Risk Factors for Spotted Fever Group Rickettsioses in Kilimanjaro Region, Tanzania

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2024 Dec 18

PMID 39691286

Authors

Thomas R Bowhay

Matthew P Rubach

Angelo J F Mendes

William L Nicholson

Jamie L Perniciaro

Michael J Maze

Ganga S Moorthy

Jo E B Halliday

Kathryn J Allan

Blandina T Mmbaga

Wilbrod Saganda

Bingileki F Lwezaula

Rudovick R Kazwala

Sarah Cleaveland

Katrina J Sharples

Venance P Maro

John A Crump

Affiliations

Soon will be listed here.

Abstract

Background: Knowledge gaps exist on risk factors for spotted fever group rickettsioses (SFGR) in sub-Saharan Africa. We sought to identify SFGR risk factors in Kilimanjaro Region, Tanzania.

Methods: We recruited febrile patients presenting at 2 hospitals in Moshi from February 2012 through May 2014. Standardized clinical and risk factor questionnaires were administered. SFGR exposure was defined as a immunofluorescence antibody reciprocal titer ≥64, and acute SFGR as a ≥4-fold rise between paired sera. Logistic regression was used to identify associations.

Results: Of 1190 participants providing ≥1 serum sample, the median age was 21.8 (range, 0.3-100.2) years, 646 (54.3%) were female, and 650 (54.6%) had SFGR exposure. Of 731 participants with paired sera, 67 (9.2%) had acute SFGR. On multivariable analysis, odds of acute SFGR were higher in the age group 0-2 years (adjusted odds ratios [aORs] for older age groups, <0.36; < .011), rural residence (aOR, 4.1; = .007), and areas with maximum daily temperature <26°C (aORs for higher temperature groups, <0.42; < .035). Odds of SFGR exposure were higher in those working in the garden (aOR, 1.8; = .010) and seeing a dog (aOR, 1.5; = .010). Odds of SFGR exposure were lower in the age group 0-2 years (aORs for older age groups, >1.5; < .026), female sex (aOR, 0.62; < .001), and being from the Chaga tribe (aOR, 0.68; = .003).

Conclusions: Those aged <2 years, rural residents, and persons residing in areas with cooler temperatures had increased odds of SFGR. Our results identify groups for further research on tick exposure and for targeted prevention interventions.

References

Raoult D, Toga B, Chaudet H . Rickettsial antibody in southern France: antibodies to Rickettsia conorii and Coxiella burnetii among urban, suburban and semi-rural blood donors. Trans R Soc Trop Med Hyg. 1987; 81(1):80-1. DOI: 10.1016/0035-9203(87)90290-2. View

Crump J, Morrissey A, Nicholson W, Massung R, Stoddard R, Galloway R . Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis. 2013; 7(7):e2324. PMC: 3715424. DOI: 10.1371/journal.pntd.0002324. View

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

Pisharody S, Rubach M, Carugati M, Nicholson W, Perniciaro J, Biggs H . Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Am J Trop Med Hyg. 2021; 106(2):494-503. PMC: 8832940. DOI: 10.4269/ajtmh.20-1036. View

Moraga P, Cano J, Baggaley R, Gyapong J, Njenga S, Nikolay B . Modelling the distribution and transmission intensity of lymphatic filariasis in sub-Saharan Africa prior to scaling up interventions: integrated use of geostatistical and mathematical modelling. Parasit Vectors. 2015; 8:560. PMC: 4620019. DOI: 10.1186/s13071-015-1166-x. View

Rahajarison P, Arimanana A, Raliniaina M, Stachurski F . Survival and moulting of Amblyomma variegatum nymphs under cold conditions of the Malagasy highlands. Infect Genet Evol. 2014; 28:666-75. DOI: 10.1016/j.meegid.2014.06.022. View

Lynen G, Zeman P, Bakuname C, Di Giulio G, Mtui P, Sanka P . Cattle ticks of the genera Rhipicephalus and Amblyomma of economic importance in Tanzania: distribution assessed with GIS based on an extensive field survey. Exp Appl Acarol. 2007; 43(4):303-19. DOI: 10.1007/s10493-007-9123-9. View

Jensenius M, Fournier P, Vene S, Hoel T, Hasle G, Henriksen A . African tick bite fever in travelers to rural sub-Equatorial Africa. Clin Infect Dis. 2003; 36(11):1411-7. DOI: 10.1086/375083. View

Noden B, Tshavuka F, van der Colf B, Chipare I, Wilkinson R . Exposure and risk factors to coxiella burnetii, spotted fever group and typhus group Rickettsiae, and Bartonella henselae among volunteer blood donors in Namibia. PLoS One. 2014; 9(9):e108674. PMC: 4178180. DOI: 10.1371/journal.pone.0108674. View

10.

Socolovschi C, Raoult D, Parola P . Influence of temperature on the attachment of Rhipicephalus sanguineus ticks on rabbits. Clin Microbiol Infect. 2009; 15 Suppl 2:326-7. DOI: 10.1111/j.1469-0691.2008.02260.x. View

11.

Biggs H, Behravesh C, Bradley K, Dahlgren F, Drexler N, Dumler J . Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States. MMWR Recomm Rep. 2016; 65(2):1-44. DOI: 10.15585/mmwr.rr6502a1. View

12.

Maina A, Farris C, Odhiambo A, Jiang J, Laktabai J, Armstrong J . Q Fever, Scrub Typhus, and Rickettsial Diseases in Children, Kenya, 2011-2012. Emerg Infect Dis. 2016; 22(5):883-6. PMC: 4861507. DOI: 10.3201/eid2205.150953. View

13.

Prabhu M, Nicholson W, Roche A, Kersh G, Fitzpatrick K, Oliver L . Q fever, spotted fever group, and typhus group rickettsioses among hospitalized febrile patients in northern Tanzania. Clin Infect Dis. 2011; 53(4):e8-15. PMC: 3148261. DOI: 10.1093/cid/cir411. View

14.

Parola P, Paddock C, Socolovschi C, Labruna M, Mediannikov O, Kernif T . Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev. 2013; 26(4):657-702. PMC: 3811236. DOI: 10.1128/CMR.00032-13. View

15.

Moorthy G, Rubach M, Maze M, Refuerzo R, Shirima G, Lukambagire A . Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016-2017. Trop Med Int Health. 2024; 29(5):365-376. PMC: 11073910. DOI: 10.1111/tmi.13980. View

16.

Textor J, van der Zander B, Gilthorpe M, Liskiewicz M, Ellison G . Robust causal inference using directed acyclic graphs: the R package 'dagitty'. Int J Epidemiol. 2017; 45(6):1887-1894. DOI: 10.1093/ije/dyw341. View

17.

Berrian A, Martinez-Lopez B, Quan V, Conrad P, van Rooyen J, Simpson G . Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province, South Africa. Zoonoses Public Health. 2019; 66(5):458-469. DOI: 10.1111/zph.12577. View

18.

Maze M, Cash-Goldwasser S, Rubach M, Biggs H, Galloway R, Sharples K . Risk factors for human acute leptospirosis in northern Tanzania. PLoS Negl Trop Dis. 2018; 12(6):e0006372. PMC: 5991637. DOI: 10.1371/journal.pntd.0006372. View

19.

Sikana L, Lembo T, Hampson K, Lushasi K, Mtenga S, Sambo M . Dog ownership practices and responsibilities for children's health in terms of rabies control and prevention in rural communities in Tanzania. PLoS Negl Trop Dis. 2021; 15(3):e0009220. PMC: 7946275. DOI: 10.1371/journal.pntd.0009220. View

20.

Jensenius M, Fournier P, Kelly P, Myrvang B, Raoult D . African tick bite fever. Lancet Infect Dis. 2003; 3(9):557-64. DOI: 10.1016/s1473-3099(03)00739-4. View