Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar

Overview

Journal Pathogens

Date 2021 Nov 27

PMID 34832637

Authors

Christian Keller

Raphael Rakotozandrindrainy

Vera von Kalckreuth

Jean Noel Heriniaina

Norbert Georg Schwarz

Gi Deok Pak

Justin Im

Ligia Maria Cruz Espinoza

Ralf Matthias Hagen

Hagen Frickmann

Jean Philibert Rakotondrainiarivelo

Tsiry Razafindrabe

Denise Dekker

Jurgen May

Sven Poppert

Florian Marks

Affiliations

Soon will be listed here.

Abstract

Rickettsiae may cause febrile infections in humans in tropical and subtropical regions. From Madagascar, no molecular data on the role of rickettsioses in febrile patients are available. Blood samples from patients presenting with fever in the area of the capital Antananarivo were screened for the presence of rickettsial DNA. EDTA (ethylenediaminetetraacetic acid) blood from 1020 patients presenting with pyrexia > 38.5 °C was analyzed by -specific qPCR. Positive samples were confirmed by -specific qPCR. From confirmed samples, the amplicons were sequenced and subjected to phylogenetic analysis. From five -reactive samples, two were confirmed by -specific qPCR. The sequence in the sample taken from a 38-year-old female showed 100% homology with . The other sample taken from a 1.5-year-old infant was 100% homologous to . Tick-borne rickettsiae were not identified. The overall rate of febrile patients with molecular evidence for a rickettsial infection from the Madagascan study site was 0.2% (2/1020 patients). Flea-borne rickettsiosis is a rare but neglected cause of infection in Madagascar. Accurate diagnosis may prompt adequate antimicrobial treatment.

References

Azad A, Radulovic S, Higgins J, Noden B, Troyer J . Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis. 1997; 3(3):319-27. PMC: 2627639. DOI: 10.3201/eid0303.970308. View

Keller C, Kruger A, Schwarz N, Rakotozandrindrainy R, Rakotondrainiarivelo J, Razafindrabe T . High detection rate of Rickettsia africae in Amblyomma variegatum but low prevalence of anti-rickettsial antibodies in healthy pregnant women in Madagascar. Ticks Tick Borne Dis. 2015; 7(1):60-65. DOI: 10.1016/j.ttbdis.2015.08.005. View

Mourembou G, Lekana-Douki J, Mediannikov O, Nzondo S, Kouna L, Essone J . Possible Role of Rickettsia felis in Acute Febrile Illness among Children in Gabon. Emerg Infect Dis. 2015; 21(10):1808-15. PMC: 4593428. DOI: 10.3201/eid2110.141825. View

Ehlers J, Ganzhorn J, Silaghi C, Kruger A, Pothmann D, Ratovonamana R . Tick (Amblyomma chabaudi) infestation of endemic tortoises in southwest Madagascar and investigation of tick-borne pathogens. Ticks Tick Borne Dis. 2016; 7(2):378-83. DOI: 10.1016/j.ttbdis.2015.12.011. View

Park S, Pak G, Aaby P, Adu-Sarkodie Y, Ali M, Aseffa A . The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa. Clin Infect Dis. 2016; 62 Suppl 1:S23-31. PMC: 4772835. DOI: 10.1093/cid/civ893. View

Doppler J, Newton P . A systematic review of the untreated mortality of murine typhus. PLoS Negl Trop Dis. 2020; 14(9):e0008641. PMC: 7515178. DOI: 10.1371/journal.pntd.0008641. View

Goodman S, Randrenjarison Andriniaina H, Soarimalala V, Beaucournu J . The Fleas of Endemic and Introduced Small Mammals in Central Highland Forests of Madagascar: Faunistics, Species Diversity, and Absence of Host Specificity. J Med Entomol. 2015; 52(5):1135-43. DOI: 10.1093/jme/tjv113. View

Dupont H, Brouqui P, Faugere B, Raoult D . Prevalence of antibodies to Coxiella burnetti, Rickettsia conorii, and Rickettsia typhi in seven African countries. Clin Infect Dis. 1995; 21(5):1126-33. DOI: 10.1093/clinids/21.5.1126. View

Civen R, NGo V . Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis. 2008; 46(6):913-8. DOI: 10.1086/527443. View

10.

von Kalckreuth V, Konings F, Aaby P, Adu-Sarkodie Y, Ali M, Aseffa A . The Typhoid Fever Surveillance in Africa Program (TSAP): Clinical, Diagnostic, and Epidemiological Methodologies. Clin Infect Dis. 2016; 62 Suppl 1:S9-S16. PMC: 4772831. DOI: 10.1093/cid/civ693. View

11.

Roch N, Epaulard O, Pelloux I, Pavese P, Brion J, Raoult D . African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clin Infect Dis. 2008; 47(3):e28-35. DOI: 10.1086/589868. View

12.

Niang M, Parola P, Tissot-Dupont H, Baidi L, Brouqui P, Raoult D . Prevalence of antibodies to Rickettsia conorii Ricketsia africae, Rickettsia typhi and Coxiella burnetii in Mauritania. Eur J Epidemiol. 1999; 14(8):817-8. DOI: 10.1023/a:1007571412030. View

13.

Henry K, Jiang J, Rozmajzl P, Azad A, Macaluso K, Richards A . Development of quantitative real-time PCR assays to detect Rickettsia typhi and Rickettsia felis, the causative agents of murine typhus and flea-borne spotted fever. Mol Cell Probes. 2006; 21(1):17-23. DOI: 10.1016/j.mcp.2006.06.002. View

14.

Angelakis E, Botelho E, Socolovschi C, Sobas C, Piketty C, Parola P . Murine typhus as a cause of Fever in travelers from Tunisia and mediterranean areas. J Travel Med. 2010; 17(5):310-5. DOI: 10.1111/j.1708-8305.2010.00435.x. View

15.

Paris D, Dumler J . State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis. 2016; 29(5):433-9. PMC: 5029442. DOI: 10.1097/QCO.0000000000000298. View

16.

Rakotonanahary R, Harrison A, Maina A, Jiang J, Richards A, Rajerison M . Molecular and serological evidence of flea-associated typhus group and spotted fever group rickettsial infections in Madagascar. Parasit Vectors. 2017; 10(1):125. PMC: 5336680. DOI: 10.1186/s13071-017-2061-4. View

17.

Sothmann P, Keller C, Krumkamp R, Kreuels B, Aldrich C, Sarpong N . Infection in Febrile Children, Ghana. Am J Trop Med Hyg. 2017; 96(4):783-785. PMC: 5392620. DOI: 10.4269/ajtmh.16-0754. View

18.

Parola P . Rickettsia felis: from a rare disease in the USA to a common cause of fever in sub-Saharan Africa. Clin Microbiol Infect. 2011; 17(7):996-1000. DOI: 10.1111/j.1469-0691.2011.03516.x. View

19.

Andrianaivoarimanana V, Kreppel K, Elissa N, Duplantier J, Carniel E, Rajerison M . Understanding the persistence of plague foci in Madagascar. PLoS Negl Trop Dis. 2013; 7(11):e2382. PMC: 3820717. DOI: 10.1371/journal.pntd.0002382. View

20.

Guillebaud J, Bernardson B, Randriambolamanantsoa T, Randrianasolo L, Randriamampionona J, Marino C . Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar. PLoS Negl Trop Dis. 2018; 12(7):e0006642. PMC: 6062140. DOI: 10.1371/journal.pntd.0006642. View