was associated with higher seroprevalence. Conclusion SFG rickettsial infection seems to be common in the more rural population of Mbeya Region. Spread seems to be further limited by temperature and higher elevation. Examination of the contribution of SFG to febrile illnesses seems warranted in a prospective study to estimate the disease burden in the population. This will also allow determination of the causative pathogens. We report a high seroprevalence for antibodies against Spotted Fever Group (SFG) rickettsiae in Southwestern Tanzania, a group of bacteria that is mostly transmitted by ectoparasites such as fleas, lice, mites, and ticks. Serum samples from 1.228 persons were selected, and 67.9% were positive indicating past infection. Seropositivity was clearly associated with warmer temperature, low population density and elevations below 1,500 m. These infections may have been caused by Rickettsia africae, which is transmitted to humans by a cattle tick, and was found in similar settings in Africa. To investigate further on the significance of SFG rickettsioses on disease burden in the area, investigations in acutely febrile patients should be conducted.
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Detection of Rickettsia felis, Rickettsia typhi, Bartonella Species and Yersinia pestis in Fleas (Siphonaptera) from Africa. PLoS Negl Trop Dis 2014; 8:e3152. [PMID: 25299702 PMCID: PMC4191943 DOI: 10.1371/journal.pntd.0003152] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/29/2014] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED Little is known about the presence/absence and prevalence of Rickettsia spp, Bartonella spp. and Yersinia pestis in domestic and urban flea populations in tropical and subtropical African countries. METHODOLOGY/PRINCIPAL FINDINGS Fleas collected in Benin, the United Republic of Tanzania and the Democratic Republic of the Congo were investigated for the presence and identity of Rickettsia spp., Bartonella spp. and Yersinia pestis using two qPCR systems or qPCR and standard PCR. In Xenopsylla cheopis fleas collected from Cotonou (Benin), Rickettsia typhi was detected in 1% (2/199), and an uncultured Bartonella sp. was detected in 34.7% (69/199). In the Lushoto district (United Republic of Tanzania), R. typhi DNA was detected in 10% (2/20) of Xenopsylla brasiliensis, and Rickettsia felis was detected in 65% (13/20) of Ctenocephalides felis strongylus, 71.4% (5/7) of Ctenocephalides canis and 25% (5/20) of Ctenophthalmus calceatus calceatus. In the Democratic Republic of the Congo, R. felis was detected in 56.5% (13/23) of Ct. f. felis from Kinshasa, in 26.3% (10/38) of Ct. f. felis and 9% (1/11) of Leptopsylla aethiopica aethiopica from Ituri district and in 19.2% (5/26) of Ct. f. strongylus and 4.7% (1/21) of Echidnophaga gallinacea. Bartonella sp. was also detected in 36.3% (4/11) of L. a. aethiopica. Finally, in Ituri, Y. pestis DNA was detected in 3.8% (1/26) of Ct. f. strongylus and 10% (3/30) of Pulex irritans from the villages of Wanyale and Zaa. CONCLUSION Most flea-borne infections are neglected diseases which should be monitored systematically in domestic rural and urban human populations to assess their epidemiological and clinical relevance. Finally, the presence of Y. pestis DNA in fleas captured in households was unexpected and raises a series of questions regarding the role of free fleas in the transmission of plague in rural Africa, especially in remote areas where the flea density in houses is high.
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Weller N, Clowes P, Dobler G, Saathoff E, Kroidl I, Ntinginya NE, Maboko L, Löscher T, Hoelscher M, Heinrich N. Seroprevalence of alphavirus antibodies in a cross-sectional study in southwestern Tanzania suggests endemic circulation of chikungunya. PLoS Negl Trop Dis 2014; 8:e2979. [PMID: 25079964 PMCID: PMC4117434 DOI: 10.1371/journal.pntd.0002979] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/13/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To date, Alphavirus infections and their most prominent member, chikungunya fever, a viral disease which first became apparent in Tanzania in 1953, have been very little investigated in regions without epidemic occurrence. Few data exist on burden of disease and socio-economic and environmental covariates disposing to infection. METHODS A cross-sectional seroprevalence study was undertaken in 1,215 persons from Mbeya region, South-Western Tanzania, to determine the seroprevalence of anti-Alphavirus IgG antibodies, and to investigate associated risk factors. RESULTS 18% of 1,215 samples were positive for Alphavirus IgG. Seropositivity was associated with participant age, low to intermediate elevation, flat terrain and with IgG positivity for Rift Valley fever, Flaviviridae, and rickettsiae of the spotted fever group. When comparing the geographical distribution of Alphavirus seropositivity to that of Rift Valley fever, it was obvious that Alphaviruses had spread more widely throughout the study area, while Rift Valley fever was concentrated along the shore of Lake Malawi. CONCLUSION Alphavirus infections may contribute significantly to the febrile disease burden in the study area, and are associated with several arthropod-borne infections. Their spread seems only limited by factors affecting mosquitoes, and seems less restricted than that of Rift Valley fever.
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Affiliation(s)
- Nina Weller
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Petra Clowes
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | | | - Leonard Maboko
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
- * E-mail:
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