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Ngamprasertchai T, Hanboonkunupakarn B, Piyaphanee W. Rickettsiosis in Southeast Asia: Summary for International Travellers during the COVID-19 Pandemic. Trop Med Infect Dis 2022; 7:tropicalmed7020018. [PMID: 35202213 PMCID: PMC8879928 DOI: 10.3390/tropicalmed7020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Rickettsiosis is an important cause of febrile illness among travellers visiting Southeast Asia (SEA). The true incidence of rickettsiosis is underestimated; however, murine typhus and scrub typhus are widely distributed across SEA. Among travellers visiting SEA, scrub typhus was mostly reported from Thailand, whereas murine typhus was frequently found in Indonesia. Although most cases are self-limited or present with mild symptoms, a few cases with severe clinical manifestations have been reported. Doxycycline remains the key treatment of rickettsiosis. Some travellers, such as backpackers, trekkers, or cave explorers, are at a higher risk for rickettsiosis than others. Therefore, in resource-limited conditions, empirical treatment should be considered in these travellers. The coronavirus disease 2019 (COVID-19) pandemic has contributed to difficulty in the diagnosis of rickettsiosis because of the clinical similarities between these diseases. In addition, physical distancing mandated by COVID-19 management guidelines limits accurate physical examination, resulting in misdiagnosis and delayed treatment of rickettsiosis. This review summarises the characteristics of murine typhus and scrub typhus, describes travel-associated rickettsiosis, and discusses the impact of the COVID-19 pandemic on rickettsiosis.
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Lokida D, Hadi U, Lau CY, Kosasih H, Liang CJ, Rusli M, Sudarmono P, Lukman N, Laras K, Asdie RH, Murniati D, Utama IMS, Mubin RH, Karyana M, Gasem MH, Alisjahbana B. Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results. BMC Infect Dis 2020; 20:364. [PMID: 32448167 PMCID: PMC7245627 DOI: 10.1186/s12879-020-05057-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023] Open
Abstract
Background Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia. Methods Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management. Results R. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities. Conclusions Rickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.
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Affiliation(s)
- Dewi Lokida
- Tangerang District Hospital, Tangerang, Indonesia.,Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Usman Hadi
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia.
| | - C Jason Liang
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Musofa Rusli
- Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Kanti Laras
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | | | | | | | | | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia.,National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | | | - Bachti Alisjahbana
- Hasan Sadikin Hospital - Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Low VL, Tan TK, Khoo JJ, Lim FS, AbuBakar S. An overview of rickettsiae in Southeast Asia: Vector-animal-human interface. Acta Trop 2020; 202:105282. [PMID: 31778642 DOI: 10.1016/j.actatropica.2019.105282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 02/07/2023]
Abstract
Rickettsioses are emerging, and re-emerging diseases caused by obligate intracellular arthropod-borne bacteria that infect humans and animals worldwide. Various rickettsiae such as Orientia, Rickettsia, Anaplasma and Ehrlichia have been circulated in companion, domesticated and wild animals through bites of infected ticks, fleas, lice or mites. This review summarizes the infections of rickettsiae, including the newly discovered regional species Rickettsia thailandii, Candidatus Rickettsia sepangensis, Candidatus Rickettsia johorensis, Candidatus Rickettsia laoensis, Candidatus Rickettsia mahosotii, Candidatus Rickettsia khammouanensis, Candidatus Anaplasma pangolinii, and other novel genotypes in vectors, humans and animals in Southeast Asia. Issues on some unidentified rickettsiae that elicit immune responses and production of antibodies that are cross-reactive with the antigens used are discussed. Knowledge gaps which required attention are also identified in this review.
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Affiliation(s)
- Van Lun Low
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia.
| | - Tiong Kai Tan
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jing Jing Khoo
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Fang Shiang Lim
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia; Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Bouchaib H, Eldin C, Laroche M, Raoult D, Parola P. Tick- and flea-borne rickettsioses in Tizi-Ouzou, Algeria: Implications for travel medicine. Travel Med Infect Dis 2018; 26:51-57. [PMID: 30419355 DOI: 10.1016/j.tmaid.2018.11.005] [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] [Received: 06/26/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Algeria, Mediterranean spotted fever (MSF), caused by Rickettsia conorii conorii and transmitted by Rhipicephalus sanguineus, is endemic. However, the documentation of cases is rare due to a lack of laboratory facilities. Our aim was to screen for rickettsioses in patients with fever, rash and a possible inoculation eschar. MATERIALS AND METHODS Between 2013 and 2015, patients with a fever and a rash presenting at hospitals in the Tizi-Ouzou region were prospectively included in our study. Sera were screened using Indirect Immunofluorescence Assay (IFA) and qPCR was performed on swab samples from eschars. RESULTS One hundred and sixty-six patients were included. For 57 patients, MSF due to R. conorii conorii was diagnosed by serology and qPCR on a swab eschar sample. Three patients were diagnosed with murine typhus, a flea borne rickettsiosis. In addition, two patients had a positive serology in IgM for R. felis. For nine patients, serology for rickettsiosis was positive, but the specific rickettsia involved could not be determined. Nine patients had a severe disease with neurological involvement or multi-organ failure. CONCLUSION Clinicians should routinely screen for rickettsioses in patients and travellers presenting with a rash upon return from Algeria. Doxycycline treatment must be given promptly because the prognosis can be severe.
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Affiliation(s)
- Hayet Bouchaib
- Service des Maladies Infectieuses, Centre Hospitalo-Universitaire de Tizi- Ouzou, Algeria
| | - Carole Eldin
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Maureen Laroche
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.
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Ehounoud C, Fenollar F, Dahmani M, N’Guessan J, Raoult D, Mediannikov O. Bacterial arthropod-borne diseases in West Africa. Acta Trop 2017; 171:124-137. [PMID: 28365316 DOI: 10.1016/j.actatropica.2017.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 01/18/2023]
Abstract
Arthropods such as ticks, lice, fleas and mites are excellent vectors for many pathogenic agents including bacteria, protozoa and viruses to animals. Moreover, many of these pathogens can also be accidentally transmitted to humans throughout the world. Bacterial vector-borne diseases seem to be numerous and very important in human pathology, however, they are often ignored and are not well known. Yet they are in a phase of geographic expansion and play an important role in the etiology of febrile episodes in regions of Africa. Since the introduction of molecular techniques, the presence of these pathogens has been confirmed in various samples from arthropods and animals, and more rarely from human samples in West Africa. In this review, the aim is to summarize the latest information about vector-borne bacteria, focusing on West Africa from 2000 until today in order to better understand the epidemiological risks associated with these arthropods. This will allow health and veterinary authorities to develop a strategy for surveillance of arthropods and bacterial disease in order to protect people and animals.
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Malheiro L, Ceia F, Alves J, Carvalho AC, Sobrinho-Simões J, Sousa R, Sarmento A, Santos L. Severe interstitial pneumonia due to murine typhus in a patient returning from Bali. IDCases 2017; 9:17-20. [PMID: 28560173 PMCID: PMC5440275 DOI: 10.1016/j.idcr.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Abstract
Murine typhus has been increasingly reported as a cause of fever in returning travelers from Southeast Asia. We report a case of a previously healthy traveler returning from Bali with an non-specific febrile illness which quickly progressed to a severe form of interstitial pneumonia. After a careful epidemiological evaluation and laboratory analysis, murine typhus was diagnosed.
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Affiliation(s)
- Luís Malheiro
- Serviço de Doenças Infecciosas (Infectious Diseases Department), Centro Hospitalar de S. João, Porto, Portugal.,Unidade de Cuidados Intensivos de Doenças Infeciosas (Intensive Care Unit of Infectious Diseases), Centro Hospitalar de S. João, Porto, Portugal
| | - Filipa Ceia
- Serviço de Doenças Infecciosas (Infectious Diseases Department), Centro Hospitalar de S. João, Porto, Portugal
| | - João Alves
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, E.P.E., Lisboa, Portugal
| | - Ana Cláudia Carvalho
- Serviço de Doenças Infecciosas (Infectious Diseases Department), Centro Hospitalar de S. João, Porto, Portugal
| | | | - Rita Sousa
- Instituto Nacional de Saúde Doutor Ricardo Jorge (National Institute of Health Doutor Ricardo Jorge), Centro de Estudos de Vectores e Doenças Infecciosas Dr. Francisco Cambournac (CEVDI) (Center for Vectors and Infectious Disease Research (CEVDI) and Gastrointestinal Infections Laboratory), Aguas de Moura, Portugal
| | - António Sarmento
- Serviço de Doenças Infecciosas (Infectious Diseases Department), Centro Hospitalar de S. João, Porto, Portugal.,Unidade de Cuidados Intensivos de Doenças Infeciosas (Intensive Care Unit of Infectious Diseases), Centro Hospitalar de S. João, Porto, Portugal
| | - Lurdes Santos
- Serviço de Doenças Infecciosas (Infectious Diseases Department), Centro Hospitalar de S. João, Porto, Portugal.,Unidade de Cuidados Intensivos de Doenças Infeciosas (Intensive Care Unit of Infectious Diseases), Centro Hospitalar de S. João, Porto, Portugal
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8
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Aung AK, Spelman DW, Murray RJ, Graves S. Rickettsial infections in Southeast Asia: implications for local populace and febrile returned travelers. Am J Trop Med Hyg 2014; 91:451-60. [PMID: 24957537 DOI: 10.4269/ajtmh.14-0191] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsial infections represent a major cause of non-malarial febrile illnesses among the residents of Southeast Asia and returned travelers from that region. There are several challenges in recognition, diagnosis, and management of rickettsioses endemic to Southeast Asia. This review focuses on the prevalent rickettsial infections, namely, murine typhus (Rickettsia typhi), scrub typhus (Orientia tsutsugamushi), and members of spotted fever group rickettsiae. Information on epidemiology and regional variance in the prevalence of rickettsial infections is analyzed. Clinical characteristics of main groups of rickettsioses, unusual presentations, and common pitfalls in diagnosis are further discussed. In particular, relevant epidemiologic and clinical aspects on emerging spotted fever group rickettsiae in the region, such as Rickettsia honei, R. felis, R. japonica, and R. helvetica, are presented. Furthermore, challenges in laboratory diagnosis and management aspects of rickettsial infections unique to Southeast Asia are discussed, and data on emerging resistance to antimicrobial drugs and treatment/prevention options are also reviewed.
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Affiliation(s)
- Ar Kar Aung
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Denis W Spelman
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Ronan J Murray
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Stephen Graves
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
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Chareonviriyaphap T, Leepitakrat W, Lerdthusnee K, Chao CC, Ching WM. Dual exposure of Rickettsia typhi and Orientia tsutsugamushi in the field-collected Rattus rodents from Thailand. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2014; 39:182-189. [PMID: 24820571 DOI: 10.1111/j.1948-7134.2014.12085.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
Field-collected rodents and fleas from ten provinces covering four regions of Thailand were investigated for possible rickettsial pathogen infections. The 257 trapped-rodents belonged to 12 species. Five species of Genus Rattus accounted for 93% of the total capture, of which Rattus exulans and Rattus norvegicus were the two major species caught. All flea specimens, removed from trapped rodents, were identified as Xenopsylla cheopis. The PCR technique was performed on ectoparasite specimens to detect the presence of murine typhus pathogen (Rickettsia typhi) and scrub typhus pathogen (Orientia tsutsugamushi). Thirteen flea specimens (2.6 %) were found to be positive for R. typhi but none for O. tsutsugamushi. An ELISA technique was used to detect the rodent's antibodies against R. typhi and O. tsutsugamushi. Sixty-one rodent serum samples (23.7%) were positive for R. typhi specific IgM, IgG, or both, while 47 of the samples (18.3%) were positive for O. tsutsugamushi. Twenty serum samples from R. norvegicus (7.8%) had detectable antibodies against both R. typhi and O. tsutsugamushi. Our findings revealed the existence of the dual infection of rickettsial pathogens in the same natural hosts.
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Znazen A, Hammami B, Mustapha AB, Chaari S, Lahiani D, Maaloul I, Jemaa MB, Hammami A. Murine typhus in Tunisia: a neglected cause of fever as a single symptom. Med Mal Infect 2013; 43:226-9. [PMID: 23619288 DOI: 10.1016/j.medmal.2013.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/17/2012] [Accepted: 02/15/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We had for aim to describe the epidemiologic and clinic characteristics of murine typhus in a series of 43 serologically confirmed cases, in our region. PATIENTS AND METHODS Serologic screening for IgG and IgM against Rickettsia typhi was performed in 1024 patients during three years (2006-2008). The characteristics of patients with a positive serology were examined retrospectively. One hundred and seventy sera obtained from blood donors were tested to detect IgG against R. typhi to determine the seroprevalence of the infection. RESULTS There was evidence of recent R. typhi infection in 43 patients (4.2%) during the study period, and 3.7% of blood donors had IgG against R. typhi. The mean age of patients was 43.1 years and the sex-ratio was 1.04. Among the patients, 58.1% were from rural areas. No patient reported any exposure to rats or rat-fleas. There were more cases during the summer and fall. The most frequent complaint was fever as a single symptom (67.5%). A cutaneous rash was reported in 44.1% and headache in 60.5% of patients. Among the patients, 44.1% presented with thrombopenia and 47.2% with elevated liver enzymes. CONCLUSION Murine typhus seems to be frequent in Tunisia. This infection could be a threat for travellers. Serology should be performed systematically in patients with fever as a single symptom since its clinical presentation is non-specific.
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Affiliation(s)
- A Znazen
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia.
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11
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Raby E, Dyer JR. Endemic (murine) typhus in returned travelers from Asia, a case series: clues to early diagnosis and comparison with dengue. Am J Trop Med Hyg 2013; 88:701-3. [PMID: 23358638 DOI: 10.4269/ajtmh.12-0590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Edward Raby
- Infectious Diseases Service, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
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12
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Walker DH. Rickettsial diseases in travelers. Travel Med Infect Dis 2012; 1:35-40. [PMID: 17291879 DOI: 10.1016/s1477-8939(03)00025-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 03/11/2003] [Indexed: 10/27/2022]
Abstract
Often undiagnosed in travelers with acute nonspecific febrile illness, gastrointestinal, abdominal, pulmonary, neurologic, or cutaneous signs and symptoms, rickettsial diseases are transmitted in particular geographic and ecologic settings by ticks, fleas, chiggers, and lice. Recognition of an eschar at the vector inoculation site can be a key diagnostic clue for scrub typhus, African tick bite fever, and other tick-borne spotted fevers. Although laboratory confirmation is necessary, usually during convalescence, for an accurate diagnosis, a clinical diagnosis and empiric treatment with doxycycline are the standard practical approach. Knowledge of potential exposure, the natural history of the infection, and incubation periods of each rickettsiosis assist in considering particular rickettsioses.
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Affiliation(s)
- David H Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, 301 University Boulevard, Rm 1.116, Keiller Building, Galveston, TX 77555-0609, USA
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13
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Walter G, Botelho-Nevers E, Socolovschi C, Raoult D, Parola P. Murine typhus in returned travelers: a report of thirty-two cases. Am J Trop Med Hyg 2012; 86:1049-53. [PMID: 22665617 DOI: 10.4269/ajtmh.2012.11-0794] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Murine typhus, caused by Rickettsia typhi and transmitted mainly by the rat fleas, Xenopsylla cheopis, has emerged in the field of travel medicine. We analyzed retrospectively the epidemiological, clinical, and biological characteristics of the 32 murine typhus cases that were diagnosed during the past 3 years at the World Health Organization Collaborative Center for Rickettsial diseases, Marseille, France. All of the cases occurred in travelers and most of them had returned from Africa (N = 13 of 32) and South-east Asia (N = 12 of 32). Exposure to rats was reported only in a few (N = 2 of 32) patients. Almost half of the cases were diagnosed in August and September. Only four patients presented the classic triad: fever, rash, and headache. Moreover, we report the first known cases of a hemophagocytic syndrome associated with this disease. Murine typhus must be considered as an etiologic agent of febrile illness in returning travelers, particularly in those with unspecific symptoms.
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Affiliation(s)
- Gaëlle Walter
- Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UMR CNRS-IRD, WHO Collaborative Center for Rickettsial Diseases and Other Arthropod-borne Bacterial Diseases, Marseille, France.
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14
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Chaliotis G, Kritsotakis EI, Psaroulaki A, Tselentis Y, Gikas A. Murine typhus in central Greece: epidemiological, clinical, laboratory, and therapeutic-response features of 90 cases. Int J Infect Dis 2012; 16:e591-6. [PMID: 22658872 DOI: 10.1016/j.ijid.2012.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/12/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To document and evaluate the clinico-epidemiological profile of murine typhus during the re-emergence of the disease in a previously endemic focus in central Greece. METHODS This was a 5-year, hospital-based, observational study, in which 90 adult patients with murine typhus were prospectively identified and studied. RESULTS Most cases of the disease occurred in rural (52%) and semi-urban (34%) settings, with a seasonal frequency peak during the late summer. The triad of fever, headache, and rash was present in 64% of the patients within 2 days of hospital admission. Normal white blood cell counts (63%), thrombocytopenia (81%), and a high erythrocyte sedimentation rate (93%) were the main hematological findings upon presentation. Elevated aminotransferases (>84%), hypoalbuminemia (81%), and hyponatremia (36%) were prominent biochemical abnormalities. Pulmonary, neurological, and renal complications were noted in 26% of the patients and subsided after specific treatment. The duration of fever was shorter in patients treated with doxycycline (median 3 days) compared to ofloxacin (p=0.001) or doxycycline plus ofloxacin (p=0.009). CONCLUSIONS Murine typhus has the potential to cause significant morbidity. Awareness of the disease in endemic areas, early recognition of its clinical and laboratory features, and prompt administration of effective treatment are key factors to prevent potentially severe complications.
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Affiliation(s)
- George Chaliotis
- Department of Internal Medicine, General Hospital of Chalkida, Evia, Greece
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15
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Takeshita N, Imoto K, Ando S, Yanagisawa K, Ohji G, Kato Y, Sakata A, Hosokawa N, Kishimoto T. Murine typhus in two travelers returning from Bali, Indonesia: an underdiagnosed disease. J Travel Med 2010; 17:356-8. [PMID: 20920060 DOI: 10.1111/j.1708-8305.2010.00438.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two Japanese travelers from Bali were diagnosed with murine typhus in Japan during the same period. Although one had only mild illness, the other experienced liver and kidney dysfunction. Murine typhus may be missed not only in endemic areas around the world, but also in travelers, especially those returning from marine resorts in these areas.
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Affiliation(s)
- Nozomi Takeshita
- Disease Control and Prevention Center, International Medical Center of Japan, Toyama Hospital, Tokyo, Japan.
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16
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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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17
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Jensenius M, Davis X, von Sonnenburg F, Schwartz E, Keystone JS, Leder K, Lopéz-Véléz R, Caumes E, Cramer JP, Chen L, Parola P. Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996-2008. Emerg Infect Dis 2010; 15:1791-8. [PMID: 19891867 PMCID: PMC2857242 DOI: 10.3201/eid1511.090677] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Spotted fever group rickettsiosis acquired in sub-Saharan Africa was the most common rickettsial disease observed.
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Affiliation(s)
- Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Ullevål, NO-0407 Oslo, Norway.
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18
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Affiliation(s)
- Nadjet Mouffok
- Service des Maladies Infectieuses CHU’Oran, Oran, Algeria
| | - Philippe Parola
- World Health Organization Collaborative Centre for Rickettsial and Arthropod-borne Bacterial Diseases, Marseilles, France
| | - Didier Raoult
- World Health Organization Collaborative Centre for Rickettsial and Arthropod-borne Bacterial Diseases, Marseilles, France
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19
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Punda-Polić V, Luksić B, Capkun V. Epidemiological features of Mediterranean spotted fever, murine typhus, and Q fever in Split-Dalmatia County (Croatia), 1982-2002. Epidemiol Infect 2008; 136:972-9. [PMID: 17850690 PMCID: PMC2870890 DOI: 10.1017/s0950268807009491] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We determined the epidemiological features of three zoonoses in hospitalized patients in southern Croatia. Patients were diagnosed by serological testing. Clinical and epidemiological data were also collected. Between 1982 and 2002, Mediterranean spotted fever (MSF) was diagnosed in 126 (incidence rate 1.27/100,000 per year), murine typhus (MT), in 57 (incidence rate 0.57/100,000 per year), and Q fever in 170 (incidence rate 1.7/100,000 per year) patients. MSF and Q fever were characterized by a marked seasonality. Incidences of Q fever and of MSF were higher for males than for females (P<0.0001 and P=0.0024, respectively). The most frequent of the three zoonoses in children was MSF. Q fever and MT cases were mostly seen in the 21-50 years age group. We found no statistically significant differences between season- and gender-specific incidence rates of MT. Whereas infections due to rickettsiae decreased, the incidence of Q fever increased over the last 12 years of the study.
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Affiliation(s)
- V Punda-Polić
- Department of Clinical Microbiology, Split University Medical School and Split University Hospital, Split, Croatia.
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20
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Abstract
In recent years, a bewildering array of emerging rickettsial pathogens have been described throughout the world, including in the tropics. Here we present an updated overview of scrub typhus, murine typhus, and epidemic typhus. We also present an update on the emerging spotted fever group rickettsioses described in the tropics through 2005, focusing on epidemiologic and clinical data and management.
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Affiliation(s)
- Philippe Parola
- Unité des Rickettsies CNRS UMR 6020, IFR48, WHO Collaborative Center for Rickettsial Reference and Research, Medicine School of Marseille, France
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21
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Shalev H, Raissa R, Evgenia Z, Yagupsky P. Murine typhus is a common cause of febrile illness in Bedouin children in Israel. ACTA ACUST UNITED AC 2006; 38:451-5. [PMID: 16798692 DOI: 10.1080/00365540500540459] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Murine typhus is known to be endemic among populations living in poverty and exposed to rats and their fleas. A prospective 2-y study was conducted to determine the contribution of murine typhus to undifferentiated febrile illnesses among Bedouin children attending an outpatient clinic in southern Israel. Children with fever > or = 38.5 degrees C lasting for > or = 3 d were enrolled in the study. Murine typhus was serologically confirmed by the microimmunofluorescence test. A total of 549 children met the inclusion criteria of whom 76 (13.8%) had serologically-confirmed murine typhus. The disease was diagnosed in 27 of 434 (6.2%) patients aged < 5 y and in 49 of 115 (42.6%) older children (p<0.001). Murine typhus was diagnosed in 54 of 288 (18.8%) patients between June and November and in 22 of 261 (8.4%) between December and May (p<0.001). Patients with murine typhus had significantly higher prevalence of anaemia, leukopenia, hyponatraemia, and elevated liver enzymes compared to children without the disease. A single child was hospitalized and all 76 patients recovered without complications. Murine typhus is an important cause of febrile illnesses among Bedouin children > or = 5 y of age living in southern Israel and usually runs a benign clinical course.
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Affiliation(s)
- Hanna Shalev
- Rahat Childrens' Health Centre, Kupat Holim Clalit, Beer-Sheva, Israel
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22
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Parola P, Soula G, Gazin P, Foucault C, Delmont J, Brouqui P. Fever in travelers returning from tropical areas: prospective observational study of 613 cases hospitalised in Marseilles, France, 1999-2003. Travel Med Infect Dis 2006; 4:61-70. [PMID: 16887726 PMCID: PMC7106190 DOI: 10.1016/j.tmaid.2005.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 01/06/2005] [Accepted: 01/10/2005] [Indexed: 11/25/2022]
Abstract
Background Febrile travelers may pose a diagnostic challenge for Western physicians who are frequently involved in the assessment of these patients but unfamiliar with tropical diseases. Evaluation of this situation requires an understanding of the common etiologies, which are associated with the demographics of travelers and the destinations. Methods We conducted a 5-year prospective observational study on the etiologies of fever in travelers returning from the tropics admitted to the infectious and tropical diseases unit of a university teaching hospital in Marseilles, France. Results A total of 613 patients were enrolled, including 364 migrants (59.4%), 126 travelers (20.6%), 37 visitors (6%), 24 expatriates (3.9%), and 62 patients (10.1%) who could not be classified. Malaria was the most common diagnosis (75.2%), with most cases (62%) acquired by migrants from the Comoros archipelago and who had traveled to these islands to visit friends and relatives. Agents of food-borne and water-borne infections (3.9%) and respiratory tract infections (3.4%) were also frequently identified as the cause of fever. Other infections included emerging diseases such as gnathostomiasis, hepatitis E infection and rickettsial diseases, as well as common infections or exotic diseases. Conclusions Although we have identified here various causes of imported fever, 8.2% of the fevers remained unexplained. An improved approach to diagnosis may allow for the discovery of new diseases in travelers in the future.
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Affiliation(s)
- Philippe Parola
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Laboratoire de Parasitologie et Mycologie, INSERM U399, IFR 48, 27 Bd. Jean Moulin, 13385 Marseille Cedex 5, France
| | - Georges Soula
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Pierre Gazin
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Cedric Foucault
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
| | - Jean Delmont
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Philippe Brouqui
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Corresponding author. Tel.: +33 491 96 89 35; fax: +33 491 96 89 38.
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23
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da Costa PSG, Brigatte ME, Greco DB. Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2005; 100:853-9. [PMID: 16444416 DOI: 10.1590/s0074-02762005000800006] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6% (7 samples); 1.1% (5 samples); 3.9% (17 samples); 13.7% (60 samples); 12.8% (56 samples), and 10.5% (46 samples). Frequent multiple/cross-reactivity was observed in this study. Age over 40 years old, urban profession, and rural residence were significantly associated with some but not all infections rate. Low seropositivity rates for R. rickettsii, R. typhi, and C. burnetii contrasted with higher rates of seropositivity for B. quintana, B. henselae, and E. chaffeensis. These results show that all tested rickettsial species or antigenically closely related possible exist in this particular region.
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24
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Jensenius M, Fournier PE, Raoult D. Rickettsioses and the international traveler. Clin Infect Dis 2004; 39:1493-9. [PMID: 15546086 DOI: 10.1086/425365] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Accepted: 07/14/2004] [Indexed: 01/10/2023] Open
Abstract
The rickettsioses--zoonotic bacterial infections transmitted to humans by arthropods--were for many years considered to be oddities in travel medicine. During the previous 2 decades, however, reports of >450 travel-associated cases have been published worldwide, the vast majority being murine typhus caused by Rickettsia typhi, Mediterranean spotted fever caused by Rickettsia conorii, African tick bite fever caused by Rickettsia africae, and scrub typhus caused by Orientia tsutsugamushi. Most patients present with a benign febrile illness accompanied by headache, myalgia, and cutaneous eruptions, but severe complications and fatalities are occasionally seen. Current microbiological tests include culture, polymerase chain reaction, and serological analysis, of which only the latter method is widely available. Tetracyclines are the drugs of first choice and should be prescribed whenever a case of rickettsiosis is suspected. Preventive measures rely on minimizing the risk of arthropod bites when traveling in areas of endemicity.
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Affiliation(s)
- Mogens Jensenius
- Department of Internal Medicine, Aker University Hospital, Oslo, Norway.
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25
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Sakaguchi S, Sato I, Muguruma H, Kawano H, Kusuhara Y, Yano S, Sone S, Uchiyama T. Reemerging murine typhus, Japan. Emerg Infect Dis 2004; 10:964-5. [PMID: 15216852 PMCID: PMC3323209 DOI: 10.3201/eid1005.030697] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Satoshi Sakaguchi
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | | | - Hiroaki Muguruma
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Hiroaki Kawano
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Yoshito Kusuhara
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Seiji Yano
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Saburo Sone
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Tsuneo Uchiyama
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
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26
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Bolaños M, Angel-Moreno A, Pérez-Arellano JL. [Murine typhus. A disease to think about here and now]. Med Clin (Barc) 2004; 122:383-9. [PMID: 15033045 DOI: 10.1016/s0025-7753(04)74250-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Margarita Bolaños
- Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
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27
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Miguélez M, Laynez P, Linares M, Hayek M, Abella L, Marañez I. [Murine typhus in Tenerife. Clinicoepidemiological study and differential clinical features with Q fever]. Med Clin (Barc) 2004; 121:613-5. [PMID: 14636536 DOI: 10.1016/s0025-7753(03)74033-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to conduct a study to define the clinical and epidemiological characteristics of patients with murine typhus in Tenerife island (Canary islands, Spain). Moreover, we investigated the differential clinical features of this disease with regard to Q fever. PATIENTS AND METHOD 5-year prospective study of patients with murine typhus (1998-2002) admited in a reference hospital in Tenerife, Spain. RESULTS Thirty two patients were included. Flea bite and rat exposure were iuncommon (6.25%). The monthly distribution showed a peak of incidence in January, August and September, without a clear seasonal prevalence. Fever and headache were the most common clinical features. Rash was present in 28% of the cases. Both an increase in liver enzyme levels (88%) and thrombocytopenia (37.5%) were the most relevant laboratory findings. Organ complications were uncommon (18.75%). Antibiotics were administered to 90% of patients and cure was achieved in all them. Compared with Q fever, patients with murine typhus more commonly had rash (p = 0.006) and thrombocytopenia (p < 0.001). CONCLUSION Murine typhus is an emerging rickettsiosis in Tenerife and must be considered in the differential diagnosis with Q fever.
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Affiliation(s)
- Máximo Miguélez
- Sección de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Nuestra Señora de la Candelaria. Santa Cruz de Tenerife. España.
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28
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Abstract
PURPOSE OF REVIEW Recent developments in molecular taxonomic methods have led to a reclassification of rickettsial diseases. The agent responsible for scrub typhus (Orientia tsutsugamushi ) has been removed from the genus Rickettsia and a bewildering array of new rickettsial pathogens have been described. An update of recent research findings is therefore particularly timely for the nonspecialist physician. RECENT FINDINGS An estimated one billion people are at risk for scrub typhus and an estimated one million cases occur annually. The disease appears to be re-emerging in Japan, with seasonal transmission. O. tsutsugamushi has evolved a variety of mechanisms to remain viable in its intracellular habitat. Slowing the release of intracellular calcium inhibits apoptosis of macrophages. Subsets of chemokine genes are induced in infected cells, some in response to transcription factor activator protein 1. Cardiac involvement is uncommon and clinical complications are predominantly pulmonary. Serious pneumonitis occurred in 22% of Chinese patients. Dual infections with leptospirosis have been reported. Standardized diagnostic tests are being developed and attempts to improve treatment of women and children are being made. Of the numerous tick-borne rickettsioses identified in recent years, African tick-bite fever appears to be of particular importance to travellers. The newly described flea-borne spotted fever caused by Rickettsia felis may be global in distribution. SUMMARY Rash and fever in a returning traveler could be rickettsial and presumptive doxycycline treatment can be curative. Recent research findings raise more questions than answers and should stimulate much needed research.
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Affiliation(s)
- George Watt
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
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29
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Houhamdi L, Fournier PE, Fang R, Raoult D. An experimental model of human body louse infection with Rickettsia typhi. Ann N Y Acad Sci 2003; 990:617-27. [PMID: 12860699 DOI: 10.1111/j.1749-6632.2003.tb07436.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Murine (endemic) typhus caused by Rickettsia typhi, one of the most widely distributed arthropod-borne diseases, is transmitted to humans mainly by the oriental rat flea. The human body louse, Pediculus humanus corporis, has been suspected to have a role in the transmission of R. typhi to humans. To evaluate the potential role of Pediculus humanus corporis as a vector of murine typhus, we used R. typhi in an experimental model of human body louse infection previously used with R. prowazekii. A rabbit was made bacteremic by inoculating it with 2 x 10(6) plaque-forming units of R. typhi; it remained bacteremic for at least 59 hours. Two hundred body lice infected by feeding on the bacteremic rabbit were compared to 200 uninfected control lice. Each louse population was fed once a day on the abdomen of a seronegative rabbit. On day 8 post-infection, as a result of disruption of the gut cells and leakage of the blood meal into the hemolymph, four infected lice became bright red and died within four hours. The life span of infected lice was 20 days less than that of the controls. Infected lice did not transmit R. typhi to their progeny (eggs and larvae) as demonstrated by PCR amplification and cell culture. With an immunofluorescence assay, R. typhi was detected in feces from day 7 post-infection, and the organism remained viable in feces for up to 80 days as demonstrated by cell culture. From the 21st day post-infection, the rabbit used to feed the R. typhi-infected lice developed an immunoglobulin response with a titer of 1:50 increasing to 1:200 at the 42nd day post-infection. It showed no clinical signs of infection. The rabbit that was used to feed uninfected lice remained seronegative. Although body lice are not clearly identified vectors of R. typhi, it seems that under certain circumstances they could transmit R. typhi.
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Affiliation(s)
- Linda Houhamdi
- Unité des rickettsies, IFR 48 CNRS UMR 6020, Université de la Méditerranée Faculté de Médecine, 13385 Marseilles cedex 5, France
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30
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Comer JA, Paddock CD, Childs JE. Urban zoonoses caused by Bartonella, Coxiella, Ehrlichia, and Rickettsia species. Vector Borne Zoonotic Dis 2003; 1:91-118. [PMID: 12653141 DOI: 10.1089/153036601316977714] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The last half of the 20th Century witnessed an increase in the occurrence and recognition of urban zoonoses caused by members of the genera Bartonella, Coxiella, Ehrlichia, and Rickettsia, all traditionally considered to be members of the family Rickettsiaceae. In recent years, new human pathogens (Bartonella elizabethae, Bartonella henselae, and Rickettsia felis) have been recognized in urban environments. Other newly recognized pathogens (Ehrlichia chaffeensis and Ehrlichia phagocytophila in the United States) have sylvan zoonotic cycles but are present in urban areas because their vertebrate hosts and associated ectoparasitic arthropod vectors are able to survive in cities. Still other agents, which were primarily of historical importance (Bartonella quintana) or have not traditionally been associated with urban environments (Rickettsia rickettsii), have been recognized as causes of human disease in urban areas. Some diseases that have traditionally been associated with urban environments, such as rickettsialpox (caused by Rickettsia akari) and murine typhus (caused by Rickettsia typhi), still occur in large cities at low or undetermined frequencies and often go undetected, despite the availability of effective measures to diagnose and control them. In addition, alternate transmission cycles have been discovered for Coxiella burnetii, Rickettsia prowazekii, and R. typhi that differ substantially from their established, classic cycles, indicating that the epidemiology of these agents is more complex than originally thought and may be changing. Factors leading to an increase in the incidence of illnesses caused by these bacteria in urban areas include societal changes as well as intrinsic components of the natural history of these organisms that favor their survival in cities. Transovarial and transstadial transmission of many of the agents in their arthropod hosts contributes to the highly focal nature of many of the diseases they cause by allowing the pathogens to persist in areas during adverse times when vertebrate amplifying hosts may be scarce or absent. Domesticated animals (primarily cats, dogs, and livestock) or commensal rodents [primarily Norway rats (Rattus norvegicus) and house mice (Mus musculus)] can serve as vertebrate amplifying hosts and bring these agents and their ectoparasitic arthropod vectors into direct association with humans and help maintain transmission cycles in densely populated urban areas. The reasons for the increase in these urban zoonoses are complex. Increasing population density worldwide, shifts in populations from rural areas to cities, increased domestic and international mobility, an increase in homelessness, the decline of inner-city neighborhoods, and an increase in the population of immunosuppressed individuals all contribute to the emergence and recognition of human diseases caused by these groups of agents. Due to the focal nature of infections in urban areas, control or prevention of these diseases is possible. Increased physician awareness and public health surveillance support will be required to detect and treat existing urban infections caused by these agents, to determine the disease burden caused by them, to design and implement control programs to combat and prevent their spread, and to recognize emerging or resurging infections caused by members of these genera as they occur.
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Affiliation(s)
- J A Comer
- Viral and Rickettsial Zoonoses Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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31
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Abstract
The primary care practitioner often is the first clinician sought out by a returning traveler, and it is important that he or she be alert to the possibility of exotic illness while remembering the more mundane causes of fever. Malaria remains one of the most serious diagnoses in a febrile traveler and should be looked for repeatedly. Other diagnoses may be suggested by exposure history and patterns of laboratory findings. A directed diagnostic workup, rational empiric therapy, and appropriate consultation are the tools with which the primary care provider successfully can manage the challenging dilemma posed by the returning traveler with fever.
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Affiliation(s)
- Susan L F McLellan
- Infectious Diseases Section, School of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
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32
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Abstract
Infections that normally occur in animal hosts, zoonoses are transmitted occasionally between animals and humans. Zoonoses occur worldwide, and the traveler may engage in activities increasing the risk of acquiring these otherwise rare infections. This article reviews selected zoonoses in the context of travel to the tropics.
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Affiliation(s)
- Jonathan Sellman
- Infectious Disease Section (111F), Minneapolis Veterans Administration Medical Center, One Veterans Drive Minneapolis, MN 55417, USA.
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33
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Laferl H, Fournier PE, Seiberl G, Pichler H, Raoult D. Murine typhus poorly responsive to ciprofloxacin: a case report. J Travel Med 2002; 9:103-4. [PMID: 12044280 DOI: 10.2310/7060.2002.21970] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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