Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India

Takajo, Ichiro; Sekizuka, Tsuyoshi; Fujita, Hiromi; Kawano, Ayako; Kawaguchi, Takeshi; Matsuda, Monique; Kubo, Kazuyoshi; Miyauchi, Shunichi; Umekita, Kunihiko; Nagatomo, Yasuhiro; Kuroda, Makoto; Takasaki, Tomohiko; Okayama, Akira; Ando, Shuji

doi:10.3201/eid2206.151985

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…Our sequences were similar to SFG Rickettsial species gltA sequence (MH036502.1) previously submitted from India, which was from a hospital-based surveillance in North India [10]. A sequence from a Japanese traveler who had returned from India (Rickettsia species Tenjiku01) [7], ticks, and environment gltA partial sequences (KU895508.1, GQ260637.1, KY825193.1, KX000250.1, MF405463.1, HM370112.1) (Supplementary Materials) were used as outgroups. amino acid sequence.…”

Section: Resultssupporting

confidence: 63%

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Rickettsial Diseases: Not Uncommon Causes of Acute Febrile Illness in India

et al. 2020

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Rickettsial diseases (RDs) are major under-diagnosed causes of arthropod borne acute febrile illness (AFI) presenting with a range of symptoms from mild self-limiting fever to fatal sepsis. The spotted fever group (SFG) and typhus group (TG) are major RDs, which are commonly caused by Rickettsia conorii and Rickettsia typhi, respectively. The limited availability and role of serological tests in the acute phase of illness warrants rapid reliable molecular methods for diagnosis and epidemiological studies. Two hundred patients with AFI in whom the routine fever diagnostics were negative, were enrolled over a period of two months (April 2019 to May 2019). DNA was extracted and in-house nested PCR using primers specific for both SPG and TG pathogens was used. The positive amplified products were sequenced for species identification and phylogenetic analysis was performed using MEGA 7.0.14 software (iGEM, Temple University, Philadelphia, PA 19122, USA). The demographic details of the RD cases were documented. The prevalence of RD among AFI cases was 7% (14/200); SFG and TG were identified as the cause in 4% and 3% of AFI cases, respectively. The median age of the RD cases was 22 years (range 2-65). The median duration of fever was 3 days (range 1-12). The RD cases presented with respiratory symptoms or signs (44.44%), jaundice (22.22%), abdominal pain (22.22%), diarrhea (22.22), vesicular rash (11.11%), vomiting (11.11%), loss of appetite (11.11%), headache (11.11%), leukocytosis (88.88% with mean count 22,750/mm 3 ), and thrombocytopenia (33.33%). The cases were treated empirically with piperacillin-tazobactam (66.66%), clindamycin (44.44%), cefotaxime (33.33%), meropenem (33.33%), metronidazole (33.33%), doxycycline (22.22%), azithromycin (22.22%), ceftriaxone (11.11%), and amoxicillin-clavulanic acid (11.11%). The mortality among the RD cases was 11.11%. The present pilot study shows that RD is not an uncommon cause of AFI in north India. The febrile episodes are usually transient, not severe and associated with heterogenous clinical presentation without documented history of tick exposure in the hospitalized patients. The transient, non-severe, febrile illness could be due to transient rickettsemia resulting from empirical antimicrobial therapy as the rickettsial organisms are expected to be more susceptible to higher doses of β-lactam antibiotics. The study emphasizes the molecular method as a useful tool to identify rickettsial etiology in AFI.

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Section: Resultssupporting

confidence: 63%

“…Among the pediatric population, AFI due to RD occurred in 0.4 to 7.4% in East Africa, 2 to 17% in South Asia, 0.5 to 20.1% in SE Asia, and 7.5% in Latin America [4]. There is increasing serological evidence for RD in various parts of India [5] and molecular evidence of new rickettsial species in AFI cases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Rickettsial Diseases: Not Uncommon Causes of Acute Febrile Illness in India

et al. 2020

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“…[11][12][13][14] However, at least one serological study used a cross-adsorption IFA protocol and concluded that exposure to more than one SFG rickettsiae may occur in Sri Lanka. 16 This observation is in agreement with descriptions of three cases of travel-acquired rickettsioses in tourists returning from Sri Lanka and India to Australia, France, and Japan, indicating that R. conorii is probably not the sole etiological agent in Sri Lanka, 19,44,47 We performed testing of ticks obtained in the vicinity of human dwellings and collected from peri-domestic animals to evaluate the presence of rickettsial agents posing potential risks to humans. The samples were mostly from cows and dogs, which can serve as sentinels of human exposure to tick-borne rickettsioses.…”

Section: Discussionsupporting

confidence: 84%

“…Ten-jiku01 (LC089865) associated with a travel case to India. 44 Thus, it appears these four agents are closely related (Supplemental Figure S2).…”

Section: Resultsmentioning

confidence: 96%

Molecular Characterization of Rickettsial Agents in Ticks (Acari: Ixodidae) from Sri Lanka

Dasch

Eremeeva

Zambrano

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Because the majority of spotted fever group rickettsiae are transmitted to humans by tick bites, it is important to understand which ticks might play a role in transmission of rickettsial pathogens in Sri Lanka. The purpose of our study was to conduct molecular surveillance of 847 ticks collected in different locations in central Sri Lanka to determine which were infected with Rickettsia and Anaplasmataceae. Molecular methods were used to identify the ticks and the agents detected. Most ticks (Amblyomma, Haemaphysalis, and Rhipicephalus) were collected by flagging, and lower number was collected from dogs, cattle, pigs, a pangolin, and tortoises. Five spotted fever genotypes were identified: a Rickettsia africae-like agent in Amblyomma larvae, Rhipicephalus massiliae and a related genotype identified in association with the tropical type of Rhipicephalus sanguineus from dogs and Rhipicephalus haemaphysaloides from dogs and cattle, and Candidatus R. kellyi and another novel genotype (SL94) in R. haemaphysaloides. Twenty-three ticks were positive for Anaplasmataceae, including one Anaplasma and two Ehrlichia genotypes. Because the sequence database for both ticks and rickettsial agents from Sri Lanka and southern India is not extensive, additional molecular characterization of the tick species of Sri Lanka and their rickettsial agents is required to understand their pathogenic potential more completely. However, several of the agents we identified in this survey may well be pathogenic for humans and domestic animals, and should be considered as a part of epidemiological surveillance and patient management.

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“…R. gannanii” Haemaphysalis qinghaiensis China [ 153 ] – – “ Ca. R. indica” Human blood Imported from India to Japan (traveler) [ 154 ] Unnamed [ 154 ] “ Ca . R. moyalensis” Rhipicephalus appendiculatus Kenya [ 155 ] – – “ Ca .…”

Section: New Rickettsiaementioning

confidence: 99%

Neglected aspects of tick-borne rickettsioses

et al. 2018

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Rickettsioses are among the oldest known infectious diseases. In spite of this, and of the extensive research carried out, many aspects of the biology and epidemiology of tick-borne rickettsiae are far from being completely understood. Their association with arthropod vectors, the importance of vertebrates as reservoirs, the rarity of clinical signs in animals, or the interactions of pathogenic species with rickettsial endosymbionts and with the host intracellular environment, are only some examples. Moreover, new rickettsiae are continuously being discovered. In this review, we focus on the ‘neglected’ aspects of tick-borne rickettsioses and on the gaps in knowledge, which could help to explain why these infections are still emerging and re-emerging threats worldwide.

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Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India

Cited by 9 publications

References 14 publications

Rickettsial Diseases: Not Uncommon Causes of Acute Febrile Illness in India

Rickettsial Diseases: Not Uncommon Causes of Acute Febrile Illness in India

Molecular Characterization of Rickettsial Agents in Ticks (Acari: Ixodidae) from Sri Lanka

Neglected aspects of tick-borne rickettsioses

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