Spotted Fever Group and Typhus Group Rickettsioses in Humans, South Korea

Choi, Yeon Joo; Jang, Won Jong; Kim, Jong Hyun; Ryu, Ji Sun; Lee, Seung Hyun; Park, Kyung Hee; Paik, Hyung Suk; Koh, Young Sang; Choi, Myung Sik; Kim, Ik Sang

doi:10.3201/eid1102.040603

Cited by 193 publications

(114 citation statements)

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“…In addition, previously demonstrated serologic evidence of spotted fever group rickettsiae infection among residents of Gag Island, in eastern Indonesia (15), could have been due to R. felis. On the basis of data presented here and of recent reports of R. felis in other countries in Asia (2)(3)(4)(5)8,9), healthcare providers in Indonesia should be alerted to the possibility of fleaborne spotted fever among their patients.…”

Section: Resultsmentioning

confidence: 99%

Rickettsia felis inXenopsylla cheopis, Java, Indonesia

Jiang¹,

Soeatmadji²,

Henry³

et al. 2006

Emerg. Infect. Dis.

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Rickettsia typhi and R. felis, etiologic agents of murine typhus and fleaborne spotted fever, respectively, were detected in Oriental rat fleas (Xenopsylla cheopis) collected from rodents and shrews in Java, Indonesia. We describe the first evidence of R. felis in Indonesia and naturally occurring R. felis in Oriental rat fleas.M urine typhus (endemic typhus, fleaborne typhus), caused by Rickettsia typhi, is transmitted to humans by infected fleas and is relatively common wherever susceptible rodent hosts reside (1). Fleaborne spotted fever (cat flea typhus), caused by Rickettsia felis, is another zoonotic disease carried by fleas and appears to have an equally wide, cosmopolitan distribution; human infections with R. felis have a clinical syndrome similar to that of murine typhus (1-4). The cat flea, Ctenocephalides felis, has been identified as the primary arthropod vector of R. felis in North and South America (United States, Mexico, Peru, Brazil), Europe (Spain, France, United Kingdom, Cyprus), Africa (Gabon, Ethiopia), Asia (Thailand, Afghanistan, Israel), Australia, and New Zealand (1,5-10). We describe the first evidence of R. felis in Indonesia and apparent natural infections of R. felis in the Oriental rat flea, Xenopsylla cheopis, implicating this flea species for the first time as a potential vector for fleaborne spotted fever. The StudySamples of X. cheopis were collected from 39 live-captured, peridomestic rodents and shrews from 3 localities in Malang, East Java, Indonesia, during an epidemiologic study conducted in 1994 (11). In this study the fleas were reidentified by using morphologic criteria, stored in fresh 70% ethanol, and subsequently evaluated for the presence of rickettsial DNA. DNA sample preparations were derived from triturates of 103 individual fleas in 100 µL PrepManUltra sample preparation reagent (Applied Biosystems, Foster City, CA, USA). DNA preparations of 1 to 5 fleas collected from the same rodent were pooled for testing. Reaction mixtures for the quantitative real-time PCR (qPCR) assays had a total volume of 25 µL and contained 3 µL DNA template. The master mixes were prepared for the 17-kDa Rickettsia-, R. typhi-and R. felis-specific qPCR assays in a separate, clean (DNA-free) room as previously described (6,12). The primer and probe sequences for the 17-kDa Rickettsia-specific and R. felis-specific assays have been reported (6,11). The R. typhi forward (Rt557F: 5′-TGG TAT TAC TGC TCA ACA AGC T-3′) and reverse (Rt678R: 5′-CAG TAA AGT CTA TTG ATC CTA CAC C-3′) primers and probe (Rt640BP: 5′-TET-CGC GAT CGT TAA TAG CAG CAC CAG CAT TAT CGC G-DABCYL-3′) sequences are listed here. Included in each run were 3 negative controls (GIBCO Ultrapure DNA-free distilled water, Invitrogen Corporation, Grand Island, NY, USA), 1 produced in the clean room and 2 in a biosafety cabinet in another laboratory where DNA templates were added. A TOPO TA plasmid (Invitrogen Corporation) that contained the target sequence at 10 3 copies for each assay was used as a positive control. qPCR reactions w...

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Section: Resultsmentioning

confidence: 99%

Rickettsia felis inXenopsylla cheopis, Java, Indonesia

Jiang¹,

Soeatmadji²,

Henry³

et al. 2006

Emerg. Infect. Dis.

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“…Dual infections with Rickettsia spp. and members of other genera have been described (10,20), as well as coinfection among Rickettsia species (21,22).…”

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confidence: 99%

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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“…DNA samples were analyzed by PCR for Rickettsia, Borrelia, and A. phagocytophilum using specific primer pairs targeting two genes for each agent, as previously described (2,4,9,16,19). Additionally, 60 DNA samples extracted from lizard blood prints were tested for A. phagocytophilum.…”

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confidence: 99%