Molecular evidence of Rickettsia typhi infection in dogs from a rural community in Yucatán, México

Murine typhus: a re-emerging rickettsial zoonotic disease

Murine typhus, caused by Rickettsia typhi, is re-emerging in many parts of the world. The disease is also called endemic typhus to differentiate from epidemic typhus (caused by Rickettsia prowazekii), and sometimes also named flea-borne typhus. Occasionally, literature sources will include Rickettsia felis as a causative agent of flea-borne typhus, but illnesses caused by R. felis are actually flea-borne spotted fever. Murine typhus occurs in warm, coastal areas worldwide. In the United States, most cases are reported from California, Texas, and Hawaii. Murine typhus is usually a self-limited febrile illness but about one-quarter of patients suffer organ complications. The disease is only infrequently fatal. Regarding disease ecology, the historical paradigm is that rats (Rattus rattus and R. norvegicus) are reservoirs of R. typhi worldwide, with rat fleas (Xenopsylla cheopis) as primary vectors. More recently, researchers have proposed an alternative suburban murine typhus transmission cycle involving opossums, cat fleas, cats, and dogs in Texas, California, and rural Mexico. Because cat fleas feed on a variety of mammals, there may be other avenues for R. typhi transmission, including stray or feral cats bringing cat fleas and other infected fleas into proximity with humans and possible aerosolization of infected flea feces. Additional fleas, ticks, lice, and mites may play a role in various areas throughout the world, but a striking lack of fundamental research on this topic makes drawing conclusions difficult. This review provides an overview of the history, epidemiology, diagnosis, and treatment of murine typhus, with special emphasis on its disease ecology.

An unusual identification of Rickettsia parkeri in synanthropic rodents and domiciliated dogs of a rural community from Yucatán, Mexico

Rickettsia parkeri belongs to the spotted fever group (SFG) of the Rickettsia genus. This bacterium causes mild rickettsiosis in humans and is mainly transmitted by Amblyomma ticks. Its medical importance is emerging in the Americas, including Mexico. Synanthropic rodents and domiciled dogs participate as accidental hosts in epidemiological cycles of Rickettsia of the SFG. The aim is to report the presence of R. parkeri in synanthropic rodents and domiciled dogs from a rural community of Yucatán, Mexico. Rodents were captured, and plasma samples were taken from dogs in 48 households from Ucú, Yucatán, Mexico. A spleen sample (rodents) and plasma (dogs) were used in the propagation of Rickettsia on Vero cells. These infected cells were used in the extraction of genomic DNA. Rickettsia DNA was identified using a semi-nested PCR (snPCR); some products were sent for sequencing. The recovered sequences were analysed with bioinformatics programs, and a phylogenetic tree was built to determine the Rickettsia species. One hundred animals were sampled: 36 synanthropic rodents and 64 dogs. The snPCR evidenced the presence of Rickettsia DNA in 10 rodents (10/36, 27.8%) and 18 dogs (18/64, 28.1%), which represents a global frequency of 28% (28/100) in this study. The bioinformatics analysis yielded homology to R. parkeri and was demonstrated in the phylogenetic tree. The first evidence of the presence of R. parkeri in synanthropic rodents (Mus musculus) from Mexico is presented; likewise, the participation of domestic dogs in the transmission cycle of this bacterium with potential importance in public health is confirmed.

Detection of Rickettsia amblyommatis and Rickettsia bellii in ticks collected from pet dogs in peri-urban and rural areas in Yucatan, Mexico

Rickettsia species are bacteria that may cause multiple diseases in animals and humans, via transmission through multiple arthropod vectors. Routine surveillance of Rickettsia spp. within vectors is critical to determine their presence and risk to mammalian hosts within human populations. Therefore, to better characterize the circulating Rickettsia species in an understudied region we targeted pet dogs to survey. Ticks were collected from pet dogs in three populations of the Yucatan where we tested for the presence of Rickettsia spp. by PCR in metagenomic DNA. In these ticks removed from pet dogs we detected Rickettsia amblyommatis and Rickettsia bellii in Amblyomma auriculatum, Amblyomma ovale and Amblyomma mixtum ticks obtained in a rural community in the Mexican state of Yucatan. This is the first report detecting both species for this state in Mexico, underpinning the importance of more routine surveillance.

Epidemiological Study of the Occurrence of Typhus Group Rickettsia Natural Infection in Domiciliated Dogs from a Rural Community in South-Eastern Mexico

Simple Summary

Rickettsioses are relevant emergent and reemergent zoonoses in the Americas, including Mexico. Murine typhus caused by typhus group (TG) Rickettsia is prevalent in humans and their companion animals, such as dogs. This study found that 23.9% of the dogs (34/142) were infected by TG Rickettsia in Maxcanú, Yucatan (southeastern Mexico). Statistical analyses showed that reduced outdoor activities, age, sex and previous antiparasitic treatment are associated factors with less risk of TG Rickettsia infection in the sampled dogs. Monitoring and controlling these factors could help to restrict the enzootic transmission risk and prevent the potential zoonotic transmission.

Abstract

The aim is to describe the Typhus group (TG) Rickettsia infection in dogs and to identify factors associated with this infection. We collected blood samples and gathered exposure and clinical data of 142 dogs from a rural community of Yucatan. The Rickettsia group was determined by semi-nested PCR. Generalized linear models with binomial error distribution were used to model the associated factors from the dog sample for risk ratio (RR) estimation. Thirty-four dogs (23.9%) showed molecular evidence of TG Rickettsia DNA. The multivariate model showed that mixed-breed dogs (RR = 0.06) and dogs that had received antiparasitic treatment (RR = 0.049) had a lower risk of getting infected, taking as reference the purebred group and the non-treated dogs, respectively. Looking at variable interactions, adult dogs without outdoor activities had a lower infection risk than puppies (RR = 0.26). Among dogs with antiparasitic treatment, females had a higher infection risk than male dogs (RR = 26.2). The results showed enzootic TG Rickettsia circulation in dogs of a rural community. The factors outdoor activities, age and previous antiparasitic treatment, as well as the clinical variables signs of hemorrhages and epistaxis, were associated with a less chance of natural infection in the studied dogs. Prevention and control of the enzootic transmission risk of TG Rickettsia should help to reduce the potential zoonotic transmission of this pathogen.

Manifestations and Management of Flea-Borne Rickettsioses

Murine typhus and flea-borne spotted fever are undifferentiated febrile illnesses caused by Rickettsia typhi and Rickettsia felis, respectively. These organisms are small obligately intracellular bacteria and are transmitted to humans by fleas. Murine typhus is endemic to coastal areas of the tropics and subtropics (especially port cities), where rats are the primary mammalian host and rat fleas (Xenopsylla cheopis) are the vector. In the United States, a cycle of transmission involving opossums and cat fleas (Ctenocephalides felis) are the presumed reservoir and vector, respectively. The incidence and distribution of murine typhus appear to be increasing in endemic areas of the US. Rickettsia felis has also been reported throughout the world and is found within the ubiquitous cat flea. Flea-borne rickettsioses manifest as an undifferentiated febrile illness. Headache, malaise, and myalgia are frequent symptoms that accompany fever. The incidence of rash is variable, so its absence should not dissuade the clinician to consider a rickettsial illness as part of the differential diagnosis. When present, the rash is usually macular or papular. Although not a feature of murine typhus, eschar has been found in 12% of those with flea-borne spotted fever. Confirmatory laboratory diagnosis is usually obtained by serology; the indirect immunofluorescence assay is the serologic test of choice. Antibodies are seldom present during the first few days of illness. Thus, the diagnosis requires acute- and convalescent-phase specimens to document seroconversion or a four-fold increase in antibody titer. Since laboratory diagnosis is usually retrospective, when a flea-borne rickettsiosis is considered, empiric treatment should be initiated. The treatment of choice for both children and adults is doxycycline, which results in a swift and effective response. The following review is aimed to summarize the key clinical, epidemiological, ecological, diagnostic, and treatment aspects of flea-borne rickettsioses.

Murine typhus in Mexico City: report of an imported case

Murine typhus is endemic in several countries. We herein report an imported case of murine typhus caused by Rickettsia typhi in Mexico City. This is the first report of a case after almost 20 years since the last report. The species was confirmed by DNA sequencing and phylogenetic reconstruction.

A review of the genus Rickettsia in Central America

In this paper, we present a historical review of rickettsiosis in Central America and also the most recent findings of Rickettsia in ectoparasites. All countries of Central America have records of rickettsiosis. Regarding the typhus group rickettsioses, there is clinical or serological evidence of Rickettsia prowazekii in Guatemala, Rickettsia typhi in Panama, Guatemala, and Costa Rica and unidentified species of the typhus group in El Salvador. Concerning spotted fever group rickettsiosis, there is serological evidence of infection by Rickettsia akari in Costa Rica and confirmed cases involving Rickettsia rickettsii in Panama and Costa Rica. There are also reports of spotted fever group rickettsiosis in acute patients from Guatemala, Honduras, and Nicaragua. Serological studies in Central America show reactivity of Rickettsia ambyommatis, Rickettsia bellii, Rickettsia felis, Rickettsia rhipicephali, and R. rickettsii in domestic and wild mammals. Eight species of Rickettsia have been detected in ectoparasites from Central America: R. africae (or very similar), R. amblyommatis, R. asembonensis, R. bellii, R. felis, R. parkeri, R. rhipicephali, and R. rickettsii, in addition to undescribed strains such as Atlantic Rainforest, Colombianensi, IbR/CRC, Barva, Aragaoi, and Candidatus "Rickettsia nicoyana;" the latter being the only one associated with Argasidae (Ornithodoros knoxjonesi). R. amblyommatis is the most common species in Central America, seeing as it has been reported in 10 species of ticks and one of fleas in five of the seven countries of the region. In this study, we demonstrate that the genus Rickettsia is widely distributed in Central America and that rickettsiosis could be an underestimated problem in the absence of greater diagnostic efforts in undetermined febrile cases.

The Re-Emergence and Emergence of Vector-Borne Rickettsioses in Taiwan

Rickettsial diseases, particularly vector-borne rickettsioses (VBR), have a long history in Taiwan, with studies on scrub typhus and murine typhus dating back over a century. The climatic and geographic diversity of Taiwan's main island and its offshore islands provide many ecological niches for the diversification and maintenance of rickettsiae alike. In recent decades, scrub typhus has re-emerged as the most prevalent type of rickettsiosis in Taiwan, particularly in eastern Taiwan and its offshore islands. While murine typhus has also re-emerged on Taiwan's western coast, it remains neglected. Perhaps more alarming than the re-emergence of these rickettsioses is the emergence of newly described VBR. The first case of human infection with Rickettsia felis was confirmed in 2005, and undetermined spotted fever group rickettsioses have recently been detected. Taiwan is at a unique advantage in terms of detecting and characterizing VBR, as it has universal health coverage and a national communicable disease surveillance system; however, these systems have not been fully utilized for this purpose. Here, we review the existing knowledge on the eco-epidemiology of VBR in Taiwan and recommend future courses of action.

Direct evidence of Rickettsia typhi infection in Rhipicephalus sanguineus ticks and their canine hosts

Murine typhus is a rickettsiosis caused by Rickettsia typhi, whose transmission is carried out by rat fleas in urban settlements as classically known, but it also has been related to cat fleas in a sub-urban alternative cycle that has been suggested by recent reports. These studies remarks that in addition to rats, other animals like cats, opossums and dogs could be implied in the transmission of Rickettsia typhi as infected fleas obtained from serologically positive animals have been detected in samples from endemic areas. In Mexico, the higher number of murine typhus cases have been detected in the Yucatan peninsula, which includes a great southeastern region of Mexico that shows ecologic characteristics similar to the sub-urban alternative cycle recently described in Texas and California at the United States. To find out which are the particular ecologic characteristics of murine typhus transmission in this region, we analyzed blood and Rhipicephalus sanguineus ticks obtained from domestic dogs by molecular approaches, demonstrating that both samples were infected by Rickettsia typhi. Following this, we obtained isolates that were analyzed by genetic sequencing to corroborate this infection in 100% of the analyzed samples. This evidence suggests for the first time that ticks and dogs could be actively participating in the transmission of murine typhus, in a role that requires further studies for its precise description.