Successful Detection of Unrecognized <i>Rickettsia typhi</i> in Pregnancy Using Cell-Free Next-Generation Sequencing

Stafford, Irene; Centeno, Fernando H; Mohajer, Mayar Al; Parkerson, George R.; Woc-Colburn, Laila; Burgos-Lee, Angelica Janice; Rac, Martha; Dunn, James J.; Muldrew, Kenneth L.

doi:10.1155/2020/6767351

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…Seven articles were found describing MT during pregnancy. Of those, five were case reports [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], and two were based on observational population studies [ 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…The confirmatory diagnosis was mainly based on serology and PCR amplification of rickettsial DNA. Recently, the use of microbial cell-free DNA in human plasma has become an attractive option for the diagnosis of MT, given the potential of higher sensitivity than conventional molecular diagnostic tests such as PCR [ 17 , 24 , 25 ]. However, this novel modality is not widely available as a standard diagnostic test.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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Murine Typhus Infection in Pregnancy: Case Series and Literature Review

et al. 2021

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Murine typhus is a flea-borne disease of worldwide distribution with a recent reemergence in the United States of America. There are limited data about the presentation, treatment, and outcomes in the pregnant population. We report on two cases of murine typhus during pregnancy and review the literature to compile previously reported cases. A comprehensive search was performed via the PubMed database for published articles between 1990 and 2020. Seven articles met the criteria of symptomatic pregnant murine typhus infection. A total of 37 patients were identified. Patients frequently presented with a prolonged duration of fevers prior to presentation, headache, and elevated hepatic transaminases. The diagnosis was predominantly based on serology. Treatment varied. Overall, the pregnancy outcome was favorable. Murine typhus can mimic other pregnancy-related pathologies. More exclusive and large-scale studies are needed to learn more of murine typhus during pregnancy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Murine Typhus Infection in Pregnancy: Case Series and Literature Review

et al. 2021

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“…Sequencing of R. typhi mcfDNA was more rapid and specific than serology and was able to change clinical management in half of the cases. NGS has also been used to detect R. typhi and diagnose murine typhus in two pregnant women [ 76 ]. R. typhi DNA was detected in both cases using a commercial assay (The Karius ® Test).…”

Section: Genomic Approaches In the Diagnosis Of Rickettsia Species Infectionmentioning

confidence: 99%

An Update on the Laboratory Diagnosis of Rickettsia spp. Infection

Stewart

2021

Pathogens

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Rickettsia species causing human illness are present globally and can cause significant disease. Diagnosis and identification of this intracellular bacteria are challenging with many available diagnostic modalities suffering from several shortcomings. Detection of antibodies directed against Rickettsia spp. via serological methods remains widely used with a broad range of sensitivity and specificity values reported depending on the assay. Molecular methods, including polymerase chain reaction (PCR) testing, enables species-specific identification with a fast turnaround time; however, due to resource requirements, use in some endemic settings is limited. Reports on the use of next-generation sequencing (NGS) and metagenomics to diagnose Rickettsia spp. infection have been increasing. Despite offering several potential advantages in the diagnosis and surveillance of disease, genomic approaches are currently only limited to reference and research laboratories. Continued development of Rickettsia spp. diagnostics is required to improve disease detection and epidemiological surveillance, and to better understand transmission dynamics.

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“… 150 The DNA of R. typhi has also been detected by next generation sequencing from the blood of 2 pregnant women during the workup for undifferentiated febrile illness. 151 The use of isothermal amplification techniques in resource limited settings offers a cost-effective diagnostic technique for the detection of infectious pathogens. Indeed, development of such assays for the detection of rickettsiae, as recently demonstrated via recombinase polymerase amplification, 152 offers a technique that rivals the analytic sensitivity of polymerase chain reaction.…”

Section: Diagnosismentioning

confidence: 99%

Manifestations and Management of Flea-Borne Rickettsioses

Martinez

Ramírez-Hernández

Blanton

2021

RRTM

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Murine typhus and flea-borne spotted fever are undifferentiated febrile illnesses caused by Rickettsia typhi and Rickettsia felis , respectively. These organisms are small obligately intracellular bacteria and are transmitted to humans by fleas. Murine typhus is endemic to coastal areas of the tropics and subtropics (especially port cities), where rats are the primary mammalian host and rat fleas ( Xenopsylla cheopis ) are the vector. In the United States, a cycle of transmission involving opossums and cat fleas ( Ctenocephalides felis ) are the presumed reservoir and vector, respectively. The incidence and distribution of murine typhus appear to be increasing in endemic areas of the US. Rickettsia felis has also been reported throughout the world and is found within the ubiquitous cat flea. Flea-borne rickettsioses manifest as an undifferentiated febrile illness. Headache, malaise, and myalgia are frequent symptoms that accompany fever. The incidence of rash is variable, so its absence should not dissuade the clinician to consider a rickettsial illness as part of the differential diagnosis. When present, the rash is usually macular or papular. Although not a feature of murine typhus, eschar has been found in 12% of those with flea-borne spotted fever. Confirmatory laboratory diagnosis is usually obtained by serology; the indirect immunofluorescence assay is the serologic test of choice. Antibodies are seldom present during the first few days of illness. Thus, the diagnosis requires acute- and convalescent-phase specimens to document seroconversion or a four-fold increase in antibody titer. Since laboratory diagnosis is usually retrospective, when a flea-borne rickettsiosis is considered, empiric treatment should be initiated. The treatment of choice for both children and adults is doxycycline, which results in a swift and effective response. The following review is aimed to summarize the key clinical, epidemiological, ecological, diagnostic, and treatment aspects of flea-borne rickettsioses.

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Successful Detection of Unrecognized Rickettsia typhi in Pregnancy Using Cell-Free Next-Generation Sequencing

Cited by 10 publications

References 25 publications

Murine Typhus Infection in Pregnancy: Case Series and Literature Review

Murine Typhus Infection in Pregnancy: Case Series and Literature Review

An Update on the Laboratory Diagnosis of Rickettsia spp. Infection

Manifestations and Management of Flea-Borne Rickettsioses

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