1
|
Rauch J, Barton J, Kwiatkowski M, Wunderlich M, Steffen P, Moderzynski K, Papp S, Höhn K, Schwanke H, Witt S, Richardt U, Mehlhoop U, Schlüter H, Pianka V, Fleischer B, Tappe D, Osterloh A. GroEL is an immunodominant surface-exposed antigen of Rickettsia typhi. PLoS One 2021; 16:e0253084. [PMID: 34111210 PMCID: PMC8191997 DOI: 10.1371/journal.pone.0253084] [Citation(s) in RCA: 3] [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: 03/08/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022] Open
Abstract
Rickettsioses are neglected and emerging potentially fatal febrile diseases that are caused by obligate intracellular bacteria, rickettsiae. Rickettsia (R.) typhi and R. prowazekii constitute the typhus group (TG) of rickettsiae and are the causative agents of endemic and epidemic typhus, respectively. We recently generated a monoclonal antibody (BNI52) against R. typhi. Characterization of BNI52 revealed that it specifically recognizes TG rickettsiae but not the members of the spotted fever group (SFG) rickettsiae. We further show that BNI52 binds to protein fragments of ±30 kDa that are exposed on the bacterial surface and also present in the periplasmic space. These protein fragments apparently derive from the cytosolic GroEL protein of R. typhi and are also recognized by antibodies in the sera from patients and infected mice. Furthermore, BNI52 opsonizes the bacteria for the uptake by antigen presenting cells (APC), indicating a contribution of GroEL-specific antibodies to protective immunity. Finally, it is interesting that the GroEL protein belongs to 32 proteins that are differentially downregulated by R. typhi after passage through immunodeficient BALB/c CB17 SCID mice. This could be a hint that the rickettsia GroEL protein may have immunomodulatory properties as shown for the homologous protein from several other bacteria, too. Overall, the results of this study provide evidence that GroEL represents an immunodominant antigen of TG rickettsiae that is recognized by the humoral immune response against these pathogens and that may be interesting as a vaccine candidate. Apart from that, the BNI52 antibody represents a new tool for specific detection of TG rickettsiae in various diagnostic and experimental setups.
Collapse
Affiliation(s)
- Jessica Rauch
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Barton
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Malte Wunderlich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Pascal Steffen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Stefanie Papp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Katharina Höhn
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hella Schwanke
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Susanne Witt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ute Mehlhoop
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Verena Pianka
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Anke Osterloh
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
2
|
Nelder MP, Russell CB, Johnson S, Li Y, Cronin K, Warshawsky B, Brandon N, Patel SN. Assessing human exposure to spotted fever and typhus group rickettsiae in Ontario, Canada (2013-2018): a retrospective, cross-sectional study. BMC Infect Dis 2020; 20:523. [PMID: 32682398 PMCID: PMC7368706 DOI: 10.1186/s12879-020-05244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Assessing the burden of rickettsial infections in Ontario, Canada, is challenging since rickettsial infections are not reportable to public health. In the absence of reportable disease data, we assessed the burden of rickettsial infections by examining patient serological data and clinical information. METHODS Our retrospective, cross-sectional study included patients who had Rickettsia serological testing ordered by their physician, in Ontario, from 2013 to 2018. We tested sera from 2755 non-travel patients for antibodies against spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) using an indirect immunofluorescence assay (IFA) (positive IgG titers ≥1:64). We classified cases using a sensitive surveillance case definition: confirmed (4-fold increase in IgG titers between acute and convalescent sera with clinical evidence of infection), possible (single positive sera with clinical evidence) and previous rickettsial infection (single positive sera without clinical evidence). We classified cases seropositive for both SFGR and TGR as unspecified Rickettsia infections (URIs). RESULTS Less than 5% of all patients had paired acute and convalescent sera tested, and of these, we found a single, laboratory-confirmed SFGR case, with a 4-fold increase in IgG titers and evidence of fever, maculopapular rash and headache. There were 45 possible (19 SFGR, 7 TGR, 19 URI) and 580 previous rickettsial infection (183 SFGR, 89 TGR, 308 URI) cases. The rate of positive tests for SFGR, TGR and URI combined (all case classifications) were 4.4 per 100,000 population. For confirmed and possible cases, the most common signs and symptoms were fever, headache, gastrointestinal complaints and maculopapular rash. The odds of having seropositive patients increased annually by 30% (odds ratio = 1.3, 95% confidence interval: 1.23-1.39). CONCLUSIONS The rates of rickettsial infections in Ontario are difficult to determine. Based on confirmed and possible cases, rates are low, but inclusion of previous rickettsial infection cases would indicate higher rates. We highlight the need for education regarding the importance of testing acute and convalescent sera and consistent completion of the laboratory requisition in confirming rickettsial disease. We suggest further research in Ontario to investigate rickettsial agents in potential vectors and clinical studies employing PCR testing of clinical samples.
Collapse
Affiliation(s)
- Mark P Nelder
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada.
| | - Curtis B Russell
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - Steven Johnson
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Ye Li
- Informatics, Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Kirby Cronin
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Bryna Warshawsky
- Enteric, Zoonotic and Vector-Borne Diseases; Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Nicholas Brandon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Chueng TA, Koch KR, Anstead GM, Agarwal AN, Dayton CL. Case Report: Early Doxycycline Therapy for Potential Rickettsiosis in Critically Ill Patients in Flea-Borne Typhus-Endemic Areas. Am J Trop Med Hyg 2019; 101:863-869. [PMID: 31436155 PMCID: PMC6779210 DOI: 10.4269/ajtmh.19-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/07/2019] [Accepted: 07/16/2019] [Indexed: 01/19/2023] Open
Abstract
Flea-borne typhus (FBT), although usually perceived as a self-resolving febrile illness, actually encompasses a wide spectrum of disease severity, including fulminant sepsis with multi-organ failure. In endemic Texas and California, the incidence of FBT has more than doubled over the last decade. Clinicians remain unfamiliar with severe septic presentations of FBT when considering the etiologies of acute undifferentiated febrile syndromes. The diagnostic challenges of FBT include the nonspecific and variable nature of both history and physical examination and the lack of diagnostic testing that can provide clinically relevant information early in the course of infection. These barriers perpetuate misdiagnoses in critically ill patients and lead to delay in initiating appropriate antibiotics, which may contribute to preventable morbidity and mortality. This case series describes the clinical and diagnostic trajectories of three patients who developed FBT-associated multi-organ dysfunction. These patients achieved resolution of infection after receiving doxycycline in the context of a high clinical suspicion. Patients residing in FBT-endemic areas presenting with a febrile illness of unknown etiology with a suggestive constellation of hyponatremia, elevated transaminase levels, and thrombocytopenia should be suspected of having FBT. Clinicians should proceed to serologic testing with early doxycycline therapy for potential rickettsiosis. Familiarizing clinicians with the presentation of rickettsiosis-associated septic syndromes and its early and appropriate antibiotic treatment can provide lifesaving care and reduce health-care costs through prevention of the morbidity associated with FBT.
Collapse
Affiliation(s)
- Teresa A. Chueng
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Kristopher R. Koch
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Gregory M. Anstead
- Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, Texas
| | - Apeksha N. Agarwal
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Christopher L. Dayton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| |
Collapse
|
5
|
Rauch J, Muntau B, Eggert P, Tappe D. Rickettsia typhi as Cause of Fatal Encephalitic Typhus in Hospitalized Patients, Hamburg, Germany, 1940-1944. Emerg Infect Dis 2019; 24:1982-1987. [PMID: 30334722 PMCID: PMC6200005 DOI: 10.3201/eid2411.171373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated formalin-fixed paraffin-embedded tissue specimens from 7 patients who died with encephalitic typhus in Hamburg, Germany, during World War II. The archived specimens included only central nervous system tissues >70 years old that had been stored at room temperature. We demonstrated successful detection of Rickettsia typhi DNA by a nested qPCR specific to prsA in 2 patients. These results indicate that R. typhi infections contributed to typhus outbreaks during World War II. Immunohistochemical analyses of brain tissue specimens of R. typhi DNA-positive and -negative specimens showed perivascular B-cell accumulation. Around blood vessels, nodular cell accumulations consisted of CD4-positive and CD8-positive T cells and CD68-positive microglia and macrophages; neutrophils were found rarely. These findings are similar to those of previously reported R. prowazekii tissue specimen testing. Because R. typhi and R. prowazekii infections can be clinically and histopathologically similar, molecular analyses should be performed to distinguish the 2 pathogens.
Collapse
|
6
|
Abstract
Typhus group rickettsiosis is caused by the vectorborne bacteria Rickettsia typhi and R. prowazekii. R. typhi, which causes murine typhus, the less severe endemic form of typhus, is transmitted by fleas; R. prowazekii, which causes the severe epidemic form of typhus, is transmitted by body lice. To examine the immunology of human infection with typhus group rickettsiae, we retrospectively reviewed clinical signs and symptoms, laboratory changes, and travel destinations of 28 patients who had typhus group rickettsiosis diagnosed by the German Reference Center for Tropical Pathogens, Hamburg, Germany, during 2010-2017. Immunofluorescence assays of follow-up serum samples indicated simultaneous seroconversion of IgM, IgA, and IgG or concurrence in the first serum sample. Cytokine levels peaked during the second week of infection, coinciding with organ dysfunction and seroconversion. For 3 patients, R. typhi was detected by species-specific nested quantitative PCR. For all 28 patients, R. typhi was the most likely causative pathogen.
Collapse
|
7
|
Erickson T, da Silva J, Nolan MS, Marquez L, Munoz FM, Murray KO. Newly Recognized Pediatric Cases of Typhus Group Rickettsiosis, Houston, Texas, USA. Emerg Infect Dis 2018; 23:2068-2071. [PMID: 29148369 PMCID: PMC5708246 DOI: 10.3201/eid2312.170631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An increase in typhus group rickettsiosis and an expanding geographic range occurred in Texas, USA, over a decade. Because this illness commonly affects children, we retrospectively examined medical records from 2008–2016 at a large Houston-area pediatric hospital and identified 36 cases. The earliest known cases were diagnosed in 2011.
Collapse
|
8
|
Abstract
Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.
Collapse
|
9
|
Moderzynski K, Papp S, Rauch J, Heine L, Kuehl S, Richardt U, Fleischer B, Osterloh A. CD4+ T Cells Are as Protective as CD8+ T Cells against Rickettsia typhi Infection by Activating Macrophage Bactericidal Activity. PLoS Negl Trop Dis 2016; 10:e0005089. [PMID: 27875529 PMCID: PMC5119731 DOI: 10.1371/journal.pntd.0005089] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/02/2016] [Indexed: 01/07/2023] Open
Abstract
Rickettsia typhi is an intracellular bacterium that causes endemic typhus, a febrile disease that can be fatal due to complications including pneumonia, hepatitis and meningoencephalitis, the latter being a regular outcome in T and B cell-deficient C57BL/6 RAG1-/- mice upon Rickettsia typhi infection. Here, we show that CD4+ TH1 cells that are generated in C57BL/6 mice upon R. typhi infection are as protective as cytotoxic CD8+ T cells. CD4+- as well as CD8+-deficient C57BL/6 survived the infection without showing symptoms of disease at any point in time. Moreover, adoptively transferred CD8+ and CD4+ immune T cells entered the CNS of C57BL/6 RAG1-/- mice with advanced infection and both eradicated the bacteria. However, immune CD4+ T cells protected only approximately 60% of the animals from death. They induced the expression of iNOS in infiltrating macrophages as well as in resident microglia in the CNS which can contribute to bacterial killing but also accelerate pathology. In vitro immune CD4+ T cells inhibited bacterial growth in infected macrophages which was in part mediated by the release of IFNγ. Collectively, our data demonstrate that CD4+ T cells are as protective as CD8+ T cells against R. typhi, provided that CD4+ TH1 effector cells are present in time to support bactericidal activity of phagocytes via the release of IFNγ and other factors. With regard to vaccination against TG Rickettsiae, our findings suggest that the induction of CD4+ TH1 effector cells is sufficient for protection. Endemic typhus caused by Rickettsia typhi usually is a relatively mild disease. However, CNS inflammation and neurological symptoms are complications that can occur in severe cases. This outcome of disease is regularly observed in T and B cell-deficient C57BL/6 RAG1-/- mice upon infection with R. typhi. We show here that CD4+ T cells are as protective as cytotoxic CD8+ T cells against R. typhi as long as they are present in time. This is evidenced by the fact that neither CD8+ nor CD4+ T cell-deficient C57BL/6 mice develop disease which is also true for R. typhi-infected C57BL/6 RAG1-/- mice that receive immune CD8+ or CD4+ at an early point in time. Moreover, adoptive transfer of immune CD4+ T cells still protects approximately 60% of C57BL/6 RAG1-/- mice when applied later in advanced infection when the bacteria start to rise. Although CD8+ T cells are faster and more efficient in bacterial elimination, R. typhi is not detectable in CD4+ T cell recipients anymore. We further show that immune CD4+ T cells activate bactericidal functions of microglia and macrophages in the CNS in vivo and inhibit bacterial growth in infected macrophages in vitro which is in part mediated by the release of IFNγ. Collectively, we demonstrate for the first time that CD4+ T cells alone are sufficient to protect against R. typhi infection. With regard to vaccination our findings suggest that the induction of R. typhi-specific CD4+ TH1 effector T cells may be as effective as the much more difficult targeting of cytotoxic CD8+ T cells.
Collapse
Affiliation(s)
- Kristin Moderzynski
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stefanie Papp
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Rauch
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Liza Heine
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Svenja Kuehl
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bernhard Fleischer
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Osterloh
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- * E-mail:
| |
Collapse
|
10
|
Papp S, Moderzynski K, Rauch J, Heine L, Kuehl S, Richardt U, Mueller H, Fleischer B, Osterloh A. Liver Necrosis and Lethal Systemic Inflammation in a Murine Model of Rickettsia typhi Infection: Role of Neutrophils, Macrophages and NK Cells. PLoS Negl Trop Dis 2016; 10:e0004935. [PMID: 27548618 PMCID: PMC4993389 DOI: 10.1371/journal.pntd.0004935] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 04/26/2016] [Accepted: 07/31/2016] [Indexed: 12/31/2022] Open
Abstract
Rickettsia (R.) typhi is the causative agent of endemic typhus, an emerging febrile disease that is associated with complications such as pneumonia, encephalitis and liver dysfunction. To elucidate how innate immune mechanisms contribute to defense and pathology we here analyzed R. typhi infection of CB17 SCID mice that are congenic to BALB/c mice but lack adaptive immunity. CB17 SCID mice succumbed to R. typhi infection within 21 days and showed high bacterial load in spleen, brain, lung, and liver. Most evident pathological changes in R. typhi-infected CB17 SCID mice were massive liver necrosis and splenomegaly due to the disproportionate accumulation of neutrophils and macrophages (MΦ). Both neutrophils and MΦ infiltrated the liver and harbored R. typhi. Both cell populations expressed iNOS and produced reactive oxygen species (ROS) and, thus, exhibited an inflammatory and bactericidal phenotype. Surprisingly, depletion of neutrophils completely prevented liver necrosis but neither altered bacterial load nor protected CB17 SCID mice from death. Furthermore, the absence of neutrophils had no impact on the overwhelming systemic inflammatory response in these mice. This response was predominantly driven by activated MΦ and NK cells both of which expressed IFNγ and is considered as the reason of death. Finally, we observed that iNOS expression by MΦ and neutrophils did not correlate with R. typhi uptake in vivo. Moreover, we demonstrate that MΦ hardly respond to R. typhi in vitro. These findings indicate that R. typhi enters MΦ and also neutrophils unrecognized and that activation of these cells is mediated by other mechanisms in the context of tissue damage in vivo.
Collapse
Affiliation(s)
- Stefanie Papp
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Kristin Moderzynski
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Rauch
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Liza Heine
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Svenja Kuehl
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ulricke Richardt
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Heidelinde Mueller
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bernhard Fleischer
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Osterloh
- Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
11
|
Bizzini A, Péter O, Baud D, Edouard S, Meylan P, Greub G. Evaluation of a new serological test for the detection of anti-Coxiella and anti-Rickettsia antibodies. Microbes Infect 2015; 17:811-6. [PMID: 26432518 DOI: 10.1016/j.micinf.2015.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/23/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/17/2022]
Abstract
Coxiella burnetii and members of the genus Rickettsia are obligate intracellular bacteria. Since cultivation of these organisms requires dedicated techniques, their diagnosis usually relies on serological or molecular biology methods. Immunofluorescence is considered the gold standard to detect antibody-reactivity towards these organisms. Here, we assessed the performance of a new automated epifluorescence immunoassay (InoDiag) to detect IgM and IgG against C. burnetii, Rickettsia typhi and Rickettsia conorii. Samples were tested with the InoDiag assay. A total of 213 sera were tested, of which 63 samples from Q fever, 20 from spotted fever rickettsiosis, 6 from murine typhus and 124 controls. InoDiag results were compared to micro-immunofluorescence. For acute Q fever, the sensitivity of phase 2 IgG was only of 30% with a cutoff of 1 arbitrary unit (AU). In patients with acute Q fever with positive IF IgM, sensitivity reached 83% with the same cutoff. Sensitivity for chronic Q fever was 100% whereas sensitivity for past Q fever was 65%. Sensitivity for spotted Mediterranean fever and murine typhus were 91% and 100%, respectively. Both assays exhibited a good specificity in control groups, ranging from 79% in sera from patients with unrelated diseases or EBV positivity to 100% in sera from healthy patients. In conclusion, the InoDiag assay exhibits an excellent performance for the diagnosis of chronic Q fever but a very low IgG sensitivity for acute Q fever likely due to low reactivity of phase 2 antigens present on the glass slide. This defect is partially compensated by the detection of IgM. Because it exhibits a good negative predictive value, the InoDiag assay is valuable to rule out a chronic Q fever. For the diagnosis of rickettsial diseases, the sensitivity of the InoDiag method is similar to conventional immunofluorescence.
Collapse
Affiliation(s)
- Alain Bizzini
- Institute of Microbiology, University of Lausanne, University Hospital Center, Lausanne, Switzerland
| | - Olivier Péter
- Department of Infectious Diseases, Central Institute of Valais, Sion, Switzerland
| | - David Baud
- Institute of Microbiology, University of Lausanne, University Hospital Center, Lausanne, Switzerland; Department of Obstetrics and Gynaecology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sophie Edouard
- URMITE UMR 6236, Faculté de Médecine et de Pharmacie, Marseille, France
| | - Pascal Meylan
- Institute of Microbiology, University of Lausanne, University Hospital Center, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University of Lausanne, University Hospital Center, Lausanne, Switzerland.
| |
Collapse
|
12
|
Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, Yoshida LM, Mai LQ, Duc-Anh D, Ando S, Arikawa J, Parry CM, Ariyoshi K, Thuy PT. Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam. Am J Trop Med Hyg 2015; 92:972-978. [PMID: 25778504 PMCID: PMC4426587 DOI: 10.4269/ajtmh.14-0806] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 12/15/2014] [Accepted: 01/20/2015] [Indexed: 01/31/2023] Open
Abstract
A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pham Thanh Thuy
- *Address correspondence to Pham Thanh Thuy, Infectious Disease Department, Bach Mai Hospital, 78 Giai Phong Road, Hanoi 84, Vietnam. E-mail:
| |
Collapse
|
13
|
Maude RR, Maude RJ, Ghose A, Amin MR, Islam MB, Ali M, Bari MS, Majumder MI, Tanganuchitcharnchai A, Dondorp AM, Paris DH, Bailey RL, Faiz MA, Blacksell SD, Day NPJ. Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh. Am J Trop Med Hyg 2014; 91:580-583. [PMID: 25092819 PMCID: PMC4155564 DOI: 10.4269/ajtmh.13-0570] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Indexed: 12/26/2022] Open
Abstract
Scrub and murine typhus infections are under-diagnosed causes of febrile illness across the tropics, and it is not known how common they are in Bangladesh. We conducted a prospective seroepidemiologic survey across six major teaching hospitals in Bangladesh by using an IgM enzyme-linked immunosorbent assay. Results indicated recent exposure (287 of 1,209, 23.7% seropositive for Orientia tsutsugamushi and 805 of 1,209, 66.6% seropositive for Rickettsia typhi). Seropositive rates were different in each region. However, there was no geographic clustering of seropositive results for both organisms. There was no difference between those from rural or urban areas. Rickettsia typhi seroreactivity was positively correlated with age. Scrub typhus and murine typhus should be considered as possible causes of infection in Bangladesh.
Collapse
Affiliation(s)
- Rapeephan R. Maude
- *Address correspondence to Rapeephan R. Maude, Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Espino Barros Palau A, Morgan ML, Lee AG. Bilateral optic atrophy in endemic typhus. Can J Ophthalmol 2014; 49:e90-2. [PMID: 25103667 DOI: 10.1016/j.jcjo.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/17/2022]
MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Bacterial/blood
- Doxycycline/therapeutic use
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Fluorescein Angiography
- Humans
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Male
- Middle Aged
- Optic Atrophy/diagnosis
- Optic Atrophy/drug therapy
- Optic Atrophy/microbiology
- Rickettsia typhi/immunology
- Rickettsia typhi/isolation & purification
- Typhus, Endemic Flea-Borne/diagnosis
- Typhus, Endemic Flea-Borne/drug therapy
- Typhus, Endemic Flea-Borne/microbiology
- Vision, Low/diagnosis
- Vision, Low/drug therapy
- Vision, Low/microbiology
Collapse
Affiliation(s)
| | | | - Andrew G Lee
- Houston Methodist Hospital, Houston; Baylor College of Medicine, Houston; Cornell Medical College, Houston; University of Texas Medical Branch, Galveston; University of Texas M.D. Anderson Cancer Center, Houston, Tex.; University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| |
Collapse
|
15
|
Chareonviriyaphap T, Leepitakrat W, Lerdthusnee K, Chao CC, Ching WM. Dual exposure of Rickettsia typhi and Orientia tsutsugamushi in the field-collected Rattus rodents from Thailand. J Vector Ecol 2014; 39:182-189. [PMID: 24820571 DOI: 10.1111/j.1948-7134.2014.12085.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
Field-collected rodents and fleas from ten provinces covering four regions of Thailand were investigated for possible rickettsial pathogen infections. The 257 trapped-rodents belonged to 12 species. Five species of Genus Rattus accounted for 93% of the total capture, of which Rattus exulans and Rattus norvegicus were the two major species caught. All flea specimens, removed from trapped rodents, were identified as Xenopsylla cheopis. The PCR technique was performed on ectoparasite specimens to detect the presence of murine typhus pathogen (Rickettsia typhi) and scrub typhus pathogen (Orientia tsutsugamushi). Thirteen flea specimens (2.6 %) were found to be positive for R. typhi but none for O. tsutsugamushi. An ELISA technique was used to detect the rodent's antibodies against R. typhi and O. tsutsugamushi. Sixty-one rodent serum samples (23.7%) were positive for R. typhi specific IgM, IgG, or both, while 47 of the samples (18.3%) were positive for O. tsutsugamushi. Twenty serum samples from R. norvegicus (7.8%) had detectable antibodies against both R. typhi and O. tsutsugamushi. Our findings revealed the existence of the dual infection of rickettsial pathogens in the same natural hosts.
Collapse
|
16
|
Loussaief C, Toumi A, Ben Brahim H, Aouam A, Kairallah M, Chakroun M. [Macrophage activation syndrome: rare complication of murine typhus]. ACTA ACUST UNITED AC 2014; 62:55-6. [PMID: 24461392 DOI: 10.1016/j.patbio.2013.10.002] [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: 05/22/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Typhi is one of the rickettsial species endemic in the Mediterranean countries and is associated with the zoonotic infection of murine typhus, which may have a complicated course especially in adult patients. The association with macrophage activation syndrome (MAS) has rarely been reported in the medical literature. CASE REPORT We describe a case of murine typhus in a diabetic woman complicated with MAS, who was effectively treated with cyclin and parenteral immunoglobulin. CONCLUSION The murine typhus can be exceptionally complicated with SAM. This infection should be suspected in front of the discovery of SAM.
Collapse
Affiliation(s)
- C Loussaief
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - A Toumi
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - H Ben Brahim
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - A Aouam
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - M Kairallah
- Service d'ophtalmologie, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - M Chakroun
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| |
Collapse
|
17
|
Znazen A, Hammami B, Mustapha AB, Chaari S, Lahiani D, Maaloul I, Jemaa MB, Hammami A. Murine typhus in Tunisia: a neglected cause of fever as a single symptom. Med Mal Infect 2013; 43:226-9. [PMID: 23619288 DOI: 10.1016/j.medmal.2013.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/17/2012] [Accepted: 02/15/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We had for aim to describe the epidemiologic and clinic characteristics of murine typhus in a series of 43 serologically confirmed cases, in our region. PATIENTS AND METHODS Serologic screening for IgG and IgM against Rickettsia typhi was performed in 1024 patients during three years (2006-2008). The characteristics of patients with a positive serology were examined retrospectively. One hundred and seventy sera obtained from blood donors were tested to detect IgG against R. typhi to determine the seroprevalence of the infection. RESULTS There was evidence of recent R. typhi infection in 43 patients (4.2%) during the study period, and 3.7% of blood donors had IgG against R. typhi. The mean age of patients was 43.1 years and the sex-ratio was 1.04. Among the patients, 58.1% were from rural areas. No patient reported any exposure to rats or rat-fleas. There were more cases during the summer and fall. The most frequent complaint was fever as a single symptom (67.5%). A cutaneous rash was reported in 44.1% and headache in 60.5% of patients. Among the patients, 44.1% presented with thrombopenia and 47.2% with elevated liver enzymes. CONCLUSION Murine typhus seems to be frequent in Tunisia. This infection could be a threat for travellers. Serology should be performed systematically in patients with fever as a single symptom since its clinical presentation is non-specific.
Collapse
Affiliation(s)
- A Znazen
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Phetsouvanh R, Thojaikong T, Phoumin P, Sibounheuang B, Phommasone K, Chansamouth V, Lee SJ, Newton PN, Blacksell SD. Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg 2013; 88:932-936. [PMID: 23478577 PMCID: PMC3752761 DOI: 10.4269/ajtmh.12-0325] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Inter- and intra-observer variation was examined among six microscopists who read 50 scrub typhus (ST) and murine typhus (MT) indirect immunofluorescence assay (IFA) immunoglobulin M (IgM) slides. Inter-observer agreement was moderate (κ = 0.45) for MT and fair (κ = 0.32) for ST, and was significantly correlated with experience (P = 0.03 and P = 0.004, respectively); κ-scores for intra-observer agreement between morning and afternoon readings (range = 0.35–0.86) were not correlated between years of experience for ST and MT IFAs (Spearman's ρ = 0.31, P = 0.54 and P = 0.14, respectively; P = 0.78). Storage at 4°C for 2 days showed a change from positive to negative in 20–32% of slides. Although the titers did not dramatically change after 14 days of storage, the final interpretation (positive to negative) did change in 36–50% of samples, and it, therefore, recommended that slides should be read as soon as possible after processing.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Stuart D. Blacksell
- *Address correspondence to Stuart D. Blacksell, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. E-mail:
| |
Collapse
|
19
|
Badiaga S, Benkouiten S, Hajji H, Raoult D, Brouqui P. Murine typhus in the homeless. Comp Immunol Microbiol Infect Dis 2011; 35:39-43. [PMID: 22093517 DOI: 10.1016/j.cimid.2011.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 11/17/2022]
Abstract
Homeless populations are particularly exposed to many vector-borne diseases because of their poor living conditions. We tested sera from 299 homeless people recruited in 2010 and 2011 in Marseilles, France for antibodies to Rickettsia typhi by microimmunofluorescence using a titer of 1:25 as a cut-off titer, and we confirmed the results by Western blot and cross-adsorption studies. Sixty-three persons (22%) had antibodies against R. typhi. The murine typhus seroprevalence rates have significantly increased in homeless populations between the 2000-2003 and 2010-2011 periods. These findings indicate that the homeless are increasingly exposed to flea-borne murine typhus in Marseilles. One might suggest that multiple strikes of sanitation workers resulting in the increase of waste and construction sites combined with the poor living conditions of the homeless expose this population to rodents and their fleas. Further annual studies are necessary to follow rodent-associated diseases among homeless people in Marseille.
Collapse
Affiliation(s)
- Sékéné Badiaga
- Institut Hospitalo-Universitaire des Maladies Infectieuses et Tropicales, Marseille, France
| | | | | | | | | |
Collapse
|
20
|
Zhang Y, Zhang ZL, Yin JY, Lv J, Yu HL, Liang CW, Wang SW, Zhao JB, Zhang LJ. [Sero-epidemiological investigation on Rickettsia typhi, Bartonella henselae and Orientia tsutsugamushi in farmers from rural areas of Tianjin, 2007 - 2009]. Zhonghua Liu Xing Bing Xue Za Zhi 2011; 32:256-259. [PMID: 21457660] [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: 05/30/2023]
Abstract
OBJECTIVE To study the sero-epidemiological status regarding Rickettsia (R.) typhi, Bartonella (B.) henselae and Orientia (O.) tsutsugamushi in farmers from rural areas of Tianjin. METHODS Field epidemiological surveys were performed in 8 districts (county) of Tianjin city from 2007 to 2009. 886 farmers were randomly recruited and their serum samples collected to detect the specific antibodies of R. typhi, B. henselae and O. tsutsugamushi by micro-indirect immunofluorescence (IFA). RESULTS The total antibody positive rates of R. typhi increased from 5.0% to 58.2% while B. henselae had an increase from 2.6% to 14.5% and O. tsutsugamushi increased from 1.8% to 39.8%. Geographic distribution showed that farmers living in the central and southeast areas were higher than that in other areas. CONCLUSION Infections of both R. typhi, B. henselae and O. tsutsugamushi in farmers from Tianjin areas were popular and the antibody positive rates of R. typhi, B. henselae and O. tsutsugamushi had an annual increase.
Collapse
Affiliation(s)
- Ying Zhang
- Tiangjin Center for Disease Control and Prevention, China
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Beltrán LM, García S, Vallejo AJ, Bernabeu-Wittel M. [Bilateral anterior uveitis and Rickettsia typhi infection]. Enferm Infecc Microbiol Clin 2011; 29:235-6. [PMID: 21324556 DOI: 10.1016/j.eimc.2010.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 05/11/2010] [Indexed: 11/18/2022]
|
22
|
Vallée J, Thaojaikong T, Moore CE, Phetsouvanh R, Richards AL, Souris M, Fournet F, Salem G, Gonzalez JPJ, Newton PN. Contrasting spatial distribution and risk factors for past infection with scrub typhus and murine typhus in Vientiane City, Lao PDR. PLoS Negl Trop Dis 2010; 4:e909. [PMID: 21151880 PMCID: PMC2998433 DOI: 10.1371/journal.pntd.0000909] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/08/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aetiological diagnostic of fevers in Laos remains difficult due to limited laboratory diagnostic facilities. However, it has recently become apparent that both scrub and murine typhus are common causes of previous undiagnosed fever. Epidemiological data suggests that scrub typhus would be more common in rural areas and murine typhus in urban areas, but there is very little recent information on factors involved in scrub and murine typhus transmission, especially where they are sympatric - as is the case in Vientiane, the capital of the Lao PDR. METHODOLOGY AND PRINCIPAL FINDINGS We therefore determined the frequency of IgG seropositivity against scrub typhus (Orientia tsutsugamushi) and murine typhus (Rickettsia typhi), as indices of prior exposure to these pathogens, in randomly selected adults in urban and peri-urban Vientiane City (n = 2,002, ≥35 years). Anti-scrub and murine typhus IgG were detected by ELISA assays using filter paper elutes. We validated the accuracy of ELISA of these elutes against ELISA using serum samples. The overall prevalence of scrub and murine typhus IgG antibodies was 20.3% and 20.6%, respectively. Scrub typhus seropositivity was significantly higher among adults living in the periphery (28.4%) than in the central zone (13.1%) of Vientiane. In contrast, seroprevalence of murine typhus IgG antibodies was significantly higher in the central zone (30.8%) as compared to the periphery (14.4%). In multivariate analysis, adults with a longer residence in Vientiane were at significant greater risk of past infection with murine typhus and at lower risk for scrub typhus. Those with no education, living on low incomes, living on plots of land with poor sanitary conditions, living in large households, and farmers were at higher risk of scrub typhus and those living in neighborhoods with high building density and close to markets were at greater risk for murine typhus and at lower risk of scrub typhus past infection. CONCLUSIONS This study underscores the intense circulation of both scrub and murine typhus in Vientiane city and underlines difference in spatial distribution and risk factors involved in the transmission of these diseases.
Collapse
Affiliation(s)
- Julie Vallée
- Institut de Recherche pour le Développement, UMR190, Marseille, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Centers for Disease Control and Prevention (CDC). Outbreak of Rickettsia typhi infection - Austin, Texas, 2008. MMWR Morb Mortal Wkly Rep 2009; 58:1267-70. [PMID: 19940832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Murine typhus is a fleaborne rickettsial disease caused by the organism Rickettsia typhi. Symptoms include fever, headache, chills, vomiting, nausea, myalgia, and rash. Although murine typhus is endemic in southern Texas, only two cases had been reported during the past 10 years from Austin, located in central Texas. On August 8, 2008, the Austin/Travis County Department of Health and Human Services (ATCDHHS) contacted the Texas Department of State Health Services (TDSHS) concerning a cluster of 14 illnesses with serologic findings indicative of murine typhus. On August 12, 2008, TDSHS initiated an investigation with assistance from CDC to characterize the magnitude of the outbreak and assess potential animal reservoirs and peridomestic factors that might have contributed to disease. This report summarizes the clinical and environmental findings of that investigation. Thirty-three confirmed cases involved illness comparable to that associated with previous outbreaks of murine typhus. Illness ranged from mild to severe, with 73% of patients requiring hospitalization. Delayed diagnosis and administration of no or inappropriate antibiotics might have contributed to illness severity. Environmental investigation suggested that opossums and domestic animals likely played a role in the maintenance and spread of R. typhi; however, their precise role in the outbreak has not been determined. These findings underscore the need to increase awareness of murine typhus and communicate appropriate treatment and prevention measures through the distribution of typhus alerts before and throughout the peak vector season of March-November.
Collapse
|
24
|
Lledó L, González R, Gegúndez MI, Beltrán M, Saz JV. Epidemiological study of rickettsial infections in patients with hypertransaminemia in Madrid (Spain). Int J Environ Res Public Health 2009; 6:2526-33. [PMID: 20054452 PMCID: PMC2790090 DOI: 10.3390/ijerph6102526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/23/2009] [Indexed: 11/30/2022]
Abstract
A retrospective analysis was performed to detect anti-rickettsial antibodies in the serum of patients with hypertransaminemia of unknown etiology, and in that of healthy members of the general population of Madrid (Spain). Among 143 patients 16 (11.2%) were positive for anti-R. conorii IgG antibodies and 7% for R. typhi. PCR analysis was performed in patients with IgM antibodies. Among 143 healthy subjects from the general population, seven (4.9%) were positive for anti-R. conorii IgG antibodies, and 2.8% for R. typhi. These results show that anti-rickettsial antibodies are more commonly detected in patients with hypertransaminemia than in healthy people.
Collapse
Affiliation(s)
- Lourdes Lledó
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain; E-Mails:
(R.G.);
(M.I.G.);
(M.B.);
(J.V.S.)
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +34-918854794; Fax: +34-918854663
| | - Rosario González
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain; E-Mails:
(R.G.);
(M.I.G.);
(M.B.);
(J.V.S.)
- Department of Microbiology, Hospital “Príncipe de Asturias”, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain
| | - María Isabel Gegúndez
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain; E-Mails:
(R.G.);
(M.I.G.);
(M.B.);
(J.V.S.)
| | - María Beltrán
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain; E-Mails:
(R.G.);
(M.I.G.);
(M.B.);
(J.V.S.)
- Department of Microbiology, Hospital “Príncipe de Asturias”, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain
| | - José Vicente Saz
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona Km 33.6, Alcalá de Henares 28871, Spain; E-Mails:
(R.G.);
(M.I.G.);
(M.B.);
(J.V.S.)
| |
Collapse
|
25
|
Reeves WK, Murray KO, Meyer TE, Bull LM, Pascua RF, Holmes KC, Loftis AD. Serological evidence of typhus group rickettsia in a homeless population in Houston, Texas. J Vector Ecol 2008; 33:205-207. [PMID: 18697325 DOI: 10.3376/1081-1710(2008)33[205:seotgr]2.0.co;2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We tested sera from 176 homeless people in Houston for antibodies against typhus group rickettsiae (TGR). Sera from 19 homeless people were reactive to TGR antigens by ELISA and IFA. Two people had antibodies against Rickettsia prowazekii (epidemic typhus) and the remaining 17 had antibodies against Rickettsia typhi (murine typhus).
Collapse
Affiliation(s)
- Will K Reeves
- Arthropod-Borne Animal Disease Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Laramie, WY 82071, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Hidalgo M, Salguero E, de la Ossa A, Sánchez R, Vesga JF, Orejuela L, Valbuena G. Murine typhus in Caldas, Colombia. Am J Trop Med Hyg 2008; 78:321-322. [PMID: 18256438] [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: 05/25/2023] Open
Abstract
In the north of Caldas, Colombia, febrile syndromes with positive Weil-Felix reactions have been reported as Murine typhus to the national health authorities. We used indirect immunofluorescence assay (IFA) of serial paired samples to confirm the diagnosis of murine typhus in 14 of 120 patients with a compatible febrile syndrome.
Collapse
Affiliation(s)
- Marylin Hidalgo
- Grupo de Microbiologia, Instituto Nacional de Salud, Bogota, Colombia.
| | | | | | | | | | | | | |
Collapse
|
27
|
Rydkina E, Sahni A, Silverman DJ, Sahni SK. Comparative analysis of host-cell signalling mechanisms activated in response to infection with Rickettsia conorii and Rickettsia typhi. J Med Microbiol 2007; 56:896-906. [PMID: 17577053 DOI: 10.1099/jmm.0.47050-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/18/2022] Open
Abstract
The Gram-negative intracellular bacteria Rickettsia conorii and Rickettsia typhi are the aetiological agents of Mediterranean spotted fever and endemic typhus, respectively, in humans. Infection of endothelial cells (ECs) lining vessel walls, and the resultant vascular inflammation and haemostatic alterations are salient pathogenetic features of both of these rickettsial diseases. An important consideration, however, is that dramatic differences in the intracellular motility and accumulation patterns for spotted fever versus typhus group rickettsiae have been documented, suggesting the possibility of unique and potentially different interactions with host cells. This study characterized and compared R. conorii- and R. typhi-mediated effects on cultured human ECs. The DNA-binding activity of nuclear transcription factor-kappaB (NF-kappaB) and the phosphorylation status of stress-activated p38 kinase were determined as indicators of NF-kappaB and p38 activation. R. conorii infection resulted in a biphasic activation of NF-kappaB, with an early increase in DNA-binding activity at 3 h, followed by a later peak at 24 h. The activated NF-kappaB species were composed mainly of RelA p65-p50 heterodimers and p50 homodimers. R. typhi infection of ECs resulted in only early activation of NF-kappaB at 3 h, composed primarily of p65-p50 heterodimers. Whilst R. conorii infection induced increased phosphorylation of p38 kinase (threefold mean induction) with the maximal response at 3 h, a considerably less-intense response peaking at about 6 h post-infection was found with R. typhi. Furthermore, mRNA expression of the chemokines interleukin (IL)-8 and monocyte chemoattractant protein-1 in ECs infected with either Rickettsia species was higher than the corresponding controls, but there were distinct differences in the secretion patterns for IL-8, suggesting the possibility of involvement of post-transcriptional control mechanisms or differences in the release from intracellular storage sites. Thus, the intensity and kinetics of host-cell responses triggered by spotted fever and typhus species exhibit distinct variations that could subsequently lead to differences in the extent of endothelial activation and inflammation and serve as important determinants of pathogenesis.
Collapse
Affiliation(s)
- Elena Rydkina
- Hematology-Oncology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Abha Sahni
- Hematology-Oncology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - David J Silverman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Sanjeev K Sahni
- Hematology-Oncology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| |
Collapse
|
28
|
Abstract
Children from South Texas were evaluated for immunoglobulin G to Rickettsia typhi, the causative agent of murine typhus. Of 513 children, 8.6% of those 1-5 years of age, 13.3% of those 6-11 years of age, and 13.8% of those 12-17 years of age had positive results.
Collapse
Affiliation(s)
- Kevin Purcell
- Healthcare Leaders 2B/Pediatric Research 4U, Corpus Christi, Texas 78418, USA.
| | | | | | | |
Collapse
|
29
|
Reeves WK, Easterbrook JD, Loftis AD, Glass GE. Serologic evidence for Rickettsia typhi and an ehrlichial agent in Norway rats from Baltimore, Maryland, USA. Vector Borne Zoonotic Dis 2007; 6:244-7. [PMID: 16989563 DOI: 10.1089/vbz.2006.6.244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/12/2022] Open
Abstract
We screened serum from 90 Norway rats trapped in East Baltimore, Maryland, USA, from April to November 2005 for antibodies against Rickettsia typhi and Ehrlichia chaffeensis. Six rats had positive titers of > or = 1:64 against R. typhi and did not react with R. akari. In addition, four rats had cross-reactive antibodies with titers of > or = 1:64 against Ehrlichia chaffeensis. Sera from these rats also cross-reacted with Anaplasma phagocytophilum or Ehrlichia muris. Our data indicate that the agent of murine typhus and ehrlichial agents are circulating in the Norway rat population in Baltimore.
Collapse
Affiliation(s)
- Will K Reeves
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | |
Collapse
|
30
|
Toumi A, Loussaief C, Ben Yahia S, Ben Romdhane F, Khairallah M, Chakroun M, Bouzouaïa N. Méningite révélant une infection à Rickettsia typhi. Rev Med Interne 2007; 28:131-3. [PMID: 17166631 DOI: 10.1016/j.revmed.2006.10.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 10/02/2006] [Accepted: 10/11/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Neurological manifestations are rarely observed in murine typhus. We present a case of meningitis caused by Rickettsia typhi. EXEGESIS We report a case of Tunisian 57-year-old woman admitted for suspicion of meningitis. Clinical examination revealed fever at 39,5 degrees C and nuchal rigidity. There were no focal neurologic signs, cutaneous rash or eschar. Lumbar puncture showed clear cerebrospinal fluid containing normal glucose, 0,48 g/l protein and 30 WBC (78% lymphocyte). Gram-stained smear and culture were negative. Serology confirmed the diagnosis. The patient was initially treated by ampicillin 12 g daily but remained febrile. Retinal lesions were detected on ophthalmic examination, suggesting rickettsial infection. Clinical outcome was good after 7-day treatment with oral ciprofloxacin 1,5 g daily. The mean follow-up was six months. CONCLUSION Murine typhus is an endemic zoonosis. Neurological manifestations were uncommon. An ophthalmic examination is recommended if rickettsiosis was suspected.
Collapse
Affiliation(s)
- A Toumi
- Service de maladies infectieuses, CHU Fattouma-Bourguiba, 5019 Monastir, Tunisie
| | | | | | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Momoyo Azuma
- University of Tokushima Graduate School, Tokushima, Japan
| | | | - Motohiko Ogawa
- National Institute for Infectious Diseases, Tokyo, Japan
| | | | - Saburo Sone
- University of Tokushima Graduate School, Tokushima, Japan
| | | |
Collapse
|
32
|
Angel-Moreno A, Bolaños M, Santana E, Pérez-Arellano JL. [Murine typhus imported from Senegal in a travelling immigrant]. Enferm Infecc Microbiol Clin 2006; 24:406-7. [PMID: 16792948 DOI: 10.1157/13089700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
33
|
Abstract
In the past century vaccine development for prevention of rickettsial diseases has been prolific. However, in the past 20 years no new rickettsial vaccine has been manufactured and there are currently no new or old rickettsial vaccines licensed. Early rickettsial vaccines were difficult, expensive and very hazardous to produce. Molecular biology techniques of today are currently being used to develop new rickettsial vaccines that are standardized, inexpensive, nonhazardous and efficacious.
Collapse
Affiliation(s)
- Allen L Richards
- Rickettsial Diseases Department, Naval Medical Research Center, RDD/IDD Rm 3S04B, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA.
| |
Collapse
|
34
|
Fodorova M, Vadovic P, Skultety L, Slaba K, Toman R. Structural features of lipopolysaccharide from Rickettsia typhi: the causative agent of endemic typhus. Ann N Y Acad Sci 2006; 1063:259-60. [PMID: 16481524 DOI: 10.1196/annals.1355.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/12/2022]
Abstract
Rickettsia typhi causes endemic typhus, a relatively mild, acute febrile illness characterized by headache and macular rash. It is maintained in rodents and transmitted to humans by flea Xenopsylla cheopis. R. typhi contains a lipopolysaccharide thought to display a noticeable antigenic activity. We examined its structural features and it appears that the O-specific chain of the R. typhi LPS is composed mainly of the alternating Glc and QuiNAc residues linked by 1-->4 bonds.
Collapse
Affiliation(s)
- Marcela Fodorova
- Laboratory of Diagnosis and Prevention of Rickettsial and Chlamydial Infections, Institute of Virology, SAS, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | | | | | | | | |
Collapse
|
35
|
|
36
|
Phongmany S, Rolain JM, Phetsouvanh R, Blacksell SD, Soukkhaseum V, Rasachack B, Phiasakha K, Soukkhaseum S, Frichithavong K, Chu V, Keolouangkhot V, Martinez-Aussel B, Chang K, Darasavath C, Rattanavong O, Sisouphone S, Mayxay M, Vidamaly S, Parola P, Thammavong C, Heuangvongsy M, Syhavong B, Raoult D, White NJ, Newton PN. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis 2006; 12:256-62. [PMID: 16494751 PMCID: PMC3373100 DOI: 10.3201/eid1202.050900] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rickettsia spp. are an underrecognized cause of undifferentiated febrile illness. Rickettsial diseases have not been described previously from Laos, but in a prospective study, acute rickettsial infection was identified as the cause of fever in 115 (27%) of 427 adults with negative blood cultures admitted to Mahosot Hospital in Vientiane, Laos. The organisms identified by serologic analysis were Orientia tsutsugamushi (14.8%), Rickettsia typhi (9.6%), and spotted fever group rickettsia (2.6% [8 R. helvetica, 1 R. felis, 1 R. conorii subsp. indica, and 1 Rickettsia "AT1"]). Patients with murine typhus had a lower frequency of peripheral lymphadenopathy than those with scrub typhus (3% vs. 46%, p<0.001). Rickettsioses are an underrecognized cause of undifferentiated febrile illnesses among adults in Laos. This finding has implications for the local empiric treatment of fever.
Collapse
Affiliation(s)
| | | | | | - Stuart D. Blacksell
- Mahosot Hospital, Vientiane, Laos
- University of Oxford, Oxford, United Kingdom
- Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Vang Chu
- Mahosot Hospital, Vientiane, Laos
| | - Valy Keolouangkhot
- Mahosot Hospital, Vientiane, Laos
- Francophone Institute for Tropical Medicine, Vientiane, Laos
| | | | - Ko Chang
- Mahosot Hospital, Vientiane, Laos
| | | | | | | | - Mayfong Mayxay
- Mahosot Hospital, Vientiane, Laos
- National University of Laos, Vientiane, Laos
| | - Sisouphane Vidamaly
- Mahosot Hospital, Vientiane, Laos
- Francophone Institute for Tropical Medicine, Vientiane, Laos
| | | | | | | | | | | | - Nicholas J. White
- Mahosot Hospital, Vientiane, Laos
- University of Oxford, Oxford, United Kingdom
- Mahidol University, Bangkok, Thailand
| | - Paul N. Newton
- Mahosot Hospital, Vientiane, Laos
- University of Oxford, Oxford, United Kingdom
| |
Collapse
|
37
|
Nogueras MM, Cardeñosa N, Sanfeliu I, Muñoz T, Font B, Segura F. Serological evidence of infection with Rickettsia typhi and Rickettsia felis among the human population of Catalonia, in the northeast of Spain. Am J Trop Med Hyg 2006; 74:123-6. [PMID: 16407356] [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: 05/06/2023] Open
Abstract
Murine typhus (MT) is a cause of fever of intermediate duration in the south of Spain. Rickettsia typhi has been described as the MT etiological agent. Rickettsia felis produces an infection similar to MT. The aim of the study is to determine their seroprevalence in humans in Catalonia. Antibodies to Rickettsia typhi and Rickettsia felis from 217 serum samples were examined by indirect immunofluorescence assay (IFA). Age, gender, residence area, contact with animals, and occupation were surveyed. Rickettsia typhi and Rickettsia felis seroprevalences were 8.8% and 3.2%, respectively. Rickettsia typhi was present in 7.6% of the samples in urban, 8.5% in semirural, and in 21.4% in rural areas, whereas Rickettsia felis was present in 3.5% in urban, 1.7% in semirural, and 7.1% in rural area. The only statistically significant association observed was that between Rickettsia felis seropositivity and age. Our data seem to indicate the presence of Rickettsia typhi and Rickettsia felis in humans in Catalonia.
Collapse
Affiliation(s)
- María Mercedes Nogueras
- Infectious Diseases Program, Department of Internal Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
38
|
Lledo L, Gegundez MI, Medina J, Gonzalez JV, Alamo R, Saz JV. Epidemiological study of Rickettsia typhi infection in two provinces of the north of Spain: analysis of sera from the general population and sheep. Vector Borne Zoonotic Dis 2005; 5:157-61. [PMID: 16011432 DOI: 10.1089/vbz.2005.5.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
Data relating to Rickettsia typhi infection in Spain are scarce. A serological survey of 383 serum samples (184 males, 199 females) from the general population and 120 sera from sheep were studied by immunofluorescence assay (IFA). The human serum samples were collected from the general population of Palencia and Burgos provinces, and sheep serum samples were collected from Palencia province. Of the 383 human serum samples studied, 29 were positive for antibodies against R. typhi (7.5%) No statistical differences were found according to age, sex, origin (rural vs. urban) or geographic distribution, but a significant difference was observed related to occupation. In addition, 69 serums were found positives for R. typhi in sheep samples (57.5%). Our results indicated the circulation of R. typhi infectious for humans and sheep in Palencia and Burgos provinces. This study indicates that sheep may be infected with R. typhi, and that animals can, therefore be used as indicators of the presence of this organism.
Collapse
Affiliation(s)
- L Lledo
- Departamento de Microbiología y Parasitología, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
39
|
Medina-Sanchez A, Bouyer DH, Alcantara-Rodriguez V, Mafra C, Zavala-Castro J, Whitworth T, Popov VL, Fernandez-Salas I, Walker DH. Detection of a Typhus Group Rickettsia in Amblyomma Ticks in the State of Nuevo Leon, Mexico. Ann N Y Acad Sci 2005; 1063:327-32. [PMID: 16481535 DOI: 10.1196/annals.1355.052] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The state of Nuevo Leon, Mexico has had outbreaks of typhus group rickettsiosis, most recently recognized in 1997. Evaluation of the sera of 345 patients with a dengue-like illness revealed that 25.5% had antibodies reactive with typhus group rickettsiae and 16% had antibodies to Rickettsia parkeri. Rickettsiae were detected by PCR and shell-vial isolations in the field-collected Amblyomma ticks. Molecular characterization by DNA sequence analysis of the gltA, ompB, and 17-kDa gene identified the organisms to be R. prowazekii.
Collapse
Affiliation(s)
- Aaron Medina-Sanchez
- Laboratorio de Entomologia Medica, Facultad de Biologia, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Letaïef AO, Kaabia N, Chakroun M, Khalifa M, Bouzouaia N, Jemni L. Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases. Int J Infect Dis 2005; 9:331-4. [PMID: 16054415 DOI: 10.1016/j.ijid.2004.09.011] [Citation(s) in RCA: 23] [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] [Received: 01/03/2004] [Revised: 08/11/2004] [Accepted: 09/14/2004] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Murine or endemic typhus, caused by Rickettsia typhi, has been reported in all continents. In the 1970s, no cases of murine typhus were diagnosed in Tunisia. METHODS The clinico-epidemiological characteristics of seven cases of murine typhus diagnosed at our hospitals since 1993 are reported. Diagnosis was confirmed by indirect fluorescence assay detecting specific R. typhi antibodies. RESULTS Murine typhus occurred in all ages from 18-80 years during the hot season in rural areas. Clinical features were: sudden onset of fever and absence of eschar in all cases, with maculo-papular rash (five cases), prostration (four cases), meningism (three cases) and pneumonia (four cases). Frequent laboratory findings were moderate thrombopenia (four cases) and elevated transaminases (four cases). Before the results of serology, clinical diagnoses were Mediterranean Spotted Fever (four cases), Q fever (one case), pneumonia (one case), and lymphocytic meningitis (one case). Serology confirmed all diagnoses with cross-reactivity with Rickettsia conorii. CONCLUSION Murine typhus exists in Tunisia and its prevalence is underestimated. Further, more specific studies are needed to evaluate the true prevalence.
Collapse
Affiliation(s)
- A Omezzine Letaïef
- Infectious Diseases Unit, F. Hached University Hospital, Sousse, Tunisia.
| | | | | | | | | | | |
Collapse
|
41
|
Valbuena G, Jordan JM, Walker DH. T Cells Mediate Cross‐Protective Immunity between Spotted Fever Group Rickettsiae and Typhus Group Rickettsiae. J Infect Dis 2004; 190:1221-7. [PMID: 15346331 DOI: 10.1086/423819] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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] [Received: 12/04/2003] [Accepted: 04/06/2004] [Indexed: 11/03/2022] Open
Abstract
Rickettsioses are severe infections caused by obligately intracellular bacteria that preferentially infect the endothelium lining the vasculature. The causative agents, rickettsiae, have been divided according to biological, genetic, and antigenic parameters into 2 main groups: spotted fever and typhus. They have not been thought to stimulate cross-reactive protective immune responses; however, in this study, we show that, in relevant animal models that mimic human rickettsial infections, there is reciprocal immunological cross-protection between spotted fever group and typhus group rickettsiae. Furthermore, we present evidence that T cells are responsible for this cross-immunity and that cross-stimulation of T cells also occurs in humans.
Collapse
Affiliation(s)
- Gustavo Valbuena
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0609, USA
| | | | | |
Collapse
|
42
|
Affiliation(s)
- Satoshi Sakaguchi
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | | | - Hiroaki Muguruma
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Hiroaki Kawano
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Yoshito Kusuhara
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Seiji Yano
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Saburo Sone
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| | - Tsuneo Uchiyama
- The University of Tokushima Graduate School of Medicine, Tokushima, Japan
| |
Collapse
|
43
|
Lledó L, Gegúndez MI, Serrano JL, Saz JV, Beltrán M. A sero-epidemiological study of Rickettsia typhi infection in dogs from Soria province, central Spain. Ann Trop Med Parasitol 2004; 97:861-4. [PMID: 14754499 DOI: 10.1179/000349803225002679] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Data relating to Rickettsia typhi infection in Spain are scarce. The seroprevalence of canine infection with this species has now been investigated, in dogs from the central province of Soria. The results of indirect immunofluorescence assays indicated that nine (12.3%) of the 73 dogs checked were carrying antibodies against R. typhi. The gender, age and breed of the dog, and whether it was used for hunting, shepherding, guarding or simply as a pet, apparently had no significant affect on the probability of it being seropositive. Being infested with fleas or having a history of such infestation was, however, significantly associated with seropositivity. The present results confirm that dogs may be infected with R. typhi and indicate their potential usefulness as sentinels in epidemiological studies of the pathogen. The results of wide-scale, serological studies of dogs may allow the geographical distribution of R. typhi to be mapped relatively simply.
Collapse
Affiliation(s)
- L Lledó
- Departamento de Microbiología y Parasitología, Universidad de Alcalá, Carretera Madrid-Barcelona Km 33.6, 28871 Alcalá de Henares, Madrid, Spain.
| | | | | | | | | |
Collapse
|
44
|
Abstract
Rickettsia typhi and R. felis are flea-transmitted human pathogenic rickettsial species. To investigate the distributional dynamics of these rickettsiae we designed a micro-immunofluorescence assay (MIF) using species-specific monoclonal antibodies (MAbs) applied to flea cryosections. Our assay was performed in less than 3 h and its applicability was demonstrated by the detection of R. typhi in 50 artificially infected human body lice but in none of 50 uninfected lice. With MIF, we identified 31 positive among 32 fleas proven with PCR to be naturally infected with R. felis; and 7 positive among 32 fleas proven with PCR to be naturally infected with R. typhi. No cross-detection was observed with both MAbs. Fresh R. felis-infected fleas were significantly more MIF-positive than long conserved R. typhi-infected fleas (31/32 vs. 7/32, P < 0.01). This discrepancy may be linked to degradation of antigens by long-term freezing. For R. typhi-infected fleas, our assay was significantly more efficient when applied to fleas in early stages of infection (less than 15 days) by comparison with fleas frozen more than 20 days after infection (7/15 vs. 0/17, P = 0.01). This difference may be related to an antigenic modification caused by selection pressure in the vector and host process. The sensitivity of the described method did not exceed 47% (7/15) for R. typhi but, in contrast, was 97% for R. felis. Thus, our method appears to be useful for surveillance in R. felis infections, but requires further studies for the detection of R. typhi.
Collapse
Affiliation(s)
- R Fang
- Unité des Rickettsies, IFR 48, CNRS UMR 6020, Faculté de Méedecine, 13385 Marseilles, France
| | | | | | | | | |
Collapse
|
45
|
Lledó L, Gegúndez I, Ruiz E, Rodríguez L, Bacellar F, Saz JV. Rickettsia typhi infection in wild rodents from central Spain. Ann Trop Med Parasitol 2003; 97:411-4. [PMID: 12831526 DOI: 10.1179/000349803235002344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
When sera from 218 rodents captured in two provinces of central Spain were tested, by indirect immunofluorescence, for antibodies to Rickettsia typhi, 46 (21.1%) were found to be positive, at titres between 1:20 and 1:320. The seropositives included rodents of each of the five species collected: Mus musculus, Mus spretus, Apodemus sylvaticus, Rattus rattus and Rattus norvegicus. Rickettsia typhi infection appears to be common and widespread among the rodents of central Spain.
Collapse
Affiliation(s)
- L Lledó
- Departamento de Microbiología y Parasitología, Universidad de Alcalá, Ctra Madrid-Barcelona, Km 33.6, 28871 Alcalá de Henares, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
46
|
Richards AL, Ratiwayanto S, Rahardjo E, Kelly DJ, Dasch GA, Fryauff DJ, Bangs MJ. Serologic evidence of infection with ehrlichiae and spotted fever group rickettsiae among residents of Gag Island, Indonesia. Am J Trop Med Hyg 2003; 68:480-4. [PMID: 12875301] [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: 03/03/2023] Open
Abstract
The causative agents of scrub and murine typhus are considered endemic to Indonesia. However, the presence of spotted fever group rickettsiae and ehrlichiae have not been previously described in this country. During an investigation of arthropod-borne diseases on Gag Island, located northwest of the island of New Guinea in eastern Indonesia, the prevalence of antibody to the etiologic agents of monocytic ehrlichiosis, spotted fever rickettsiosis, and scrub and murine typhus were determined. Analysis of 55 blood samples from residents of Gag Island showed seroreactivity to antigen preparations of Ehrlichia chaffeensis (7 of 48, 14.6%), two spotted fever group rickettsiae: Rickettsia rickettsii (5 of 48, 10.4%) and R. conorii (10 of 49, 20.4%), Orientia tsutsugamushi (5 of 53, 9.4%), and R. typhi (1 of 48, 2.1% [by an indirect immunofluorescence assay] and 1 of 50, 2.0% [by an enzyme-linked immunosorbent assay]). These results show serologic evidence of infection with ehrlichiae and spotted fever group rickettsiae for the first time in Indonesia in a location where the prevalence of antibody to O. tsutsugamushi and R. typhi was lower.
Collapse
|
47
|
Tay ST, Kamalanathan M, Rohani MY. Antibody prevalence of Orientia tsutsugamushi, Rickettsia typhi and TT118 spotted fever group rickettsiae among Malaysian blood donors and febrile patients in the urban areas. Southeast Asian J Trop Med Public Health 2003; 34:165-70. [PMID: 12971530] [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: 03/04/2023]
Abstract
The seroprevalence of Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) among blood donors and febrile Malaysian patients in the urban areas was determined. Of the 240 blood donors, 5.4%, 9.2% and 1.7% had either present or previous exposure to OT, RT and SFG rickettsiae, respectively. Patients admitted to an urban hospital had high seroprevalences of OT (43.5%) and RT (22.9%), as compared to SFGR (11.6%). Antibody levels suggestive of recent infections of scrub typhus, murine typhus and tick typhus were detected in 16.8%, 12.7% and 8.2% of patients respectively. No significant difference was noted in the distribution of rickettsial antibodies among urban patients from 2 geographical locations. However, the serologic patterns of rickettsial infection in the urban areas were different form those of rural areas.
Collapse
Affiliation(s)
- S T Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia.
| | | | | |
Collapse
|
48
|
Smith HM, Reporter R, Rood MP, Linscott AJ, Mascola LM, Hogrefe W, Purcell RH. Prevalence study of antibody to ratborne pathogens and other agents among patients using a free clinic in downtown Los Angeles. J Infect Dis 2002; 186:1673-6. [PMID: 12447746 DOI: 10.1086/345377] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 06/27/2002] [Revised: 08/12/2002] [Indexed: 11/04/2022] Open
Abstract
Norway rats (Rattus norvegicus) are hosts for various microbes. Homeless people who have contact with rats may be at risk of infection by them. The Los Angeles County Department of Health Services initiated a seroepidemiologic study among patients who used a free clinic in downtown Los Angeles; 200 serum specimens obtained for other routine assays were tested for antibodies to ratborne pathogens and other agents. The seroprevalence of antibody to hepatitis E virus in this population was 13.6%; to Bartonella elizabethae, 12.5%; to B. quintana, 9.5%; to B. henselae, 3.5%; to Seoul virus, 0.5%; and to Rickettsia typhi, 0.0%. This study found that patients and locally trapped rats had antibodies to some of the same agents.
Collapse
Affiliation(s)
- Heather M Smith
- Acute Communicable Disease Control Unit, Los Angeles County Department of Health Services, California 90012, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
It was the aim of the present work to evaluate Rickettsia typhi antibody prevalence in 'Comunidad Autónoma de Madrid' (CAM), an area in the centre of Spain. A total of 640 serum samples from the general population were tested by an indirect immunofluorescence assay. Specific R. typhi antibodies were found in 44 (6.8%) of the samples. The present survey results demonstrate the occurrence of R. typhi human infections in this area.
Collapse
Affiliation(s)
- L Lledó
- Department of Microbiology and Parasitology, Faculty of Medicine, Alcalá University, Madrid, Spain.
| | | | | | | |
Collapse
|
50
|
Vaiopoulos G, Sideris P, Anargyrou K, Melas P, Plessas N, Konstantopoulos K. Transient monoclonal hypergammaglobulinemia during the course of a rickettsia infection. Infection 2002; 30:249-50. [PMID: 12236573 DOI: 10.1007/s15010-002-2119-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|