Reemergence of Murine Typhus in Galveston, Texas, USA, 2013

Blanton, Lucas S.; Vohra, Rahat F.; Bouyer, Donald H.; Walker, David H.

doi:10.3201/eid2103.140716

Cited by 40 publications

(28 citation statements)

References 15 publications

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“…Presently, infections are encountered in populations living in unsanitary, crowded conditions (Brouqui & Raoult 2006; Raoult et al 2006) as urban expansion into suburban environments worldwide has generated ideal ecosystems for infectious disease outbreaks caused by these prevalent pathogens ( e.g. reemergence of flea-borne endemic typhus in southern California and Texas) (Blanton et al 2015; Gillespie et al 2009). Observed with considerable frequency, a third insect-borne rickettsial pathogen, Rickettsia felis , was identified as the causative agent of the emerging flea-borne spotted fever in hospitalized patients with acute febrile illness (Edouard et al 2014; Mediannikov et al 2013a; Mediannikov et al 2013b; Parola 2011; Parola et al 2003; Raoult et al 2001; Richards et al 2010; Schriefer et al 1994a; Socolovschi et al 2010; Zavala-Castro et al 2009; Zavala-Velazquez et al 2000).…”

Section: Introductionmentioning

confidence: 99%

Cofeeding intra‐ and interspecific transmission of an emerging insect‐borne rickettsial pathogen

et al. 2015

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Cat fleas (Ctenocephalides felis) are known as the primary vector and reservoir of Rickettsia felis, the causative agent of flea‐borne spotted fever; however, field surveys regularly report molecular detection of this infectious agent from other blood‐feeding arthropods. The presence of R. felis in additional arthropods may be the result of chance consumption of an infectious bloodmeal, but isolation of viable rickettsiae circulating in the blood of suspected vertebrate reservoirs has not been demonstrated. Successful transmission of pathogens between actively blood‐feeding arthropods in the absence of a disseminated vertebrate infection has been verified, referred to as cofeeding transmission. Therefore, the principal route from systemically infected vertebrates to uninfected arthropods may not be applicable to the R. felis transmission cycle. Here, we show both intra‐ and interspecific transmission of R. felis between cofeeding arthropods on a vertebrate host. Analyses revealed that infected cat fleas transmitted R. felis to naïve cat fleas and rat fleas (Xenopsylla cheopis) via fleabite on a nonrickettsemic vertebrate host. Also, cat fleas infected by cofeeding were infectious to newly emerged uninfected cat fleas in an artificial system. Furthermore, we utilized a stochastic model to demonstrate that cofeeding is sufficient to explain the enzootic spread of R. felis amongst populations of the biological vector. Our results implicate cat fleas in the spread of R. felis amongst different vectors, and the demonstration of cofeeding transmission of R. felis through a vertebrate host represents a novel transmission paradigm for insect‐borne Rickettsia and furthers our understanding of this emerging rickettsiosis.

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Section: Introductionmentioning

confidence: 99%

Cofeeding intra‐ and interspecific transmission of an emerging insect‐borne rickettsial pathogen

et al. 2015

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“…4 Since this reemergence, murine typhus has continued to affect residents of Galveston County (L. Blanton, unpublished data). We hypothesize that in Galveston, opossums play a role in the transmission of R. typhi, as they do in the southernmost counties of Texas and in southern California.…”

Section: 10mentioning

confidence: 99%

“…3 Although often ignored or deemed irrelevant as a cause of febrile illness, murine typhus continues to emerge as a cause of illness in communities in the United States. [4][5][6] It has also been increasingly recognized as a cause of fever in returning travelers. 2 In 1944, the number of murine typhus cases in the United States reached a peak of 5,401 and experienced a precipitous decline in the years following.…”

Section: Introductionmentioning

confidence: 99%

Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, Texas

Blanton

Idowu

Tatsch

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Murine typhus is an acute undifferentiated febrile illness caused by Rickettsia typhi. The classic reservoir (Rattus spp.) and flea vector (Xenopsylla cheopis) were once culprits of murine typhus in the United States. Vector and rodent control efforts have drastically decreased the prevalence of disease, except in a few endemic foci where opossums and cat fleas play a role in transmission. Since 2012, there has been a reemergence of murine typhus in Galveston, TX. We hypothesize that opossums and cat fleas are involved in the transmission of R. typhi in Galveston. To explore this, we sought to find the seroprevalence of typhus group antibodies from opossums. We also sought to find the prevalence of R. typhi in fleas parasitizing these animals. We collected blood from 12 opossums and found that eight (66.7%) had the presence of anti-R. typhi antibodies. All opossums were infested with fleas; a total of 250 Ctenocephalides felis fleas were collected from these animals. Seven opossums (53.8%) were infested with fleas that had molecular evidence of R. typhi infection, while six (46.2%) were infested with fleas that contained Candidatus Rickettsia senegalensis, an organism closely related to R. felis. The minimum flea infection rate for R. typhi was 7.0%. The minimum infection rate for Candidatus R. senegalensis was 6.1%. Our study demonstrates that fleas infected with R. typhi parasitize opossums in Galveston. It is therefore likely that opossums and their fleas play a role in the city's recent reemergence of murine typhus.

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“…Initial laboratory testing revealed a leukocyte count of 4,500 cells/mm 3 , hemoglobin of 14.5 g/dL, platelet count of 86,000/mm Because of the patient's field of study and potential occupational exposures, he was evaluated in the infectious diseases and dermatology clinics on October 31, 2014. Additional acute phase serologic tests sent for syphilis, human immunodeficiency virus, viral hepatitis, cytomegalovirus, Epstein-Barr virus, West Nile virus, SFGR, and typhus group rickettsiae (TGR) were all negative.…”

Section: Case Reportmentioning

confidence: 99%

“…2 After decades of quiescence, murine typhus has reemerged as a cause of illness in Galveston. 3 The disease presents as an undifferentiated febrile illness accompanied by a maculopapular rash in 59% of infected persons. [4][5][6][7][8][9][10][11][12][13] Unlike many spotted fever group rickettsioses (SFGR) and scrub typhus, infection caused by R. typhi is not associated with an inoculation lesion.…”

Section: Introductionmentioning

confidence: 99%