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Sam G, Plain K, Chen S, Islam A, Westman ME, Marsh I, Stenos J, Graves SR, Rehm BHA. Synthetic Particulate Subunit Vaccines for the Prevention of Q Fever. Adv Healthc Mater 2024; 13:e2302351. [PMID: 38198823 DOI: 10.1002/adhm.202302351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/10/2023] [Indexed: 01/12/2024]
Abstract
Coxiella burnetti is an intracellular bacterium that causes Q fever, a disease of worldwide importance. Q-VAX® , the approved human Q fever vaccine, is a whole cell vaccine associated with safety concerns. Here a safe particulate subunit vaccine candidate is developed that is ambient-temperature stable and can be cost-effectively manufactured. Endotoxin-free Escherichia coli is bioengineered to efficiently self-assemble biopolymer particles (BPs) that are densely coated with either strings of 18 T-cell epitopes (COX-BP) or two full-length immunodominant antigens (YbgF-BP-Com1) all derived from C. burnetii. BP vaccine candidates are ambient-temperature stable. Safety and immunogenicity are confirmed in mice and guinea pig (GP) models. YbgF-BP-Com1 elicits specific and strong humoral immune responses in GPs with IgG titers that are at least 1 000 times higher than those induced by Q-VAX® . BP vaccine candidates are not reactogenic. After challenge with C. burnetii, YbgF-BP-Com1 vaccine leads to reduced fever responses and pathogen burden in the liver and the induction of proinflammatory cytokines IL-12 and IFN-γ inducible protein (IP-10) when compared to negative control groups. These data suggest that YbgF-BP-Com1 induces functional immune responses reducing infection by C. burnetii. Collectively, these findings illustrate the potential of BPs as effective antigen carrier for Q fever vaccine development.
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Affiliation(s)
- Gayathri Sam
- Centre for Cell Factories and Biopolymers, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, 4111, Australia
| | - Karren Plain
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, 2568, Australia
| | - Shuxiong Chen
- Centre for Cell Factories and Biopolymers, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, 4111, Australia
| | - Aminul Islam
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC, 3220, Australia
| | - Mark E Westman
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, 2568, Australia
| | - Ian Marsh
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, 2568, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC, 3220, Australia
| | - Stephen R Graves
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, 2568, Australia
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC, 3220, Australia
| | - Bernd H A Rehm
- Centre for Cell Factories and Biopolymers, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
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Blacksell SD, Le KK, Rungrojn A, Wongsantichon J, Stenos J, Graves SR, Day NPJ. Gaps and inconsistencies in the current knowledge and implementation of biosafety and biosecurity practices for rickettsial pathogens. BMC Infect Dis 2024; 24:268. [PMID: 38424500 PMCID: PMC10905923 DOI: 10.1186/s12879-024-09151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Rickettsia spp. and Orientia spp. are the causes of neglected infections that can lead to severe febrile and systemic illnesses in humans. Implementing proper biosafety practices when handling these pathogens is crucial to ensure a safe and sustainable work environment. It is essential to assess the current knowledge and identify any potential gaps to develop effective measures that minimise the risk of exposure to these pathogens. By doing so, we can establish a comprehensive framework that promotes safety, mitigates hazards, and safeguards the well-being of personnel and the surrounding community. METHODS AND RESULTS This review aimed to synthesise and determine the evidence base for biosafety precautions for Rickettsia spp. and Orientia spp. pathogens. Enhancing our understanding of the relative infectious risk associated with different strains of Rickettsia and Orientia spp. requires identifying the infectious dose of these pathogens that can cause human disease. The application of risk groups for Rickettsia and Orientia spp. is inconsistent across jurisdictions. There is also incomplete evidence regarding decontamination methods for these pathogens. With regards to Orientia spp. most of the available information is derived from experiments conducted with Rickettsia spp. CONCLUSIONS Rickettsia and Orientia spp. are neglected diseases, as demonstrated by the lack of evidence-based and specific biosafety information about these pathogens. In the case of Orientia spp., most of the available information is derived from Rickettsia spp., which may not be appropriate and overstate the risks of working with this pathogen. The advent of effective antibiotic therapy and a better understanding of the true hazards and risks associated with pathogen manipulation should inform decisions, allowing a sustainable and safe work environment.
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Affiliation(s)
- Stuart D Blacksell
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Department of Medicine Research Building, University of Oxford, Nuffield, Oxford, UK.
| | - Khanh Kim Le
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand
| | - Artharee Rungrojn
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand
| | - Jantana Wongsantichon
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC, Australia
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Department of Medicine Research Building, University of Oxford, Nuffield, Oxford, UK
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Liew KC, Nguyen C, Waidyatillake NT, Nguyen T, Walton A, Harris O, Athan E, Stenos J, Graves SR. A serological assay using Tropheryma whipplei antigens for the presumptive exclusion of Whipple disease. Pathology 2024; 56:98-103. [PMID: 38061960 DOI: 10.1016/j.pathol.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 01/24/2024]
Abstract
Whipple disease (WD) is a rare infection in genetically susceptible people caused by the bacterium Tropheryma whipplei. An indirect immunofluorescence serological assay (IFA), detecting patient antibodies to the bacterium, was developed using T. whipplei as antigen. We hypothesised that this assay could be used to rule out WD in patients in whom the diagnosis was being considered, based on high immunoglobulin (Ig) G titres to T. whipplei. In this study, 16 confirmed WD patients and 156 age-matched controls from across Australia were compared serologically. WD patients mostly underproduced IgG antibody to T. whipplei, with titres of ≤1:32 being common. While at an antibody titre of <1:64 the assay sensitivity for WD was only 69% [95% confidence interval (CI) 41-89%], its specificity for excluding WD was 91% (95% CI 85-95%). This specificity increased to 95% (95% CI 90-98%) at an antibody titre of <1:16. Patients with antibody titres of >1:64 were unlikely to have WD. At this titre, the seroprevalence of T. whipplei IgG antibody was 92% (223/242) in Australian blood donors. Unlike other serological assays, which are used to confirm a specific infection, this novel assay is designed to rule out WD infection with a specificity in Australia of 91%. Further validation of this assay, by trialling in other countries, should now be undertaken, as its usefulness is dependent on there being a high background seropositivity to T. whipplei in the general population at the location in which the assay is being used.
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Affiliation(s)
- Kwee Chin Liew
- Department of Microbiology, Australian Clinical Labs, Geelong, Vic, Australia; Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia; Deakin University, School of Medicine, Geelong, Vic, Australia.
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia
| | - Nilakshi T Waidyatillake
- Barwon Health, University Hospital Geelong, Geelong, Vic, Australia; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Trang Nguyen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Sydney, NSW, Australia
| | - Aaron Walton
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia; Deakin University, School of Medicine, Geelong, Vic, Australia
| | - Owen Harris
- Department of Microbiology, Australian Clinical Labs, Geelong, Vic, Australia; Deakin University, School of Medicine, Geelong, Vic, Australia; Barwon Health, University Hospital Geelong, Geelong, Vic, Australia
| | - Eugene Athan
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia; Deakin University, School of Medicine, Geelong, Vic, Australia; Barwon Health, University Hospital Geelong, Geelong, Vic, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Vic, Australia
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Sam G, Stenos J, Graves SR, Rehm BHA. Q fever immunology: the quest for a safe and effective vaccine. NPJ Vaccines 2023; 8:133. [PMID: 37679410 PMCID: PMC10484952 DOI: 10.1038/s41541-023-00727-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Q fever is an infectious zoonotic disease, caused by the Gram-negative bacterium Coxiella burnetii. Transmission occurs from livestock to humans through inhalation of a survival form of the bacterium, the Small Cell Variant, often via handling of animal parturition products. Q fever manifests as an acute self-limiting febrile illness or as a chronic disease with complications such as vasculitis and endocarditis. The current preventative human Q fever vaccine Q-VAX poses limitations on its worldwide implementation due to reactogenic responses in pre-sensitized individuals. Many strategies have been undertaken to develop a universal Q fever vaccine but with little success to date. The mechanisms of the underlying reactogenic responses remain only partially understood and are important factors in the development of a safe Q fever vaccine. This review provides an overview of previous and current experimental vaccines developed for use against Q fever and proposes approaches to develop a vaccine that establishes immunological memory while eliminating harmful reactogenic responses.
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Affiliation(s)
- Gayathri Sam
- Centre for Cell Factories and Biopolymers, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, 4111, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC, 3220, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC, 3220, Australia
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, 2567, Australia
| | - Bernd H A Rehm
- Centre for Cell Factories and Biopolymers, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, 4111, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia.
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Graves SR, Islam A, Webb LD, Marsh I, Plain K, Westman M, Conlan XA, Carbis R, Toman R, Stenos J. An O-Specific Polysaccharide/Tetanus Toxoid Conjugate Vaccine Induces Protection in Guinea Pigs against Virulent Challenge with Coxiella burnetii. Vaccines (Basel) 2022; 10:vaccines10091393. [PMID: 36146471 PMCID: PMC9503072 DOI: 10.3390/vaccines10091393] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Q fever is caused by the bacterium Coxiella burnetii and is spread to humans from infected animals especially goats, sheep and cattle, predominantly when giving birth. There is an effective human vaccine (Q-VAX) against Q fever, and although Q fever is a worldwide problem, the vaccine is only used in Australia due to difficulties associated with its use and the risk of adverse reactions. The desire to protect humans, particularly farmers and abattoir workers, from Q fever prompted the development of a new safe and effective human vaccine without all the difficulties associated with the current vaccine. Candidate vaccines were prepared using purified O-specific polysaccharide (OSP) extracted from the lipopolysaccharide of virulent (phase 1) C. burnetii, strain Nine Mile, which was then conjugated to a tetanus toxoid (TT) carrier protein. Two vaccines were prepared using OSP from C. burnetii grown in embryonated eggs (vaccine A) and axenic media (vaccine B). Vaccines with or without alum adjuvant were used to vaccinate guinea pigs, which were later challenged by intranasal inoculation with virulent C. burnetii. Both vaccines protected guinea pigs from fever and loss of weight post challenge. Post-mortem samples of the spleen, liver and kidney of vaccinated guinea pigs contained substantially less C. burnetii DNA as measured by PCR than those of the unvaccinated control animals. This study demonstrated that a C. burnetii OSP-TT conjugate vaccine is capable of inducing protection against virulent C. burnetii in guinea pigs. Additionally, OSP derived from C. burnetii grown in axenic media compared to OSP from embryonated eggs is equivalent in terms of providing a protective immune response.
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Affiliation(s)
- Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC 3220, Australia
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW 2567, Australia
- Correspondence:
| | - Aminul Islam
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC 3220, Australia
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW 2567, Australia
| | - Lawrence D. Webb
- School of Life and Environmental Science, Deakin University, Waurn Ponds, VIC 3216, Australia
| | - Ian Marsh
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW 2567, Australia
| | - Karren Plain
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW 2567, Australia
| | - Mark Westman
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW 2567, Australia
| | - Xavier A. Conlan
- School of Life and Environmental Science, Deakin University, Waurn Ponds, VIC 3216, Australia
| | - Rodney Carbis
- Symbioticus Pty Ltd., Strathmore, VIC 3041, Australia
| | - Rudolf Toman
- Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC 3220, Australia
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Garg P, Chan S, Peeceeyen S, Youssef G, Graves SR, Sullivan R. Culture-negative polymicrobial chronic Q fever prosthetic valve infective endocarditis utilizing 16S ribosomal RNA polymerase chain reaction on explanted valvular tissue. Int J Infect Dis 2022; 121:138-140. [PMID: 35562042 DOI: 10.1016/j.ijid.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Coxiella burnetti is the causative organism of the zoonotic infection Q fever, of which endocarditis is one of the most common manifestations of the chronic form. Polymicrobial endocarditis with Q fever is extremely rare and is yet to be described among an Australasian cohort. SUMMARY: We present the case of a 32-year-old gardener with culture-negative chronic Q fever prosthetic valve endocarditis concomitant with another bacterial pathogen, leading to aortic root abscess formation, requiring a Bentall procedure, extracorporeal membrane oxygenation, and prolonged antimicrobial therapy, with a fatal outcome. Unique to our case, Q fever was identified early, and the second pathogen was only detected on 16S ribosomal RNA (rRNA) polymerase chain reaction of explanted valvular tissue. Given the high risk for morbidity, we recommend that screening for Q fever in endemic areas among patients with infective endocarditis from other etiologies be considered. In addition, this case highlights the role for Q fever vaccination of the at-risk population with underlying valvulopathy. Furthermore, clinicians should be aware of polymicrobial infective endocarditis and suspicious in case of patients with atypical clinical features.
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Affiliation(s)
- Priya Garg
- St George Hospital, Sydney, New South Wales, Australia.
| | | | | | | | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong University Hospital, Barwon Health, Geelong, Victoria, Australia
| | - Richard Sullivan
- St George Hospital, Sydney, New South Wales, Australia; School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health; Menzies School of Health Research, Charles Darwin University
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Affiliation(s)
- Stephen R Graves
- BSc(Hons), MBBS, PhD, FRCPA, FASM, FACTM, Australian Rickettsial Reference Laboratory, University Hospital Geelong, Vic; NSW Health Pathology, Nepean Hospital, Penrith, NSW
| | - John Gerrard
- BSc (Med), MBBS (Syd), DTM@H MSc (Lon), FRACP (Infec Dis), Director of Infectious Diseases, Gold Coast University Hospital, Qld
| | - Sarah Coghill
- BBiomedSci, MBBS (Hons), FRACP (Infec Dis), Infectious Diseases Physician, Lismore Base Hospital, NSW; Conjoint Lecturer, School of Medicine, The University of Western Sydney, NSW
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Ghanem-Zoubi N, Graves SR. The prognostic value of serological titres in chronic Q fever: treat the patient, not the laboratory data. Clin Microbiol Infect 2021; 27:1202-1203. [PMID: 34153455 DOI: 10.1016/j.cmi.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong University Hospital, Geelong, VIC, Australia
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Mathews KO, Toribio JA, Norris JM, Phalen D, Wood N, Graves SR, Sheehy PA, Bosward KL. Coxiella burnetii seroprevalence and Q fever in Australian wildlife rehabilitators. One Health 2021; 12:100197. [PMID: 33319024 PMCID: PMC7725937 DOI: 10.1016/j.onehlt.2020.100197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022] Open
Abstract
Coxiella burnetii is the causative bacterium of the zoonotic disease Q fever, which is recognised as a public health concern globally. Macropods have been suggested as a potential source of C. burnetii infection for humans. The aim of this cross-sectional study was to determine the prevalence of C. burnetii exposure in a cohort of Australian wildlife rehabilitators (AWRs) and assess Q fever disease and vaccination status within this population. Blood samples were collected from adult participants attending the Australian Wildlife Rehabilitation Conference in Sydney in July 2018. Participants completed a questionnaire at the time of blood collection. Antibody titres (IgG, IgA and IgM) against phase I and phase II C. burnetii antigens as determined by immunofluorescence assay, revealed that of the unvaccinated participants, 6.1% (9/147) had evidence of exposure to C. burnetii. Of the total participants, 8.1% (13/160) had received Q fever vaccination, four of whom remained seropositive at the time of blood collection. Participants reporting occupational contact with ruminants, were eight times more likely to have been vaccinated against Q fever, than those reporting no occupational animal contact (OR 8.1; 95% CI 1.85-45.08). Three AWRs (2%) reported having had medically diagnosed Q fever, two of whom remained seropositive at the time of blood collection. Despite the lack of association between macropod contacts and C. burnetii seropositivity in this cohort, these findings suggest that AWRs are approximately twice as likely to be exposed to C. burnetii, compared with the general Australian population. This provides support for the recommendation of Q fever vaccination for this potentially 'at-risk' population. The role of macropods in human Q fever disease remains unclear, and further research into C. burnetii infection in macropods including: infection rate and transmission cycles between vectors, macropods as reservoirs, other animals and humans is required.
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Key Words
- Australia, wildlife rehabilitators
- Australian Statistical Geography Standard, ASGS
- Australian Wildlife Rehabilitation Conference, AWRC
- Australian wildlife rehabilitators, AWRs
- Coxiella burnetii
- Indirect immunofluorescence assay, IFA
- Macropods, kangaroos
- Personal protection equipment, PPE
- Q fever
- Q fever disease status, QFDS
- Q fever disease, QFD
- Q fever serostatus, QFSS
- Q fever vaccination status, QFVS
- Q fever vaccination, QFV
- Seroprevalence
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Affiliation(s)
- Karen O. Mathews
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jenny-Ann Toribio
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jacqueline M. Norris
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - David Phalen
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Nicholas Wood
- The University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Camperdown, NSW, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Victoria 3220, Australia
| | - Paul A. Sheehy
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Katrina L. Bosward
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
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Towns JM, Leslie DE, Denham I, Wigan R, Azzato F, Williamson DA, Lee D, Chow EPF, Fairley CK, Graves SR, Zhang L, Chen MY. Treponema pallidum detection in lesion and non-lesion sites in men who have sex with men with early syphilis: a prospective, cross-sectional study. Lancet Infect Dis 2021; 21:1324-1331. [PMID: 33894904 DOI: 10.1016/s1473-3099(20)30838-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/04/2020] [Accepted: 10/02/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Syphilis transmission is increasing, and precisely how Treponema pallidum is transmitted sexually from person to person is unclear. We aimed to determine the frequency of T pallidum shedding from potentially asymptomatic sites and the stage of infection at which shedding is most frequent in men who have sex with men (MSM), who have been disproportionately affected by syphilis. METHODS We did a prospective, cross-sectional study in MSM recruited from Melbourne Sexual Health Centre (Melbourne, VIC, Australia). Men were eligible if they were aged 18 years or older, reported sex with men during the past 12 months, and had laboratory confirmed primary, secondary, or early latent syphilis, consistent with Australian definitions. Primary and secondary syphilis lesions were swabbed and non-lesion samples were collected via oral rinse, oral cavity swab, anal canal swab, urine, and semen. Samples were tested for T pallidum using PCR assays targeting polA (lesion and non-lesion samples) and 47 kDa (non-lesion samples only) gene targets. The primary outcome was the proportion of men with T pallidum detected from potentially asymptomatic sites-namely, the mouth, anus, urethra, and semen. FINDINGS Between Nov 30, 2015, and May 23, 2019, 246 MSM were screened for inclusion, of whom 200 had serologically confirmed early syphilis and were included in the study: 54 (27%) of 200 had primary syphilis, 93 (47%) had secondary syphilis, and 53 (27%) had early latent syphilis. T pallidum DNA was detected in 48 (24%; 95% CI 18·3-30·5) of 200 men by oral rinse or oral lesion swab, or both, of whom 24 had no oral lesions. Oral T pallidum detection was most frequent in those with secondary syphilis compared with those at other stages of disease (41 [44%] of 93 vs seven [7%] of 107; p<0·0001), and in men with rapid plasma reagin titres of 1/64 or higher compared with those with lower titres (37 [32%] of 117 vs 11 [13%] of 83; p=0·0026). T pallidum was detected by anal canal swab or anal lesion swab, or both, in 45 (23·0%; 95% CI 17·3-29·5) of 196 men with available samples, of whom ten had no anal lesion. Furthermore, T pallidum was detected in urine samples of 12 (6·1%, 3·2-10·3) of 198 men and in semen samples from six (12·0%, 4·5-24·3) of 50 men who provided samples. Among the 93 men with secondary syphilis, 69 (74%) had T pallidum detected at any site, and 24 (26%) had detection at two or more separate sites. Among the 54 men with primary syphilis, 49 (91%) had T pallidum detected at any site, and 11 (20%) had detection at two or more separate sites. Among the 53 men with early latent syphilis, four (8%) had T pallidum detected at any site and none had T pallidum detected at two or more separate sites. INTERPRETATION Unrecognised oral and anal shedding of T pallidum occurs in MSM with early syphilis, most frequently in those with secondary syphilis, suggesting secondary syphilis is the most infectious stage and that earlier detection and treatment of syphilis to prevent progression to the secondary stage might improve syphilis control. Future research is needed to ascertain the contribution of shedding of T pallidum from non-lesion sites to transmission of syphilis. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Microbiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Darren Lee
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia
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11
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Towns JM, Leslie DE, Denham I, Azzato F, Karapanagiotidis T, Williamson DA, Graves SR, Fairley CK, Bissessor M, Chow EPF, Zhang L, Chen MY. Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study. Sex Transm Infect 2021; 98:161-165. [PMID: 33782149 DOI: 10.1136/sextrans-2020-054739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/19/2020] [Accepted: 03/06/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Serology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert. METHODS Serodiscordant primary syphilis cases that were T. pallidum PCR-positive and serology-negative (including rapid plasma reagin, T. pallidum particle agglutination, T. pallidum enzyme immunoassay or T. pallidum chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined. RESULTS There were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6 weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1. DISCUSSION Earlier treatment of primary syphilis can prevent the development of serological markers. T. pallidum PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Microbiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou, People's Republic of China
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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12
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Dhawan S, Robinson MT, Stenos J, Graves SR, Wangrangsimakul T, Newton PN, Day NPJ, Blacksell SD. Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review. Am J Trop Med Hyg 2020; 103:55-63. [PMID: 32274984 PMCID: PMC7356422 DOI: 10.4269/ajtmh.19-0818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the "gold standard" to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: "murine typhus," "rickettsia typhi," "immunofluorescence," "IFA," and "serologic" with restrictions (i.e., "rickettsia typhi" or "murine typhus," and "IFA" or "immunofluorescence," or "serologic*"). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients.
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Affiliation(s)
- Sandhya Dhawan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Matthew T. Robinson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
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13
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Browning S, Lai K, Pickles R, Graves SR. Q fever vertebral osteomyelitis in the absence of cardiovascular involvement: Two cases and a literature review. Clinical Infection in Practice 2020. [DOI: 10.1016/j.clinpr.2020.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Tapia T, Stenos J, Flores R, Duery O, Iglesias R, Olivares MF, Gallegos D, Rosas C, Wood H, Acevedo J, Araya P, Graves SR, Hormazabal JC. Evidence of Q Fever and Rickettsial Disease in Chile. Trop Med Infect Dis 2020; 5:tropicalmed5020099. [PMID: 32545152 PMCID: PMC7344882 DOI: 10.3390/tropicalmed5020099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Q fever and rickettsial diseases occur throughout the world and appear to be emergent zoonoses in Chile. The diagnosis of these diseases is currently uncommon in Chile, as their clinical presentations are non-specific and appropriate diagnostic laboratory assays are of limited availability. During a recent outbreak of undiagnosed human atypical pneumonia, we serologically investigated a series of 357 cases from three regions of southern Chile. The aim was to identify those caused by Coxiella burnetii and/or Rickettsia spp. Serological analysis was performed by ELISA and an immunofluorescence assay (IFA) for acute and convalescence sera of patients. Our results, including data from two international reference laboratories, demonstrate that 71 (20%) of the cases were Q fever, and 44 (15%) were a likely rickettsial infection, although the rickettsial species could not be confirmed by serology. This study is the first report of endemic Q fever and rickettsial disease affecting humans in Chile.
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Affiliation(s)
- Teresa Tapia
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC 3220, Australia; (J.S.); (S.R.G.)
| | - Roberto Flores
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
| | - Oscar Duery
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
| | - Rodrigo Iglesias
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
| | - Maria Fernanda Olivares
- Departamento de Epidemiología, DIPLAS, Ministerio de Salud de Chile, Santiago 8320123, Chile; (M.F.O.); (D.G.); (J.A.)
| | - Doris Gallegos
- Departamento de Epidemiología, DIPLAS, Ministerio de Salud de Chile, Santiago 8320123, Chile; (M.F.O.); (D.G.); (J.A.)
| | - Cristian Rosas
- SEREMI de Salud Región de Los Lagos, Ministerio de Salud de Chile, Osorno 5290000, Chile;
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada;
| | - Johanna Acevedo
- Departamento de Epidemiología, DIPLAS, Ministerio de Salud de Chile, Santiago 8320123, Chile; (M.F.O.); (D.G.); (J.A.)
| | - Pamela Araya
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC 3220, Australia; (J.S.); (S.R.G.)
| | - Juan Carlos Hormazabal
- Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; (T.T.); (R.F.); (O.D.); (R.I.); (P.A.)
- Correspondence: ; Tel.: +56-(2)-25755417
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15
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Staines M, Bradford T, Graves SR, Bull S, Gardner MG. Proposing a new hypothesis:
Rickettsia
spp. as a mechanism maintaining parapatry between two Australian reptile tick species. AUSTRAL ECOL 2020. [DOI: 10.1111/aec.12897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Morgan Staines
- College of Science and Engineering Flinders University GPO Box 2100 Adelaide SA 5001 Australia
| | - Tessa Bradford
- Evolutionary Biology Unit South Australian Museum Adelaide South Australia Australia
- Australian Centre for Evolutionary Biology and Biodiversity Department of Ecology and Evolutionary Biology School of Biological Sciences University of Adelaide Adelaide South Australia Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory Barwon Health Geelong Hospital Geelong Victoria Australia
| | - Simon Bull
- College of Science and Engineering Flinders University GPO Box 2100 Adelaide SA 5001 Australia
| | - Michael G. Gardner
- College of Science and Engineering Flinders University GPO Box 2100 Adelaide SA 5001 Australia
- Evolutionary Biology Unit South Australian Museum Adelaide South Australia Australia
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16
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Meher-Homji Z, Graves SR, Trubiano J, Holmes NE. Bartonella Quintana prosthetic aortitis successfully treated with doxycycline. BMJ Case Rep 2019; 12:12/7/e229877. [PMID: 31296621 DOI: 10.1136/bcr-2019-229877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bartonella quintana is a rare cause of culture-negative endovascular infection, characterised by intracellular persistence. We describe a case of ascending aortic prosthetic graft infection due to B. quintana, in a patient with past unrecognised necrotising aortitis, which was successfully treated with doxycycline monotherapy.
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Affiliation(s)
- Zaal Meher-Homji
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Victoria, Australia
| | - Jason Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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17
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Raijmakers RP, Stenos J, Keijmel SP, Ter Horst R, Novakovic B, Nguyen C, Van Der Meer JW, Netea MG, Bleeker-Rovers CP, Joosten LA, Graves SR. Long-Lasting Transcriptional Changes in Circulating Monocytes of Acute Q Fever Patients. Open Forum Infect Dis 2019; 6:5523799. [PMID: 31363773 PMCID: PMC6667718 DOI: 10.1093/ofid/ofz296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Although most patients recover from acute Q fever, around 20% develop Q fever fatigue syndrome (QFS), a debilitating fatigue syndrome that lasts at least 6 months. This study investigated transcriptional profiles of circulating monocytes and circulating cytokines as a subsequent mirror of myeloid cell function, 1 and 6 months after an acute Q fever infection. Methods Total RNA of circulating monocytes was collected from 11 acute Q fever patients and 15 healthy controls, matched for age (±5 years) and sex. Samples were collected at a median of 27 days (baseline, interquartile range, 15–35 days) after the infection and again 6 months thereafter. Transcriptome analysis was performed using RNA sequencing. Additionally, concentrations of circulating interleukin (IL)-10, IL-1β, IL-1Ra, and IL-6 were measured in serum. Results At baseline, acute Q fever patients clearly show a differential transcriptional program compared with healthy controls. This is still the case at follow-up, albeit to a lesser extent. At baseline, a significant difference in levels of circulating IL-10 (P = .0019), IL-1β (P = .0067), IL-1Ra (P = .0008), and IL-6 (P = .0003) was seen. At follow-up, this difference had decreased for IL-10 (P = .0136) and IL-1Ra (P = .0017) and had become nonsignificant for IL-1β (P = .1139) and IL-6 (P = .2792). Conclusions We show that an acute Q fever infection has a long-term effect on the transcriptional program of circulating monocytes and, therefore, likely their myeloid progenitor cells, as well as concentrations of circulating IL-10, IL-1β, IL-1Ra, and IL-6.
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Affiliation(s)
- Ruud Ph Raijmakers
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong
| | - Stephan P Keijmel
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rob Ter Horst
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Boris Novakovic
- Faculty of Science, Department of Molecular Biology, Radboud University, Nijmegen, the Netherlands
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, University Hospital Geelong
| | - Jos Wm Van Der Meer
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Bleeker-Rovers
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo Ab Joosten
- Radboud Expertise Center for Q Fever.,Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong
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18
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Abstract
BACKGROUND Q fever often presents as an undifferentiated febrile illness. Cases occur throughout Australia, with higher rates occurring in northern New South Wales and southern Queensland. OBJECTIVE This article aims to provide clinicians with an overview of Q fever, and covers epidemiology, clinical features, laboratory diagnosis, sequelae, management and prevention. DISCUSSION In Australia, Q fever is the most commonly reported zoonotic disease. Presentation includes fever, rigors, chills, headache, extreme fatigue, drenching sweats, weight loss, arthralgia and myalgia, often in conjunction with abnormal liver function tests. These features make it indistinguishable from many other febrile illnesses. Exposure occurs through contact with livestock and other animals. Coxiella bacteria can survive in dust, where infection may result from inhalation. Laboratory diagnosis is made by serology or polymerase chain reaction. An effective vaccine is available for adults (aged >15 years), but can only be administered after a rigorous pre-vaccination assessment to exclude prior exposure to Coxiella burnetii, requiring a detailed medical history, skin test and serology.
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Affiliation(s)
- Keith Eastwood
- BAppSci, MAppEpi, DrPH, Hunter New England Population Health, University of Newcastle, NSW
| | - Stephen R Graves
- BSc(Hons), MBBS, PhD, FRCPA, FASM, FACTM, Australian Rickettsial Reference Laboratory, University Hospital Geelong, Vic; NSW Health Pathology, Nepean Hospital, Penrith, NSW
| | - Peter D Massey
- DrPH, GCPH, RN, Hunter New England Population Health, Wallsend, NSW; College of Medicine @ Dentistry, James Cook University, Townsville, Qld
| | - Katrina Bosward
- BSc (Vet), BVSc PhD, GradDiplVet ClinSciGradCert (Higher Ed), Faculty of Science, University of Sydney, NSW
| | - Debra van den Berg
- MPH, RN, Public Health Officer, Communicable Disease Surveillance, North Coast Public Health Unit, Lismore, NSW
| | - Penny Hutchinson
- BMed, FRACGP, MPH@TM, FAFPHM, FNZCPHM, Darling Downs Hospital and Health Service, Toowoomba, Qld
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19
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Gidding HF, Faddy HM, Durrheim DN, Graves SR, Nguyen C, Hutchinson P, Massey P, Wood N. Seroprevalence of Q fever among metropolitan and non‐metropolitan blood donors in New South Wales and Queensland, 2014–2015. Med J Aust 2019; 210:309-315. [DOI: 10.5694/mja2.13004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Heather F Gidding
- Northern Clinical SchoolUniversity of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
| | | | | | - Stephen R Graves
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | - Chelsea Nguyen
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | | | - Peter Massey
- Hunter New England Local Health District Newcastle NSW
- University of New England Armidale NSW
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
- University of Sydney Sydney NSW
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20
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Tshokey T, Stenos J, Tenzin T, Drukpa K, Gurung RB, Graves SR. Serological Evidence of Rickettsia, Orientia, and Coxiella in Domestic Animals from Bhutan: Preliminary Findings. Vector Borne Zoonotic Dis 2018; 19:95-101. [PMID: 30148695 DOI: 10.1089/vbz.2018.2336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is no information on rickettsial diseases in domestic animals in Bhutan. This study provides preliminary serological data on exposure of domestic animals to Rickettsia, Orientia, and Coxiella. Animal sera were collected opportunistically from Bhutan and tested in the Australian Rickettsial Reference Laboratory for IgG antibodies against spotted fever group (SFG) and typhus group (TG) Rickettsia, scrub typhus group (STG), and Q fever (QF). Of the 294 animals tested, 136 (46%) showed serological evidence of past exposure to one or more rickettsiae: 106 (36%), 62 (21%), 45 (15%), and 11 (4%) being positive against SFG Rickettsia, Orientia, TG Rickettsia, and Coxiella, respectively. Dogs appeared to exhibit the highest seropositivity against SFG (55%) and TG Rickettsia (45%), horses against STG (91%), while goats were mostly positive for Coxiella (9%). Dogs also appeared to have high risk of being exposed to SFG Rickettsia (odd ratios [OR] 5.71, 95% confidence interval [CI] 3.02-10.80, p < 0.001), TG Rickettsia (OR 48.74, 95% CI 11.29-210.32, p < 0.001), and STG (OR 6.80, 95% CI 3.32-13.95, p < 0.001), but not against QF (OR 1.95, 95% CI 0.42-8.95, p = 0.390). Differences in seropositivity rates between animal species may have been significant for SFG, TG, and STG, but not for QF. The differences in the seropositivity rates of the four infections between districts appeared to be significant for TG and STG, but not for SFG and QF. The seropositivity rates of domestic animals to the four rickettsial infections were consistent with similar studies on the human population in the same areas and appear to demonstrate a high prevalence of exposure to rickettsiae in Bhutan. These preliminary findings constitute baseline data for Bhutan. The findings of this study call for an increased human-livestock sector collaboration in rickettsial diseases research aimed at developing diagnostic and therapeutic guidelines and formulating preventive and control measures through a One Health approach.
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Affiliation(s)
- Tshokey Tshokey
- 1 Faculty of Health and Medicine, University of Newcastle , Newcastle, Australia .,2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia .,3 Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) , Thimphu, Bhutan
| | - John Stenos
- 2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia
| | - Tenzin Tenzin
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Kinzang Drukpa
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Ratna Bahadur Gurung
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Stephen R Graves
- 1 Faculty of Health and Medicine, University of Newcastle , Newcastle, Australia .,2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia
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21
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Graves PS, Graves SR, Minhas T, Lewinson RE, Vallerand IA, Lewinson RT. Effects of medical scribes on physician productivity in a Canadian emergency department: a pilot study. CMAJ Open 2018; 6:E360-E364. [PMID: 30181347 PMCID: PMC6182119 DOI: 10.9778/cmajo.20180031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Emergency department efficiency is a priority across Canada. In the United States, scribes may increase the number of patients seen per hour per physician; however, Canadian data are lacking. We sought to implement scribes in a Canadian emergency department with the hypothesis that scribes would increase the number of patients seen per hour per physician. METHODS We conducted a 4-month quality improvement pilot study in a community emergency department in Ottawa, Ontario. Data collection began January 2015 after scribe training. Physicians received shifts with and without a scribe for a period of 4 months. Across the study, the mean number of patients seen per hour was determined for each physician during shifts with and without a scribe. We compared mean (± standard deviation [SD]) number of patients seen per hour based on presence or absence of a scribe by 2-tailed paired-samples t test. RESULTS Eleven scribes participated and ranged in age from 18 to 23 years. Twenty-two full- or part-time emergency physicians were followed. We documented 463 physician-hours without use of a scribe and 693.75 physician-hours with use of a scribe. Across all 22 physicians, 18 (81.8%) saw more patients per hour with use of a scribe. Overall, the number of patients seen per hour per physician was significantly greater (+12.9%) during shifts with a scribe (mean [± SD] 2.81 [± 0.78]) than during shifts without a scribe (mean [± SD] 2.49 [± 0.60]; p = 0.006). INTERPRETATION In this pilot study, the use of scribes resulted in an increased number of patients seen per hour per physician. Because this was a small study at a single centre, further research on the effects of scribes in Canada is warranted.
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Affiliation(s)
- Peter S Graves
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta.
| | - Stephen R Graves
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta
| | - Tanvir Minhas
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta
| | - Rebecca E Lewinson
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta
| | - Isabelle A Vallerand
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta
| | - Ryan T Lewinson
- Department of Emergency Medicine (P. Graves), Queensway- Carleton Hospital; Faculty of Medicine (P. Graves, Minhas), University of Ottawa; Medical Scribes of Canada (P. Graves, S. Graves, Minhas, R.E. Lewinson), Ottawa, Ont.; Faculty of Health (R.E. Lewinson), York University, Toronto, Ont.; Cumming School of Medicine (Vallerand, R.T. Lewinson), University of Calgary, Calgary, Alta
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Khan SF, Tadepalli M, Stenos J, Graves SR, Korman TM. Foreign tick smuggling rickettsia evades Australian border control. Med J Aust 2018; 208:505. [DOI: 10.5694/mja17.01201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/27/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mythili Tadepalli
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC
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Stenos J, Graves SR. Laboratory diagnosis of human infections transmitted by ticks, fleas, mites and lice in Australia. Microbiol Aust 2018. [DOI: 10.1071/ma18059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A wide range of human pathogens (viruses, bacteria, protozoa) are transmitted by ticks, fleas, mites and lice worldwide. Some of these infections occur in Australia1, whereas others appear to be absent, although they may occur in returned travellers. The key to diagnosis is two-fold: recognition of the possibility of a vector-borne infection by the treating doctor and confirmation of the diagnosis in a diagnostic, microbiology laboratory. Laboratory diagnostic assays include culture (used rarely), nucleic acid amplification (used increasingly) and serology (used often).
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Graves SR. Tick-borne pathogens and diseases. Microbiol Aust 2018. [DOI: 10.1071/ma18058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Welcome to this edition of Microbiology Australia in which we examine the second most dangerous ectoparasite for humans, the tick (the most dangerous being without doubt the mosquito!), for the pathogens it carries and the diseases it can cause.
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Tshokey T, Stenos J, Durrheim DN, Eastwood K, Nguyen C, Graves SR. Seroprevalence of rickettsial infections and Q fever in Bhutan. PLoS Negl Trop Dis 2017; 11:e0006107. [PMID: 29176880 PMCID: PMC5720829 DOI: 10.1371/journal.pntd.0006107] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/07/2017] [Accepted: 11/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background With few studies conducted to date, very little is known about the epidemiology of rickettsioses in Bhutan. Due to two previous outbreaks and increasing clinical cases, scrub typhus is better recognized than other rickettsial infections and Q fever. Methodology A descriptive cross-sectional serosurvey was conducted from January to March 2015 in eight districts of Bhutan. Participants were 864 healthy individuals from an urban (30%) and a rural (70%) sampling unit in each of the eight districts. Serum samples were tested by microimmunofluorescence assay for rickettsial antibodies at the Australian Rickettsial Reference Laboratory. Results Of the 864 participants, 345 (39.9%) were males and the mean age of participants was 41.1 (range 13–98) years. An overall seroprevalence of 49% against rickettsioses was detected. Seroprevalence was highest against scrub typhus group (STG) (22.6%) followed by spotted fever group (SFG) rickettsia (15.7%), Q fever (QF) (6.9%) and typhus group (TG) rickettsia (3.5%). Evidence of exposure to multiple agents was also noted; the commonest being dual exposure to STG and SFG at 5%. A person’s likelihood of exposure to STG and SFG rickettsia significantly increased with age and farmers were twice as likely to have evidence of STG exposure as other occupations. Trongsa district appeared to be a hotspot for STG exposure while Punakha district had the lowest STG exposure risk. Zhemgang had the lowest exposure risk to SFG rickettsia compared to other districts. People living at altitudes above 2000 meters were relatively protected from STG infections but this was not observed for SFG, TG or QF exposure. Conclusion This seroprevalence study highlights the endemicity of STG and SFG rickettsia in Bhutan. The high seroprevalence warrants appropriate public health interventions, such as diagnostic improvements and clinical treatment guidelines. Future studies should focus on vector profiles, geospatial, bio-social and environmental risk assessment and preventive and control strategies. Rickettsial infections including scrub typhus and Q fever are not widely recognised in Bhutan although the country is situated in an endemic Asian region. With two recorded outbreaks, scrub typhus is known to occur but other rickettsial infections and Q fever have not been recorded. In this first seroprevalence study of rickettsial infections, an overall seroprevalence of 49% was detected against rickettsioses amongst 864 participants. Seroprevalence was highest against scrub typhus group (STG) (22.6%) followed by spotted fever group (SFG) rickettsia (15.7%), Q fever (QF) (6.9%) and typhus group (TG) rickettsia (3.5%). Evidence of exposure to multiple agents were also noted; the commonest being dual exposure to STG and SFG at 5%. A person’s likelihood of exposure to STG and SFG significantly increased with age and farmers were twice as likely to have evidence of STG exposure as other occupations. Trongsa district in central Bhutan appeared to be a hotspot for STG exposure. People living at altitudes above 2000 meters were relatively protected from STG infections but this was not observed for SFG, TG and QF exposure. The findings from this study may direct future research on rickettsioses in Bhutan. These neglected tropical diseases warrant specific public health interventions in Bhutan.
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Affiliation(s)
- Tshokey Tshokey
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - David N. Durrheim
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Population Health, Hunter New England Local Health District, NSW Health, Newcastle, Australia
| | - Keith Eastwood
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Population Health, Hunter New England Local Health District, NSW Health, Newcastle, Australia
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
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Abstract
Tick bites in Australia can lead to a variety of illnesses in patients. These include infection, allergies, paralysis, autoimmune disease, post-infection fatigue and Australian multisystem disorder. Rickettsial (Rickettsia spp.) infections (Queensland tick typhus, Flinders Island spotted fever and Australian spotted fever) and Q fever (Coxiella burnetii) are the only systemic bacterial infections that are known to be transmitted by tick bites in Australia. Three species of local ticks transmit bacterial infection following a tick bite: the paralysis tick (Ixodes holocyclus) is endemic on the east coast of Australia and causes Queensland tick typhus due to R. australis and Q fever due to C. burnetii; the ornate kangaroo tick (Amblyomma triguttatum) occurs throughout much of northern, central and western Australia and causes Q fever; and the southern reptile tick (Bothriocroton hydrosauri) is found mainly in south-eastern Australia and causes Flinders Island spotted fever due to R. honei. Much about Australian ticks and the medical outcomes following tick bites remains unknown. Further research is required to increase understanding of these areas.
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Affiliation(s)
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, VIC
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Raby E, Pearn T, Marangou AG, Merritt AJ, Murray RJ, Dyer JR, Graves SR. New Foci of Spotted Fever Group Rickettsiae Including Rickettsia honei in Western Australia. Trop Med Infect Dis 2016; 1:tropicalmed1010005. [PMID: 30270856 PMCID: PMC6082045 DOI: 10.3390/tropicalmed1010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022] Open
Abstract
We describe the first reported case of spotted fever group rickettsiosis in Western Australia, and two cases of probable Rickettsia honei from a new geographic focus. These findings highlight the need to raise awareness of ricksettsial infection among local clinicians as well as those treating visitors to this region, important for outdoor recreation.
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Affiliation(s)
- Edward Raby
- Fiona Stanley Hospital, Murdoch, WA 6150, Australia.
| | - Toby Pearn
- Recherche Medical Centre, Esperance, WA 6450, Australia.
| | | | - Adam J Merritt
- PathWest Laboratory Medicine, Nedlands, WA 6009, Australia.
| | - Ronan J Murray
- PathWest Laboratory Medicine, Nedlands, WA 6009, Australia.
| | - John R Dyer
- Fiona Stanley Hospital, Murdoch, WA 6150, Australia.
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong, VIC 3220, Australia.
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Graves SR, Jackson C, Hussain-Yusuf H, Vincent G, Nguyen C, Stenos J, Webster M. Ixodes holocyclus Tick-Transmitted Human Pathogens in North-Eastern New South Wales, Australia. Trop Med Infect Dis 2016; 1:tropicalmed1010004. [PMID: 30270855 PMCID: PMC6082046 DOI: 10.3390/tropicalmed1010004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Abstract
A group of 14 persons who live in an area of Australia endemic for the Australian paralysis tick, Ixodes holocyclus, and who were involved in regularly collecting and handling these ticks, was examined for antibodies to tick-transmitted bacterial pathogens. Five (36%) had antibodies to Coxiella burnetii, the causative agent of Q fever and three (21%) had antibodies to spotted fever group (SFG) rickettsiae (Rickettsia spp). None had antibodies to Ehrlichia, Anaplasma, Orientia, or Borrelia (Lymedisease) suggesting that they had not been exposed to these bacteria. A total of 149 I. holocyclus ticks were examined for the citrate synthase (gltA) gene of the SFG rickettsiae and the com1 gene of C. burnetii; 23 (15.4%) ticks were positive for Rickettsia spp. and 8 (5.6%) positive for Coxiella spp. Sequencing of fragments of the gltA gene and the 17 kDa antigen gene from a selection of the ticks showed 99% and 100% homology, respectively, to Rickettsia australis, the bacterium causing Queenslandtick typhus. Thus, it appears that persons bitten by I. holocyclus in NE NSW, Australia have an approximate one in six risk of being infected with R. australis. Risks of Q fever were also high in this region but this may have been due to exposure by aerosol from the environment rather than by tick bite. A subset of 74 I. holocyclus ticks were further examined for DNA from Borrelia spp., Anaplasma spp. and Ehrlichia spp. but none was positive. Some of these recognised human bacterial pathogens associated with ticks may not be present in this Australian tick species from northeastern New South Wales.
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Affiliation(s)
- Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Chrissie Jackson
- Wongaburra Research Centre, Vetx Research, Casino, NSW 2470, Australia.
| | | | - Gemma Vincent
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, 3220 VIC, Australia.
| | - Maurice Webster
- Wongaburra Research Centre, Vetx Research, Casino, NSW 2470, Australia.
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Graves SR, Islam A. Endemic Q Fever in New South Wales, Australia: A Case Series (2005-2013). Am J Trop Med Hyg 2016; 95:55-9. [PMID: 27139451 PMCID: PMC4944709 DOI: 10.4269/ajtmh.15-0828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/22/2016] [Indexed: 12/13/2022] Open
Abstract
Q fever is endemic in Australia, and during the period 2005-2013 our laboratory diagnosed 379 cases in New South Wales. To evaluate clinical symptoms, epidemiology, mode of diagnosis, antibody profiles, and treatment, a subset of 160 (42%) Q fever cases were analyzed in detail following the return of a questionnaire by the patient's doctor and from their laboratory reports. Overall, 82% patients were male and predominantly middle aged. The majority of patients (89%) had animal contact among which 63% were with cattle, 11% with sheep, and 7% with kangaroos. Clinical symptoms were nonspecific: myalgia (94%), fever (91%), headache (80%), acute fatigue (64%), and arthralgia (55%). Most cases (93%) were acute, and serology (immunofluorescence) was the main diagnostic modality. Positive real-time polymerase chain reaction results were useful in the diagnosis of both acute and chronic Q fever, as was the isolation of Coxiella burnetii in cell culture. Doxycycline was the antibiotic most commonly used.
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Affiliation(s)
- Stephen R Graves
- Australian Rickettsial Reference Laboratory, Newcastle Branch, New South Wales, Australia. Department of Microbiology, Pathology North-John Hunter Hospital, New South Wales, Australia.
| | - Aminul Islam
- Australian Rickettsial Reference Laboratory, Newcastle Branch, New South Wales, Australia. Department of Microbiology, Pathology North-John Hunter Hospital, New South Wales, Australia
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Vincent GA, Graves SR, Robson JM, Nguyen C, Hussain-Yusuf H, Islam A, Fenwick SG, Stenos J. Isolation of Coxiella burnetii from serum of patients with acute Q fever. J Microbiol Methods 2015; 119:74-8. [DOI: 10.1016/j.mimet.2015.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
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Affiliation(s)
| | | | - Nicholas M Anstey
- Royal Darwin Hospital, Darwin, NT
- Menzies School of Health Research, Darwin, NT
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Punj P, Nelson R, Gardiner S, Lodge M, Graves SR, Warner MS. A pilgrim's progress: severe Rickettsia conorii infection complicated by gangrene. Med J Aust 2013; 198:629-31. [DOI: 10.5694/mja13.10025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/27/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Morgyn S Warner
- Queen Elizabeth Hospital, Adelaide, SA
- SA Pathology, Adelaide, SA
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Jiang J, Paris DH, Blacksell SD, Aukkanit N, Newton PN, Phetsouvanh R, Izzard L, Stenos J, Graves SR, Day NPJ, Richards AL. Diversity of the 47-kD HtrA nucleic acid and translated amino acid sequences from 17 recent human isolates of Orientia. Vector Borne Zoonotic Dis 2013; 13:367-75. [PMID: 23590326 DOI: 10.1089/vbz.2012.1112] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Orientia tsutsugamushi, the etiologic agent of potentially fatal scrub typhus, is characterized by a high antigenic diversity, which complicates the development of a broadly protective vaccine. Efficacy studies in murine and nonhuman primate models demonstrated the DNA vaccine candidate pKarp47, based upon the O. tsutsugamushi Karp 47-kD HtrA protein gene, to be a successful immunoprophylactic against scrub typhus. To characterize 47-kD HtrA protein diversity among human isolates of Orientia, we sequenced the full open reading frame (ORF) of the 47-kD HtrA gene and analyzed the translated amino acid sequences of 17 patient isolates from Thailand (n=13), Laos (n=2), Australia (n=1), and the United Arab Emirates (UAE) (n=1) and 9 reference strains: Karp (New Guinea), Kato (Japan), Ikeda (Japan), Gilliam (Burma), Boryong (Korea), TA763, TH1811 and TH1817 (Thailand), and MAK243 (China). The percentage identity (similarity) of translated amino acid sequences between 16 new isolates and 9 reference strains of O. tsutsugamushi ranged from 96.4% to 100% (97.4% to 100%). However, inclusion of the recently identified Orientia chuto sp. nov. reduced identity (similarity) values to 82.2% to 83.3% (90.4% to 91.4%). These results demonstrate the diversity of Orientia 47-kD HtrA among isolates encountered by humans and therefore provide support for the necessity of developing a broadly protective scrub typhus vaccine that takes this diversity into account.
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Affiliation(s)
- Ju Jiang
- Naval Medical Research Center , Silver Spring, Maryland, USA
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Affiliation(s)
- Heather F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW
| | - Stephen R Graves
- Hunter Area Pathology Service, Newcastle, NSW
- Australian Rickettsial Reference Laboratory Foundation, Geelong, VIC
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Lockhart MG, Islam A, Fenwick SG, Graves SR, Stenos J. Comparative sensitivity of four different cell lines for the isolation of Coxiella burnetii. FEMS Microbiol Lett 2012; 334:75-8. [DOI: 10.1111/j.1574-6968.2012.02617.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/26/2012] [Accepted: 06/03/2012] [Indexed: 11/27/2022] Open
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Hess IM, Massey PD, Durrheim DN, O'Connor S, Graves SR. Preventing Q fever endocarditis: a review of cardiac assessment in hospitalised Q fever patients. Rural Remote Health 2011; 11:1763. [PMID: 22115319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Acute Q fever is an important zoonotic disease in some parts of rural Australia. Q Fever can lead to chronic disease such as endocarditis, this complication occurring more commonly in patients with underlying heart valve pathology or an impaired immune system. Untreated Q fever endocarditis has a high mortality rate, but even with appropriate therapy, 10% of patients will die. Cardiac assessment can identify patients at risk. The aim of this review was to examine recorded cardiac assessment of hospitalised Q fever patients within the regional area of Hunter New England (HNE), New South Wales (NSW). METHODS Medical records of patients with Q fever admitted to hospitals in HNE during the period 2005-2009 were identified through the NSW Notifiable Diseases Database and the NSW Inpatient Statistics Collection. A standardised medical record review tool was used to undertake the review. RESULTS Eighty-nine records were reviewed. Over 50% of patients were admitted to a district hospital staffed by local GPs. Cardiac assessment was not routinely documented and for 91% there was no record of a cardiac history being taken. Approximately 25% had no record of a cardiac physical examination and only 6 cases had a record of a complete cardiac examination. CONCLUSION Q Fever remains an important disease in some parts of rural Australia. Q Fever endocarditis is a serious sequel to acute Q fever and underlying heart valve pathology. Due to its indolent progression and poor outcome when diagnosis is delayed, a thorough cardiac assessment of all patients with suspected or confirmed Q fever is important. The level of documentation of cardiac assessment for Q fever patients is of concern because it may indicate cardiac assessments were not performed. General practitioners, especially in rural and regional areas, are encouraged to conduct cardiac assessments for all patients with acute Q fever to identify patients at risk of developing Q fever endocarditis.
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Affiliation(s)
- I M Hess
- Public Health Training and Development Branch, NSW Department of Health, Sydney, New South Wales, Australia.
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Simon NG, Cremer PD, Graves SR. Murine typhus returns to New South Wales: a case of isolated meningoencephalitis with raised intracranial pressure. Med J Aust 2011; 194:652-4. [DOI: 10.5694/j.1326-5377.2011.tb03152.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/19/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Neil G Simon
- Royal North Shore Hospital, Sydney, NSW
- Northern Clinical School, University of Sydney, Sydney, NSW
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Williams M, Izzard L, Graves SR, Stenos J, Kelly JJ. First probable Australian cases of human infection with Rickettsia felis (cat-flea typhus). Med J Aust 2011; 194:41-3. [PMID: 21449868 DOI: 10.5694/j.1326-5377.2011.tb04145.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 09/19/2010] [Indexed: 11/17/2022]
Abstract
Human infection with Rickettsia felis has been reported in most parts of the world, and R. felis has recently been confirmed in cat fleas in Western Australia. The clinical presentations of R. typhi and R. felis are similar, and in the past, the incidence of R. felis infection may have been underestimated. We describe the first reported cases of probable human R. felis infection in Australia. Two adults and three children in Victoria contracted a rickettsial disease after exposure to fleas from kittens. Molecular testing of fleas demonstrated the presence of R. felis but not R. typhi.
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Lockhart MG, Graves SR, Banazis MJ, Fenwick SG, Stenos J. A comparison of methods for extracting DNA from Coxiella burnetii as measured by a duplex qPCR assay. Lett Appl Microbiol 2011; 52:514-20. [PMID: 21338377 DOI: 10.1111/j.1472-765x.2011.03034.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the optimal DNA extraction method for the detection of Coxiella burnetii including the small-cell variant (SCV) by real-time PCR (qPCR) in clinical samples. METHODS AND RESULTS A duplex qPCR detecting two Coxiella burnetii gene targets (com1 and IS1111a genes) was developed. Each target in this PCR had a sensitivity of one copy number per reaction. DNA extraction methods were compared on spiked negative samples and included a silica column kit, a chloroform separation prior to a silica column method and a chloroform/phenol separation and DNA precipitation method. CONCLUSIONS The silica column extraction method was more efficient at recovering C. burnetii DNA, from large-cell and small-cell variants, than a chloroform or chloroform/phenol method. The silica column method was useful on spiked human samples including serum, buffy coat and bone marrow samples. SIGNIFICANCE AND IMPACT OF STUDY This study demonstrated that a simple column kit method is efficient to use for the detection of C. burnetii in clinical samples including the SCV.
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Affiliation(s)
- M G Lockhart
- The Australian Rickettsial Reference Laboratory/Barwon Biomedical Research, The Geelong Hospital, Bellarine Street, Geelong, Victoria 3220, Australia
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Paris DH, Blacksell SD, Stenos J, Graves SR, Unsworth NB, Phetsouvanh R, Newton PN, Day NPJ. Real-time multiplex PCR assay for detection and differentiation of rickettsiae and orientiae. Trans R Soc Trop Med Hyg 2008; 102:186-93. [PMID: 18093627 DOI: 10.1016/j.trstmh.2007.11.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 11/01/2007] [Accepted: 11/01/2007] [Indexed: 11/30/2022] Open
Abstract
The high incidence of rickettsial diseases in Southeast Asia necessitates rapid and accurate diagnostic tools for a broad range of rickettsial agents, including Orientia tsutsugamushi (scrub typhus) and Rickettsia typhi (murine typhus), but also spotted fever group infections, which are increasingly reported. We present an SYBR-Green-based, real-time multiplex PCR assay for rapid identification and differentiation of scrub typhus group, typhus group and spotted fever group rickettsiae using 47kDa, gltA and ompB gene targets. Detection limits for amplification of these genes in reference strains ranged from 24 copies/microl, 5 copies/microl and 1 copy/microl in multiplex and 2 copies/microl, 1 copy/microl and 1 copy/microl in single template format, respectively. Differentiation by melt-curve analysis led to distinct melt temperatures for each group-specific amplicon. The assay was subjected to 54 samples, of which all cell-culture and 75% of characterised clinical buffy coat samples were correctly identified. Real-time PCR has the advantage of reliably detecting and differentiating rickettsial and orientia cell-culture isolates in a single-template assay, compared with the more time-consuming and laborious immunofluorescence assay. However, further optimisation and validation on samples taken directly from patients to assess its clinical diagnostic utility is required.
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Affiliation(s)
- Daniel H Paris
- Mahidol-Oxford Tropical Medicine Programme, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Abstract
We report 3 rickettsioses on Darnley Island, Australia, in the Torres Strait. In addition to previously described cases of Flinders Island spotted fever (Rickettsia honei strain “marmionii”), we describe 1 case of Queensland tick typhus (R. australis) and 2 cases of scrub typhus caused by a unique strain (Orientia tsutsugamushi).
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Affiliation(s)
- Nathan B Unsworth
- The Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
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Unsworth NB, Stenos J, Graves SR, Faa AG, Cox GE, Dyer JR, Boutlis CS, Lane AM, Shaw MD, Robson J, Nissen MD. Flinders Island spotted fever rickettsioses caused by "marmionii" strain of Rickettsia honei, Eastern Australia. Emerg Infect Dis 2007. [PMID: 17553271 PMCID: PMC2725950 DOI: 10.3201/eid1304.060087] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report 7 cases of rickettsiosis caused by a new rickettsial strain. Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis, with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the “marmionii” strain of R. honei, in honor of Australian physician and scientist Barrie Marmion.
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Affiliation(s)
- Nathan B Unsworth
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
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Unsworth NB, Stenos J, Graves SR, Faa AG, Cox GE, Dyer JR, Boutlis CS, Lane AM, Shaw MD, Robson J, Nissen MD. Flinders Island Spotted Fever Rickettsioses Caused by “marmionii” Strain ofRickettsia honei,Eastern Australia. Emerg Infect Dis 2007; 13:566-73. [PMID: 17553271 PMCID: PMC2725950 DOI: 10.3201/eid1304.050087] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the "marmionii" strain of R. honei, in honor of Australian physician and scientist Barrie Marmion.
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Affiliation(s)
- Nathan B. Unsworth
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Antony G. Faa
- Warwick Hospital (Southern Downs Health Services District), Warwick, Queensland, Australia
| | - G. Erika Cox
- Launceston General Hospital, Launceston, Tasmania, Australia
| | - John R. Dyer
- Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Craig S. Boutlis
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Amanda M. Lane
- University of Queensland, Brisbane, Queensland, Australia
| | | | - Jennifer Robson
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
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Dyer JR, Einsiedel L, Ferguson PE, Lee AS, Unsworth NB, Graves SR, Gordon DL. A new focus of Rickettsia honei spotted fever in South Australia. Med J Aust 2006; 182:231-4. [PMID: 15748134 DOI: 10.5694/j.1326-5377.2005.tb06673.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 11/18/2004] [Indexed: 11/17/2022]
Abstract
We recently diagnosed rickettsial spotted fever in four patients from the south-eastern coastal region of South Australia near Adelaide, an area not known to be endemic for this infection. All infections were acquired within the geographic range of Aponomma hydrosauri, the tick vector of Rickettsia honei. Infection by R. honei was confirmed in two patients. This extension of the known geographic range of R. honei infection may be explained, in part, by alterations in host-parasite ecology.
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Affiliation(s)
- John R Dyer
- Department of Infectious Diseases, Fremantle Hospital, PO Box 480, Fremantle, 6959 WA, Australia.
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Faa AG, Graves SR, Nguyen C, Stenos J. A serological survey of rickettsial infections in the Gazelle Peninsula, East New Britain and a review of the literature. P N G Med J 2006; 49:43-46. [PMID: 18396611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Of the various rickettsial diseases, only scrub typhus has been well documented in Papua New Guinea. A review of the historical literature confirms this. A serological survey was conducted on 113 antenatal patients presenting to a district hospital in Kokopo, East New Britain. Results suggested that a spotted fever rickettsial infection is common in this area with a seroprevalence of about 17% in young women. There was no evidence of scrub typhus or murine (endemic) typhus in the population sampled. Clinical implications of these findings are discussed.
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Affiliation(s)
- Antony G Faa
- St Mary's Hospital Vunapope, Kokopo, Papua New Guinea
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47
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Stenos J, Graves SR, Unsworth NB. A highly sensitive and specific real-time PCR assay for the detection of spotted fever and typhus group Rickettsiae. Am J Trop Med Hyg 2005; 73:1083-5. [PMID: 16354816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
A highly specific real-time polymerase chain reaction (PCR) assay was developed to detect spotted fever and typhus group rickettsiae using the citrate synthase gene as the target. The assay amplified rickettsial members of the spotted fever and typhus group including Rickettsia akari, R. australis, R. conorii, R. honei, "R. marmionii," R. sibirica, R. rickettsii, R. typhi, and R. prowazekii. The ancestral group rickettsia, R. bellii, did not produce a positive reaction, nor did other members of the order Rickettsiales or any non-rickettsial bacteria. The assay had a sensitivity of one target copy number per reaction as determined by serial dilutions of a plasmid containing a spotted fever group target sequence. This quantitative assay is useful for the enumeration of rickettsiae in clinical specimens and the diagnosis of rickettsial illnesses, when rickettsial numbers are very low.
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Affiliation(s)
- John Stenos
- The Australian Rickettsial Reference Laboratory, Department of Clinical and Biomedical Sciences, The University of Melbourne, The Geelong Hospital, Victoria, Australia
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48
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Abstract
AIM To demonstrate that Flinders Island spotted fever (FISF), a spotted fever group rickettsial infection caused by Rickettsia honei, is found not only on Flinders Island (Bass Strait), Tasmania, but elsewhere in south-east Australia. METHODS Cases of FISF were identified by rickettsial serology, culture and the detection of rickettsial DNA via PCR. Isolates and PCR products were sequenced to identify the aetiological agent as R. honei. RESULTS Three new cases of FISF were detected outside of Flinders Island. One on Schouten Island, south of the Freycinet Peninsula, Tasmania, and two in south-eastern South Australia (McLaren Vale and Goolwa). CONCLUSIONS These cases show that FISF extends beyond Flinders Island and most likely has the same distribution across south-east Australia as its vector, the reptile tick Aponomma hydrosauri. FISF should be considered as a differential diagnosis in patients from south-eastern Australia presenting with fever, headache and rash following a tick bite.
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Affiliation(s)
- Nathan B Unsworth
- The Australian Rickettsial Reference Laboratory, Department of Clinical and Biomedical Sciences, The University of Melbourne, The Geelong Hospital, Victoria, Australia.
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49
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Jones SL, Athan E, O'Brien D, Graves SR, Nguyen C, Stenos J. Murine typhus: the first reported case from Victoria. Med J Aust 2004; 180:482. [PMID: 15115431 DOI: 10.5694/j.1326-5377.2004.tb06032.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 02/12/2004] [Indexed: 11/17/2022]
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50
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Land MV, Ching WM, Dasch GA, Zhang Z, Kelly DJ, Graves SR, Devine PL. Evaluation of a commercially available recombinant-protein enzyme-linked immunosorbent assay for detection of antibodies produced in scrub typhus rickettsial infections. J Clin Microbiol 2000; 38:2701-5. [PMID: 10878067 PMCID: PMC87002 DOI: 10.1128/jcm.38.7.2701-2705.2000] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 56-kDa major outer membrane protein antigen of Orientia tsutsugamuchi is the immunodominant antigen in human scrub typhus (ST) infections. An enzyme-linked immunosorbent assay (ELISA) using a recombinant 56-kDa protein (r56) to detect specific immunoglobulin M (IgM) produced in ST infections was developed, and its performance was evaluated using sera from patients with active ST (n = 59), spotted fever (SF) (n = 31), and murine typhus (MT) (n = 6) and from those without rickettsial infection (n = 52). The r56 ELISA was compared to an ELISA using native whole cell lysate of O. tsutsugamushi Karp or O. tsutsugamushi Gilliam as antigens. The performance of the assays using r56 was similar to that of those using native antigens. Using indirect immunoperoxidase (IIP) as the reference test, sensitivities were 86, 88, and 88% while specificities were 84, 90, and 87% in the three assays. Furthermore, cross-reactivity in confirmed cases of SF and MT was low (5.4, 2.7, and 2.7% respectively). The additional use of IgG in the r56 ELISA gave improved performance (sensitivity, 80%; specificity, 96%; cross-reactivity in SF and MT, 2.7%). The detection of high levels of IgG in some IgM-negative patients illustrates the importance of including a test for IgG in the detection of secondary or reactivated infections, since many of these patients were from regions in Thailand where these infections are endemic.
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Affiliation(s)
- M V Land
- PanBio Pty. Ltd., Windsor, Queensland, Australia
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