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Adamu A, Reyer F, Lawal N, Hassan AJ, Imam MU, Bello MB, Kraiczy P. Aetiologies of bacterial tick-borne febrile illnesses in humans in Africa: diagnostic limitations and the need for improvement. Front Med (Lausanne) 2024; 11:1419575. [PMID: 39351006 PMCID: PMC11441061 DOI: 10.3389/fmed.2024.1419575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/19/2024] [Indexed: 10/04/2024] Open
Abstract
Tick-borne febrile illnesses caused by pathogens like Anaplasma spp., Bartonella spp., Borrelia spp., Ehrlichia spp., Coxiella burnetii, Francisella tularensis, and Rickettsia spp., are significant health concerns in Africa. The epidemiological occurrence of these pathogens is closely linked to the habitats of their vectors, prevalent in rural and semi-urban areas where humans and livestock coexist. The overlapping clinical presentations, non-specific symptoms, and limited access to commercially available in vitro diagnostics in resource-limited settings exacerbate the complexity of accurate diagnoses. This review aimed to systematically extract and analyze existing literature on tick-borne febrile illnesses in Africa, highlighting the diagnostic challenges and presenting an up-to-date overview of the most relevant pathogens affecting human populations. A comprehensive literature search from January 1990 to June 2024 using databases like PubMed, Cochrane Library, Science Direct, EMBASE, and Google Scholar yielded 13,420 articles, of which 70 met the inclusion criteria. Anaplasma spp. were reported in Morocco, Egypt, and South Africa; Francisella spp. in Kenya and Ethiopia; Ehrlichia spp. in Cameroon; Bartonella spp. in Senegal, Namibia, South Africa, and Ethiopia; Borrelia spp. in Senegal, Gabon, Tanzania, and Ethiopia; Coxiella burnetii in 10 countries including Senegal, Mali, and South Africa; and Rickettsia spp. in 14 countries including Senegal, Algeria, and Uganda. Data were analyzed using a fixed-effect model in R version 4.0.1 and visualized on an African map using Tableau version 2022.2. This review highlights the urgent need for improved diagnostics to better manage and control tick-borne febrile illnesses in Africa.
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Affiliation(s)
- Abdulrahman Adamu
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
- Department of Animal Health and Production Technology, Federal Polytechnic Bali, Taraba State, Nigeria
- Department of Veterinary Microbiology, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Flavia Reyer
- Goethe University Frankfurt, Institute of Medical Microbiology and Infection Control, University Hospital of Frankfurt, Frankfurt, Germany
| | - Nafiú Lawal
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
- Department of Veterinary Microbiology, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Abdurrahman Jibril Hassan
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
- Department of Veterinary Public and Preventive Medicine, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Mustapha Umar Imam
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
- Department of Medical Biochemistry, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
| | - Muhammad Bashir Bello
- Infectious Disease Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Peter Kraiczy
- Goethe University Frankfurt, Institute of Medical Microbiology and Infection Control, University Hospital of Frankfurt, Frankfurt, Germany
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Ichikawa T, Qiu Y, Ando S, Takeuchi Y, Nagasaka A. The case of Mediterranean spotted fever of the traveler returned from Zambia. Ticks Tick Borne Dis 2024; 15:102347. [PMID: 38714072 DOI: 10.1016/j.ttbdis.2024.102347] [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: 01/16/2024] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
We report the case of a traveler who returned from Zambia and was diagnosed with Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii conorii. The patient presented to Sapporo City General Hospital with symptoms of fever, malaise, headache, and rash. The pathogen was identified by Polymerase Chain Reaction assays and subsequent analyses. The patient improved with 10-day treatment of oral doxycycline. Although some cases of MSF have been reported in sub-Saharan Africa, none have been reported in Zambia. Rhipicephalus sanguineus sensu lato, the vector of the Rickettsia conorii conorii, has been found in various areas of Zambia. Our case report highlights the potential threat of Mediterranean spotted fever in urban areas of Zambia.
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Affiliation(s)
- Takahiro Ichikawa
- Sapporo City General Hospital Department of Infectious Diseases, 13-1-1, Kita-11-jonishi, Chuo-ku, Sapporo 060-8604, Japan.
| | - Yongjin Qiu
- Laboratory of Parasitology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo: Kita 8, Nishi 5, Kita-ku, Sapporo 060-0808, Japan
| | - Shuji Ando
- National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Yuto Takeuchi
- Sapporo City General Hospital Department of Infectious Diseases, 13-1-1, Kita-11-jonishi, Chuo-ku, Sapporo 060-8604, Japan
| | - Atsushi Nagasaka
- Sapporo City General Hospital Department of Infectious Diseases, 13-1-1, Kita-11-jonishi, Chuo-ku, Sapporo 060-8604, Japan
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Phiri BSJ, Kattner S, Chitimia-Dobler L, Woelfel S, Albanus C, Dobler G, Küpper T. Rickettsia spp. in Ticks of South Luangwa Valley, Eastern Province, Zambia. Microorganisms 2023; 11:microorganisms11010167. [PMID: 36677459 PMCID: PMC9861334 DOI: 10.3390/microorganisms11010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Ticks are important vectors for Rickettsia spp. belonging to the Spotted Fever Group responsible for causing Rickettsiosis worldwide. Rickettsioses pose an underestimated health risk to tourists and local inhabitants. There is evidence of the presence of Rickettsia spp. in Zambia, however there is limited data. A total of 1465 ticks were collected in 20 different locations from dogs and cattle including one cat. Ticks were identified by morphological features or by sequencing of the 16S mitochondrial rRNA gene. Individual ticks were further tested for rickettsiae using a pan-Rickettsia real-time-PCR. Rickettsia species in PCR-positive ticks were identified by sequencing the 23S-5S intergenic spacer region or partial ompA gene, respectively. Seven tick species belonging to three different tick genera were found, namely: Amblyomma variegatum, Rhipicephalus appendiculatus, Rhipicephalus (Boophilus) microplus, Rhipicephalus simus, Rhipicephalus sanguineus, Rhipicephalus zambesiensis and Haemaphysalis elliptica. Out of the 1465 ticks collected, 67 (4.6%) tested positive in the pan-Rickettsia PCR. This study provides detailed data about the presence of Rickettsia species in South Luangwa Valley, Eastern Province, Zambia for the first time. High prevalence of Rickettsia africae in Amblyomma variegatum was found, which indicates the potential risk of infection in the investigated area. Furthermore, to our best knowledge, this is the first time Rickettsia massiliae, a human pathogen causing spotted fever, has been detected in Zambia.
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Affiliation(s)
- Bruno S. J. Phiri
- Central Veterinary Research Institute (CVRI), Ministry of Fisheries and Livestock, Lusaka P.O. Box 33980, Zambia
| | - Simone Kattner
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
- Correspondence:
| | - Lidia Chitimia-Dobler
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
- German Center of Infection Research (DZIF) Partner Munich, 80937 Munich, Germany
| | - Silke Woelfel
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
- German Center of Infection Research (DZIF) Partner Munich, 80937 Munich, Germany
- Amedes MVZ for Laboratory Medicine and Microbiology, 82256 Fürstenfeldbruck, Germany
| | - Celina Albanus
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
- German Center of Infection Research (DZIF) Partner Munich, 80937 Munich, Germany
- Parasitology Unit, University of Hohenheim, 70599 Stuttgart, Germany
| | - Thomas Küpper
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
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Mubemba B, Mburu MM, Changula K, Muleya W, Moonga LC, Chambaro HM, Kajihara M, Qiu Y, Orba Y, Hayashida K, Sutcliffe CG, Norris DE, Thuma PE, Ndubani P, Chitanga S, Sawa H, Takada A, Simulundu E. Current knowledge of vector-borne zoonotic pathogens in Zambia: A clarion call to scaling-up "One Health" research in the wake of emerging and re-emerging infectious diseases. PLoS Negl Trop Dis 2022; 16:e0010193. [PMID: 35120135 PMCID: PMC8849493 DOI: 10.1371/journal.pntd.0010193] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/16/2022] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background Although vector-borne zoonotic diseases are a major public health threat globally, they are usually neglected, especially among resource-constrained countries, including those in sub-Saharan Africa. This scoping review examined the current knowledge and identified research gaps of vector-borne zoonotic pathogens in Zambia. Methods and findings Major scientific databases (Web of Science, PubMed, Scopus, Google Scholar, CABI, Scientific Information Database (SID)) were searched for articles describing vector-borne (mosquitoes, ticks, fleas and tsetse flies) zoonotic pathogens in Zambia. Several mosquito-borne arboviruses have been reported including Yellow fever, Ntaya, Mayaro, Dengue, Zika, West Nile, Chikungunya, Sindbis, and Rift Valley fever viruses. Flea-borne zoonotic pathogens reported include Yersinia pestis and Rickettsia felis. Trypanosoma sp. was the only tsetse fly-borne pathogen identified. Further, tick-borne zoonotic pathogens reported included Crimean-Congo Haemorrhagic fever virus, Rickettsia sp., Anaplasma sp., Ehrlichia sp., Borrelia sp., and Coxiella burnetii. Conclusions This study revealed the presence of many vector-borne zoonotic pathogens circulating in vectors and animals in Zambia. Though reports of human clinical cases were limited, several serological studies provided considerable evidence of zoonotic transmission of vector-borne pathogens in humans. However, the disease burden in humans attributable to vector-borne zoonotic infections could not be ascertained from the available reports and this precludes the formulation of national policies that could help in the control and mitigation of the impact of these diseases in Zambia. Therefore, there is an urgent need to scale-up “One Health” research in emerging and re-emerging infectious diseases to enable the country to prepare for future epidemics, including pandemics. Despite vector-borne zoonoses being a major public health threat globally, they are often overlooked, particularly among resource-constrained countries in sub-Saharan Africa, including Zambia. Therefore, we reviewed the current knowledge and identified research gaps of vector-borne zoonotic pathogens in Zambia. We focussed on mosquito-, tick-, flea- and tsetse fly-borne zoonotic pathogens reported in the country. Although we found evidence of circulation of several vector-borne zoonotic pathogens among vectors, animals and humans, clinical cases in humans were rarely reported. This suggests sparse capacity for diagnosis of vector-borne pathogens in healthcare facilities in the country and possibly limited awareness and knowledge of the local epidemiology of these infectious agents. Establishment of facility-based surveillance of vector-borne zoonoses in health facilities could provide valuable insights on morbidity, disease severity, and mortalities associated with infections as well as immune responses. In addition, there is also need for increased genomic surveillance of vector-borne pathogens in vectors and animals and humans for a better understanding of the molecular epidemiology of these diseases in Zambia. Furthermore, vector ecology studies aimed at understanding the drivers of vector abundance, pathogen host range (i.e., including the range of vectors and reservoirs), parasite-host interactions and factors influencing frequency of human-vector contacts should be prioritized. The study revealed the need for Zambia to scale-up One Health research in emerging and re-emerging infectious diseases to enable the country to be better prepared for future epidemics, including pandemics.
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Affiliation(s)
- Benjamin Mubemba
- Department of Wildlife Sciences, School of Natural Resources, Copperbelt University, Kitwe, Zambia
- Department of Biomedical Sciences, School of Medicine, Copperbelt University, Ndola, Zambia
| | | | - Katendi Changula
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Walter Muleya
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Lavel C. Moonga
- Division of Collaboration and Education, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Herman M. Chambaro
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Masahiro Kajihara
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Yongjin Qiu
- Division of International Research Promotion, Hokkaido University International Institute for Zoonosis Control, Sapporo, Japan
| | - Yasuko Orba
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Kyoko Hayashida
- Division of Collaboration and Education, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Catherine G. Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Douglas E. Norris
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Simbarashe Chitanga
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Namibia, Windhoek, Namibia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
- School of Life Sciences, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hirofumi Sawa
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Division of International Research Promotion, Hokkaido University International Institute for Zoonosis Control, Sapporo, Japan
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Africa Centre of Excellence for Infectious Diseases of Humans and Animals, University of Zambia, Lusaka, Zambia
- Global Virus Network, Baltimore, Maryland, United States of America
- One Health Research Center, Hokkaido University, Sapporo, Japan
| | - Ayato Takada
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Africa Centre of Excellence for Infectious Diseases of Humans and Animals, University of Zambia, Lusaka, Zambia
- * E-mail: (AT); (ES)
| | - Edgar Simulundu
- Macha Research Trust, Choma, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- * E-mail: (AT); (ES)
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Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar. Pathogens 2021; 10:pathogens10111482. [PMID: 34832637 PMCID: PMC8621948 DOI: 10.3390/pathogens10111482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Rickettsiae may cause febrile infections in humans in tropical and subtropical regions. From Madagascar, no molecular data on the role of rickettsioses in febrile patients are available. Blood samples from patients presenting with fever in the area of the capital Antananarivo were screened for the presence of rickettsial DNA. EDTA (ethylenediaminetetraacetic acid) blood from 1020 patients presenting with pyrexia > 38.5 °C was analyzed by gltA-specific qPCR. Positive samples were confirmed by ompB-specific qPCR. From confirmed samples, the gltA amplicons were sequenced and subjected to phylogenetic analysis. From five gltA-reactive samples, two were confirmed by ompB-specific qPCR. The gltA sequence in the sample taken from a 38-year-old female showed 100% homology with R. typhi. The other sample taken from a 1.5-year-old infant was 100% homologous to R. felis. Tick-borne rickettsiae were not identified. The overall rate of febrile patients with molecular evidence for a rickettsial infection from the Madagascan study site was 0.2% (2/1020 patients). Flea-borne rickettsiosis is a rare but neglected cause of infection in Madagascar. Accurate diagnosis may prompt adequate antimicrobial treatment.
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Chitanga S, Chibesa K, Sichibalo K, Mubemba B, Nalubamba KS, Muleya W, Changula K, Simulundu E. Molecular Detection and Characterization of Rickettsia Species in Ixodid Ticks Collected From Cattle in Southern Zambia. Front Vet Sci 2021; 8:684487. [PMID: 34164457 PMCID: PMC8215536 DOI: 10.3389/fvets.2021.684487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022] Open
Abstract
Tick-borne zoonotic pathogens are increasingly becoming important across the world. In sub-Saharan Africa, tick-borne pathogens identified include viruses, bacteria and protozoa, with Rickettsia being the most frequently reported. This study was conducted to screen and identify Rickettsia species in ticks (Family Ixodidae) infesting livestock in selected districts of southern Zambia. A total of 236 ticks from three different genera (Amblyomma, Hyalomma, and Rhipicephalus) were collected over 14 months (May 2018-July 2019) and were subsequently screened for the presence of Rickettsia pathogens based on PCR amplification targeting the outer membrane protein B (ompB). An overall Rickettsia prevalence of 18.6% (44/236) was recorded. Multi-locus sequencing and phylogenetic characterization based on the ompB, ompA, 16S rRNA and citrate synthase (gltA) genes revealed the presence of Rickettsia africae (R. africae), R. aeschlimannii-like species and unidentified Rickettsia species. While R. aeschlimannii-like species are being reported for the first time in Zambia, R. africae has been reported previously, with our results showing a wider distribution of the bacteria in the country. Our study reveals the potential risk of human infection by zoonotic Rickettsia species and highlights the need for increased awareness of these infections in Zambia's public health systems.
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Affiliation(s)
- Simbarashe Chitanga
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Department of Pathobiology, School of Veterinary Medicine, University of Namibia, Windhoek, Namibia
- School of Life Sciences, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kennedy Chibesa
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Karen Sichibalo
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Benjamin Mubemba
- Department of Wildlife Sciences, School of Natural Resources, Copperbelt University, Kitwe, Zambia
- Department of Biomedical Sciences, School of Medicine, Copperbelt University, Ndola, Zambia
| | - King S. Nalubamba
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Walter Muleya
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Katendi Changula
- Department of Paraclinical Studies, School of Veterinary Sciences, University of Zambia, Lusaka, Zambia
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Macha Research Trust, Choma, Zambia
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Dhawan S, Robinson MT, Stenos J, Graves SR, Wangrangsimakul T, Newton PN, Day NPJ, Blacksell SD. Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review. Am J Trop Med Hyg 2020; 103:55-63. [PMID: 32274984 PMCID: PMC7356422 DOI: 10.4269/ajtmh.19-0818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the "gold standard" to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: "murine typhus," "rickettsia typhi," "immunofluorescence," "IFA," and "serologic" with restrictions (i.e., "rickettsia typhi" or "murine typhus," and "IFA" or "immunofluorescence," or "serologic*"). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients.
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Affiliation(s)
- Sandhya Dhawan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Matthew T. Robinson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
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Moonga LC, Hayashida K, Nakao R, Lisulo M, Kaneko C, Nakamura I, Eshita Y, Mweene AS, Namangala B, Sugimoto C, Yamagishi J. Molecular detection of Rickettsia felis in dogs, rodents and cat fleas in Zambia. Parasit Vectors 2019; 12:168. [PMID: 30975188 PMCID: PMC6460736 DOI: 10.1186/s13071-019-3435-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background Flea-borne spotted fever is a zoonosis caused by Rickettsia felis, a Gram-negative obligate intracellular bacterium. The disease has a worldwide distribution including western and eastern sub-Saharan Africa where it is associated with febrile illness in humans. However, epidemiology and the public health risks it poses remain neglected especially in developing countries including Zambia. While Ctenocephalides felis (cat fleas) has been suggested to be the main vector, other arthropods including mosquitoes have been implicated in transmission and maintenance of the pathogen; however, their role in the epidemiological cycle remains to be elucidated. Thus, the aim of this study was to detect and characterize R. felis from animal hosts and blood-sucking arthropod vectors in Zambia. Methods Dog blood and rodent tissue samples as well as cat fleas and mosquitoes were collected from various areas in Zambia. DNA was extracted and screened by polymerase chain reaction (PCR) targeting genus Rickettsia and amplicons subjected to sequence analysis. Positive samples were further subjected to R. felis-specific real-time quantitative polymerase chain reactions. Results Rickettsia felis was detected in 4.7% (7/150) of dog blood samples and in 11.3% (12/106) of rodent tissue samples tested by PCR; this species was also detected in 3.7% (2/53) of cat fleas infesting dogs, co-infected with Rickettsia asembonensis. Furthermore, 37.7% (20/53) of cat flea samples tested positive for R. asembonensis, a member of spotted fever group rickettsiae of unknown pathogenicity. All the mosquitoes tested (n = 190 pools) were negative for Rickettsia spp. Conclusions These observations suggest that R. felis is circulating among domestic dogs and cat fleas as well as rodents in Zambia, posing a potential public health risk to humans. This is because R. felis, a known human pathogen is present in hosts and vectors sharing habitat with humans. Electronic supplementary material The online version of this article (10.1186/s13071-019-3435-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lavel Chinyama Moonga
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan
| | - Kyoko Hayashida
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan
| | - Ryo Nakao
- Laboratory of Parasitology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-Ku, Sapporo, Hokkaido, 060-0818, Japan
| | - Malimba Lisulo
- The University of Edinburgh, College of Medicine and Veterinary Medicine, Deanery of Biomedical Sciences, 1 George Square, Edinburgh, EH8 9JZ, UK
| | - Chiho Kaneko
- Project for Zoonoses Education and Research, Faculty of Agriculture, University of Miyazaki, 1-1, Gakuen-kibanadai-nishi, Miyazaki, 889-2192, Japan
| | - Ichiro Nakamura
- Unit of International Cooperation, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan
| | - Yuki Eshita
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan
| | - Aaron S Mweene
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, P. O. Box 32379, Lusaka, Zambia.,African Centre of Excellence for Infectious Diseases of Human and Animals, University of Zambia, PO Box 32379, Lusaka, Zambia
| | - Boniface Namangala
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, PO Box 32379, Lusaka, Zambia.,African Centre of Excellence for Infectious Diseases of Human and Animals, University of Zambia, PO Box 32379, Lusaka, Zambia
| | - Chihiro Sugimoto
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan.,Global Station for Zoonosis Control, GI-CoRE, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Junya Yamagishi
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Kita 20, Nishi 10, Kita-Ku, Sapporo, Hokkaido, 001-0020, Japan. .,Global Station for Zoonosis Control, GI-CoRE, Hokkaido University, Sapporo, Hokkaido, Japan.
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9
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Chitanga S, Simulundu E, Simuunza MC, Changula K, Qiu Y, Kajihara M, Nakao R, Syakalima M, Takada A, Mweene AS, Mukaratirwa S, Hang'ombe BM. First molecular detection and genetic characterization of Coxiella burnetii in Zambian dogs and rodents. Parasit Vectors 2018; 11:40. [PMID: 29343277 PMCID: PMC5773031 DOI: 10.1186/s13071-018-2629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022] Open
Abstract
Coxiella burnetii, the causative agent of Q fever, is a zoonotic pathogen associated with sylvatic or domestic transmission cycles, with rodents being suspected to link the two transmission cycles. Infection and subsequent disease in humans has historically been associated with contact with infected livestock, especially sheep. However, recently there have been reports of Q fever outbreaks associated with contact with infected rodents and dogs. Studies exploring the potential role of these animal hosts in the epidemiology of Q fever in many developing countries in Africa are very limited. This study aimed to determine the potential role of rodents and dogs in the epidemiological cycle of C. burnetti in Zambia. Using pathogen-specific polymerase chain reaction assays targeting the 16S rRNA gene, C. burnetii was detected for the first time in 45% of rodents (9/20), in one shrew and in 10% of domestic dogs (15/150) screened in Zambia. Phylogenetic characterization of six samples based on the isocitrate synthase gene revealed that the strains were similar to a group of isolates from chronic human Q fever patients, goats and rodents reported in multiple continents. Considering the close proximity of domestic dogs and rodents to humans, especially in resource-limited communities, the presence of C. burnetii in these animals could be of significant public health importance. It is thus important to determine the burden of Q fever in humans in such resource-limited communities where there is close contact between humans, rodents and dogs.
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Affiliation(s)
- Simbarashe Chitanga
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, PO Box 50110, 10101, Lusaka, Zambia.
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
| | - Martin C Simuunza
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
| | - Katendi Changula
- Department of Paraclinical studies, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
| | - Yongjin Qiu
- Hokudai Center for Zoonosis Control in Zambia, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
| | - Masahiro Kajihara
- Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Ryo Nakao
- Unit of Risk Analysis and Management, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan.,Laboratory of Parasitology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Michelo Syakalima
- Department of Animal Health, School of Agricultural Sciences, Northwest University, Mafikeng Campus, P/B. X2046, Mmabatho, South Africa
| | - Ayato Takada
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia.,Division of Global Epidemiology, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Aaron S Mweene
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bernard M Hang'ombe
- Department of Paraclinical studies, School of Veterinary Medicine, University of Zambia, PO Box 32379, 10101, Lusaka, Zambia
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10
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Khor CS, Mohd-Rahim NF, Hassan H, Chandren JR, Nore SS, Johari J, Loong SK, Abd-Jamil J, Khoo JJ, Lee HY, Pike BL, Wong LP, Lim YAL, Zandi K, AbuBakar S. Seroprevalence of Q Fever Among the Indigenous People (Orang Asli) of Peninsular Malaysia. Vector Borne Zoonotic Dis 2018; 18:131-137. [PMID: 29336685 DOI: 10.1089/vbz.2017.2153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Q fever is a disease caused by Coxiella burnetii. It is a disease of public health concern in many parts of the world. In this study, we described the seroprevalence of Q fever among selected populations of Orang Asli (OA), indigenous people, many of whom live within the forest fringe areas of Peninsular Malaysia. Serum samples were obtained from 887 OA participants from selected villages. Samples were analyzed for the presence of IgG antibodies reactive against C. burnetii by enzyme-linked immunosorbent assay. Statistical methods were used to identify possible associations between seropositivity for C. burnetii and a number of demographic variables obtained from the questionnaires. In total, 9.6% (n = 85/887) of the serum samples were reactive to C. burnetii. Statistical results suggest that elderly male OA residing in OA village, Bukit Payung, were most likely to be tested seropositive for C. burnetii. This study suggests that OA are at a significant risk of contracting C. burnetii infection, and both demographic and geographic factors are important contributors to this risk. Further prospective studies are needed to establish the true burden of C. burnetii infection within the indigenous population as well as within Peninsular Malaysia as a whole.
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Affiliation(s)
- Chee-Sieng Khor
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Nurul-Farhana Mohd-Rahim
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia .,2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Habibi Hassan
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia .,2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Josephine Rebecca Chandren
- 3 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Siti-Sarah Nore
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Jefree Johari
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Shih-Keng Loong
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Juraina Abd-Jamil
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Jing-Jing Khoo
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Hai-Yen Lee
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia
| | - Brian L Pike
- 4 U.S. Naval Medical Research Center-Asia , Singapore, Singapore
| | - Li Ping Wong
- 3 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Yvonne Ai-Lian Lim
- 5 Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Keivan Zandi
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia .,6 Laboratory of Biochemical Pharmacology, Department of Pediatrics, Center for AIDS Research, Emory University School of Medicine , Atlanta, Georgia
| | - Sazaly AbuBakar
- 1 Tropical Infectious Diseases Research & Education Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia .,2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
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11
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First detection of Rickettsia conorii ssp. caspia in Rhipicephalus sanguineus in Zambia. Parasitol Res 2017; 116:3249-3251. [PMID: 28986641 DOI: 10.1007/s00436-017-5639-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
Ticks are important vectors for Rickettsia spp. of the spotted fever group all around the world. Rickettsia conorii is the etiological agent of boutonneuse fever in the Mediterranean region and Africa. Tick identification was based on morphological features and further characterized using the 16S rRNA gene. The ticks were individually tested using pan-Rickettsia real-time-PCR for screening, and 23S-5S intergenic spacer region, 16S rDNA, gltA, sca4, ompB, and ompA genes were used to analyze the Rickettsia positive samples. Rickettsia conorii ssp. caspia was detected in tick collected in Zambia for the first time, thus demonstrating the possibility of the occurrence of human disease, namely Astrakhan fever, due to this Rickettsia ssp. in this region of Africa. The prevalence of R. conorii ssp. caspia was 0.06% (one positive tick out of 1465 tested ticks) and 0.07% (one positive tick out of 1254 tested Rh. sanguineus).
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12
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Koka H, Sang R, Kutima HL, Musila L. The Detection of Spotted Fever Group Rickettsia DNA in Tick Samples From Pastoral Communities in Kenya. JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:774-780. [PMID: 28073909 PMCID: PMC5850802 DOI: 10.1093/jme/tjw238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
In this study, ticks from pastoral communities in Kenya were tested for Rickettsia spp. infections in geographical regions where the presence of tick-borne arboviruses had previously been reported. Rickettsial and arbovirus infections have similar clinical features which makes differential diagnosis challenging when both diseases occur. The tick samples were tested for Rickettsia spp. by conventional PCR using three primer sets targeting the gltA, ompA, and ompB genes followed by amplicon sequencing. Of the tick pools screened, 25% (95/380) were positive for Rickettsia spp. DNA using the gltA primer set. Of the tick-positive pools, 60% were ticks collected from camels. Rickettsia aeschlimannii and R. africae were the main Rickettsia spp. detected in the tick pools sequenced. The findings of this study indicate that multiple Rickettsia species are circulating in ticks from pastoral communities in Kenya and could contribute to the etiology of febrile illness in these areas. Diagnosis and treatment of rickettsial infections should be a public health priority in these regions.
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Affiliation(s)
- Hellen Koka
- Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya ( ; )
- US Army Medical Research Directorate - Kenya, P. O. Box 606-00621, Nairobi, Kenya ( )
| | - Rosemary Sang
- Kenya Medical Research Institute, Centre for Virus Research, P. O. Box 54628-00200, Nairobi, Kenya ( )
- International Centre for Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi, Kenya
| | - Helen Lydia Kutima
- Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya (; )
| | - Lillian Musila
- US Army Medical Research Directorate - Kenya, P. O. Box 606-00621, Nairobi, Kenya
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13
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Hackert VH, Dukers-Muijrers NHTM, van Loo IHM, Wegdam-Blans M, Somers C, Hoebe CJPA. Coxiella burnetii Infection Is Lower in Children than in Adults After Community Exposure: Overlooked Cause of Infrequent Q Fever Reporting in the Young. Pediatr Infect Dis J 2015; 34:1283-8. [PMID: 26252570 DOI: 10.1097/inf.0000000000000871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Q fever is rarely reported in children/adolescents. Although lower reporting rates are commonly attributed to milder disease and subsequent underdiagnosis in infected children/adolescents, pertinent evidence is scarce. We present data from a large, well-defined single-point source outbreak of Q fever to fill this gap. METHODS We compared (A) Q fever testing and notification rates in children/adolescents who were 0-19 years of age with those in adults 20+ years of age in October 2009; (B) serological attack rates of acute Q fever in children/adolescents with the rates in adults after on-source exposure on the outbreak farm's premises; (C) incidence of Q fever infection in children/adolescents with that in adults after off-source exposure in the municipality located closest to the farm. RESULTS (A) Children/adolescents represented 19.3% (59,404 of 307,348) of the study area population, 12.1% (149 of 1217) of all subjects tested in October 2009 and 4.3% (11 of 253) of notified laboratory-confirmed community cases. (B) Serological attack rate of acute Q fever in children with on-source exposure was 71% (12 of 17), similar to adults [68% (40 of 59)]. (C) Incidence of infection in children/adolescents after community (off-source) exposure was 4.5% (13 of 287) versus 11.0% (12 of 109) in adults (adjusted odds ratio: 0.36; 95% confidence interval: 0.16-0.84; P = 0.02). No children/adolescents reported clinical symptoms. Proportion of notified infections was significantly lower in children/adolescents (2.5%) than in adults (10.4%; risk ratio: 0.26; 95% confidence interval: 0.08-0.80, P = 0.02). CONCLUSION Notified Q fever was less frequent in children/adolescents than in adults. Although underrecognition contributed to this phenomenon, lower rates of infection in children after community exposure played an unexpected major role. On-source (presumed high-dose) exposure, by contrast, was associated with high serological and clinical attack rates not only in adults but also in children/adolescents. Our findings allow for improved age-specific clinical and public health risk assessment in Q fever outbreaks.
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Affiliation(s)
- Volker H Hackert
- From the *Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Geleen, The Netherlands; †Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands; and ‡Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, The Netherlands
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14
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Slok ENE, Dijkstra F, de Vries E, Rietveld A, Wong A, Notermans DW, van Steenbergen JE. Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature. BMC Res Notes 2015; 8:456. [PMID: 26384483 PMCID: PMC4575485 DOI: 10.1186/s13104-015-1389-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 08/24/2015] [Indexed: 11/23/2022] Open
Abstract
Background In the Dutch 2007–2009 Q fever outbreak Coxiella burnetii was transmitted aerogenically from dairy goat farms to those living in the surrounding areas. Relatively few children were reported. The true number of pediatric infections is unknown. In this study, we estimate the expected number of acute and chronic childhood infections. Methods As Coxiella was transmitted aerogenic to those living near infected dairy goat farms, we could use adult seroprevalence data to estimate infection risk for inhabitants, children and
adults alike. Using Statistics Netherlands data we estimated the number of children at (high) risk for developing chronic Q fever. Literature was reviewed for childhood (0–15 years) Q fever reports and disease rates. We compared this with Dutch reported and our estimated data for 2007–2009. Results In The Netherlands epidemic, 44 children were reported (1.2 % of total notifications). The childhood incidence was 0.15 compared to 2.6 per 10,000 inhabitants for adults. No complications were reported. Based on the expected similarity in childhood and adult exposure we assume that 9.8 % of children in the high-risk area had Q fever infection, resulting
in 1562 acute infections during the Q fever epidemic interval. Based on the prevalence of congenital heart disease, at least 13 children are at high risk for developing chronic Q fever. In medical literature, 42 case reports described 140 childhood Q fever cases with a serious outcome (four deaths). In chronic Q fever, cardiac infections were predominant. Four outbreaks were reported involving children, describing 11 childhood cases. 36 National and/or regional studies reported seroprevalences varying between 0 and 70 %. Conclusion In the 3-year Dutch epidemic, few childhood cases were reported, with pulmonary symptoms leading, and none with a serious presentation. With an estimated 13 high-risk children for chronic infection in the high exposure area, and probably forty in the whole country, we may expect several chronic Q fever complications in the coming years in paediatric practice. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1389-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edwin N E Slok
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
| | - Ariene Rietveld
- Department of Infectious Disease Control, Municipal Health Service 'Hart voor Brabant', 's-Hertogenbosch, The Netherlands.
| | - Albert Wong
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Department of Statistics, Mathematical Modelling and Data Logistics, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Daan W Notermans
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Jim E van Steenbergen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Centre for Infectious Diseases, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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15
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Keller C, Krüger A, Schwarz NG, Rakotozandrindrainy R, Rakotondrainiarivelo JP, Razafindrabe T, Derschum H, Silaghi C, Pothmann D, Veit A, Hogan B, May J, Girmann M, Kramme S, Fleischer B, Poppert S. High detection rate of Rickettsia africae in Amblyomma variegatum but low prevalence of anti-rickettsial antibodies in healthy pregnant women in Madagascar. Ticks Tick Borne Dis 2015; 7:60-65. [PMID: 26318262 DOI: 10.1016/j.ttbdis.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 05/22/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
Tick-borne spotted fever group (SFG) rickettsioses are emerging infectious diseases in Sub-Saharan Africa. In Madagascar, the endemicity of tick-borne rickettsiae and their vectors has been incompletely studied. The first part of the present study was conducted in 2011 and 2012 to identify potential anthropophilic tick vectors for SFG rickettsiae on cattle from seven Malagasy regions, and to detect and characterize rickettsiae in these ticks. Amblyomma variegatum was the only anthropophilic tick species found on 262 cattle. Using a novel ompB-specific qPCR, screening for rickettsial DNA was performed on 111 A. variegatum ticks. Rickettsial DNA was detected in 96 of 111 ticks studied (86.5%). Rickettsia africae was identified as the only infecting rickettsia using phylogenetic analysis of ompA and ompB gene sequences and three variable intergenic spacers from 11 ticks. The second part of the study was a cross-sectional survey for antibodies against SFG rickettsiae in plasma samples taken from healthy, pregnant women at six locations in Madagascar, two at sea level and four between 450 and 1300m altitude. An indirect fluorescent antibody test with Rickettsia conorii as surrogate SFG rickettsial antigen was used. We found R. conorii-seropositives at all altitudes with prevalences between 0.5% and 3.1%. Our results suggest that A. variegatum ticks highly infected with R. africae are the most prevalent cattle-associated tick vectors for SFG rickettsiosis in Madagascar. Transmission of SFG rickettsiosis to humans occurs at different altitudes in Madagascar and should be considered as a relevant cause of febrile diseases.
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Affiliation(s)
- Christian Keller
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute for Virology, Philipps University, Marburg, Germany.
| | | | | | | | | | | | | | - Cornelia Silaghi
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniela Pothmann
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Veit
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Hogan
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Mirko Girmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stefanie Kramme
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Sven Poppert
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute for Medical Microbiology, Justus Liebig University, Giessen, Germany
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16
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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: 6] [Impact Index Per Article: 0.7] [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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17
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Ruiz S, Wolfe DN. Vaccination against Q fever for biodefense and public health indications. Front Microbiol 2014; 5:726. [PMID: 25566235 PMCID: PMC4267281 DOI: 10.3389/fmicb.2014.00726] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/03/2014] [Indexed: 01/02/2023] Open
Abstract
Coxiella burnetii is the etiological agent of Q fever, a disease that is often spread to humans via inhalational exposure to the bacteria from contaminated agricultural sources. Outbreaks have been observed all over the world with larger foci generating interest in vaccination programs, most notably in Australia and the Netherlands. Importantly, exposure rates among military personnel deployed to the Middle East can be relatively high as measured by seroconversion to C. burnetii-specific antibodies. Q fever has been of interest to the biodefense community over the years due to its low infectious dose and environmental stability. Recent advances in cell-free growth and genetics of C. burnetii also make this organism easier to culture and manipulate. While there is a vaccine that is licensed for use in Australia, the combination of biodefense- and public health-related issues associated with Q fever warrant the development of a safer and more effective vaccine against this disease.
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Affiliation(s)
- Sara Ruiz
- Center for Aerobiological Sciences, U.S. Army Medical Research Institute of Infectious Diseases Fort Detrick, MD USA
| | - Daniel N Wolfe
- Chemical and Biological Technologies Department, Defense Threat Reduction Agency Fort Belvoir, VA USA
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18
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Noden BH, Tshavuka FI, van der Colf BE, Chipare I, Wilkinson R. Exposure and risk factors to coxiella burnetii, spotted fever group and typhus group Rickettsiae, and Bartonella henselae among volunteer blood donors in Namibia. PLoS One 2014; 9:e108674. [PMID: 25259959 PMCID: PMC4178180 DOI: 10.1371/journal.pone.0108674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/03/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The role of pathogen-mediated febrile illness in sub-Saharan Africa is receiving more attention, especially in Southern Africa where four countries (including Namibia) are actively working to eliminate malaria. With a high concentration of livestock and high rates of companion animal ownership, the influence of zoonotic bacterial diseases as causes of febrile illness in Namibia remains unknown. METHODOLOGY/PRINCIPAL FINDINGS The aim of the study was to evaluate exposure to Coxiella burnetii, spotted fever and typhus group rickettsiae, and Bartonella henselae using IFA and ELISA (IgG) in serum collected from 319 volunteer blood donors identified by the Blood Transfusion Service of Namibia (NAMBTS). Serum samples were linked to a basic questionnaire to identify possible risk factors. The majority of the participants (64.8%) had extensive exposure to rural areas or farms. Results indicated a C. burnetii prevalence of 26.1% (screening titre 1∶16), and prevalence rates of 11.9% and 14.9% (screening titre 1∶100) for spotted fever group and typhus group rickettsiae, respectively. There was a significant spatial association between C. burnetii exposure and place of residence in southern Namibia (P<0.021). Donors with occupations involving animals (P>0.012), especially cattle (P>0.006), were also significantly associated with C. burnetii exposure. Males were significantly more likely than females to have been exposed to spotted fever (P<0.013) and typhus (P<0.011) group rickettsiae. Three (2.9%) samples were positive for B. henselae possibly indicating low levels of exposure to a pathogen never reported in Namibia. CONCLUSIONS/SIGNIFICANCE These results indicate that Namibians are exposed to pathogenic fever-causing bacteria, most of which have flea or tick vectors/reservoirs. The epidemiology of febrile illnesses in Namibia needs further evaluation in order to develop comprehensive local diagnostic and treatment algorithms.
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Affiliation(s)
- Bruce H. Noden
- Department of Biomedical Science, Polytechnic of Namibia, Windhoek, Namibia
| | | | | | | | - Rob Wilkinson
- Blood Transfusion Service of Namibia, Windhoek, Namibia
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Qiu Y, Nakao R, Namangala B, Sugimoto C. First genetic detection of Coxiella burnetii in Zambian livestock. Am J Trop Med Hyg 2013; 89:518-9. [PMID: 23857023 DOI: 10.4269/ajtmh.13-0162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Q fever is a widespread zoonosis caused by Coxiella burnetii, an obligate intracellular gram-negative bacterium. The investigation of C. burnetii infection in Zambian livestock was carried out using molecular detection techniques. A total of 489 cattle and 53 goat blood samples were collected from Chama, Chongwe, Monze, and Petauke districts in Zambia. Molecular screening by polymerase chain reaction was performed using C. burnetii-species-specific primers. In total, 38 cattle and 4 goat samples were positive. The prevalence of C. burnetii differed among the four sites, with Chama (Eastern province) recording the highest, although Monze (Southern province) did not record any case of the bacteria. This study reports the first genetic detection of C. burnetii in Zambia.
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Affiliation(s)
- Yongjin Qiu
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan.
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van der Hoek W, Sarge-Njie R, Herremans T, Chisnall T, Okebe J, Oriero E, Versteeg B, Goossens B, van der Sande M, Kampmann B, Nwakanma D. Short communication: prevalence of antibodies against Coxiella burnetii (Q fever) in children in The Gambia, West Africa. Trop Med Int Health 2013; 18:850-3. [PMID: 23600611 DOI: 10.1111/tmi.12116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the prevalence of antibodies against Coxiella burnetii (Q fever) among children in eight villages in The Gambia, West Africa. METHODS Sera of 796 children aged 1-15 years were tested for presence of antibodies against phase II of C. burnetii by ELISA. RESULTS IgG and/or IgM phase II antibodies against C. burnetii were detectable in 8.3% (66/796) of all serum samples analysed with significant differences in seroprevalence between villages. Highest prevalence was found in the age group 1-4 years. CONCLUSIONS Exposure to C. burnetii is considerable in the early years of life in The Gambia, and further studies are warranted to estimate the role of Q fever in acute febrile illness in The Gambia and elsewhere in Africa.
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Affiliation(s)
- Wim van der Hoek
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Mediannikov O, Diatta G, Fenollar F, Sokhna C, Trape JF, Raoult D. Tick-borne rickettsioses, neglected emerging diseases in rural Senegal. PLoS Negl Trop Dis 2010; 4:e821. [PMID: 20856858 PMCID: PMC2939048 DOI: 10.1371/journal.pntd.0000821] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/12/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rickettsioses are one of the most important causes of systemic febrile illness among travelers from developed countries, but little is known about their incidence in indigenous populations, especially in West Africa. METHODOLOGY/PRINCIPAL FINDINGS Overall seroprevalence evaluated by immunofluorescence using six rickettsial antigens (spotted fever and typhus group) in rural populations of two villages of the Sine-Saloum region of Senegal was found to be 21.4% and 51% for spotted fever group rickettsiae for Dielmo and Ndiop villages, respectively. We investigated the role of tick-borne rickettsiae as the cause of acute non-malarial febrile diseases in the same villages. The incidence of rickettsial DNA in 204 blood samples from 134 (62M and 72F) febrile patients negative for malaria was studied. DNA extracted from whole blood was tested by two qPCR systems. Rickettsial DNA was found in nine patients, eight with Rickettsia felis (separately reported). For the first time in West Africa, Rickettsia conorii was diagnosed in one patient. We also tested 2,767 Ixodid ticks collected in two regions of Senegal (Niakhar and Sine-Saloum) from domestic animals (cows, sheep, goats, donkeys and horses) by qPCR and identified five different pathogenic rickettsiae. We found the following: Rickettsia aeschlimannii in Hyalomma marginatum rufipes (51.3% and 44.8% in Niakhar and Sine-Saloum region, respectively), in Hyalomma truncatum (6% and 6.8%) and in Rhipicephalus evertsi evertsi (0.5%, only in Niakhar); R. c. conorii in Rh. e. evertsi (0.4%, only in Sine-Saloum); Rickettsia massiliae in Rhipicephalus guilhoni (22.4%, only in Niakhar); Rickettsia sibirica mongolitimonae in Hyalomma truncatum (13.5%, only in Sine-Saloum); and Rickettsia africae in Rhipicephalus evertsi evertsi (0.7% and 0.4% in Niakhar and Sine-Saloum region, respectively) as well as in Rhipicephalus annulatus (20%, only in Sine-Saloum). We isolated two rickettsial strains from H. truncatum: R. s. mongolitimonae and R. aeschlimannii. CONCLUSIONS/SIGNIFICANCE We believe that together with our previous data on the high prevalence of R. africae in Amblyomma ticks and R. felis infection in patients, the presented results on the distribution of pathogenic rickettsiae in ticks and the first R. conorii case in West Africa show that the rural population of Senegal is at risk for other tick-borne rickettsioses, which are significant causes of febrile disease in this area.
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Affiliation(s)
- Oleg Mediannikov
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
| | - Georges Diatta
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
| | - Florence Fenollar
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
| | - Cheikh Sokhna
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
| | - Jean-François Trape
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
| | - Didier Raoult
- URMITE, UMR IRD 198/CNRS 6236, Medical Faculty, Mediterranean University, Marseille, France and Dakar, Senegal
- * E-mail:
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Bernabeu-Wittel M, del Toro MD, Nogueras MM, Muniain MA, Cardeñosa N, Márquez FJ, Segura F, Pachón J. Seroepidemiological study of Rickettsia felis, Rickettsia typhi, and Rickettsia conorii infection among the population of southern Spain. Eur J Clin Microbiol Infect Dis 2006; 25:375-81. [PMID: 16767485 DOI: 10.1007/s10096-006-0147-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rickettsia typhi and Rickettsia conorii, the etiologic agents of, respectively, murine typhus and Mediterranean spotted fever, are recognized as frequent causes of fever of intermediate duration in southern Spain; in addition, in recent years Rickettsia felis has been detected in potential vectors in this area. Nevertheless, limited data exist regarding the actual prevalence of past infection due to these three pathogens. In the present study, the prevalence of past infection due to R. felis, R. typhi, and R. conorii was determined in a representative population of southern Spain during 2002. In addition, the possible risk factors associated with exposure to these pathogens were investigated. An epidemiological survey was completed by all subjects included in the study. Serum samples were tested by indirect immunofluorescence assay. The prevalence of past infection due to R. felis, R. typhi, and R. conorii among the 504 total subjects was 6.5, 3.8 and 8.7%, respectively. In multivariate analysis, infection due to R. felis was independently associated with a high-risk occupation (one that required working outdoors in nature, close contact with domestic animals, or potential contact with rodents) (OR=5.8; 95%CI 2.1-15.6), while infection due to R. typhi was associated with older age (factor of 1.04 [95%CI 1.008-1.068]) and frequent insect bites (OR=10.3; 95%CI 2.3-45.5). Two factors were associated with infection due to R. conorii: a high-risk occupation (OR=9.3; 95%CI 3.7-23.2), and participation in outdoor activities (OR=7.2; 95%CI 1.4-38.5). The results confirm the widespread prevalence of past infection due to R. felis, R. typhi, and R. conorii in the population of southern Spain.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain.
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Jensenius M, Fournier PE, Kelly P, Myrvang B, Raoult D. African tick bite fever. THE LANCET. INFECTIOUS DISEASES 2003; 3:557-64. [PMID: 12954562 DOI: 10.1016/s1473-3099(03)00739-4] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
African tick bite fever is an acute febrile illness that is frequently accompanied by headache, prominent neck muscle myalgia, inoculation eschars, and regional lymphadenitis. The disease is caused by Rickettsia africae, a recently identified spotted fever group rickettsia, which is transmitted by ungulate ticks of the Amblyomma genus in rural sub-Saharan Africa and the French West Indies. Whereas reports on African tick bite fever in indigenous populations are scarce, the number of reported cases in travellers from Europe and elsewhere has recently increased significantly. Treatment with doxycycline is associated with rapid recovery in most patients. An immunofluorescence assay is recommended for the diagnosis but seroconversion is commonly delayed and this limits the usefulness of the test. Travellers to endemic areas should be informed of the risk of contracting African tick bite fever and be encouraged to take personal protective measures against tick bites.
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Affiliation(s)
- Mogens Jensenius
- Department of Internal Medicine, Aker University Hospital, Oslo, Norway.
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Abstract
Q fever is a zoonosis caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection, and transmission to human beings is mainly accomplished through inhalation of contaminated aerosols. This illness is associated with a wide clinical spectrum, from asymptomatic or mildly symptomatic seroconversion to fatal disease. Q fever in children has been rarely reported. We reviewed published work on this topic. Seroepidemiological studies show that children are frequently exposed to C burnetii. However, children are less frequently symptomatic than adults following infection, and may have milder diseases. Using the standard diagnostic criteria, we identified 46 published paediatric cases only. Self-limited febrile illness and pneumonia were the most common manifestations of acute Q fever. Chronic disease manifested as endocarditis and osteomyelitis. A history of exposure to possible sources of infection with C burnetii in a child with a compatible infectious syndrome should prompt testing for Q fever. Studies are required to determine the spectrum of morbidity associated with Q fever during childhood.
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Affiliation(s)
- Helen C Maltezou
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Ki-Zerbo G, Tall F, Nagalo K, Ledru E, Durand G, Patey O. Séroprévalence des rickettsioses et de la fièvre Q chez les patients fébriles à l'hôpital de Bobo-Dioulasso (Burkina Faso). Med Mal Infect 2000. [DOI: 10.1016/s0399-077x(00)89140-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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