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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
Emerging infectious diseases, 2014Co-Authors: Rezak Drali, Aurelie Veracx, Cristina Socolovschi, Philippe Brouqui, Abdoul Karim Sangaré, Amina Boutellis, Emmanouil Angelakis, Didier RaoultAbstract:To the Editor: Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and Homeless Persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3). The head louse, Pediculus humanus capitis, and the body louse, Pediculus humanus humanus, are obligatory ectoparasites that feed exclusively on human blood (4). Outside of their habitats, the 2 ecotypes are morphologically indistinguishable (1). Sequence variation in the PHUM540560 gene discriminates between head and body lice by determining the genotype of the lice (5). While surveying for trench fever among Homeless Persons in shelters in Marseille, France during October 2012–March 2013, we investigated the presence of B. quintana DNA in nits, larvae, and adult lice collected from mono-infested and dually infested Persons and determined the genotypes of the specimens. The Persons included in this study received long-lasting insecticide-treated underwear; lice were collected by removing them from clothing, including underwear, pants, and shirts. Because body lice reside in the clothing of infested Persons except when feeding, they are sometimes called clothing lice. A total of 989 specimens were tested, including 149 (83 from clothing and 66 from hair) first–instar larvae hatched in the laboratory from eggs collected from 7 dually infested Persons, and 840 adult body lice collected from the clothing of 80 mono-infested patients. We included DNA isolated from 3 nits collected from the hair of a mono-infested Person who had previously been confirmed as positive for B. quintana (6) (Table). Table Distribution of Bartonella quintana DNA in nits, larvae, and adult body lice collected from hair and clothing of Homeless Persons in shelters, Marseille, France, October 2012– March 2013* Total DNA was extracted by using an EZ1 automated extractor (QIAGEN, Courtaboeuf, France) and subjected twice to real-time PCR specific for B. quintana. The first PCR targeted the 16S-23S intergenic spacer region. Positive samples were confirmed by using a second real-time PCR targeting the yopP gene (6). Samples that tested positive for B. quintana DNA were analyzed by multiplex real-time PCR that targeted the PHUM540560 gene (5). We used head and body lice that had known genotypes positive controls. Negative controls were included in each assay. Of the hatched larvae, 5 (6%) of the 83 recovered from clothing and 7 (11%) of 66 from the hair (Table) of 4 of the 7 dually infested Persons were positive for B. quintana DNA (Technical Appendix). Of the 840 adult body lice, 174 (21%) collected from 42 (53%) of 80 of the mono-infested Persons contained B. quintana DNA (Table, Technical Appendix). The multiplex real-time PCR that targeted the PHUM540560 gene clearly identified all nits, larvae, and adult lice as belonging to the body lice lineage. Negative controls remained negative in all PCR-based experiments. For 2 decades, B. quintana DNA has been regularly detected in lice collected from the heads of Persons living in poverty, but it had not been detected in head lice that infest schoolchildren (7,8). All of the lice collected during this study that tested positive for B. quintana from Homeless Persons were body lice, including some that were recovered from hair. This observation supports our assertion that body lice are not confined to the body. The 3 eggs that were removed from the hair of a mono-infested Homeless Person whose samples tested positive for B. quintana were also body lice. During the clinical examination, no adult head lice or adult body lice were found on that Person, confirming that the patient had been heavily infested with body lice in the past, not head lice. The nits were most likely laid by body lice that migrated toward the patient’s head. When a member of this research team (DR) collected the eggs from the hair shaft, they were found ≈3–3.5 cm from the hair follicle. Because hair grows ≈1.25 cm per month, the louse infestation occurred ≈3 months before egg collection (6). Homeless Persons that we have monitored for many years are often heavily infested by body lice but are also occasionally infested with head lice. Before genetic tools that differentiate the head and body louse lineages were available (5), it was speculated that body lice may have originated from head lice (9). From our study, it is clear that under conditions of massive infestation, body lice can migrate and colonize hair; the opposite may also be true. However, there is no evidence that body lice are capable of causing an outbreak of lice living on the head, as happens among schoolchildren that have been found to be infested only by head lice. This suggests that body lice cannot thrive in the environment of head lice, which infest millions of children worldwide (10), further suggesting that outbreaks of trench fever are most likely not linked to head lice in industrialized countries. In conclusion, by analyzing lice harvested from the heads and clothing of Homeless Persons, we have shown that the 2 ecotypes belong to the same body lice population. Technical Appendix: Detailed distribution of B. quintana DNA among lice from mono-infested and dually infested Homeless Persons, France Click here to view.(33K, pdf)
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Brill-Zinsser disease in Moroccan man, France, 2011.
Emerging Infectious Diseases, 2012Co-Authors: Jean-françois Faucher, Catherine Chirouze, L. Hustache-mathieu, Cristina Socolovschi, Didier Raoult, Camille Aubry, Bruno HoenAbstract:To the Editor: Epidemic typhus is caused by Rickettsia prowazekii and transmitted by human body lice. For centuries, it has been associated with overcrowding, cold weather, and poor hygiene. Brill-Zinsser disease is a recurrent form of epidemic typhus that is unrelated to louse infestation and develops sporadically years after the primary illness. Clinical features are similar to, but milder than, those of epidemic typhus (1). We report a case of Brill-Zinsser disease in a patient who was born in Morocco and had no history of epidemic typhus. A 69-year-old man living in France sought care from his general practitioner on March 7, 2011, after 2 days of high-grade fever (40°C) associated with headache, myalgia, fatigue, and mild cough. Amoxicillin was prescribed for a putative diagnosis of acute respiratory infection. He was admitted to hospital on March 9 for persistent fever. Physical examination results were unremarkable. Blood test results were as follows: C-reactive protein 111 mg/L (reference 0–8 mg/L); procalcitonin 0.49 ng/mL (reference 0.1–0.4 ng/mL), lymphocyte count 0.7 × 103 cells/μL (reference 1–4 × 103 cells/μL), platelet count 92 × 103 cells/μL (reference 150–450 × 103 cells/μL), and lactate dehydrogenase 376 U/L (reference 94–246 U/L). Chest radiograph results were normal. Results of 5 blood cultures and a urine culture were negative. Stupor developed on March 11. Cerebrospinal fluid test results were normal. Because the patient lived near a goat farm, Q fever and tularemia were considered plausible hypotheses, and oral doxycycline was introduced on March 13. The patient became afebrile on March 15, and he was discharged from the hospital and remained well. On the basis of serologic results, the following diagnoses could be ruled out: viral infections (HIV, cytomegalovirus, Epstein-Barr virus); tularemia; Q fever; leptospirosis; salmonellosis; and Legionella, Mycoplasma, and Chlamydia spp. infections. Acute-phase and convalescent-phase serum samples were positive for typhus-group rickettsiae by the microimmunofluorescence assay at the World Health Organization Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases (Marseille, France). A microimmunofluorescence assay showed titers of 100 for IgM and 6,400 for IgG. Western blot analyses and cross-adsorption studies strongly suggested R. prowazekii as the cause of the man’s illness. Quantitative PCR result on DNA extracted from the acute-phase serum was negative (2). The patient had been raised in Morocco. At 19 years of age, he emigrated to France, where he lived in a urban area. He subsequently traveled every 3 years to Morocco for 1-month summer holidays, always in urban areas. He had most recently traveled to Morocco in 2008. He denied any history of hospitalization for a severe febrile illness and any exposure to louse bites. In the weeks before disease onset, he had not taken any new drug. He had no immunoglobulin deficiency. On the basis of serologic analysis with Western blot, we confirmed R. prowazekii infection in a patient with no recent travel and no contact with lice or flying squirrels. R. prowazekii infection may occur rarely in France; it was found in Marseille in 2002 in an asymptomatic Homeless Person (3). In contrast, the patient in our report was living in a hygienic environment, and an autochthonous infection is therefore highly unlikely. Epidemic typhus was endemic to North Africa until the 1970s (4). Subsequently, this region was thought to be free from epidemic typhus, but 2 cases have been reported since 1999 in Algeria, where 1 case of Brill-Zinsser disease was observed in a man who had had epidemic typhus in 1960 during the Algerian civil war (5–7). Few published data exist about the seroprevalence of R. prowazekii infections in North Africa (4). In Tunisia, no epidemic typhus was found in 2005 among 47 febrile patients (8). However, a seroepidemiologic survey performed in blood donors and hospitalized patients in the Aures, Algeria, found a prevalence of 2% (4). This finding suggests that R. prowazekii infection might have occurred in this population more often than suspected. No recent published data are available from Morocco. Since 1970, reports of only 8 cases of Brill-Zinsser disease have been published (9,10). In all cases, known risk factors were present (overcrowding, poor hygiene, or contact with flying squirrels). Brill and Zinsser described that stress or waning immunity could reactivate R. prowazekii infection (2). Corticosteroids can trigger recurrence of R. prowazekii in mice (2), but no such observations were made in humans. In the case presented here, we found no stress factor, no immunosuppression, and no medical history of epidemic typhus. Brill-Zinsser disease can develop >40 years after acute infection. The mechanism of R. prowazekii latency has not been established. A recently explored reservoir for silent forms of R. prowazekii infection is adipose tissue because it contains endothelial cells, which are the target cells for R. prowazekii infection, and because of its wide distribution throughout the body (2). Brill-Zinsser disease should be considered as a possible diagnosis for acute fever in any patient who has lived in an area where epidemic typhus is endemic.
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Autochthonous epidemic typhus associated with Bartonella quintana bacteremia in a Homeless Person.
The American journal of tropical medicine and hygiene, 2005Co-Authors: Sékéné Badiaga, Philippe Brouqui, Didier RaoultAbstract:Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in Homeless Persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a Homeless Person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the Homeless population, this disease is likely to reemerge in such situation.
Aurelie Veracx - One of the best experts on this subject based on the ideXlab platform.
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Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
Emerging infectious diseases, 2014Co-Authors: Rezak Drali, Aurelie Veracx, Cristina Socolovschi, Philippe Brouqui, Abdoul Karim Sangaré, Amina Boutellis, Emmanouil Angelakis, Didier RaoultAbstract:To the Editor: Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and Homeless Persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3). The head louse, Pediculus humanus capitis, and the body louse, Pediculus humanus humanus, are obligatory ectoparasites that feed exclusively on human blood (4). Outside of their habitats, the 2 ecotypes are morphologically indistinguishable (1). Sequence variation in the PHUM540560 gene discriminates between head and body lice by determining the genotype of the lice (5). While surveying for trench fever among Homeless Persons in shelters in Marseille, France during October 2012–March 2013, we investigated the presence of B. quintana DNA in nits, larvae, and adult lice collected from mono-infested and dually infested Persons and determined the genotypes of the specimens. The Persons included in this study received long-lasting insecticide-treated underwear; lice were collected by removing them from clothing, including underwear, pants, and shirts. Because body lice reside in the clothing of infested Persons except when feeding, they are sometimes called clothing lice. A total of 989 specimens were tested, including 149 (83 from clothing and 66 from hair) first–instar larvae hatched in the laboratory from eggs collected from 7 dually infested Persons, and 840 adult body lice collected from the clothing of 80 mono-infested patients. We included DNA isolated from 3 nits collected from the hair of a mono-infested Person who had previously been confirmed as positive for B. quintana (6) (Table). Table Distribution of Bartonella quintana DNA in nits, larvae, and adult body lice collected from hair and clothing of Homeless Persons in shelters, Marseille, France, October 2012– March 2013* Total DNA was extracted by using an EZ1 automated extractor (QIAGEN, Courtaboeuf, France) and subjected twice to real-time PCR specific for B. quintana. The first PCR targeted the 16S-23S intergenic spacer region. Positive samples were confirmed by using a second real-time PCR targeting the yopP gene (6). Samples that tested positive for B. quintana DNA were analyzed by multiplex real-time PCR that targeted the PHUM540560 gene (5). We used head and body lice that had known genotypes positive controls. Negative controls were included in each assay. Of the hatched larvae, 5 (6%) of the 83 recovered from clothing and 7 (11%) of 66 from the hair (Table) of 4 of the 7 dually infested Persons were positive for B. quintana DNA (Technical Appendix). Of the 840 adult body lice, 174 (21%) collected from 42 (53%) of 80 of the mono-infested Persons contained B. quintana DNA (Table, Technical Appendix). The multiplex real-time PCR that targeted the PHUM540560 gene clearly identified all nits, larvae, and adult lice as belonging to the body lice lineage. Negative controls remained negative in all PCR-based experiments. For 2 decades, B. quintana DNA has been regularly detected in lice collected from the heads of Persons living in poverty, but it had not been detected in head lice that infest schoolchildren (7,8). All of the lice collected during this study that tested positive for B. quintana from Homeless Persons were body lice, including some that were recovered from hair. This observation supports our assertion that body lice are not confined to the body. The 3 eggs that were removed from the hair of a mono-infested Homeless Person whose samples tested positive for B. quintana were also body lice. During the clinical examination, no adult head lice or adult body lice were found on that Person, confirming that the patient had been heavily infested with body lice in the past, not head lice. The nits were most likely laid by body lice that migrated toward the patient’s head. When a member of this research team (DR) collected the eggs from the hair shaft, they were found ≈3–3.5 cm from the hair follicle. Because hair grows ≈1.25 cm per month, the louse infestation occurred ≈3 months before egg collection (6). Homeless Persons that we have monitored for many years are often heavily infested by body lice but are also occasionally infested with head lice. Before genetic tools that differentiate the head and body louse lineages were available (5), it was speculated that body lice may have originated from head lice (9). From our study, it is clear that under conditions of massive infestation, body lice can migrate and colonize hair; the opposite may also be true. However, there is no evidence that body lice are capable of causing an outbreak of lice living on the head, as happens among schoolchildren that have been found to be infested only by head lice. This suggests that body lice cannot thrive in the environment of head lice, which infest millions of children worldwide (10), further suggesting that outbreaks of trench fever are most likely not linked to head lice in industrialized countries. In conclusion, by analyzing lice harvested from the heads and clothing of Homeless Persons, we have shown that the 2 ecotypes belong to the same body lice population. Technical Appendix: Detailed distribution of B. quintana DNA among lice from mono-infested and dually infested Homeless Persons, France Click here to view.(33K, pdf)
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Evidence That Head and Body Lice on Homeless Persons Have the Same Genotype
PLoS ONE, 2012Co-Authors: Aurelie Veracx, Karen MccoyAbstract:Human head lice and body lice are morphologically and biologically similar but have distinct ecologies. They were shown to have almost the same basic genetic content (one gene is absent in head lice), but differentially express certain genes, presumably responsible for the vector competence. They are now believed to be ecotypes of the same species (Pediculus humanus) and based on mitochondrial studies, body lice have been included with head lice in one of three clades of human head lice (Clade A). Here, we tested whether head and body lice collected from the same host belong to the same population by examining highly polymorphic intergenic spacers. This study was performed on lice collected from five Homeless Persons living in the same shelter in which Clade A lice are prevalent. Lice were individually genotyped at four spacer loci. The genetic identity and diversity of lice from head and body populations were compared for each Homeless Person. Population genetic structure was tested between lice from the two body regions and between the lice from different host individuals. We found two pairs of head and body lice on the same Homeless Person with identical multi locus genotypes. No difference in genetic diversity was found between head and body louse populations and no evidence of significant structure between the louse populations was found, even after controlling for a possible effect of the host individual. More surprisingly, no structure was obvious between lice of different Homeless Persons. We believe that the head and body lice collected from our five subjects belong to the same population and are shared between people living in the same shelter. These findings confirm that head and body lice are two ecotypes of the same species and show the importance of implementing measures to prevent lice transmission between Homeless people in shelters.
Karen Mccoy - One of the best experts on this subject based on the ideXlab platform.
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Evidence That Head and Body Lice on Homeless Persons Have the Same Genotype
PLoS ONE, 2012Co-Authors: Aurelie Veracx, Karen MccoyAbstract:Human head lice and body lice are morphologically and biologically similar but have distinct ecologies. They were shown to have almost the same basic genetic content (one gene is absent in head lice), but differentially express certain genes, presumably responsible for the vector competence. They are now believed to be ecotypes of the same species (Pediculus humanus) and based on mitochondrial studies, body lice have been included with head lice in one of three clades of human head lice (Clade A). Here, we tested whether head and body lice collected from the same host belong to the same population by examining highly polymorphic intergenic spacers. This study was performed on lice collected from five Homeless Persons living in the same shelter in which Clade A lice are prevalent. Lice were individually genotyped at four spacer loci. The genetic identity and diversity of lice from head and body populations were compared for each Homeless Person. Population genetic structure was tested between lice from the two body regions and between the lice from different host individuals. We found two pairs of head and body lice on the same Homeless Person with identical multi locus genotypes. No difference in genetic diversity was found between head and body louse populations and no evidence of significant structure between the louse populations was found, even after controlling for a possible effect of the host individual. More surprisingly, no structure was obvious between lice of different Homeless Persons. We believe that the head and body lice collected from our five subjects belong to the same population and are shared between people living in the same shelter. These findings confirm that head and body lice are two ecotypes of the same species and show the importance of implementing measures to prevent lice transmission between Homeless people in shelters.
Cristina Socolovschi - One of the best experts on this subject based on the ideXlab platform.
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Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
Emerging infectious diseases, 2014Co-Authors: Rezak Drali, Aurelie Veracx, Cristina Socolovschi, Philippe Brouqui, Abdoul Karim Sangaré, Amina Boutellis, Emmanouil Angelakis, Didier RaoultAbstract:To the Editor: Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and Homeless Persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3). The head louse, Pediculus humanus capitis, and the body louse, Pediculus humanus humanus, are obligatory ectoparasites that feed exclusively on human blood (4). Outside of their habitats, the 2 ecotypes are morphologically indistinguishable (1). Sequence variation in the PHUM540560 gene discriminates between head and body lice by determining the genotype of the lice (5). While surveying for trench fever among Homeless Persons in shelters in Marseille, France during October 2012–March 2013, we investigated the presence of B. quintana DNA in nits, larvae, and adult lice collected from mono-infested and dually infested Persons and determined the genotypes of the specimens. The Persons included in this study received long-lasting insecticide-treated underwear; lice were collected by removing them from clothing, including underwear, pants, and shirts. Because body lice reside in the clothing of infested Persons except when feeding, they are sometimes called clothing lice. A total of 989 specimens were tested, including 149 (83 from clothing and 66 from hair) first–instar larvae hatched in the laboratory from eggs collected from 7 dually infested Persons, and 840 adult body lice collected from the clothing of 80 mono-infested patients. We included DNA isolated from 3 nits collected from the hair of a mono-infested Person who had previously been confirmed as positive for B. quintana (6) (Table). Table Distribution of Bartonella quintana DNA in nits, larvae, and adult body lice collected from hair and clothing of Homeless Persons in shelters, Marseille, France, October 2012– March 2013* Total DNA was extracted by using an EZ1 automated extractor (QIAGEN, Courtaboeuf, France) and subjected twice to real-time PCR specific for B. quintana. The first PCR targeted the 16S-23S intergenic spacer region. Positive samples were confirmed by using a second real-time PCR targeting the yopP gene (6). Samples that tested positive for B. quintana DNA were analyzed by multiplex real-time PCR that targeted the PHUM540560 gene (5). We used head and body lice that had known genotypes positive controls. Negative controls were included in each assay. Of the hatched larvae, 5 (6%) of the 83 recovered from clothing and 7 (11%) of 66 from the hair (Table) of 4 of the 7 dually infested Persons were positive for B. quintana DNA (Technical Appendix). Of the 840 adult body lice, 174 (21%) collected from 42 (53%) of 80 of the mono-infested Persons contained B. quintana DNA (Table, Technical Appendix). The multiplex real-time PCR that targeted the PHUM540560 gene clearly identified all nits, larvae, and adult lice as belonging to the body lice lineage. Negative controls remained negative in all PCR-based experiments. For 2 decades, B. quintana DNA has been regularly detected in lice collected from the heads of Persons living in poverty, but it had not been detected in head lice that infest schoolchildren (7,8). All of the lice collected during this study that tested positive for B. quintana from Homeless Persons were body lice, including some that were recovered from hair. This observation supports our assertion that body lice are not confined to the body. The 3 eggs that were removed from the hair of a mono-infested Homeless Person whose samples tested positive for B. quintana were also body lice. During the clinical examination, no adult head lice or adult body lice were found on that Person, confirming that the patient had been heavily infested with body lice in the past, not head lice. The nits were most likely laid by body lice that migrated toward the patient’s head. When a member of this research team (DR) collected the eggs from the hair shaft, they were found ≈3–3.5 cm from the hair follicle. Because hair grows ≈1.25 cm per month, the louse infestation occurred ≈3 months before egg collection (6). Homeless Persons that we have monitored for many years are often heavily infested by body lice but are also occasionally infested with head lice. Before genetic tools that differentiate the head and body louse lineages were available (5), it was speculated that body lice may have originated from head lice (9). From our study, it is clear that under conditions of massive infestation, body lice can migrate and colonize hair; the opposite may also be true. However, there is no evidence that body lice are capable of causing an outbreak of lice living on the head, as happens among schoolchildren that have been found to be infested only by head lice. This suggests that body lice cannot thrive in the environment of head lice, which infest millions of children worldwide (10), further suggesting that outbreaks of trench fever are most likely not linked to head lice in industrialized countries. In conclusion, by analyzing lice harvested from the heads and clothing of Homeless Persons, we have shown that the 2 ecotypes belong to the same body lice population. Technical Appendix: Detailed distribution of B. quintana DNA among lice from mono-infested and dually infested Homeless Persons, France Click here to view.(33K, pdf)
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Brill-Zinsser disease in Moroccan man, France, 2011.
Emerging Infectious Diseases, 2012Co-Authors: Jean-françois Faucher, Catherine Chirouze, L. Hustache-mathieu, Cristina Socolovschi, Didier Raoult, Camille Aubry, Bruno HoenAbstract:To the Editor: Epidemic typhus is caused by Rickettsia prowazekii and transmitted by human body lice. For centuries, it has been associated with overcrowding, cold weather, and poor hygiene. Brill-Zinsser disease is a recurrent form of epidemic typhus that is unrelated to louse infestation and develops sporadically years after the primary illness. Clinical features are similar to, but milder than, those of epidemic typhus (1). We report a case of Brill-Zinsser disease in a patient who was born in Morocco and had no history of epidemic typhus. A 69-year-old man living in France sought care from his general practitioner on March 7, 2011, after 2 days of high-grade fever (40°C) associated with headache, myalgia, fatigue, and mild cough. Amoxicillin was prescribed for a putative diagnosis of acute respiratory infection. He was admitted to hospital on March 9 for persistent fever. Physical examination results were unremarkable. Blood test results were as follows: C-reactive protein 111 mg/L (reference 0–8 mg/L); procalcitonin 0.49 ng/mL (reference 0.1–0.4 ng/mL), lymphocyte count 0.7 × 103 cells/μL (reference 1–4 × 103 cells/μL), platelet count 92 × 103 cells/μL (reference 150–450 × 103 cells/μL), and lactate dehydrogenase 376 U/L (reference 94–246 U/L). Chest radiograph results were normal. Results of 5 blood cultures and a urine culture were negative. Stupor developed on March 11. Cerebrospinal fluid test results were normal. Because the patient lived near a goat farm, Q fever and tularemia were considered plausible hypotheses, and oral doxycycline was introduced on March 13. The patient became afebrile on March 15, and he was discharged from the hospital and remained well. On the basis of serologic results, the following diagnoses could be ruled out: viral infections (HIV, cytomegalovirus, Epstein-Barr virus); tularemia; Q fever; leptospirosis; salmonellosis; and Legionella, Mycoplasma, and Chlamydia spp. infections. Acute-phase and convalescent-phase serum samples were positive for typhus-group rickettsiae by the microimmunofluorescence assay at the World Health Organization Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases (Marseille, France). A microimmunofluorescence assay showed titers of 100 for IgM and 6,400 for IgG. Western blot analyses and cross-adsorption studies strongly suggested R. prowazekii as the cause of the man’s illness. Quantitative PCR result on DNA extracted from the acute-phase serum was negative (2). The patient had been raised in Morocco. At 19 years of age, he emigrated to France, where he lived in a urban area. He subsequently traveled every 3 years to Morocco for 1-month summer holidays, always in urban areas. He had most recently traveled to Morocco in 2008. He denied any history of hospitalization for a severe febrile illness and any exposure to louse bites. In the weeks before disease onset, he had not taken any new drug. He had no immunoglobulin deficiency. On the basis of serologic analysis with Western blot, we confirmed R. prowazekii infection in a patient with no recent travel and no contact with lice or flying squirrels. R. prowazekii infection may occur rarely in France; it was found in Marseille in 2002 in an asymptomatic Homeless Person (3). In contrast, the patient in our report was living in a hygienic environment, and an autochthonous infection is therefore highly unlikely. Epidemic typhus was endemic to North Africa until the 1970s (4). Subsequently, this region was thought to be free from epidemic typhus, but 2 cases have been reported since 1999 in Algeria, where 1 case of Brill-Zinsser disease was observed in a man who had had epidemic typhus in 1960 during the Algerian civil war (5–7). Few published data exist about the seroprevalence of R. prowazekii infections in North Africa (4). In Tunisia, no epidemic typhus was found in 2005 among 47 febrile patients (8). However, a seroepidemiologic survey performed in blood donors and hospitalized patients in the Aures, Algeria, found a prevalence of 2% (4). This finding suggests that R. prowazekii infection might have occurred in this population more often than suspected. No recent published data are available from Morocco. Since 1970, reports of only 8 cases of Brill-Zinsser disease have been published (9,10). In all cases, known risk factors were present (overcrowding, poor hygiene, or contact with flying squirrels). Brill and Zinsser described that stress or waning immunity could reactivate R. prowazekii infection (2). Corticosteroids can trigger recurrence of R. prowazekii in mice (2), but no such observations were made in humans. In the case presented here, we found no stress factor, no immunosuppression, and no medical history of epidemic typhus. Brill-Zinsser disease can develop >40 years after acute infection. The mechanism of R. prowazekii latency has not been established. A recently explored reservoir for silent forms of R. prowazekii infection is adipose tissue because it contains endothelial cells, which are the target cells for R. prowazekii infection, and because of its wide distribution throughout the body (2). Brill-Zinsser disease should be considered as a possible diagnosis for acute fever in any patient who has lived in an area where epidemic typhus is endemic.
Philippe Brouqui - One of the best experts on this subject based on the ideXlab platform.
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Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
Emerging infectious diseases, 2014Co-Authors: Rezak Drali, Aurelie Veracx, Cristina Socolovschi, Philippe Brouqui, Abdoul Karim Sangaré, Amina Boutellis, Emmanouil Angelakis, Didier RaoultAbstract:To the Editor: Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and Homeless Persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3). The head louse, Pediculus humanus capitis, and the body louse, Pediculus humanus humanus, are obligatory ectoparasites that feed exclusively on human blood (4). Outside of their habitats, the 2 ecotypes are morphologically indistinguishable (1). Sequence variation in the PHUM540560 gene discriminates between head and body lice by determining the genotype of the lice (5). While surveying for trench fever among Homeless Persons in shelters in Marseille, France during October 2012–March 2013, we investigated the presence of B. quintana DNA in nits, larvae, and adult lice collected from mono-infested and dually infested Persons and determined the genotypes of the specimens. The Persons included in this study received long-lasting insecticide-treated underwear; lice were collected by removing them from clothing, including underwear, pants, and shirts. Because body lice reside in the clothing of infested Persons except when feeding, they are sometimes called clothing lice. A total of 989 specimens were tested, including 149 (83 from clothing and 66 from hair) first–instar larvae hatched in the laboratory from eggs collected from 7 dually infested Persons, and 840 adult body lice collected from the clothing of 80 mono-infested patients. We included DNA isolated from 3 nits collected from the hair of a mono-infested Person who had previously been confirmed as positive for B. quintana (6) (Table). Table Distribution of Bartonella quintana DNA in nits, larvae, and adult body lice collected from hair and clothing of Homeless Persons in shelters, Marseille, France, October 2012– March 2013* Total DNA was extracted by using an EZ1 automated extractor (QIAGEN, Courtaboeuf, France) and subjected twice to real-time PCR specific for B. quintana. The first PCR targeted the 16S-23S intergenic spacer region. Positive samples were confirmed by using a second real-time PCR targeting the yopP gene (6). Samples that tested positive for B. quintana DNA were analyzed by multiplex real-time PCR that targeted the PHUM540560 gene (5). We used head and body lice that had known genotypes positive controls. Negative controls were included in each assay. Of the hatched larvae, 5 (6%) of the 83 recovered from clothing and 7 (11%) of 66 from the hair (Table) of 4 of the 7 dually infested Persons were positive for B. quintana DNA (Technical Appendix). Of the 840 adult body lice, 174 (21%) collected from 42 (53%) of 80 of the mono-infested Persons contained B. quintana DNA (Table, Technical Appendix). The multiplex real-time PCR that targeted the PHUM540560 gene clearly identified all nits, larvae, and adult lice as belonging to the body lice lineage. Negative controls remained negative in all PCR-based experiments. For 2 decades, B. quintana DNA has been regularly detected in lice collected from the heads of Persons living in poverty, but it had not been detected in head lice that infest schoolchildren (7,8). All of the lice collected during this study that tested positive for B. quintana from Homeless Persons were body lice, including some that were recovered from hair. This observation supports our assertion that body lice are not confined to the body. The 3 eggs that were removed from the hair of a mono-infested Homeless Person whose samples tested positive for B. quintana were also body lice. During the clinical examination, no adult head lice or adult body lice were found on that Person, confirming that the patient had been heavily infested with body lice in the past, not head lice. The nits were most likely laid by body lice that migrated toward the patient’s head. When a member of this research team (DR) collected the eggs from the hair shaft, they were found ≈3–3.5 cm from the hair follicle. Because hair grows ≈1.25 cm per month, the louse infestation occurred ≈3 months before egg collection (6). Homeless Persons that we have monitored for many years are often heavily infested by body lice but are also occasionally infested with head lice. Before genetic tools that differentiate the head and body louse lineages were available (5), it was speculated that body lice may have originated from head lice (9). From our study, it is clear that under conditions of massive infestation, body lice can migrate and colonize hair; the opposite may also be true. However, there is no evidence that body lice are capable of causing an outbreak of lice living on the head, as happens among schoolchildren that have been found to be infested only by head lice. This suggests that body lice cannot thrive in the environment of head lice, which infest millions of children worldwide (10), further suggesting that outbreaks of trench fever are most likely not linked to head lice in industrialized countries. In conclusion, by analyzing lice harvested from the heads and clothing of Homeless Persons, we have shown that the 2 ecotypes belong to the same body lice population. Technical Appendix: Detailed distribution of B. quintana DNA among lice from mono-infested and dually infested Homeless Persons, France Click here to view.(33K, pdf)
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Autochthonous epidemic typhus associated with Bartonella quintana bacteremia in a Homeless Person.
The American journal of tropical medicine and hygiene, 2005Co-Authors: Sékéné Badiaga, Philippe Brouqui, Didier RaoultAbstract:Trench fever, a louse-borne disease caused by Bartonella quintana, is reemerging in Homeless Persons. Epidemic typhus is another life-threatening louse-borne disease caused by Rickettsia prowazekii and known to occur in conditions of war, famine, refugee camps, cold weather, poverty, or lapses in public health. We report the first case of seroconversion to R. prowazekii in a Homeless Person of Marseilles, France. This was associated with B. quintana bacteremia. Although no outbreaks of typhus have been notified yet in the Homeless population, this disease is likely to reemerge in such situation.