Rickettsial infection in hospitalised patients in central Tunisia: report of 119 cases

Kaabia, N.; Bellazreg, F.; Hachfi, W.; Khalifa, M.; Ghanouchi, N.; Bahri, F.; Létaief, A.

doi:10.1111/j.1469-0691.2008.02139.x

Cited by 8 publications

(11 citation statements)

References 6 publications

(5 reference statements)

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“…R. felis , was diagnosed in many human cases by serology from our region and from the centre of Tunisia [5,6]. In our work, the DNA of the bacteria was detected in a flea.…”

Section: Discussionmentioning

confidence: 57%

“…In recent years, many studies based on both serological and molecular techniques described a variety of species causing rickettsioses. Thus, R. conorii , R. typhi, R. aeschlimannii and R. felis were characterized by serology [5,6]. Using molecular methods, R. conorii subsp conorii and R. conorii subsp israelensis were detected in humans [7,8], R. monacensis and R. helvetica in Ixodes ricinus [9] and recently R. massiliae in Rhipicephalus sanguineus [10].…”

Section: Introductionmentioning

confidence: 99%

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Multispacer typing of Rickettsia isolates from humans and ticks in Tunisia revealing new genotypes

et al. 2013

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BackgroundRickettsioses are important remerging vector born infections. In Tunisia, many species have been described in humans and vectors. Genotyping is important for tracking pathogen movement between hosts and vectors. In this study, we characterized Rickettsia species detected in patients and vectors using multispacer typing (MST), proposed by Founier et al. and based on three intergenic spacers (dksA-xerC, rmpE- tRNAfMet, mppA-pruC) sequencing.MethodsOur study included 25 patients hospitalized during 2009. Ticks and fleas were collected in the vicinity of confirmed cases. Serology was performed on serum samples by microimmunofluorescence using Rickettsia conorii and Rickettsia typhi antigens. To detect and identify Rickettsia species, PCR targeting ompA, ompB and gltA genes followed by sequencing was performed on 18 obtained skin biopsies and on all collected vectors. Rickettsia positive samples were further characterized using primers targeting three intergenic spacers (dksA-xerC, rmpE- tRNAfMet and mppA-purC).ResultsA rickettsial infection was confirmed in 15 cases (60%). Serology was positive in 13 cases (52%). PCR detected Rickettsia DNA in four biopsies (16%) allowing the identification of R. conorii subsp israelensis in three cases and R. conorii subsp conorii in one case. Among 380 collected ticks, nine presented positive PCR (2.4%) allowing the identification of six R. conorii subsp israelensis, two R. massiliae and one R. conorii subsp conorii. Among 322 collected fleas, only one was positive for R. felis. R. conorii subsp israelensis strains detected in humans and vectors clustered together and showed a new MST genotype. Similarly, R. conorii subsp conorii strains detected in a skin biopsy and a tick were genetically related and presented a new MST genotype.ConclusionsNew Rickettsia spotted fever strain genotypes were found in Tunisia. Isolates detected in humans and vectors were genetically homogenous despite location differences in their original isolation suggesting epidemiologic circulation of these strains.

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“…R. felis , was diagnosed in many human cases by serology from our region and from the centre of Tunisia [5,6]. In our work, the DNA of the bacteria was detected in a flea.…”

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Multispacer typing of Rickettsia isolates from humans and ticks in Tunisia revealing new genotypes

et al. 2013

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“…Additionally, in Algerian cases, 49% of patients were hospitalized with a severe form of the disease. The overall case-fatality rate was 3.6%, but it was 54.5% for patients hospitalized with major neurological manifestations and multiorgan involvement (334,335). In addition, direct contact with dogs or domestic animals has been reported in 76.5% to 95.2% of the cases, and a history of a tick bite has been found in 38% to 50.3% of the cases (333).…”

Section: Tick-borne Rickettsiae In Africa North Africamentioning

confidence: 99%

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

et al. 2013

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SUMMARY Tick-borne rickettsioses are caused by obligate intracellular bacteria belonging to the spotted fever group of the genus Rickettsia . These zoonoses are among the oldest known vector-borne diseases. However, in the past 25 years, the scope and importance of the recognized tick-associated rickettsial pathogens have increased dramatically, making this complex of diseases an ideal paradigm for the understanding of emerging and reemerging infections. Several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections, and novel Rickettsia species of undetermined pathogenicity continue to be detected in or isolated from ticks around the world. This remarkable expansion of information has been driven largely by the use of molecular techniques that have facilitated the identification of novel and previously recognized rickettsiae in ticks. New approaches, such as swabbing of eschars to obtain material to be tested by PCR, have emerged in recent years and have played a role in describing emerging tick-borne rickettsioses. Here, we present the current knowledge on tick-borne rickettsiae and rickettsioses using a geographic approach toward the epidemiology of these diseases.

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“…In a prospective study conducted in the year 1995, among 300 patients hospitalized with fever, infectious diseases were confirmed or suspected in 220 cases—in this group, when serology of rickettsial infections were performed systematically, 6% of patients had acute rickettsioses, and seroprevalence of R. conorii and R. typhi were 22.6% and 15.6%, respectively 7 . In 2007, from 605 hospitalized patients of our unit of Infectious Diseases at Farhat Hached University Hospital in Sousse, half of the cases met clinical criteria of MSF and/or were confirmed by rickettsial serology 8 . In the same unit during the summer of 2004, when serology of rickettsial infections and Coxiella burnetii was systematically performed in 47 patients—hospitalized for acute fever with undetermined origin—rickettsioses were confirmed in 58%, and acute Q fever in 8% 9 …”

Section: Prevalence Of Rickettsioses In Hospitalized Patientsmentioning

confidence: 99%

“…The majority of these abnormalities resolved after 3 to 10 weeks, and final visual acuity was restored in 93% of affected eyes 10 Leukopenia and/or normal blood cells, thrombopenia, and moderate elevation of transaminases were the most frequent laboratory findings noted in 79, 67.5, and 83.5%, respectively (Table 1). In addition, 5% had an elevated creatine level 4,8,11 …”

Section: Epidemiological Clinical and Laboratory Featuresmentioning

confidence: 99%

Characterization of Rickettsial Diseases in a Hospital‐Based Population in Central Tunisia

Kaabia

Létaief

2009

Annals of the New York Academy of Sciences

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In Tunisia, 2 rickettsial groups, spotted fever group and typhus group, have been described since the beginning of the 20th century. Mediterranean spotted fever (MSF), also known as Boutonneuse fever, caused by Rickettsia conorii and transmitted by the dog tick Rhipicephalus sanguineus, is the most frequent rickettsial infection observed. Its seroprevalence in our region is 9% among blood donors and 23% in hospitalized febrile patients. Typhus group rickettsioses, caused by R. typhi and R. prowazekii, are less frequently reported than in the 1970s. Only sporadic cases of typhus were reported in the last decade. However, R. typhi antibodies were present in 3.6% among healthy people and 40% in patients with acute fever of undetermined origin. In the unit of Infectious Diseases at Farhat Hached University Hospital in Sousse, during 2007, 5% of hospitalized patients had eruptive fever, and half of the cases met clinical criteria of MSF and/or were confirmed by rickettsial serology. The majority of cases (90%) were noted in hot seasons, and contact with domestic animals was found in 76%. The most common symptoms were fever (present in all cases), skin rash (in 85% to 98% of cases), and headache (in 69.5% of cases). The clinical triad (fever + rash +"tache noire") was noted in 32 to 61%. Normal blood cells or leukopenia, cytolysis, and thrombopenia were the most frequent biological abnormalities. Complications and malignant forms of rickettsial infections were reported in 3.5 to 6% among hospitalized adult patients. When specific serology was performed, MSF was confirmed in 15%, and we noted an emergence of murine typhus (MT) mistaken for R. conorii or viral infection. Rickettsia felis was identified in 1 patient, whereas 17% of cases remained undetermined. Rickettsia conorii Malish was identified by PCR in skin biopsies. Doxycycline was the antibiotic of choice for rickettsial infections; it was prescribed in the majority of patients, associated with fever defervescence, in a mean of 72 hours. The mean length of stay among hospitalized patients with rickettsial infections was 5.9 days. In conclusion, in our region, MSF and murine typhus are endemic. Doxycycline should be prescribed in patients with acute fever and skin rash, especially in hot seasons. These rickettsioses were characterized by benign prognosis. More skin biopsies are needed to identify other SFG rickettsies.

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Rickettsial infection in hospitalised patients in central Tunisia: report of 119 cases

Cited by 8 publications

References 6 publications

Multispacer typing of Rickettsia isolates from humans and ticks in Tunisia revealing new genotypes

Multispacer typing of Rickettsia isolates from humans and ticks in Tunisia revealing new genotypes

Update on Tick-Borne Rickettsioses around the World: a Geographic Approach

Characterization of Rickettsial Diseases in a Hospital‐Based Population in Central Tunisia

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