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Silva-Ramos CR, Faccini-Martínez ÁA. Clinical, epidemiological, and laboratory features of Rickettsia africae infection, African tick-bite fever: A systematic review. LE INFEZIONI IN MEDICINA 2022; 29:366-377. [PMID: 35146341 DOI: 10.53854/liim-2903-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
African tick-bite fever (ATBF), caused by Rickettsia africae, is the main tick-borne rickettsiosis and the second most frequent cause of fever after malaria in travelers returning from sub-Saharan Africa. General descriptions on ATBF were made in the first two decades after recognized as a new infectious entity, and since then, many authors have contributed to the knowledge of the disease by reporting clinical cases in scientific literature. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of confirmed R. africae rickettsiosis cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. A total of 48 scientific publications (108 confirmed cases) were analyzed in order to extract data for developing this review. Overall, our results show that R. africae rickettsiosis is more frequent in males in the age group of 18-64 years, more than 80% of the cases occurred in European travelers, South Africa was the country where most infections were acquired, and almost 40% of cases occurred in clusters. Clinically, more than 80% of the cases had fever and eschar (55% developed multiple eschars), rash was present in less than the half of cases, and lymphangitis was not a common sign (11%). Headache, myalgia and regional lymphadenopathy were predominant nonspecific clinical manifestation (mean of 60%, 49% and 51%, respectively). Our results show that at least 70% of R. africae cases had altered laboratory parameters, most often showing an increase in transaminases and C-reactive protein. Tetracycline-class antibiotics, as monotherapy, were used in most (>90%) of the patients. Overall, only 4% of cases had complications, 12% required hospitalization, and there was a 100% rate of clinical recovery.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro A Faccini-Martínez
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.,Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia
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Charles RA, Bermúdez S, Banović P, Alvarez DO, Díaz-Sánchez AA, Corona-González B, Etter EMC, Rodríguez González I, Ghafar A, Jabbar A, Moutailler S, Cabezas-Cruz A. Ticks and Tick-Borne Diseases in Central America and the Caribbean: A One Health Perspective. Pathogens 2021; 10:1273. [PMID: 34684222 PMCID: PMC8538257 DOI: 10.3390/pathogens10101273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Ticks have complex life cycles which involve blood-feeding stages found on wild and domestic animals, with humans as accidental hosts. At each blood-feeding stage, ticks can transmit and/or acquire pathogens from their hosts. Therefore, the circulation of tick-borne pathogens (TBPs), especially the zoonotic ones, should be studied in a multi-layered manner, including all components of the chain of infections, following the 'One Health' tenets. The implementation of such an approach requires coordination among major stakeholders (such as veterinarians, physicians, acarologists, and researchers) for the identification of exposure and infection risks and application of effective prevention measures. In this review, we summarize our current knowledge on the epidemiology of tick-borne diseases in Central America and the Caribbean and the challenges associated with the implementation of 'One Health' surveillance and control programs in the region.
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Affiliation(s)
- Roxanne A Charles
- Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sergio Bermúdez
- Department of Medical Entomology, Gorgas Memorial Institute for Health Research, Panama 0816-02593, Panama
| | - Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | | | - Belkis Corona-González
- Department of Animal Health, National Center for Animal and Plant Health, Carretera de Tapaste y Autopista Nacional, Apartado Postal 10, San José de las Lajas, Mayabeque 32700, Cuba
| | - Eric Marcel Charles Etter
- CIRAD, UMR ASTRE, Petit-Bourg, 97170 Guadeloupe, France
- ASTRE, University de Montpellier, CIRAD, INRAE, 34398 Montpellier, France
| | - Islay Rodríguez González
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Marianao 13, Havana 10400, Cuba
| | - Abdul Ghafar
- Department of Veterinary Biosciences, Melbourne Veterinary School, the University of Melbourne, Werribee, VIC 3030, Australia
| | - Abdul Jabbar
- Department of Veterinary Biosciences, Melbourne Veterinary School, the University of Melbourne, Werribee, VIC 3030, Australia
| | - Sara Moutailler
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Alejandro Cabezas-Cruz
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
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3
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Identification of rickettsial immunoreactive proteins using a proximity ligation assay Western blotting and the traditional immunoproteomic approach. Comp Immunol Microbiol Infect Dis 2018; 58:17-25. [DOI: 10.1016/j.cimid.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/16/2018] [Accepted: 06/10/2018] [Indexed: 11/23/2022]
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4
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Laroche M, Bérenger JM, Delaunay P, Charrel R, Pradines B, Berger F, Ranque S, Bitam I, Davoust B, Raoult D, Parola P. Medical Entomology: A Reemerging Field of Research to Better Understand Vector-Borne Infectious Diseases. Clin Infect Dis 2018; 65:S30-S38. [PMID: 28859353 DOI: 10.1093/cid/cix463] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In the last decade, the Chikungunya and Zika virus outbreaks have turned public attention to the possibility of the expansion of vector-borne infectious diseases worldwide. Medical entomology is focused on the study of arthropods involved in human health. We review here some of the research approaches taken by the medical entomology team of the University Hospital Institute (UHI) Méditerranée Infection of Marseille, France, with the support of recent or representative studies. We propose our approaches to technical innovations in arthropod identification and the detection of microorganisms in arthropods, the use of arthropods as epidemiological or diagnostic tools, entomological investigations around clinical cases or within specific populations, and how we have developed experimental models to decipher the interactions between arthropods, microorganisms, and humans.
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Affiliation(s)
- Maureen Laroche
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
| | - Jean-Michel Bérenger
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
| | - Pascal Delaunay
- Service de Parasitologie-Mycologie, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Inserm U1065, Centre Méditerranéen de Médecine Moléculaire, Université de Nice-Sophia Antipolis
| | - Remi Charrel
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille Université, IRD 190, Inserm 1207, EHESP), AP-HM, IHU Méditerranée Infection
| | - Bruno Pradines
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille ( AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille.,Unité Parasitologie et Entomologie, Institut de Recherche Biomédicale des Armées.,Centre National de Référence du Paludisme
| | - Franck Berger
- GSBDD Marseille-Aubagne, Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - Stéphane Ranque
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
| | - Idir Bitam
- Laboratoire Biodiversité et Environnement: Interactions Génomes, Faculté des Sciences Biologiques Université des Sciences et de la Technologie Houari Boumediene, Bab Ezzouar, Algeria
| | - Bernard Davoust
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
| | - Didier Raoult
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
| | - Philippe Parola
- Aix Marseille Université, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), IHU Méditerranée Infection, Marseille
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Gondard M, Cabezas-Cruz A, Charles RA, Vayssier-Taussat M, Albina E, Moutailler S. Ticks and Tick-Borne Pathogens of the Caribbean: Current Understanding and Future Directions for More Comprehensive Surveillance. Front Cell Infect Microbiol 2017; 7:490. [PMID: 29238699 PMCID: PMC5713125 DOI: 10.3389/fcimb.2017.00490] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/14/2017] [Indexed: 12/05/2022] Open
Abstract
Ticks are obligate hematophagous arthropods of significant importance to human and veterinary medicine. They transmit a vast array of pathogens, including bacteria, viruses, protozoa, and helminths. Most epidemiological data on ticks and tick-borne pathogens (TBPs) in the West Indies are limited to common livestock pathogens such as Ehrlichia ruminantium, Babesia spp. (i.e., B. bovis and B. bigemina), and Anaplasma marginale, and less information is available on companion animal pathogens. Of note, human tick-borne diseases (TBDs) remain almost completely uncharacterized in the West Indies. Information on TBP presence in wildlife is also missing. Herein, we provide a comprehensive review of the ticks and TBPs affecting human and animal health in the Caribbean, and introduce the challenges associated with understanding TBD epidemiology and implementing successful TBD management in this region. In particular, we stress the need for innovative and versatile surveillance tools using high-throughput pathogen detection (e.g., high-throughput real-time microfluidic PCR). The use of such tools in large epidemiological surveys will likely improve TBD prevention and control programs in the Caribbean.
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Affiliation(s)
- Mathilde Gondard
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
- CIRAD, UMR ASTRE, Petit-Bourg, France
| | - Alejandro Cabezas-Cruz
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
- Faculty of Science, University of South Bohemia, Ceské Budejovice, Czechia
- Biology Center, Institute of Parasitology, Czech Academy of Sciences, Ceské Budejovice, Czechia
| | - Roxanne A. Charles
- Faculty of Medical Sciences, School of Veterinary Medicine, University of the West Indies, Mt. Hope, Trinidad and Tobago
| | - Muriel Vayssier-Taussat
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Emmanuel Albina
- CIRAD, UMR ASTRE, Petit-Bourg, France
- INRA, UMR 1319 ASTRE, Montpellier, France
| | - Sara Moutailler
- UMR BIPAR, Animal Health Laboratory, ANSES, INRA, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
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Abdel-Wahab N, Lopez-Olivo MA, Pinto-Patarroyo GP, Suarez-Almazor ME. Systematic review of case reports of antiphospholipid syndrome following infection. Lupus 2016; 25:1520-1531. [PMID: 27060064 PMCID: PMC7508159 DOI: 10.1177/0961203316640912] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to conduct a systematic review of case reports documenting the development of antiphospholipid syndrome or antiphospholipid syndrome-related features after an infection. METHODS We searched Medline, EMBASE, Web of Science, PubMed ePubs, and The Cochrane Library - CENTRAL through March 2015 without restrictions. Studies reporting cases of antiphospholipid syndrome or antiphospholipid syndrome-related features following an infection were included. RESULTS Two hundred and fifty-nine publications met inclusion criteria, reporting on 293 cases. Three different groups of patients were identified; group 1 included patients who fulfilled the criteria for definitive antiphospholipid syndrome (24.6%), group 2 included patients who developed transient antiphospholipid antibodies with thromboembolic phenomena (43.7%), and group 3 included patients who developed transient antiphospholipid antibodies without thromboembolic events (31.7%). The most common preceding infection was viral (55.6%). In cases that developed thromboembolic events Human immunodeficiency and Hepatitis C viruses were the most frequently reported. Parvovirus B19 was the most common in cases that developed antibodies without thromboembolic events. Hematological manifestations and peripheral thrombosis were the most common clinical manifestations. Positive anticardiolipin antibodies were the most frequent antibodies reported, primarily coexisting IgG and IgM isotypes. Few patients in groups 1 and 2 had persistent antiphospholipid antibodies for more than 6 months. Outcome was variable with some cases reporting persistent antiphospholipid syndrome features and others achieving complete resolution of clinical events. CONCLUSIONS Development of antiphospholipid antibodies with all traditional manifestations of antiphospholipid syndrome were observed after variety of infections, most frequently after chronic viral infections with Human immunodeficiency and Hepatitis C. The causal relationship between infection and antiphospholipid syndrome cannot be established, but the possible contribution of various infections in the pathogenesis of antiphospholipid syndrome need further longitudinal and controlled studies to establish the incidence, and better quantify the risk and the outcomes of antiphospholipid-related events after infection.
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Affiliation(s)
- N Abdel-Wahab
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt
| | - M A Lopez-Olivo
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G P Pinto-Patarroyo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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African Tick Bite Fever in a Portuguese Traveler Returning From South Africa. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31821ed104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wieten RW, Hovius JWR, Groen EJ, van der Wal AC, de Vries PJ, Beersma MFC, Tijsse-Klasen E, Sprong H, Grobusch MP. Molecular diagnostics of Rickettsia africae infection in travelers returning from South Africa to The Netherlands. Vector Borne Zoonotic Dis 2011; 11:1541-7. [PMID: 21867422 DOI: 10.1089/vbz.2011.0653] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND African tick-bite fever (ATBF) is frequently diagnosed in The Netherlands in travelers returning from South Africa. It is caused by Rickettsia africae and diagnosis is based on travel history and clinical presentation and usually confirmed by detecting serum antibodies against rickettsiae of the spotted fever group. However, these typically occur late in the course of the disease, and a mild clinical course or early antibiotic treatment can diminish antibody production. METHODS AND RESULTS Four travelers presented with (sub)febrile temperatures and eschar(s), several days after returning from South Africa. R. africae DNA was amplified and sequenced from skin biopsies of the eschars of all patients. Initial immunofluorescence assays yielded no immunoglobulin M (IgM)/IgG antibodies directed against spotted fever group rickettsiae; however, serology in the convalescent phase-several weeks after the patients had fully recovered-was positive. CONCLUSIONS ATBF should be considered in travelers returning from South Africa to The Netherlands with febrile illness and (multiple) skin lesions. The diagnosis can be confirmed by (paired) serology; however, polymerase chain reaction and sequencing on skin biopsies could be a (faster and more accurate) confirmatory test. Advantages of molecular methods over serology are species identification and high sensitivity early in the course of the disease.
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Affiliation(s)
- Rosanne W Wieten
- Department of Infectious Diseases, Tropical Medicine, and AIDS, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Hendershot EF, Sexton DJ. Scrub typhus and rickettsial diseases in international travelers: a review. Curr Infect Dis Rep 2010; 11:66-72. [PMID: 19094827 DOI: 10.1007/s11908-009-0010-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Physicians caring for febrile returned travelers face the difficult task of recognizing the typical and atypical features of more than 16 known rickettsial diseases and separating these diseases from potentially serious nonrickettsial diseases. Currently available diagnostic tools are inadequate for timely diagnosis. This review summarizes the English-language literature concerning imported rickettsial diseases in international travelers and describes important clinical principles in diagnosis and treatment of these illnesses. -Travelers with imported rickettsial disease often become sick before or within a few days of return from an endemic region. Illness that begins more than 18 days after return is unlikely to be rickettsial in origin. The absence of a skin rash or exposure to a vector should not dissuade clinicians from considering the possibility of a rickettsial disease in a returned traveler. Finally, if empiric therapy does not result in defervescence within 48 hours, an alternative nonrickettsial illness should be strongly considered.
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Affiliation(s)
- Edward F Hendershot
- Division of Infectious Diseases, Box 3281, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
During most of the 20th century, Rickettsia rickettsii, the agent of Rocky Mountain spotted fever, was considered the only tick-borne rickettsia associated with human diseases in the Americas. This dogma suggested that the other characterized and noncharacterized rickettsiae isolated from ticks were not pathogenic to humans. This concept has been modified extensively in the past 10 years with the identification of at least three additional rickettsial species that cause human tick-borne rickettsioses and that are prevalent in the Americas, including Rickettsia parkeri, Rickettsia massiliae, and Rickettsia africae. Moreover, the genetic variability of R. rickettsii and the milder forms of Rocky Mountain spotted fever reactivate the hypothesis that some circulating genotypes of R. rickettsii may be more virulent than others and may explain the wide variations in fatality rates of the disease.
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Mediannikov O, Trape JF, Diatta G, Parola P, Fournier PE, Raoult D. Rickettsia africae, Western Africa. Emerg Infect Dis 2010; 16:571-3. [PMID: 20202453 PMCID: PMC3322006 DOI: 10.3201/eid1603.090346] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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African tick-bite fever: a new entity in the differential diagnosis of multiple eschars in travelers. Description of five cases imported from South Africa to Switzerland. Int J Infect Dis 2010; 14 Suppl 3:e274-6. [PMID: 20233665 DOI: 10.1016/j.ijid.2009.11.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/10/2009] [Indexed: 11/23/2022] Open
Abstract
African tick-bite fever (ATBF) is a newly described spotted fever rickettsiosis that frequently presents with multiple eschars in travelers returning from sub-Saharan Africa and, to a lesser extent, from the West Indies. It is caused by the bite of an infected Amblyomma tick, whose hunting habits explain the typical presence of multiple inoculation skin lesions and the occurrence of clustered cases. The etiological agent of ATBF is Rickettsia africae, an emerging tick-borne pathogenic bacterium. We describe herein a cluster of five cases of ATBF occurring in Swiss travelers returning from South Africa. The co-incidental infections in these five patients and the presence of multiple inoculation eschars, two features pathognomonic of this rickettsial disease, suggested the diagnosis of ATBF. Indeed, the presence of at least one inoculation eschar is observed in 53-100% of cases and multiple eschars in 21-54%. Two patients presented regional lymphadenitis and one a mild local lymphangitis. Though a cutaneous rash is described in 15-46% of cases, no rash was observed in our series. ATBF was confirmed by serology. Thus, ATBF has recently emerged as one of the most important causes of flu-like illness in travelers returning from Southern Africa. The presence of one or multiple eschars of inoculation is an important clinical clue to the diagnosis. It can be confirmed by serology or by PCR of a biopsy of the eschar. Culture can also be done in reference laboratories. Dermatologists and primary care physicians should know this clinical entity, since an inexpensive and efficient treatment is available.
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13
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Robinson JB, Eremeeva ME, Olson PE, Thornton SA, Medina MJ, Sumner JW, Daschi GA. New approaches to detection and identification of Rickettsia africae and Ehrlichia ruminantium in Amblyomma variegatum (Acari: Ixodidae) ticks from the Caribbean. JOURNAL OF MEDICAL ENTOMOLOGY 2009; 46:942-951. [PMID: 19645301 DOI: 10.1603/033.046.0429] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Imported from Africa in the 1700s and despite frequent modern eradication efforts, Amblyomma variegatum (F.) spread through the Caribbean by cattle transport, small ruminants, and migrating birds. A. variegatum is a vector for Rickettsia africae, the causative agent of African tick bite fever, and Ehrlichia ruminantium, the causative agent of heartwater. We examined 95 A. variegatum and six Rhipicephalus (Boophilus) microplus (Canestrini) collected from cattle at an abattoir in Antigua. Engorged tick extracts adsorbed on Nobotu filter paper strips and new nested polymerase chain reaction (PCR) assays for E. ruminantium and Dermatophilus congolensis were used to evaluate these ticks for the presence of these pathogenic bacteria. Amblyomma ticks (62.4%) contained R. africae DNA by PCR/restriction fragment length polymorphism analysis and DNA sequencing of the OmpA and 17-kDa antigen genes. Twenty Amblyomma and two Rh. microplus contained E. ruminantium DNA. No E. chaffeensis, Anaplasma phagocytophilum, Coxiella burnetii, or D. congolensis DNA was detected in these ticks. The continued presence of Am. variegatum in the Caribbean poses a significant risk of infection in cattle with E. ruminantium and in humans by R. africae. Eradication efforts are essential to prevent the further spread of Am. variegatum.
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Affiliation(s)
- Jennilee B Robinson
- National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA
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Cazorla C, Socolovschi C, Jensenius M, Parola P. Tick-borne Diseases: Tick-borne Spotted Fever Rickettsioses in Africa. Infect Dis Clin North Am 2008; 22:531-44, ix-x. [DOI: 10.1016/j.idc.2008.03.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roch N, Epaulard O, Pelloux I, Pavese P, Brion JP, Raoult D, Maurin M. African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clin Infect Dis 2008; 47:e28-35. [PMID: 18558881 DOI: 10.1086/589868] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND African tick-bite fever, a tickborne disease caused by Rickettsia africae, is endemic in rural areas of sub-Saharan Africa and in the French West Indies. Most cases reported in the literature occurred in middle-aged, otherwise-healthy persons and corresponded to benign diseases. The course of African tick bite fever in elderly people is less well documented. METHODS The medical records of 8 elderly patients infected with R. africae during a trip to South Africa in 2005 are presented to summarize the epidemiologic, clinical, microbiological, treatment, and disease course characteristics. RESULTS Eight patients, aged 63-75 years, developed African tick bite fever symptoms after a trip to South Africa. R. africae was grown from cutaneous eschar biopsy specimens obtained from 4 patients, confirming African tick bite fever. We observed unusual findings in this elderly population. Rash was frequent (present in 87.5% of patients), vesicular (in 100% of patients with rash), and often associated with an enanthema (in 50% of patients with rash). Severe clinical manifestations occurred: lymphangitis and myocarditis in 1 patient and suspected brain involvement in 2 patients. We observed severe and long-lasting general symptoms, including fever (in 75% of patients), chills (87.5%), asthenia (50%), anorexia (50%), and weight loss (12.5%). With doxycycline therapy, the outcome was favorable in all cases, but complete recovery was slow. CONCLUSION Ecotourism to sub-Saharan Africa is expanding, and people of advanced age, often with underlying chronic diseases, account for an increasing proportion of travelers. African tick bite fever appears to be more symptomatic in this population. Recommendations advising personal prophylactic measures to prevent tick bites in travelers to regions of endemicity may be particularly important for elderly individuals.
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Affiliation(s)
- Nathalie Roch
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
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A case of spotted fever group rickettsiosis imported into the United Kingdom and treated with ciprofloxacin: a case report. J Med Case Rep 2008; 2:98. [PMID: 18387179 PMCID: PMC2358909 DOI: 10.1186/1752-1947-2-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 04/03/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Spotted fever group rickettsioses are an interesting group of infections, which are increasing in incidence worldwide. Case presentation Here we describe an imported case to the United Kingdom occurring in a patient who had recently visited Kruger National Park in South Africa – a highly endemic area for Rickettsia infections. Initial treatment with doxycycline failed but the patient made a prompt recovery after commencement of ciprofloxacin. Conclusion This finding raises the possibility that there are resistant strains of Rickettsia present.
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Jensenius M, Fournier PE, Fladby T, Hellum KB, Hagen T, Priø T, Christiansen MS, Vene S, Raoult D, Myrvang B. Sub-acute neuropathy in patients with African tick bite fever. ACTA ACUST UNITED AC 2006; 38:114-8. [PMID: 16449002 DOI: 10.1080/00365540500321579] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
African tick bite fever (ATBF) caused by Rickettsia africae is an emerging health problem in travellers to sub-Saharan Africa. We here present 6 patients with evidence of long-lasting sub-acute neuropathy following ATBF contracted during safari trips to southern Africa. Three patients developed radiating pain, paresthaesia and/or motor weakness of extremities, 2 had hemi-facial pain and paresthaesia, and 1 developed unilateral sensorineural hearing loss. When evaluated 3-26 months after symptom onset, cerebrospinal fluid samples from 5 patients were negative for R. africae PCR and serology, but revealed elevated protein content in 3 and mild pleocytosis in 1 case. Despite extensive investigations, no plausible alternative causes of neuropathy could be identified. Treatment with doxycycline in 2 patients had no clinical effect. Given the current increase of international safari tourism to sub-Saharan Africa, more cases of sub-acute neuropathy following ATBF may well be encountered in Europe and elsewhere in the y to come.
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Abstract
Rickettsia africae is the agent of African tick-bite fever, a mild but common disease of local persons and tourists in Africa. The major vector of this spotted fever group rickettsia is most likely Amblyomma variegatum, the tropical bont tick, which has become widely distributed through the West Indies in the last 30 years. This report reviews all available information on R. africae in the West Indies.
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Affiliation(s)
- Patrick J Kelly
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis, West Indies.
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Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 2005; 18:719-56. [PMID: 16223955 PMCID: PMC1265907 DOI: 10.1128/cmr.18.4.719-756.2005] [Citation(s) in RCA: 716] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
During most of the 20th century, the epidemiology of tick-borne rickettsioses could be summarized as the occurrence of a single pathogenic rickettsia on each continent. An element of this paradigm suggested that the many other characterized and noncharacterized rickettsiae isolated from ticks were not pathogenic to humans. In this context, it was considered that relatively few tick-borne rickettsiae caused human disease. This concept was modified extensively from 1984 through 2005 by the identification of at least 11 additional rickettsial species or subspecies that cause tick-borne rickettsioses around the world. Of these agents, seven were initially isolated from ticks, often years or decades before a definitive association with human disease was established. We present here the tick-borne rickettsioses described through 2005 and focus on the epidemiological circumstances that have played a role in the emergence of the newly recognized diseases.
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Affiliation(s)
- Philippe Parola
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Université de la Méditerranée, Faculté de Médecine, 13385 Marseille Cedex 5, France
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20
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Jensenius M, Parola P, Raoult D. Threats to international travellers posed by tick-borne diseases. Travel Med Infect Dis 2004; 4:4-13. [PMID: 16887719 DOI: 10.1016/j.tmaid.2004.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To date, 14 tick-borne diseases have been reported in international travellers, the majority of cases being Lyme borreliosis caused by Borrelia burgdorferi sensu lato in North America and Eurasia, African tick bite fever caused by Rickettsia africae in sub-Saharan Africa and eastern Caribbean, and Central European encephalitis caused by tick-borne encephalitis virus in Europe. The clinical presentation is frequently non-specific, and tick-borne diseases should always, in the absence of other likely diagnoses, be suspected in travellers with flu-like symptoms following a recent visit to tick-infested areas. Feasible microbiological diagnostic tests are widely unavailable, at least outside areas of endemicity where many infected travellers present. Empiric treatment with doxycycline should be considered in suspected cases of tick-borne bacterial diseases. Since ecotourism and adventure travel are increasingly popular worldwide, the incidence of travel-associated tick-borne diseases is likely to increase in the future.
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Affiliation(s)
- Mogens Jensenius
- Department of Internal Medicine, Aker University Hospital, Oslo, Norway.
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21
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Oteo JA, Portillo A, Blanco JR, Ibarra V, Santibáñez S. [Rickettsia africae infection. Three cases confirmed by PCR]. Med Clin (Barc) 2004; 122:786-8. [PMID: 15207109 DOI: 10.1016/s0025-7753(04)74386-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE African tick bite fever or Rickettsia africae infection has been recognized as an emerging health problem in the last few years. The aim of this study was to describe 3 cases of Spanish tourists who suffered from R. africae infection after visiting South Africa. PATIENTS AND METHOD Three patients with a suspected rickettsial disease according to epidemiological and clinical manifestations (fever, eschar and exanthema) were studied. Antibodies against Rickettsia conorii were determined by IFI assays. Semi-nested PCR reactions (rOmpA) and subsequent sequence analysis of the amplified products were also carried out. RESULTS Epidemiological and clinical aspects of this rickettsiosis are described. For diagnosis of this rickettsial disease, conventional serological assays (IFI) were less useful than semi-nested rOmpA PCR reactions, which showed a sensitivity of 100% in our samples. CONCLUSIONS Three cases of R. africae infection are reported. PCR and subsequent sequencing of the amplicons are useful for the microbiological confirmation of this type of infection. We must think about African tick-bite fever as a possible diagnosis in patients with a febrile rash after returning from endemic areas.
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Affiliation(s)
- José A Oteo
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital de La Rioja, Logroño, España.
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22
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Jensenius M, Fournier PE, Raoult D. Tick-borne rickettsioses in international travellers. Int J Infect Dis 2004; 8:139-46. [PMID: 15109588 DOI: 10.1016/j.ijid.2003.06.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2003] [Revised: 06/24/2003] [Accepted: 06/25/2003] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tick-borne rickettsioses are of emerging importance in today's travel medicine but have until recently received little attention. We describe the current knowledge of tick-borne rickettsioses as they relate to international travel, their microbiological diagnosis, treatment, possible prevention, and future prospects. METHODS Literature-based review and personal observations. RESULTS During the last decade, some 400 cases of tick-borne rickettsioses have been reported in international travellers, the vast majority being African tick bite fever caused by Rickettsia africae and Mediterranean spotted fever caused by Rickettsia conorii. Only a minority of infected travellers can recall a preceding tick bite. Most patients present with a mild-to-moderately severe flu-like illness typically accompanied by a cutaneous rash and an inoculation eschar at the site of the tick bite, but potentially life-threatening disease with disseminated vaculitis is occasionally seen. Definite microbiological confirmation of tick-borne rickettsioses by isolation or antigen detection is only available at reference laboratories and diagnosis must in most cases rely on clinical and epidemiological data supported by serology. Doxycycline is the recommended treatment for tick-borne rickettsioses and prevention is based on personal protective measures against tick bites when travelling in endemic areas. CONCLUSION Tick-borne rickettsiosis should be suspected in febrile returnees from endemic areas, especially in cases with skin eruptions. Travellers to endemic areas should be encouraged to use 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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23
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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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Parola P, Attali J, Raoult D. First detection of Rickettsia africae on Martinique, in the French West Indies. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2003; 97:535-7. [PMID: 12930619 DOI: 10.1179/000349803225001382] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- P Parola
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
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25
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Abstract
Ticks are a part of the landscape where humans live, work, and play. Because ticks carry a wide range of organisms that potentially can cause disease in humans, many studies have focused on ways to reduce risk of these diseases. Ticks have biologically complex interactions with microorganisms and with their vertebrate hosts, on whom they depend for blood meals and survival. To consider ways to reduce the burden of tick-borne diseases in humans, it is necessary to understand the biology and ecology of ticks and their interface with humans. In many areas, changes in land use, reforestation, and patterns of human settlements have led to more abundant tick populations, increasing rates of infections in ticks, and increasing contact with human populations. Warmer winter temperatures in temperate regions may extend the transmission season for some ticks and pathogens. Although much of the discussion in this article has focused on I. scapularis and the Lyme disease spirochete (because they have been studied extensively), other tick-pathogen pairs may differ in risk factors for infection and transmission dynamics. Interventions studied to reduce the burden of tick-borne diseases include changing the environment, controlling vertebrate hosts, killing ticks, altering the behavior of humans, treating tick bites, and trying to protect humans through immunologic means (vaccine). All of these approaches have limitations and drawbacks. From a public health perspective, a plan that employs multiple strategies may be most effective. This article has reviewed what is known about preventive interventions, including the vaccine.
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Fournier PE, Jensenius M, Laferl H, Vene S, Raoult D. Kinetics of antibody responses in Rickettsia africae and Rickettsia conorii infections. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2002; 9:324-8. [PMID: 11874871 PMCID: PMC119950 DOI: 10.1128/cdli.9.2.324-328.2002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
African tick-bite fever, caused by Rickettsia africae, is the most common tick-borne rickettsiosis in sub-Saharan Africa. Mediterranean spotted fever due to Rickettsia conorii also occurs in the region but is more prevalent in Mediterranean countries. Using microimmunofluorescence, we compared the development of immunoglobulin G (IgG) and IgM titers in 48 patients with African tick-bite fever and 48 patients with Mediterranean spotted fever. Doxycycline treatment within 7 days from the onset of disease significantly prevented the development of antibodies to R. africae. In patients with African tick-bite fever, the median times to seroconversion with IgG and IgM were 28 and 25 days, respectively, after the onset of symptoms. These were significantly longer by a median of 6 days for IgG and 9 days for IgM than the times for seroconversion in patients with Mediterranean spotted fever (P < 10(-2)). We recommend that sera collected 4 weeks after the onset of signs of patients with suspected African tick-bite fever should be used for the definitive serological diagnosis of R. africae infections.
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Affiliation(s)
- Pierre-Edouard Fournier
- Unité des Rickettsies, CNRS:UPRESA 6020, Faculté de Médecine, Université de la Méditerranée, 13385 Marseille Cedex 05, France
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27
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Raoult D, Fournier PE, Fenollar F, Jensenius M, Prioe T, de Pina JJ, Caruso G, Jones N, Laferl H, Rosenblatt JE, Marrie TJ. Rickettsia africae, a tick-borne pathogen in travelers to sub-Saharan Africa. N Engl J Med 2001; 344:1504-10. [PMID: 11357153 DOI: 10.1056/nejm200105173442003] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND African tick-bite fever occurs after contact with ticks that carry Rickettsia africae and that parasitize cattle and game. Sporadic reports suggest that this infection has specific clinical and epidemiologic features. METHODS We studied patients who were tested for a rickettsial disease after returning from a visit to Africa or Guadeloupe. To assess the value of the microimmunofluorescence assay, Western blotting, and cross-adsorption assays, we compared the results of these tests in 39 patients in whom African tick-bite fever had been confirmed by the polymerase-chain reaction assay, cell culture, or both; 50 patients with documented R. conorii infection; and 50 blood donors. These diagnostic criteria were then applied to 376 additional patients who had returned from southern Africa and 2 who had returned from Guadeloupe and whose serum was being tested for rickettsial disease. RESULTS In the 39 patients with direct evidence of R. africae infection, the combination of microimmunofluorescence assay, Western blotting, and cross-adsorption assays showing antibodies specific for R. africae had a sensitivity of 0.56; however, each test had a positive predictive value and a specificity of 1.0. An additional 80 patients were found to have an R. africae infection on the basis of these serologic criteria. Infections with R. africae were acquired by visitors to 11 African countries and Guadeloupe. The illness was generally mild and was characterized by a rash in 46 percent of the patients; the rash was usually maculopapular or vesicular and rarely purpuric. Ninety-five percent of patients had an inoculation eschar or eschars, and 54 percent of these patients had multiple eschars, a finding that is unusual in patients with rickettsial infection. CONCLUSIONS In this series, R. africae was the cause of nearly all cases of tick-bite rickettsiosis in patients who became ill after a trip to sub-Saharan Africa.
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Affiliation(s)
- D Raoult
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseilles, France.
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28
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Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. Clin Infect Dis 2001; 32:897-928. [PMID: 11247714 DOI: 10.1086/319347] [Citation(s) in RCA: 711] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2000] [Revised: 07/21/2000] [Indexed: 11/04/2022] Open
Abstract
Ticks are currently considered to be second only to mosquitoes as vectors of human infectious diseases in the world. Each tick species has preferred environmental conditions and biotopes that determine the geographic distribution of the ticks and, consequently, the risk areas for tickborne diseases. This is particularly the case when ticks are vectors and reservoirs of the pathogens. Since the identification of Borrelia burgdorferi as the agent of Lyme disease in 1982, 15 ixodid-borne bacterial pathogens have been described throughout the world, including 8 rickettsiae, 3 ehrlichiae, and 4 species of the Borrelia burgdorferi complex. This article reviews and illustrate various aspects of the biology of ticks and the tickborne bacterial diseases (rickettsioses, ehrlichioses, Lyme disease, relapsing fever borrelioses, tularemia, Q fever), particularly those regarded as emerging diseases. Methods are described for the detection and isolation of bacteria from ticks and advice is given on how tick bites may be prevented and how clinicians should deal with patients who have been bitten by ticks.
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Affiliation(s)
- P Parola
- Unité des Rickettsies, CNRS UMR 6020, Université de la Méditerranée, Faculté de Médecine, Marseille, France
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Burridge MJ, Simmons LA, Allan SA. Introduction of potential heartwater vectors and other exotic ticks into Florida on imported reptiles. J Parasitol 2000; 86:700-4. [PMID: 10958443 DOI: 10.1645/0022-3395(2000)086[0700:iophva]2.0.co;2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following the discovery of establishment of the African tortoise tick Amblyomma marmoreum in Florida, the present study was undertaken to determine the extent of introduction of exotic ticks into Florida on imported reptiles. Exotic ticks were identified on 29 (91%) of 32 reptile premises in 18 counties of Florida. The ticks, found on a variety of imported tortoises, snakes, and monitor lizards, belonged to 4 Amblyomma species (A. marmoreum, Amblyomma nuttalli, Amblyomma sabanerae, and Amblyomma sparsum) and 4 Aponomma species (Aponomma exornatum, Aponomma flavomaculatum, Aponomma latum, and Aponomma varanensis). The most commonly encountered ticks were A. latum and A. marmoreum. The identifications of A. marmoreum on 8 premises in 7 counties, and of A. sparsum on 1 premises, are of great concern because both species are vectors of heartwater, a lethal disease of cattle, sheep, goats, and deer.
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Affiliation(s)
- M J Burridge
- Department of Pathobiology, College of Veterinary Medicine, University of Florida, Gainesville 32611-0880, USA
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