Human Infection with<i>Rickettsia sibirica mongolitimonae</i>, Spain, 2007–2011

Ramos, José Manuel; Jado, Isabel; Padilla, Sergio; Masiá, Mar; Anda, Pedro; Gutiérrez, Félix

doi:10.3201/eid1902.111706

Cited by 41 publications

(26 citation statements)

References 13 publications

(17 reference statements)

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“…mongolotimonae infection, despite the lack of lymphangitis. In fact, this case had some features similar to those described recently in another Mediterranean coast region of Spain (17). Recently, R. sibirica subsp.…”

supporting

confidence: 86%

“…The fact that two members of spotted fever group rickettsiae were found in the same patient should not be surprising, considering that they could share the same vector (13,15,18). Both microorganisms found in our patient are present in our country (8,9,(16)(17)(18). In addition, R. sibirica subsp.…”

supporting

confidence: 52%

“…Since then, other cases have been described in different countries (12)(13)(14)(15), including Spain (16)(17)(18). Although it is mainly associated with Hyalomma spp.…”

mentioning

confidence: 99%

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Coinfection with “Rickettsia sibirica subsp. mongolotimonae” and Rickettsia conorii in a Human Patient: a Challenge for Molecular Diagnosis Tools

et al. 2015

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Rickettsioses are zoonoses transmitted by vectors. More than one agent can coexist in vectors. Although vectors may transmit more than one microorganism to humans, information on dual infections is scarce. We present a case of a patient with an atypical rickettsiosis diagnosis in whom two species of Rickettsia were detected. CASE REPORTA 46-year-old woman was admitted to Bellvitge University Hospital in May with fever (38°C) as well as a retroauricular adenopathy and a subsequent preauricular and lateral cervical adenopathy that had lasted for 10 days. On examination at admission, she was afebrile and she had a necrotic eschar on the scalp (tache noire), face swelling, and a rash on her upper extremities. Laboratory examination showed normal values, except for the presence of activated lymphocytes and increased levels of alanine aminotransferase/aspartate aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase. Testing of the patient's serum for toxoplasma and cytomegalovirus were negative. She reported that she had a dog and she had observed ticks on it recently.Tick-borne lymphadenopathy (TIBOLA) (recently called scalp eschar and neck lymphadenopathy syndrome [SENLAT]) caused by Rickettsia slovaca was suspected. As a consequence, a regimen of doxycycline (100 mg every 12 h for 4 days) was prescribed. The patient's condition improved. She was discharged 5 days after admission. The patient underwent periodical clinical evaluations for 49 days until her symptoms resolved completely.At admission, an acute-phase serum sample, a blood sample, and a scalp eschar biopsy specimen were collected. Serum was evaluated by indirect immunofluorescence assay (IFA).Antibodies against Rickettsia conorii were tested for using a commercial antigen (R. conorii spot; bioMérieux, Marcy l'Étoile, France). Antibodies against R. slovaca were tested for using an R. slovaca antigen kindly provided by the Unité de Rickettsies, Marseille, France. IgG antibodies against R. conorii antigen (titer Ͼ 5,120) were detected, whereas the IFA using R. slovaca antigen was negative. As neither clinical nor epidemiological variables were typical of Mediterranean spotted fever (MSF, whose etiological agent is R. conorii), and IFA for R. slovaca was not positive, a more accurate diagnosis was carried out.DNA was obtained from the whole-blood sample, the scalp eschar biopsy specimen, and the liquid that contained the scalp eschar biopsy specimen. For this purpose, the MasterPure DNA purification kit (Epicentre, Madison, WI) was used. PCR assays targeting the rickettsial genes for the citrate synthase (gltA) and the outer membrane protein A (ompA), were performed (Table 1). For the citrate synthase gene (gltA), primer CS890r and a new primer (CS214_for), designed by our team, were used. For the ompA gene, a real-time PCR was designed by our team using a new pair of primers: Rr190.314 and Rr190.630. In addition, another pair of primers was used (Rr190.70 and Rr190.701). This set of primers amplifies a bigger fragment that includes the on...

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supporting

confidence: 86%

supporting

confidence: 52%

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Coinfection with “Rickettsia sibirica subsp. mongolotimonae” and Rickettsia conorii in a Human Patient: a Challenge for Molecular Diagnosis Tools

et al. 2015

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“…However, she did not present with a rope-like lymphangitis extending from the eschar to the draining lymph node, that is the characteristic manifestation of this rickettsiosis. Ramos et al proposed that the term lymphangitis-associated rickettsiosis may be unwarranted for R. sibirica mongolitimonae infection, as it is not present in all R. sibirica mongolitimonae cases, and other rickettsioses produce lymphangitis [18]. Moreover, in a recent series of patients with R. sibirica mongolitimonae infection, only 35% of patients presented a rope-like lymphangitis [5].…”

Section: Discussionmentioning

confidence: 99%

Rickettsia sibirica mongolitimonae infection, Sri Lanka

Cordier

Tattevin

Leyer

et al. 2017

J Infect Dev Ctries

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Introduction. Rickettsia sibirica mongolitimonae was recently reported as a common rickettsiosis in France. Current serological evidence suggests the presence of scrub typhus and spotted fever group rickettsiosis in Sri Lanka. We detected a human case of R. sibirica mongolitimonae in Sri Lanka. Methodology. A skin biopsy of the eschar was tested for the presence of Rickettsia spp. using qPCR assay targeting a 109-bp fragment of a hypothetical protein and by PCR amplification and sequencing targeting the ompA gene. Results. A 30-year-old woman who had just returned from travel to a jungle in Sri Lanka was evaluated as an outpatient for fever. Examination revealed an enlarged axillary lymph node, a maculopapular rash and an eschar at her left flank and a skin biopsy of the eschar was performed. The skin biopsy was positive for the presence of Rickettsia spp. by qPCR and PCR amplification and sequencing targeting the ompA gene revealed R. sibirica mongolitimonae. Immunofluorescence assay on an acute serum sample for spotted fever group rickettsial antigens (Rickettsia conorii conorii, R. sibirica mongolitimonae, Rickettsia felis) and typhus group rickettsiae (Rickettsia typhi) was negative. The patient was treated by oral doxycycline (200 mg/day) for one week. Conclusions. R. sibirica mongolitimonae should be considered in the differential diagnosis of patients with suspected rickettsiosis in, or returning from, Sri Lanka.

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“…Recently, Ramos et al described six additional cases of R. sibirica mongolitimonae infections that occurred in the Mediterranean coast region of Spain during the period 2007-2011. All patients had fever (38.5°C-39.5°C), myalgia, headache, and a single inoculation eschar, five (83%) had enlarged regional lymph nodes, and three (50%) had regional lymphangitis (14).…”

Section: Rickettsia Sibirica Mongolitimonae Was First Isolated From mentioning

confidence: 99%

First human case of <i>Rickettsia sibirica mongolotimonae</i> infection in Northern Greece in a teenager from Thrace.

et al. 2016

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Human Infection withRickettsia sibirica mongolitimonae, Spain, 2007–2011

Cited by 41 publications

References 13 publications

Coinfection with “Rickettsia sibirica subsp. mongolotimonae” and Rickettsia conorii in a Human Patient: a Challenge for Molecular Diagnosis Tools

Coinfection with “Rickettsia sibirica subsp. mongolotimonae” and Rickettsia conorii in a Human Patient: a Challenge for Molecular Diagnosis Tools

Rickettsia sibirica mongolitimonae infection, Sri Lanka

First human case of <i>Rickettsia sibirica mongolotimonae</i> infection in Northern Greece in a teenager from Thrace.

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