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Hoang MTT, Ngo VP, Stenos J, Ng-Nguyen D. The presence of Rickettsia felis in communities in the central highlands of Vietnam. Acta Trop 2023; 248:107034. [PMID: 37793492 DOI: 10.1016/j.actatropica.2023.107034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023]
Abstract
Rickettsia felis is an emerging flea-borne spotted fever pathogen that causes febrile illness in humans. In Vietnam, R. felis was detected in hospitalized patients, but there is no information on its presence in the Vietnamese community. This cross-sectional study aimed to determine the presence of R. felis in humans of the Central Highlands of Vietnam. A total of 158 blood and 213 serum samples were subjected to PCR and IFAT, respectively, to detect the presence of R. felis DNA and antibodies against R. felis. PCR assays detected R. felis DNA in four out of 158 blood samples, accounting for a prevalence of 2.53 % (95 % CI: 0.81 %-6.76 %). Phylogenetic analysis indicated the presence of R. felis and R. felis genotype RF2125 in the communities in the Central Highlands of Vietnam. The result of IFAT identified seven out of 213 serum samples (3.29 %, 95 % CI: 1.45 %-6.93 %) positive for antibodies against R. felis. This study was the first to demonstrate the presence of active R. felis infections in the communities in the Central Highlands of Vietnam utilizing both molecular and serological methods.
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Affiliation(s)
- Minh-Trang Thi Hoang
- Faculty of Medicine, Buon Ma Thuot Medical University, 298 Ha Huy Tap St., Buon Ma Thuot City, Dak Lak Province, Vietnam
| | - Van-Phuong Ngo
- Faculty of Medicine, Buon Ma Thuot Medical University, 298 Ha Huy Tap St., Buon Ma Thuot City, Dak Lak Province, Vietnam
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC, Australia
| | - Dinh Ng-Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, 567 Le Duan St., Buon Ma Thuot City, Dak Lak Province, Vietnam.
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2
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Mediannikov O, Bechah Y, Amanzougaghene N, Lepidi H, Bassene H, Sambou M, Lienhard C, Benkacimi L, Dieme C, Sokhna C, Fenollar F, Raoult D. Booklice Liposcelis bostrychophila naturally infected by Rickettsia felis cause fever and experimental pneumonia in mammals. J Infect Dis 2022; 226:1075-1083. [PMID: 35776143 DOI: 10.1093/infdis/jiac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rickettsia felis is emergent in tropical areas. Despite its high morbidity, its natural history has not yet been fully determined. We investigated the role of the common household booklouse, Liposcelis bostrychophila, recently found to harbour R. felis. METHODS Blood samples from 372 febrile patients from Senegalese villages, as well as nasal and skin samples from 264 asymptomatic individuals, were tested for cat flea-associated and booklice-associated strains of R. felis. Dust samples from beds were collected to isolate booklice and R. felis. Mice were infected with aerosol of R. felis strain from naturally infected booklice. RESULTS Forty febrile patients (11%) were infected by R. felis, including 26 (7%) by the booklice-associated strain. Nine nasal samples (3.4%) and 28 skin samples (10.6%) contained R. felis, including seven and 24, respectively, with the booklice-associated strain. The presence of live L. bostrychophila was observed in 32 dust samples (16.8%); R. felis was identified in 62 dust samples (32.5%). Several mice samples were positive for R. felis; interstitial lymphohistiocytic infiltrates were identified in lungs. CONCLUSIONS L. bostrychophila may be a reservoir of R. felis. The booklice-associated strain is pathogenic in mammals causing pneumonia. Human infection may be acquired via inhalation of infected booklice particles.
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Affiliation(s)
- Oleg Mediannikov
- Aix Marseille Univ, IRD, AP-HM, MEPHII, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Yassina Bechah
- Aix Marseille Univ, IRD, AP-HM, MEPHII, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Nadia Amanzougaghene
- Aix Marseille Univ, IRD, AP-HM, MEPHII, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Hubert Lepidi
- Aix Marseille Univ, IRD, AP-HM, MEPHII, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | | | - Masse Sambou
- VITROME, Campus International UCAD-IRD, Dakar, Senegal
| | | | - Linda Benkacimi
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | | | - Cheikh Sokhna
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Florence Fenollar
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHII, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
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3
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Jiang J, Martínez-Valdebenito C, Weitzel T, Farris CM, Acosta-Jamett G, Abarca K, Richards AL. Development of a New Genus-Specific Quantitative Real-Time PCR Assay for the Diagnosis of Scrub Typhus in South America. Front Med (Lausanne) 2022; 9:831045. [PMID: 35573006 PMCID: PMC9095740 DOI: 10.3389/fmed.2022.831045] [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: 12/07/2021] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Scrub typhus is a potentially severe rickettsiosis, caused by Orientia tsutsugamushi in the Asia-Pacific region. Recently, however, two distinct pathogens, “Candidatus Orientia chuto” and “Candidatus Orientia chiloensis”, have been discovered in the Middle East and South America, respectively. Since the novel pathogens differ significantly from O. tsutsugamushi, many established diagnostic methods are unreliable. This work describes the development and validation of a new quantitative real-time PCR (qPCR) assay (Orien16S) for the detection of all known Orientia species. Based on a 94 bp sequence of the 16S rRNA gene (rrs), Orien16S recognized DNA samples from O. tsutsugamushi (n = 41), Ca. O. chiloensis (n = 5), and Ca. O. chuto (n = 1), but was negative for DNA preparations from closely related rickettsiae and other members of the order Rickettsiales (n = 22) as well as unrelated bacterial species (n = 11). After its implementation in Chile, the assay was verified, correctly identifying all tested eschar and buffy coat samples (n = 28) of clinical suspected cases. Furthermore, Orien16S detected Orientia DNA in trombiculid mites collected in endemic regions in southern Chile. The presented novel qPCR assay provides a useful tool for detecting Orientia and diagnosing scrub typhus from all geographical regions.
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Affiliation(s)
- Ju Jiang
- Naval Medical Research Center, Silver Spring, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Constanza Martínez-Valdebenito
- Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas Weitzel
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.,Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - Gerardo Acosta-Jamett
- Instituto de Medicina Preventiva Veterinaria, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile.,Programa de Investigación Aplicada en Fauna Silvestre, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Katia Abarca
- Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allen L Richards
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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4
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Assessment of the burden of malaria and bacteraemia by retrospective molecular diagnosis in febrile illnesses and first-line anti-infectives in Côte d'Ivoire. Travel Med Infect Dis 2021; 43:102105. [PMID: 34146685 DOI: 10.1016/j.tmaid.2021.102105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 04/21/2021] [Accepted: 06/04/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aetiologies of fever are poorly understood in sub-Saharan Africa. We aimed to assess the burden of malaria and bacteria in Côte d'Ivoire. METHODS Blood samples from 438 febrile and 346 afebrile people were screened using molecular tools. RESULTS Plasmodium falciparum was the most common microorganism associated with fever (46.8% in febrile, 23.4% in afebrile people; p < 0.001). Bacteraemia was detected in 21.7% of febrile people and 12.7% of afebrile people (p = 0.001). Streptococcus pneumoniae was the main cause of bacteraemia (7.1% of febrile and 0.6% of afebrile individuals; p < 0.001). Non-typhoidal Salmonella spp. was detected in 4.5% of febrile people and 1.2% of afebrile individuals (p < 0.001). Salmonella enterica Typhi and S. enterica Paratyphi were only detected in febrile subjects (1.4% and 2.1%), as well as Tropheryma whipplei (0.9%), Streptococcus pyogenes (0.7%), and Plasmodium ovale (4.6%). The prevalence in febrile and afebrile people was similar for Staphylococcus aureus (3.6-4.9%), Rickettsia felis (5.5-6.4%), Mansonella perstans (3.0-3.2%), and Plasmodium malariae (1.6-2.3%). Comorbidities were higher in febrile than in afebrile subjects (10.3% versus 5.5%; p = 0.01); 82% involving P. falciparum. All patients co-infected with P. falciparum and S. pneumoniae were febrile whereas 30% of those infected by P. falciparum alone were not (p = 0.02). Among febrile participants, 30.4% with malaria and 54.7% with bacteraemia had received neither antimalarial nor antibiotic therapy. CONCLUSION Identification of etiologies of acute febrile diseases in sub-Saharan Africa proposes keys to successful treatment and prevention of infectious diseases. Vaccination campaigns may decrease the morbidity of mono- and co-infections by preventable microorganisms.
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Yang WH, Hsu MS, Shu PY, Tsai KH, Fang CT. Neglected human Rickettsia felis infection in Taiwan: A retrospective seroepidemiological survey of patients with suspected rickettsioses. PLoS Negl Trop Dis 2021; 15:e0009355. [PMID: 33872325 PMCID: PMC8084327 DOI: 10.1371/journal.pntd.0009355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/29/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current knowledge on Rickettsia felis infection in humans is based on sporadic case reports. Here we conducted a retrospective seroepidemiological survey of R. felis infection among febrile patients visiting a medical center in Taipei. METHODOLOGY/PRINCIPAL FINDINGS A total of 122 patients with suspected rickettsioses presenting with fever of unknown origin (FUO) but tested negative for scrub typhus, murine typhus, or Q fever were retrospectively identified during 2009 to 2010. The archived serum samples were examined for the presence of antibodies against R. felis, Rickettsia japonica, and Rickettsia typhi using microimmunofluorescence (MIF) assay. Serological evidence of Rickettsia exposure was found in 23 (19%, 23/122) patients. Eight patients had antibodies reactive to R. felis, including four with current infection (a ≥4-fold increase in IgG titer between acute and convalescent sera). The clinical presentations of these four patients included fever, skin rash, lymphadenopathy, as well as more severe conditions such as pancytopenia, hepatomegaly, elevated liver enzymes/bilirubin, and life-threatening acute respiratory distress syndrome. One of the patients died after doxycycline was stopped after being tested negative for scrub typhus, Q fever, and murine typhus. CONCLUSIONS Rickettsia felis is a neglected flea-borne pathogen in Taiwan, and its infection can be life-threatening. Further prospective studies of the prevalence of R. felis among patients with FUO and compatible clinical manifestations are warranted.
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Affiliation(s)
- Wan-Hsiu Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Meng-Shiuan Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, Section of Infectious Disease, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Healthcare Administration, Oriental Institute of Technology, Taipei, Taiwan
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Caravedo Martinez MA, Ramírez-Hernández A, Blanton LS. Manifestations and Management of Flea-Borne Rickettsioses. Res Rep Trop Med 2021; 12:1-14. [PMID: 33574726 PMCID: PMC7873028 DOI: 10.2147/rrtm.s274724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Murine typhus and flea-borne spotted fever are undifferentiated febrile illnesses caused by Rickettsia typhi and Rickettsia felis, respectively. These organisms are small obligately intracellular bacteria and are transmitted to humans by fleas. Murine typhus is endemic to coastal areas of the tropics and subtropics (especially port cities), where rats are the primary mammalian host and rat fleas (Xenopsylla cheopis) are the vector. In the United States, a cycle of transmission involving opossums and cat fleas (Ctenocephalides felis) are the presumed reservoir and vector, respectively. The incidence and distribution of murine typhus appear to be increasing in endemic areas of the US. Rickettsia felis has also been reported throughout the world and is found within the ubiquitous cat flea. Flea-borne rickettsioses manifest as an undifferentiated febrile illness. Headache, malaise, and myalgia are frequent symptoms that accompany fever. The incidence of rash is variable, so its absence should not dissuade the clinician to consider a rickettsial illness as part of the differential diagnosis. When present, the rash is usually macular or papular. Although not a feature of murine typhus, eschar has been found in 12% of those with flea-borne spotted fever. Confirmatory laboratory diagnosis is usually obtained by serology; the indirect immunofluorescence assay is the serologic test of choice. Antibodies are seldom present during the first few days of illness. Thus, the diagnosis requires acute- and convalescent-phase specimens to document seroconversion or a four-fold increase in antibody titer. Since laboratory diagnosis is usually retrospective, when a flea-borne rickettsiosis is considered, empiric treatment should be initiated. The treatment of choice for both children and adults is doxycycline, which results in a swift and effective response. The following review is aimed to summarize the key clinical, epidemiological, ecological, diagnostic, and treatment aspects of flea-borne rickettsioses.
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Affiliation(s)
- Maria A Caravedo Martinez
- Department of Internal Medicine – Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Lucas S Blanton
- Department of Internal Medicine – Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
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Tsai KH, Yen TY, Wu WJ, Carvalho R, Raoult D, Fournier PE. Investigation of Ctenocephalides felis on domestic dogs and Rickettsia felis infection in the Democratic Republic of Sao Tome and Principe. Zoonoses Public Health 2020; 67:892-902. [PMID: 33145971 DOI: 10.1111/zph.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
Rickettsia felis is an obligate intracellular Gram-negative bacterium which causes flea-borne spotted fever in humans. In the past decades, R. felis has been detected worldwide in Ctenocephalides felis fleas and various other arthropods. However, due to its shared symptoms with other common vector-borne diseases, human infection is prone to be underestimated or misdiagnosed, especially in the malaria-endemic areas including sub-Saharan Africa, where confirmatory laboratory diagnoses are not usually available. In this study, a 'One Health' approach was adopted to explore potential vector-borne and zoonotic pathogens in the Democratic Republic of Sao Tome and Principe (DRSTP), an island nation in the Gulf of Guinea. By collaborating with local veterinarians, 1,187 fleas were collected from 95 domestic dogs across the country and later identified as Ct. felis using taxonomic keys. A cytochrome oxidase gene-based phylogenetic analysis revealed that all collected fleas belonged to a single haplotype and were identical to isolates from Ivory Coast and Brazil that clustered into a clade of tropical distribution. Additional samples of 14 chigoe fleas (Tunga penetrans) were collected from the surrounding environment of the dogs' resting spots. Rickettsia felis infection in fleas was examined by molecular methods targeting the citrate synthase (gltA)- and outer membrane protein A (ompA)-coding genes as well as the R. felis-specific pRF plasmid. The bacterial DNA was detected in 21.01% (146/695) of cat fleas but none of the chigoe fleas. Microimmunofluorescence assay was then performed to assess pathogen exposure of the residents. Of 240 dried blood spots from participants with dog contacts, 8 (3.33%) exhibited R. felis antibodies. Our findings demonstrated the presence of R. felis in DRSTP. Further extensive epidemiological studies regarding its prevalence and its role in causing febrile illness while the nation is entering pre-elimination stage of malaria will be carried out.
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Affiliation(s)
- Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Entomology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Tsai-Ying Yen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Jer Wu
- Department of Entomology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Ronalg Carvalho
- Taiwanese Medical Mission, Sao Tome, Democratic Republic of Sao Tome and Principe
| | - Didier Raoult
- Aix-Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France.,French Reference Center for Rickettsioses, Q fever and Bartonelloses, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - Pierre-Edouard Fournier
- Aix-Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France.,French Reference Center for Rickettsioses, Q fever and Bartonelloses, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
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Mawuntu AHP, Johar E, Anggraeni R, Feliana F, Bernadus JBB, Safari D, Yudhaputri FA, Dhenni R, Dewi YP, Kato C, Powers AM, Rosenberg R, Soebandrio A, Myint KSA. Rickettsia felis identified in two fatal cases of acute meningoencephalitis. PLoS Negl Trop Dis 2020; 14:e0007893. [PMID: 32069292 PMCID: PMC7048312 DOI: 10.1371/journal.pntd.0007893] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/28/2020] [Accepted: 10/31/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rickettsia felis has recently emerged worldwide as a cause of human illness. Typically causing mild, undifferentiated fever, it has been implicated in several cases of non-fatal neurological disease in Mexico and Sweden. Its distribution and pathogenicity in Southeast Asia is poorly understood. METHODOLOGY/PRINCIPAL FINDINGS We retroactively tested cerebrospinal fluid (CSF) or sera from 64 adult patients admitted to hospital in North Sulawesi, Indonesia with acute neurological disease. Rickettsia felis DNA was identified in the CSF of two fatal cases of meningoencephalitis using multi-locus sequence typing semi-nested PCR followed by Sanger sequencing. DNA from both cases had 100% sequence homologies to the R. felis reference strain URRWXCal2 for the 17-kDa and ompB genes, and 99.91% to gltA. CONCLUSION/SIGNIFICANCE The identification of R. felis in the CSF of two fatal cases of meningoencephalitis in Indonesia suggests the distribution and pathogenicity of this emerging vector-borne bacteria might be greater than generally recognized. Typically Rickettsia are susceptible to the tetracyclines and greater knowledge of R. felis endemicity in Indonesia should lead to better management of some acute neurological cases.
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Affiliation(s)
| | - Edison Johar
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Riane Anggraeni
- Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Feliana Feliana
- Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | | | - Dodi Safari
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | - Rama Dhenni
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Yora P. Dewi
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Cecilia Kato
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Ann M. Powers
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Ronald Rosenberg
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Amin Soebandrio
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Khin S. A. Myint
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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9
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Boumbanda Koyo CS, Oyegue-Liabagui SL, Mediannikov O, Cortaredona S, Kouna LC, Raoult D, Lekana-Douki JB, Fenollar F. High Circulation of Malaria and Low Prevalence of Bacteremia in Febrile and Afebrile Children in Northeastern Gabon. Am J Trop Med Hyg 2019; 102:121-129. [PMID: 31769404 DOI: 10.4269/ajtmh.19-0368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The epidemiology of febrile illness etiologies is under-explored in resource-poor settings. Establishing a local repertory of microorganisms circulating in blood of febrile and afebrile people is important for physicians. Blood was collected from 428 febrile and 88 afebrile children in Makokou (Gabon) and analyzed using polymerase chain reaction. Plasmodium spp. were the pathogens, which were most detected in febrile children (69.6%; 298/428) and in afebrile children (31.8%; 28/88) (P < 0.0001). Plasmodium falciparum was the most prevalent species in both febrile and afebrile children (66.8% and 27.3%, respectively). No differences were observed between febrile and afebrile children for Plasmodium malariae and Plasmodium ovale (8.2% versus 10.2% and 3.3% versus 3.4%, respectively). Triple infection with P. falciparum, P. malariae, and P. ovale was also detected in 1% of febrile children (4/428). Filariasis due to Mansonella perstans was detected in 10 febrile patients (2.3%), whereas Loa loa was detected in both febrile and afebrile children (1.4% and 2.3%, respectively). Bacterial DNA was detected in only 4.4% (19/428) of febrile children, including 13 (68.4%) who were coinfected with at least one Plasmodium species. These were Haemophilus influenzae (1.6%, 7/428), Streptococcus pneumoniae and Staphylococcus aureus (1.2%, 5/428), and Rickettsia felis (0.9%, 4/428). Coxiella burnetii, Bartonella spp., Borrelia spp., Tropheryma whipplei, Anaplasma spp., Leptospira spp., Streptococcus pyogenes, and Salmonella spp. were not detected. This study also highlights the over-prescription and the overuse of antibiotics and antimalarials. Overall, malaria remains a major health problem in Makokou. Malaria control measures must be reconsidered in this region.
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Affiliation(s)
- Célia Scherelle Boumbanda Koyo
- Aix Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Unité d'Evolution, Epidémiologie et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.,Ecole Doctorale Régionale en Infectiologie Tropicale d'Afrique Centrale, Franceville, Gabon
| | - Sandrine Lydie Oyegue-Liabagui
- Laboratoire d'Immunologie, Parasitologie et Microbiologie, École Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale, Université des Sciences et Techniques de Masuku, Franceville, Gabon
| | - Oleg Mediannikov
- Aix Marseille University, IRD, AP-HM, Microbes, Evolution, Phylogénie et Infection (MEPHI), Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Sébastien Cortaredona
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Lady Charlene Kouna
- Unité d'Evolution, Epidémiologie et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Didier Raoult
- Aix Marseille University, IRD, AP-HM, Microbes, Evolution, Phylogénie et Infection (MEPHI), Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Jean Bernard Lekana-Douki
- Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon.,Ecole Doctorale Régionale en Infectiologie Tropicale d'Afrique Centrale, Franceville, Gabon.,Unité d'Evolution, Epidémiologie et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Florence Fenollar
- Aix Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France.,IHU-Méditerranée Infection, Marseille, France
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10
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Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, Plewes K, Maude RJ, Chowdhury MAH, Paul S, Uddin RAME, Siddiqui MAN, Zahed AS, Abu Sayeed A, Rahman MH, Barua A, Uddin MJ, Sattar MA, Dondorp AM, Blacksell SD, Day NPJ, Ghose A, Hossain A, Paris DH. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis 2019; 24. [PMID: 29553921 PMCID: PMC5875266 DOI: 10.3201/eid2404.170190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Scrub and murine typhus are common, treatable causes of undifferentiated febrile illnesses in hospitalized patients. We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence–confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.
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11
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Asymptomatic carriage of Streptococcus pneumoniae detected by qPCR on the palm of hands of populations in rural Senegal. PLoS Negl Trop Dis 2018; 12:e0006945. [PMID: 30532182 PMCID: PMC6312329 DOI: 10.1371/journal.pntd.0006945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/31/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022] Open
Abstract
Aside from malaria, infectious diseases are an important cause of death in sub-Saharan Africa and continue to pose major public health problems in African countries, notably pneumonia. Streptococcus pneumoniae remains the most common bacterial cause of pneumonia in all age groups. The skin is one of the main infection sites followed by the oropharynx. The skin carriage of certain pathogenic bacteria such as S. pneumoniae is often ignored or under-diagnosed. Finally, the mode of transmission of these infections remains uncertain. Here, we hypothesized that skin could play a role in the transmission of these infections. We collected 649 cotton swabs from a healthy population in Dielmo and Ndiop, rural Senegal. The sampling was carried out on the palm of the hands. After DNA extraction and actin control, qPCR targeting eight different bacteria was performed on 614 skin samples. We detected Streptococcus pneumoniae in 33.06% (203/614), Staphylococcus aureus in 18.08% (111/614) and Streptococcus pyogenes in 1.95% (12/614) of samples. A skin S. pneumoniae carriage was detected in more than a third of a rural population in rural Africa, highlighting the need to develop hand disinfection programs in order to reduce the burden of infections.
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12
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Fenollar F, Mediannikov O. Emerging infectious diseases in Africa in the 21st century. New Microbes New Infect 2018; 26:S10-S18. [PMID: 30402238 PMCID: PMC6205565 DOI: 10.1016/j.nmni.2018.09.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022] Open
Abstract
Many infectious diseases have emerged or reemerged in Africa in the 21st century. Some of them are associated with newly discovered microorganisms such as Rickettsia felis and Tropheryma whipplei; others are known, historical diseases such as plague and cholera. In addition are diseases related to previously known microorganisms which recently have been involved for the first time in massive outbreaks with worldwide impacts (such as Ebola virus, Zika virus and Chikungunya virus). Research on emerging infectious diseases needs to be identified as a priority.
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Affiliation(s)
| | - O Mediannikov
- IRD, AP-HM, MEPHI, Aix-Marseille Université, IRD, IHU-Méditerranée Infection, Marseille, France
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13
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Serum cytokine responses in Rickettsia felis infected febrile children, Ghana. Med Microbiol Immunol 2018; 207:243-248. [PMID: 29736763 PMCID: PMC6096778 DOI: 10.1007/s00430-018-0544-3] [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: 11/17/2017] [Accepted: 04/24/2018] [Indexed: 11/13/2022]
Abstract
The intracellular pathogen Rickettsia felis causes flea-borne spotted fever and is increasingly recognized as an emerging cause of febrile illness in Africa, where co-infection with Plasmodium falciparum is common. Rickettsiae invade endothelial cells. Little is known, however, about the early immune responses to infection. In this study, we characterize for the first time the cytokine profile in the acute phase of illness caused by R. felis infection, as well as in plasmodial co-infection, using serum from 23 febrile children < 15 years of age and 20 age-matched healthy controls from Ghana. Levels of IL-8 (interleukin-8), IP-10 (interferon-γ-induced protein-10), MCP-1 (monocyte chemotactic protein-1), MIP-1α (macrophage inflammatory protein-1α) and VEGF (vascular endothelial growth factor) were significantly elevated in R. felis mono-infection; however, IL-8 and VEGF elevation was not observed in plasmodial co-infections. These results have important implications in understanding the early immune responses to R. felis and suggest a complex interplay in co-infections.
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14
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Chowdhury NF, Paul SK, Aung MS, Hossain MA, Ahamed F, Ahmed S, Haque N, Nasreen SA, Khan SI, Rahman SMM, Rahman ASMM, Ferdouse F, Ahmed R, Sultan SM, Ahmed MU, Urushibara N, Kobayashi N. Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh. New Microbes New Infect 2017; 19:123-125. [PMID: 28831298 PMCID: PMC5552056 DOI: 10.1016/j.nmni.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022] Open
Abstract
From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.
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Affiliation(s)
| | - S K Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M S Aung
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M A Hossain
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - F Ahamed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S Ahmed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N Haque
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S A Nasreen
- Jamalpur Medical College, Jamalpur, Bangladesh
| | - S I Khan
- Patuakhali Medical College, Patuakhali, Bangladesh
| | | | | | - F Ferdouse
- Shaheed Monsur Ali Medical College, Dhaka, Bangladesh
| | - R Ahmed
- Manikganj Medical College, Manikganj, Bangladesh
| | - S M Sultan
- Uttara Adhunik Medical College, Dhaka, Bangladesh
| | - M U Ahmed
- Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - N Urushibara
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N Kobayashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
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15
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Healy SP, Brown LD, Hagstrom MR, Foil LD, Macaluso KR. Effect of Rickettsia felis Strain Variation on Infection, Transmission, and Fitness in the Cat Flea (Siphonaptera: Pulicidae). JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:1037-1043. [PMID: 28399259 PMCID: PMC5850810 DOI: 10.1093/jme/tjx046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Indexed: 05/12/2023]
Abstract
Rickettsia felis is a human pathogen transmitted by the cat flea, Ctenocephalides felis (Bouché) (str. LSU), as well as an obligate symbiont of the parthenogenic booklouse Liposcelis bostrychophila (Badonnel) (str. LSU-Lb). The influence of genetic variability in these two strains of R. felis on host specialization and fitness and possible resulting differences on infection and transmission kinetics in C. felis is unknown. Utilizing an artificial host system, cat fleas were exposed to a R. felis str. LSU-Lb-infected bloodmeal and monitored for infection at 7-d intervals for 28 d. Quantitative real-time PCR was used to determine rickettsial load and infection density in newly exposed cat fleas, and transmission frequency between cat fleas. The effect of persistent R. felis infection on cat flea F1 progeny was also assessed. At 7 d postexposure 76.7% of the cat fleas successfully acquired R. felis str. LSU-Lb. In R. felis str. LSU-Lb-exposed cat fleas, the mean infection load (6.15 × 106), infection density (0.76), and infection prevalence (91/114) were significantly greater than R. felis str. LSU infection load (3.09 × 106), infection density (0.68), and infection prevalence (76/113). A persistent R. felis str. LSU-Lb infection was detected for 28 d in adult cat fleas but neither female:male ratio distortion nor vertical transmission was observed in F1 progeny. While infection kinetics differed, with higher intensity associated with R. felis str. LSU-Lb, no distinct phenotype was observed in the F1 progeny.
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Affiliation(s)
- Sean P. Healy
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Vector-Borne Disease Laboratories, Baton Rouge, LA 70803 (; ; ; )
- Department of Entomology, Louisiana State University, Baton Rouge, LA 70803 ()
| | - Lisa D. Brown
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Vector-Borne Disease Laboratories, Baton Rouge, LA 70803 (; ; ; )
- Current address: Department of Biological Science, Vanderbilt University, Nashville, TN 37235
| | - Melena R. Hagstrom
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Vector-Borne Disease Laboratories, Baton Rouge, LA 70803 (; ; ; )
- Current address: Iowa State University, College of Veterinary Medicine, Ames, IA 50011
| | - Lane D. Foil
- Department of Entomology, Louisiana State University, Baton Rouge, LA 70803 ()
| | - Kevin R. Macaluso
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Vector-Borne Disease Laboratories, Baton Rouge, LA 70803 (; ; ; )
- Corresponding author, e-mail:
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16
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Nawas ZY, Tong Y, Kollipara R, Peranteau AJ, Woc-Colburn L, Yan AC, Lupi O, Tyring SK. Emerging infectious diseases with cutaneous manifestations: Viral and bacterial infections. J Am Acad Dermatol 2017; 75:1-16. [PMID: 27317512 DOI: 10.1016/j.jaad.2016.04.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/16/2022]
Abstract
Given increased international travel, immigration, and climate change, bacterial and viral infections that were once unrecognized or uncommon are being seen more frequently in the Western Hemisphere. A delay in diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. We review the epidemiology, cutaneous manifestations, diagnosis, and management of these emerging bacterial and viral diseases.
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Affiliation(s)
| | - Yun Tong
- Center for Clinical Studies, Houston, Texas
| | - Ramya Kollipara
- Department of Dermatology, Texas Tech Health Sciences Center, Lubbock, Texas
| | | | - Laila Woc-Colburn
- Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Albert C Yan
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Omar Lupi
- Federal University of the State of Rio de Janeiro and Policlinica Geral do Rio de Janeiro, Rio de Janerio, Brazil
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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17
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Sothmann P, Keller C, Krumkamp R, Kreuels B, Aldrich C, Sarpong N, Steierberg S, Winter D, Boahen KG, Owusu-Dabo E, May J, Eibach D. Rickettsia felis Infection in Febrile Children, Ghana. Am J Trop Med Hyg 2017; 96:783-785. [PMID: 28115672 DOI: 10.4269/ajtmh.16-0754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractRickettsial infections are an underrecognized cause of febrile illness in sub-Saharan Africa. To evaluate the epidemiology and clinical features of rickettsial disease in pediatric patients in Ghana, we screened blood samples from febrile children aged less than 15 years presenting to an outpatient department in Ghana's Ashanti Region for the presence of rickettsial DNA. We detected Rickettsia felis in 7/470 (1.5%) blood samples, using two independent real-time polymerase chain reactions. No other Rickettsia species were found. R. felis was detected repeatedly in one patient, and coinfection with Plasmodium falciparum was found in 3/7 samples. Symptoms apart from fever included cough (6/7) and vomiting (4/7). None of the R. felis-positive patients reported a rash. This study is the first report on R. felis in Ghana and adds to the growing evidence for its widespread occurrence with and without malaria coinfection in sub-Saharan Africa.
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Affiliation(s)
- Peter Sothmann
- Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Christian Keller
- Institute of Virology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Ralf Krumkamp
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Benno Kreuels
- Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Cassandra Aldrich
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stefanie Steierberg
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Doris Winter
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Kennedy Gyau Boahen
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jürgen May
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Daniel Eibach
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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18
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Billeter SA, Metzger ME. Limited Evidence for Rickettsia felis as a Cause of Zoonotic Flea-Borne Rickettsiosis in Southern California. JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:4-7. [PMID: 28082625 DOI: 10.1093/jme/tjw179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Abstract
Over 90% of human flea-borne rickettsioses cases in California are reported from suburban communities of Los Angeles and Orange counties and are presumed to be associated with either Rickettsia typhi or Rickettsia felis infection. Ctenocephalides felis (Bouché) is considered the principal vector for both rickettsiae, and R. felis has largely replaced R. typhi as the presumptive etiologic agent based on the widespread incidence of R. felis in cat flea populations. However, with no evidence to confirm R. felis as the cause of human illness in southern California, coupled with recent findings that showed R. felis to be widespread in cat fleas statewide, we propose that this hypothesis should be reconsidered. Evidence of only limited numbers of R. typhi-infected cat fleas in the environment may indicate a very rare infection and explain why so few cases of flea-borne rickettsioses are reported each year in southern California relative to the population.
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Affiliation(s)
- Sarah A Billeter
- California Department of Public Health, Vector-Borne Disease Section, Ontario, CA 91764 (; )
| | - Marco E Metzger
- California Department of Public Health, Vector-Borne Disease Section, Ontario, CA 91764 (; )
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19
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Abstract
Point-of-care (POC) laboratories that deliver rapid diagnoses of infectious diseases were invented to balance the centralization of core laboratories. POC laboratories operate 24 h a day and 7 days a week to provide diagnoses within 2 h, largely based on immunochromatography and real-time PCR tests. In our experience, these tests are conveniently combined into syndrome-based kits that facilitate sampling, including self-sampling and test operations, as POC laboratories can be operated by trained operators who are not necessarily biologists. POC laboratories are a way of easily providing clinical microbiology testing for populations distant from laboratories in developing and developed countries and on ships. Modern Internet connections enable support from core laboratories. The cost-effectiveness of POC laboratories has been established for the rapid diagnosis of tuberculosis and sexually transmitted infections in both developed and developing countries.
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20
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Blanton LS, Walker DH. Flea-Borne Rickettsioses and Rickettsiae. Am J Trop Med Hyg 2016; 96:53-56. [PMID: 27799640 PMCID: PMC5239709 DOI: 10.4269/ajtmh.16-0537] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022] Open
Abstract
Rickettsia typhi and Rickettsia felis are flea-borne rickettsiae that are distributed throughout the world. This mini-review outlines the ecology and epidemiology of flea-borne rickettsioses; highlights important clinical, diagnostic, and therapeutic considerations; and discusses areas of uncertainty regarding Rickettsia felis and other rickettsiae harbored by fleas.
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Affiliation(s)
- Lucas S Blanton
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - David H Walker
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
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21
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Mourembou G, Lekana-Douki JB, Mediannikov O, Nzondo SM, Kouna LC, Essone JCBB, Fenollar F, Raoult D. Possible Role of Rickettsia felis in Acute Febrile Illness among Children in Gabon. Emerg Infect Dis 2016; 21:1808-15. [PMID: 26402580 PMCID: PMC4593428 DOI: 10.3201/eid2110.141825] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infection is widespread but most prevalent among young, rural residents with fever. Rickettsia felis has been reported to be a cause of fever in sub-Saharan Africa, but this association has been poorly evaluated in Gabon. We assessed the prevalence of this bacterium among children <15 years of age in 4 areas of Gabon; the locations were in urban, semiurban, and rural areas. DNA samples from 410 febrile children and 60 afebrile children were analyzed by quantitative PCR. Overall, the prevalence of R. felis among febrile and afebrile children was 10.2% (42/410 children) and 3.3% (2/60 children), respectively. Prevalence differed among febrile children living in areas that are urban (Franceville, 1.3% [1/77]), semiurban (Koulamoutou, 2.1% [3/141]), and rural (Lastourville, 11.2% [15/134]; Fougamou, 39.7% [23/58]). Furthermore, in a rural area (Fougamou), R. felis was significantly more prevalent in febrile (39.7% [23/58]) than afebrile children (5.0% [1/20]). Additional studies are needed to better understand the pathogenic role of R. felis in this part of the world.
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22
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Angelakis E, Mediannikov O, Parola P, Raoult D. Rickettsia felis: The Complex Journey of an Emergent Human Pathogen. Trends Parasitol 2016; 32:554-564. [PMID: 27155905 DOI: 10.1016/j.pt.2016.04.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
Rickettsia felis is an obligate intracellular bacterium that is different from other officially recognized rickettsial species. It has multiple genes of different origins, an incubation temperature of less than 32°C, and a conjugative plasmid. This Rickettsia is commonly detected in febrile patients in sub-Saharan Africa. R. felis is frequently detected in cat fleas, but recently mosquitoes have been suspected to be able to transmit the bacterium. However, many aspects of the ecology and epidemiology of R. felis are not completely understood and remain to be uncovered. We aim here to give an update of the current knowledge about this fascinating organism.
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Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France.
| | - Oleg Mediannikov
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Philippe Parola
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
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23
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Brown LD, Banajee KH, Foil LD, Macaluso KR. Transmission mechanisms of an emerging insect-borne rickettsial pathogen. Parasit Vectors 2016; 9:237. [PMID: 27117813 PMCID: PMC4847369 DOI: 10.1186/s13071-016-1511-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vector-borne pathogens must overcome arthropod infection and escape barriers (e.g. midgut and salivary glands) during the extrinsic incubation period (EIP) before subsequent transmission to another host. This particular timespan is undetermined for the etiological agent of flea-borne spotted fever (Rickettsia felis). Artificial acquisition of R. felis by blood-feeding cat fleas revealed dissemination to the salivary glands after seven days; however, this length of time is inconsistent with co-feeding studies that produced infectious cat fleas within 24 h of infection. In the current study, we demonstrated that an alternative mechanism is responsible for the early-phase transmission that typifies flea-borne R. felis spread. METHODS Co-feeding transmission bioassays were constructed to assess temporal dynamics of R. felis amongst cat fleas, including exposure time to produce infectious fleas and association time to transmit infection to naïve fleas. Additional experiments examined the proportion of R. felis-exposed cat fleas with contaminated mouthparts, as well as the likelihood for cat fleas to release R. felis from their mouthparts following exposure to an infectious bloodmeal. The potential for mechanical transmission of R. felis by co-feeding cat fleas was further examined using fluorescent latex beads, as opposed to a live pathogen, which would not require a biological mechanism to achieve transmission. RESULTS Analyses revealed that R. felis-infected cat fleas were infectious to naïve fleas less than 24 h after exposure to the pathogen, but showed no rickettsial dissemination to the salivary glands during this early-phase transmission. Additionally, the current study revealed that R. felis-infected cat fleas must co-feed with naïve fleas for more than 12 h in order for early-phase transmission to occur. Further evidence supported that contaminated flea mouthparts may be the source of the bacteria transmitted early, and demonstrated that R. felis is released from the mouthparts during brief probing events. Moreover, the use of fluorescent latex beads supports the notion that early-phase transmission of R. felis is a mechanical mechanism. CONCLUSIONS Determination of the transmission mechanisms utilized by R. felis is essential to fully understand the vulnerability of susceptible vertebrate hosts, including humans, to this pathogen.
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Affiliation(s)
- Lisa D. Brown
- />Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, SVM-3213, Baton Rouge, LA 70803 USA
| | - Kaikhushroo H. Banajee
- />Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, SVM-3213, Baton Rouge, LA 70803 USA
| | - Lane D. Foil
- />Department of Entomology, Louisiana State University Agricultural Center, LSB-413, Baton Rouge, LA 70803 USA
| | - Kevin R. Macaluso
- />Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, SVM-3213, Baton Rouge, LA 70803 USA
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24
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Abstract
Rickettsia felis is an emerging insect-borne rickettsial pathogen and the causative agent of flea-borne spotted fever. First described as a human pathogen from the USA in 1991, R. felis is now identified throughout the world and considered a common cause of fever in Africa. The cosmopolitan distribution of this pathogen is credited to the equally widespread occurrence of cat fleas (Ctenocephalides felis), the primary vector and reservoir of R. felis. Although R. felis is a relatively new member of the pathogenic Rickettsia, limited knowledge of basic R. felis biology continues to hinder research progression of this unique bacterium. This is a comprehensive review examining what is known and unknown relative to R. felis transmission biology, epidemiology of the disease, and genetics, with an insight into areas of needed investigation.
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Affiliation(s)
- Lisa D. Brown
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, SVM-3213, Baton Rouge, LA 70803 USA
| | - Kevin R. Macaluso
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, SVM-3213, Baton Rouge, LA 70803 USA
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Reply to Slesak et al.: So much about Rickettsia felis infection to be discovered. Proc Natl Acad Sci U S A 2015; 112:E6595-6. [PMID: 26598651 DOI: 10.1073/pnas.1517919112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mourembou G, Fenollar F, Socolovschi C, Lemamy GJ, Nzoughe H, Kouna LC, Toure-Ndouo F, Million M, Mbiguino AN, Lekana-Douki JB, Raoult D. Molecular Detection of Fastidious and Common Bacteria as Well as Plasmodium spp. in Febrile and Afebrile Children in Franceville, Gabon. Am J Trop Med Hyg 2015; 92:926-32. [PMID: 25802432 DOI: 10.4269/ajtmh.14-0699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/07/2015] [Indexed: 01/19/2023] Open
Abstract
Malaria was considered as the main cause of fever in Africa. However, with the roll back malaria initiative, the causes of fever in Africa may change. This study aimed to evaluate the prevalence of bacteria and Plasmodium spp. in febrile and afebrile (controls) children from Franceville, Gabon. About 793 blood samples from febrile children and 100 from controls were analyzed using polymerase chain reaction (PCR) coupled with sequencing. Plasmodium spp. was the microorganism most detected in febrile (74.5%, 591/793) and controls (13%, 13/100), P < 0.0001. Its coinfection with bacteria was found only in febrile children (P = 0.0001). Staphylococcus aureus was the most prevalent bacterium in febrile children (2.8%, 22/793) and controls (3%, 3/100). Eight cases of Salmonella spp. (including two Salmonella enterica serovar Paratyphi) and two of Streptococcus pneumoniae were found only among febrile children. Borrelia spp. was found in 2 controls while Rickettsia felis was detected in 10 children (in 8 febriles and 2 afebriles). No DNA of other targeted microorganisms was detected. Plasmodium spp. remains prevalent while Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae were common bacteria in Gabon. Two fastidious bacteria, Rickettsia felis and Borrelia spp., were found. Inclusion of controls should improve the understanding of the causes of fever in sub-Saharan Africa.
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Affiliation(s)
- Gaël Mourembou
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Florence Fenollar
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Cristina Socolovschi
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Guy Joseph Lemamy
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Hermann Nzoughe
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Lady Charlene Kouna
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Fousseyni Toure-Ndouo
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Matthieu Million
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Angelique Ndjoyi Mbiguino
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Jean Bernard Lekana-Douki
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Didier Raoult
- URMITE, Aix Marseille Université, Marseille, France; Unité de Parasitologie Médicale (UPARAM) CIRMF, Franceville, Gabon; Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon; Département de Biologie Cellulaire et Génétique, Université des Science de la Santé, Libreville, Gabon; Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon; Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
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