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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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SHORT REPORT: MOLECULAR IDENTIFICATION OF A COLLECTION OF SPOTTED FEVER GROUP RickettsiaE OBTAINED FROM PATIENTS AND TICKS FROM RUSSIA
2016Co-Authors: S N Shpynov, Pierre-edouard Fournier, Irina E Samoilenko, Nikolay V. Rudakov, Tatjana A. Reshetnikova, Vladimer K. Yastrebov, Matvey S. Schaiman, Irina V. Tarasevich, Didier RaoultAbstract:Abstract. Thirty-one Rickettsial isolates from ticks or patients in North Asian tick typhus (NATT) foci from the Ural region to the Russian Far East were obtained at the Omsk Research Institute of Natural Foci Infections between 1954 and 2001. Using citrate synthase (gltA) and outermenbrane protein a (ompA) gene sequencing, we identified these isolates as Rickettsia Sibirica sensu stricto (25 isolates), R. Sibirica strain BJ-90 (2 isolates), R. slovaca (1 isolate), and R. heilongjiangensis (3 isolates). We demonstrate that Ixodes persulcatus ticks should be considered potential vectors of NATT. We also demonstrate the presence of R. slovaca in Ural and R. heilongjiangensis in Siberia and Russian Far East, where they may cause human infections misdiagnosed as cases of NATT. Clinicians should be aware that several spotted fever rickettsioses with different prognoses coexist in Russia in areas where NATT was the only previously recognized rickettsiosis. Prior to 1991, North Asian tick typhus (NATT), which is caused by Rickettsia Sibirica sensu stricto, was the only spotted fever group (SFG) rickettsiosis recognized in Russia. North Asian tick typhus is a potentially lethal disease characterized by high fever, an inoculation eschar at the site of the tick bite, regional lymphadenopathy, general weakness, severe head
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Genome Sequence of “Rickettsia Sibirica subsp. mongolitimonae”
2016Co-Authors: Erwin Sentausa, Didier Raoult, Khalid El Karkouri, Catherine Robert, Pierre-edouard FournierAbstract:“Rickettsia Sibirica subsp.mongolitimonae ” is the agent of lymphangitis-associated rickettsiosis, an emerging human disease that has been diagnosed in Europe and Africa. The present study reports the draft genome of Rickettsia Sibirica subsp.mongoliti-monae strain HA-91. “Rickettsia Sibirica subsp. mongolitimonae ” is a spotted fevergroup (SFG) Rickettsia first isolated from Hyalomma asiati
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Rickettsia Sibirica mongolitimonae Infection, France, 2010–2014
'Centers for Disease Control and Prevention (CDC)', 2016Co-Authors: Emmanouil Angelakis, Herve Richet, Didier RaoultAbstract:To further characterize human infections caused by Rickettsia Sibirica mongolitimonae, we tested skin biopsy and swab samples and analyzed clinical, epidemiologic, and diagnostic characteristics of patients with a rickettsiosis. The most common (38%) indigenous species was R. Sibirica mongolitimonae. Significantly more cases of R. Sibirica mongolitimonae infection occurred during spring and summer
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detection of Rickettsia Sibirica mongolitimonae by using cutaneous swab samples and quantitative pcr
Emerging Infectious Diseases, 2014Co-Authors: Julie Solary, Philippe Brouqui, Cristina Socolovschi, Didier Raoult, Camille Aubry, Philippe ParolaAbstract:To the Editor: Tick-borne rickettsioses are caused by the obligate intracellular bacteria spotted fever group (SFG) Rickettsia spp. These zoonoses are now recognized as emerging or reemerging human infections worldwide, with ≈15 new tick-borne Rickettsial species or subspecies recognized as human pathogens during the 30 past years (1). New approaches have emerged in recent years to definitively identify the causative agents, including emerging pathogens. Using cutaneous swab specimens from patients for quantitative PCR (qPCR) testing rather than cutaneous biopsy specimens is a major innovation in the diagnosis of SFG rickettsioses (2–4). Using this approach, we report 1 of the few documented infections caused by Rickettsia Sibirica mongolitimonae. A 16-year-old boy with no medical history was admitted to the Department of Infectious diseases at University Hospital in Marseille on May 25, 2012, with a fever (40°C) and skin lesions on his lower right eyelid. He had been fishing 7 days earlier at a pond situated in southern France near Marseille (43°26′N, 5°6′E). He had been given amoxicillin/clavulanic acid by his family doctor and showed no improvement after 2 days. The only sign on physical examination was the presence of 2 eschars on his lower right eyelid, associated with right periorbital edema (Figure) and painful right-sided cervical lymphadenopathies. Results of standard laboratory tests were normal except for the C-reactive protein level (21 mg/L; reference value <10 mg/L). He reported that the black spots on his lower eyelid were most likely related to bites from ticks that he got while fishing. He removed the ticks the next day. Because a tick-borne rickettsiosis was suspected, oral empirical treatment with doxycycline (200 mg/daily) was started. The patient improved in 48 hours and remained well (Figure). Figure Palpebral eschars caused by Rickettsia Sibirica mongolitimonae infection in a 16-year-old febrile boy with fever, southern France, spring, 2012 (left). He recovered after doxycycline treatment (right). The first serologic test result for Rickettsia spp. was negative. Because of the location of the eschars, it was not possible to obtain biopsy specimens from them. Nevertheless, real-time qPCR that was performed on 2 eschar swab specimens showed positive results for Rickettsia spp in 24 hours. The specific qPCR test results were positive for Rickettsia Sibirica mongolitimonae in both samples (1). Amplification and sequencing of a fragment of ompA gene on these samples showed 100% (533/533) identity with R. Sibirica mongolitimonae HA-91 ({"type":"entrez-nucleotide","attrs":{"text":"RHU43796","term_id":"1174120"}}RHU43796). Four days later, after doxycycline treatment, 1 additional swab specimen was positive by specific qPCR for R. Sibirica mongolitimonae. The convalescent-phase serum specimen (obtained 14 days after admission) was positive by indirect immunofluorescence assay for Rickettsial antigens against SFG, suggesting seroconversion. R. Sibirica mongolitimonae is an intracellular bacterium that was recognized as a human pathogen in 1996 (1). The inoculation eschar at the tick bite site is a hallmark of many tick-borne SPG rickettsioses. However, because lymphangitis was also observed in a few of the patients reported subsequently, R. Sibirica mongolitimonae infection was named lymphangitis-associated rickettsiosis (5). To date, 24 cases have been reported in Europe (France, Spain, Portugal, Greece) and 3 in Africa (Egypt, Algeria, South Africa) (6,7). Vectors include ticks in the genus Hyalomma and also Rhipicephalus pusillus, a species of tick found on the European wild rabbit (also can be found on wild carnivorous animals, dogs, and domestic cats), which may bite humans (7). The life-threatening Mediterranean spotted fever caused by R. conorii peaks in the warmer months of July and August because of a heat-mediated increase in the aggressiveness and, therefore propensity to bite humans, of the brown dog tick vector, R. sanguineus (8). In contrast, R. Sibirica mongolitimonae infection is more frequently reported in the spring (7). The diagnosis of rickettsioses is most commonly based on serologic testing (1). However, serologic evidence of infection generally appears in the second and third weeks of illness, as in the case-patient described here. The use of molecular tools or cell culture on a skin biopsy specimen from an eschar is the best method of identifying Rickettsia spp. However, this invasive and painful procedure needs to be performed in sterile conditions with local anesthesia. Swabbing an eschar is easy and painless; the physician only needs a dry sterile swab that must be directed, while being rotated vigorously, to the base of the eschar, after the crust is removed (4). The sensitivity of this technique is comparable with that of Rickettsial detection on skin biopsy samples by molecular tools. If the eschar lesion is dry, a wet compress, previously humidified with sterile water, should be placed on the inoculation eschar for 1 minute before swabbing, to increase the quantity of material swabbed. In addition, the crust eschar also can be used for Rickettsial diagnosis. Because sufficient material can be obtained during swabbing, this test can be used by any practitioner at the patient’s bedside. As soon as the samples are sent to a laboratory with qPCR capability, results can be obtained quickly. In any case, when a physician is confronted with a patient with a fever and an eschar, doxycycline treatment should be initiated immediately because β-lactam antimicrobial drugs are inefficient for the treatment of rickettsioses (9).
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Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2014Co-Authors: Grégory Dubourg, Cristina Socolovschi, P. Del Giudice, P.-e. Fournier, Didier RaoultAbstract:The clinical and epidemiological features of 56 patients with scalp eschar associated with neck lymphadenopathy after a tick bite (SENLAT) syndrome were evaluated at the National French Rickettsial Center. Eschar swabs, crusts, and biopsies as well as ticks and blood samples were acquired for molecular and serological assays. SENLAT predominantly affects children (p < 0.05), followed by 40- to 70-year-olds, and it is found mostly in women (p < 0.05). The seasonal distribution has two peaks: one in the spring (55%) and one in the autumn (30%). The etiological agent was identified in 18 cases, which include Rickettsia slovaca in 13 cases with incidences of two co-infections with Rickettsia raoultii and one case caused by Rickettsia Sibirica mongolitimonae. Other possible agents that were found in attached ticks were Candidatus R. rioja, Coxiella burnetii, and Borrelia burgdorferi. The tick vector was Dermacentor marginatus in almost all cases, with the exception of one case, in which Ixodes ricinus was identified as the vector. Our findings show that SENLAT is a clinical entity characterized as a local infection controlled by the immune system and is neither pathogen- nor vector-specific.
Pierre-edouard Fournier - One of the best experts on this subject based on the ideXlab platform.
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SHORT REPORT: MOLECULAR IDENTIFICATION OF A COLLECTION OF SPOTTED FEVER GROUP RickettsiaE OBTAINED FROM PATIENTS AND TICKS FROM RUSSIA
2016Co-Authors: S N Shpynov, Pierre-edouard Fournier, Irina E Samoilenko, Nikolay V. Rudakov, Tatjana A. Reshetnikova, Vladimer K. Yastrebov, Matvey S. Schaiman, Irina V. Tarasevich, Didier RaoultAbstract:Abstract. Thirty-one Rickettsial isolates from ticks or patients in North Asian tick typhus (NATT) foci from the Ural region to the Russian Far East were obtained at the Omsk Research Institute of Natural Foci Infections between 1954 and 2001. Using citrate synthase (gltA) and outermenbrane protein a (ompA) gene sequencing, we identified these isolates as Rickettsia Sibirica sensu stricto (25 isolates), R. Sibirica strain BJ-90 (2 isolates), R. slovaca (1 isolate), and R. heilongjiangensis (3 isolates). We demonstrate that Ixodes persulcatus ticks should be considered potential vectors of NATT. We also demonstrate the presence of R. slovaca in Ural and R. heilongjiangensis in Siberia and Russian Far East, where they may cause human infections misdiagnosed as cases of NATT. Clinicians should be aware that several spotted fever rickettsioses with different prognoses coexist in Russia in areas where NATT was the only previously recognized rickettsiosis. Prior to 1991, North Asian tick typhus (NATT), which is caused by Rickettsia Sibirica sensu stricto, was the only spotted fever group (SFG) rickettsiosis recognized in Russia. North Asian tick typhus is a potentially lethal disease characterized by high fever, an inoculation eschar at the site of the tick bite, regional lymphadenopathy, general weakness, severe head
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Genome Sequence of “Rickettsia Sibirica subsp. mongolitimonae”
2016Co-Authors: Erwin Sentausa, Didier Raoult, Khalid El Karkouri, Catherine Robert, Pierre-edouard FournierAbstract:“Rickettsia Sibirica subsp.mongolitimonae ” is the agent of lymphangitis-associated rickettsiosis, an emerging human disease that has been diagnosed in Europe and Africa. The present study reports the draft genome of Rickettsia Sibirica subsp.mongoliti-monae strain HA-91. “Rickettsia Sibirica subsp. mongolitimonae ” is a spotted fevergroup (SFG) Rickettsia first isolated from Hyalomma asiati
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genome sequence of Rickettsia Sibirica subsp mongolitimonae
Journal of Bacteriology, 2012Co-Authors: Erwin Sentausa, Didier Raoult, Khalid El Karkouri, Catherine Robert, Pierre-edouard FournierAbstract:"Rickettsia Sibirica subsp. mongolitimonae" is the agent of lymphangitis-associated rickettsiosis, an emerging human disease that has been diagnosed in Europe and Africa. The present study reports the draft genome of Rickettsia Sibirica subsp. mongolitimonae strain HA-91.
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sequence and annotation of Rickettsia Sibirica Sibirica genome
Journal of Bacteriology, 2012Co-Authors: Erwin Sentausa, Didier Raoult, Khalid El Karkouri, Catherine Robert, Pierre-edouard FournierAbstract:Rickettsia Sibirica Sibirica is the causative agent of Siberian or North Asian tick typhus, a tick-borne rickettsiosis known to exist in Siberia and eastern China. Here we present the draft genome of Rickettsia Sibirica Sibirica strain BJ-90 isolated from Dermacentor sinicus ticks collected in Beijing, China.
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spotted fever rickettsioses in southern and eastern europe
Fems Immunology and Medical Microbiology, 2007Co-Authors: Philippe Brouqui, Philippe Parola, Pierre-edouard FournierAbstract:Mediterranean spotted fever due to Rickettsia conorii conorii was thought, for many years, to be the only tick-borne Rickettsial disease prevalent in southern and eastern Europe. However, in recent years, six more species or subspecies within the spotted fever group of the genus Rickettsia have been described as emerging pathogens in this part of the world. Tick-borne agents include Rickettsia conorii israelensis, Rickettsia conorii caspia, Rickettsia aeschlimannii, Rickettsia slovaca, Rickettsia Sibirica mongolitimonae and Rickettsia massiliae. Many Rickettsia of unknown pathogenicity have also been detected from ticks and could represent potential emerging pathogens to be discovered in the future. Furthermore, a new spotted fever Rickettsia, Rickettsia felis, was found to be associated with cat fleas and is an emerging human pathogen. Finally, the mite-transmitted Rickettsia akari, the agent of Rickettsialpox, is also known to be prevalent in Europe. We present here an overview of these rickettsioses, focusing on emerging diseases.
José A. Oteo - One of the best experts on this subject based on the ideXlab platform.
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Acute Myopericarditis Associated with Tickborne Rickettsia Sibirica mongolitimonae.
Emerging infectious diseases, 2017Co-Authors: Pablo Revilla-martí, Álvaro Cecilio-irazola, Jara Gayán-ordás, Isabel Sanjoaquín-conde, Jose Antonio Linares-vicente, José A. OteoAbstract:We report an unusual case of myopericarditis caused by Rickettsia Sibirica mongolitimonae. Because of increasing reports of Rickettsia spp. as etiologic agents of acute myopericarditis and the ease and success with which it was treated in the patient reported here, Rickettsial infection should be included in the differential diagnosis for myopericarditis.
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septic shock in a patient infected with Rickettsia Sibirica mongolitimonae spain
Clinical Microbiology and Infection, 2012Co-Authors: Valvanera Ibarra, Aranzazu Portillo, Ana M Palomar, Mercedes Sanz, Luis Metola, Jose Ramon Blanco, José A. OteoAbstract:In 1996, the first human case of infection by Rickettsia Sibirica subsp. mongolitimonae was described in France. Subsequently, other human cases were reported in the same country. The acronym LAR (lymphangitis-associated rickettsiosis) has been proposed to designate this disease because lymphangitis is one of the main clinical manifestations. Later, a few more cases were described in Portugal, South Africa, Egypt, Greece and Spain. We report a case of R. Sibirica mongolitimonae infection as a cause of septic shock in a Spanish patient living in La Rioja (northern Spain). In addition, the broad clinical spectrum of this tick-borne disease is discussed.
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human Rickettsia Sibirica mongolitimonae infection spain
Emerging Infectious Diseases, 2008Co-Authors: Koldo Aguirrebengoa, Aranzazu Portillo, Sonia Santibanez, Juan J Marin, Miguel Montejo, José A. OteoAbstract:To the Editor: Rickettsia Sibirica mongolitimonae has been recently reported as a subspecies of R. Sibirica (1). The first evidence of R. Sibirica mongolitimonae pathogenicity in humans was documented in France in 1996 (2). Since then, 11 more cases in France, Algeria, South Africa, Greece, and Portugal have been reported (3–6). Because the main clinical manifestations include lymphangitis, the acronym LAR (lymphangitis-associated rickettsiosis) has been proposed (3). We report a case from Spain that confirms the broad distribution of this agent in southern Europe. A 41-year-old man was admitted on June 19, 2007, to the Hospital de Cruces (Baracaldo, Spain) with fever (39°C), malaise for a week, sweating, lumbar and knee pain, disseminated myalgias, and headache. He reported that 20 days before admission he had removed an engorged tick from his right leg while working as a topographer in the Balmaseda Mountains, 30 km from Bilbao. He had also removed several ticks from his body 4 days before the onset of symptoms. Physical examination did not demonstrate relevant findings. There was no inoculation eschar at the tick-bite sites. Rash, lymphadenopathies, and lymphangitis were not observed. Chest radiograph did not show consolidation or other abnormality. Initial laboratory examination, on June 21, 2007, showed a leukocyte count 5.2 × 103/μL, hemoglobin 14.1 g/dL, platelet count 190,000/μL, erythrocyte sedimentation speed 9 mm/h, urea 38 mg/dL, creatinine 0.9 mg/dL, aspartate aminotransferase 229 IU/L, alanine aminotransferase 170 IU/L, alkaline phosphatase 158 IU/L, gamma-glutamyl-transpeptidase 111 IU/L, total bilirubin 1.3 mg/dL, and C-reactive protein 4.3 mg/dL. Because the patient had been bitten by a tick, acute-phase serum and EDTA-treated blood samples were sent to the Special Pathogens Laboratory (Area de Enfermedades Infecciosas – Hospital San Pedro from La Rioja), where a presumptive diagnosis of rickettsiosis was made. On June 22, 2007, treatment with doxycycline was begun (100 mg/day for 12 days), and his condition rapidly improved. The early-phase serum yielded low immunoglobulin (Ig) G titer (<64) against Rickettsia conorii and Anaplasma phagocytophilum antigens, and results of ELISA and Western blotting for Lyme borreliosis were negative. A convalescent-phase serum sample collected 7 weeks later did not contain IgG antibodies against spotted fever group Rickettsia species when R. conorii antigen was used. DNA was extracted from the early whole-blood specimen by using QIAamp DNA Blood minikit (QIAGEN, Hilden, Germany) according to the manufacturer’s instructions. This DNA extract was used as template in nested PCR assays targeting the spotted fever group Rickettsial ompB (420 bp) and gltA (337 bp) genes (7). Quality control included both positive (with R. conorii Malish #7 grown in Vero cells) and negative controls that were extracted and PCR amplified in parallel with the specimens. Negative controls consisted of sterile water instead of template DNA. Amplification products of the expected size were obtained. The sequences of these amplicons allowed the identification of R. Sibirica mongolitimonae with 99.5% and 100% similarity for ompB and gltA, respectively (GenBank accession nos. {"type":"entrez-nucleotide","attrs":{"text":"DQ097083","term_id":"73620233"}}DQ097083 and {"type":"entrez-nucleotide","attrs":{"text":"DQ097081","term_id":"73620146"}}DQ097081). To our knowledge, Rickettsia species have never been detected in ticks or human specimens in Spain. The host ticks of this Rickettsia are likely Hyalomma species, which are more prevalent in southern Spain. In our region in northern Spain, Hyalomma marginatum represented 8% of ticks that fed on humans during 2001–2005, although an increase in this number was recorded last year (data not shown). In our patient, Rickettsia’s pathogenic role was demonstrated by PCR, a technique that has previously enabled us to identify other arthropod-borne Rickettsia species (8,9). This case suggests that R. Sibirica mongolitimonae infection should be considered in the differential diagnosis of rickettsiosis and tick-bite febrile patients in Spain and confirms the distribution of this Rickettsia in southern Europe. According to the literature (3), some patients in whom R. Sibirica mongolitimonae infection is diagnosed have >1 eschar, which raises the suspicion that some cases of Mediterranean spotted fever with multiple eschars reported in Spain could be caused by this Rickettsial species. More studies about the vectors of this bacteria are needed because studies of Hyalomma and Rhipicephalus ticks (the suspected hosts) conducted in our area have not demonstrated the presence of this Rickettsia species.
Philippe Parola - One of the best experts on this subject based on the ideXlab platform.
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Rickettsia mongolitimonae encephalitis southern france 2018
Emerging Infectious Diseases, 2020Co-Authors: Maria Dolores Corbacho Loarte, Clea Melenotte, Serge Cammilleri, Philippe Dorylautrec, Nadim Cassir, Philippe ParolaAbstract:We report a case of Rickettsia Sibirica mongolitimonae infection, an emerging tickborne rickettsiosis, with associated encephalitis in a 66-year-old man. Diagnosis was rapidly confirmed by quantitative PCR obtained from an eschar swab sample. The patient was successfully treated with oral doxycycline.
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detection of Rickettsia Sibirica mongolitimonae by using cutaneous swab samples and quantitative pcr
Emerging Infectious Diseases, 2014Co-Authors: Julie Solary, Philippe Brouqui, Cristina Socolovschi, Didier Raoult, Camille Aubry, Philippe ParolaAbstract:To the Editor: Tick-borne rickettsioses are caused by the obligate intracellular bacteria spotted fever group (SFG) Rickettsia spp. These zoonoses are now recognized as emerging or reemerging human infections worldwide, with ≈15 new tick-borne Rickettsial species or subspecies recognized as human pathogens during the 30 past years (1). New approaches have emerged in recent years to definitively identify the causative agents, including emerging pathogens. Using cutaneous swab specimens from patients for quantitative PCR (qPCR) testing rather than cutaneous biopsy specimens is a major innovation in the diagnosis of SFG rickettsioses (2–4). Using this approach, we report 1 of the few documented infections caused by Rickettsia Sibirica mongolitimonae. A 16-year-old boy with no medical history was admitted to the Department of Infectious diseases at University Hospital in Marseille on May 25, 2012, with a fever (40°C) and skin lesions on his lower right eyelid. He had been fishing 7 days earlier at a pond situated in southern France near Marseille (43°26′N, 5°6′E). He had been given amoxicillin/clavulanic acid by his family doctor and showed no improvement after 2 days. The only sign on physical examination was the presence of 2 eschars on his lower right eyelid, associated with right periorbital edema (Figure) and painful right-sided cervical lymphadenopathies. Results of standard laboratory tests were normal except for the C-reactive protein level (21 mg/L; reference value <10 mg/L). He reported that the black spots on his lower eyelid were most likely related to bites from ticks that he got while fishing. He removed the ticks the next day. Because a tick-borne rickettsiosis was suspected, oral empirical treatment with doxycycline (200 mg/daily) was started. The patient improved in 48 hours and remained well (Figure). Figure Palpebral eschars caused by Rickettsia Sibirica mongolitimonae infection in a 16-year-old febrile boy with fever, southern France, spring, 2012 (left). He recovered after doxycycline treatment (right). The first serologic test result for Rickettsia spp. was negative. Because of the location of the eschars, it was not possible to obtain biopsy specimens from them. Nevertheless, real-time qPCR that was performed on 2 eschar swab specimens showed positive results for Rickettsia spp in 24 hours. The specific qPCR test results were positive for Rickettsia Sibirica mongolitimonae in both samples (1). Amplification and sequencing of a fragment of ompA gene on these samples showed 100% (533/533) identity with R. Sibirica mongolitimonae HA-91 ({"type":"entrez-nucleotide","attrs":{"text":"RHU43796","term_id":"1174120"}}RHU43796). Four days later, after doxycycline treatment, 1 additional swab specimen was positive by specific qPCR for R. Sibirica mongolitimonae. The convalescent-phase serum specimen (obtained 14 days after admission) was positive by indirect immunofluorescence assay for Rickettsial antigens against SFG, suggesting seroconversion. R. Sibirica mongolitimonae is an intracellular bacterium that was recognized as a human pathogen in 1996 (1). The inoculation eschar at the tick bite site is a hallmark of many tick-borne SPG rickettsioses. However, because lymphangitis was also observed in a few of the patients reported subsequently, R. Sibirica mongolitimonae infection was named lymphangitis-associated rickettsiosis (5). To date, 24 cases have been reported in Europe (France, Spain, Portugal, Greece) and 3 in Africa (Egypt, Algeria, South Africa) (6,7). Vectors include ticks in the genus Hyalomma and also Rhipicephalus pusillus, a species of tick found on the European wild rabbit (also can be found on wild carnivorous animals, dogs, and domestic cats), which may bite humans (7). The life-threatening Mediterranean spotted fever caused by R. conorii peaks in the warmer months of July and August because of a heat-mediated increase in the aggressiveness and, therefore propensity to bite humans, of the brown dog tick vector, R. sanguineus (8). In contrast, R. Sibirica mongolitimonae infection is more frequently reported in the spring (7). The diagnosis of rickettsioses is most commonly based on serologic testing (1). However, serologic evidence of infection generally appears in the second and third weeks of illness, as in the case-patient described here. The use of molecular tools or cell culture on a skin biopsy specimen from an eschar is the best method of identifying Rickettsia spp. However, this invasive and painful procedure needs to be performed in sterile conditions with local anesthesia. Swabbing an eschar is easy and painless; the physician only needs a dry sterile swab that must be directed, while being rotated vigorously, to the base of the eschar, after the crust is removed (4). The sensitivity of this technique is comparable with that of Rickettsial detection on skin biopsy samples by molecular tools. If the eschar lesion is dry, a wet compress, previously humidified with sterile water, should be placed on the inoculation eschar for 1 minute before swabbing, to increase the quantity of material swabbed. In addition, the crust eschar also can be used for Rickettsial diagnosis. Because sufficient material can be obtained during swabbing, this test can be used by any practitioner at the patient’s bedside. As soon as the samples are sent to a laboratory with qPCR capability, results can be obtained quickly. In any case, when a physician is confronted with a patient with a fever and an eschar, doxycycline treatment should be initiated immediately because β-lactam antimicrobial drugs are inefficient for the treatment of rickettsioses (9).
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clustered cases of Rickettsia Sibirica mongolitimonae infection france
Emerging Infectious Diseases, 2013Co-Authors: Sophie Edouard, Cristina Socolovschi, Philippe Parola, Bernard Davoust, Bernard La Scola, Didier RaoultAbstract:To the Editor: Rickettsia Sibirica mongolitimonae, a member of the tick-borne spotted fever group (SFG) of Rickettsia, was first isolated from Hyalomma asiaticum ticks in China (1). The first human case was described in France in 1996, and 7 new cases were described in 2005 (1). This rickettsiosis was named lymphangitis-associated rickettsiosis because lymphangitis was observed in 50% of the patients (1). Only 17 cases have been reported, for which 7 patients had lymphangitis, and 13 had inoculation eschars, including 2 patients with 2 eschars (1,2). We report a cluster of cases of R. Sibirica mongolitimonae infection. Patient 1, a 73-year-old man in France, had fever, rash, lymphadenopathies, and an axillary inoculation eschar in February 2011. A diagnosis of lymphangitis-associated rickettsiosis was suspected because of the season (most cases occur in spring in France) and clinical manifestations. The patient was confined to bed for several weeks after surgical placement of a knee prosthesis when his disease occurred; the domestic cat was suspected to have introduced ticks into the home. In April, his wife (67 years of age) (patient 2) became febrile, had popliteal lymphadenopathies associated with lymphangitis, and had an eschar on the leg from which a swab specimen was obtained. Patient 3 was their neighbor; he had the same symptoms in March 2011 but samples were not collected from him. None of patients reported tick bites, but they were in regular contact with animals, including a cat, a dog, horses, and birds. Both patients who lived with the cat reported that it would return home with ticks. Infections in these patients were successfully treated with doxycycline. An immunofluorescence assay for antibodies against SFG antigens showed IgG/IgM titers of 128/0 for patient 1 and 64/16 for patient 2 (3). DNA was extracted from the skin swab specimen of patient 2 by using the QIAamp Mini Kit (QIAGEN, Hilden, Germany). A fragment of the citrate synthase gene of Rickettsia spp. was amplified by PCR and sequenced. The sequence show 99.7% homology with that of the same gene sequence of R. Sibirica mongolitimonae in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"DQ423370","term_id":"90657243","term_text":"DQ423370"}}DQ423370) (4). Ticks were collected from the property of the 2 patients: from the garden by flagging vegetation (3), from animals, and near the cat litter (Table). SFG Rickettsiae were detected by specific quantitative PCR. Species identification was confirmed by specific quantitative PCR for R. massiliae and sequencing of outer membrane protein A gene for others species (5). A negative control (sterile water) and positive control (DNA from R. montanensis or R. massiliae) were included in each PCR. Table Ticks collected from property of 2 patients infected with Rickettsia Sibirica mongolitimonae, France, 2011* Ticks were morphologically identified as adult Rhipicephalus sanguineus. Molecular identification of these ticks harboring Rickettsiae was performed by amplification of the 12S rRNA gene. DNA from R. massiliae was found in 3 ticks collected from the dog and near the cat litter morphologically identified as Rh. sanguineus. This DNA showed 98% homology with the sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"AY559843","term_id":"45594402","term_text":"AY559843"}}AY559843). R. Sibirica mongolitimonae with 99.8% homology for the outer membrane protein gene sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"DQ097082","term_id":"73620201","term_text":"DQ097082"}}DQ097082) was isolated from 1 tick collected from the cat. This tick was identified as Rh. pusillus and showed 99.7% homology with the sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"FJ536547","term_id":"257783763","term_text":"FJ536547"}}FJ536547). R. massiliae was cultured from an Rh. sanguineus tick, and R. Sibirica mongolitimonae was cultured from an Rh. pusillus tick. A cluster of 1 documented case and 2 probable cases of lymphangitis-associated rickettsiosis in southern France was linked to a cat and Rh. pusillus ticks. Infection with R. massiliae for the 2 probable case-patients was unlikely because clinical findings were typical of lymphangitis-associated rickettsiosis, and most cases of rickettsioses in southern France in the spring are caused by R. Sibirica mongolitimonae. Clustered cases of SFG Rickettsiae infection have been reported in Europe, including southern France (3,6). In 2007, R. conorii and R. massiliae infections in humans were reported (3). In 2010, cases for which we were unable to discriminate between R. conorii and R. massiliae infections occurred in a family (6). In these 2 studies, clustered cases of SFG rickettsiosis involved Rh. sanguineus ticks. Clustered cases appeared to be related to an increase in aggressiveness of ticks toward humans during warmer periods (3). In our study, no correlation was identified with warmer weather. R. Sibirica mongolitimonae is most frequently associated with Hyalomma spp. ticks (1,2,4). However, 1 case of infection with this bacterium was associated with Rh. pusillus ticks collected in Portugal (7); DNA from this bacteria was also identified in an Rh. pusillus tick collected from a mongoose. The European wild rabbit is the primary host of Rh. pusillus ticks. However, these ticks have been found on wild carnivorous animals, dogs, and domestic cats (8); these ticks can bite humans (8). Moreover, R. massiliae and R. Sibirica mongolitimonae were found in Rh. pusillus ticks from Spain (9), and SFG Rickettsiae were found in ticks from Sardinia (10). Therefore, Rh. pusillus ticks appear to be an emerging vector for R. Sibirica mongolitimonae in Europe.
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Rickettsia Sibirica mongolitimonae in traveler from egypt
Emerging Infectious Diseases, 2010Co-Authors: Cristina Socolovschi, Philippe Parola, S Barbarot, M Lefebvre, Didier RaoultAbstract:To the Editor: Tick-borne rickettsioses are zoonoses caused by spotted fever group (SFG) Rickettsia spp (1), which have been reported as a frequent cause of fever in international travelers (2). In Egypt, Mediterranean spotted fever caused by Rickettsia conorii transmitted by the brown dog tick, Rhipicephalus sanguineus, is known to be present, although cases are rarely documented. Moreover, an emerging pathogen, R. aeschlimannii, has been detected in Hyalomma dromedarii ticks, collected from camels, and in H. impeltatum and H. marginatum rufipes, collected from cows (3). We report a case of Rickettsia Sibirica mongolitimonae infection in a French traveler who returned from Egypt
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spotted fever rickettsioses in southern and eastern europe
Fems Immunology and Medical Microbiology, 2007Co-Authors: Philippe Brouqui, Philippe Parola, Pierre-edouard FournierAbstract:Mediterranean spotted fever due to Rickettsia conorii conorii was thought, for many years, to be the only tick-borne Rickettsial disease prevalent in southern and eastern Europe. However, in recent years, six more species or subspecies within the spotted fever group of the genus Rickettsia have been described as emerging pathogens in this part of the world. Tick-borne agents include Rickettsia conorii israelensis, Rickettsia conorii caspia, Rickettsia aeschlimannii, Rickettsia slovaca, Rickettsia Sibirica mongolitimonae and Rickettsia massiliae. Many Rickettsia of unknown pathogenicity have also been detected from ticks and could represent potential emerging pathogens to be discovered in the future. Furthermore, a new spotted fever Rickettsia, Rickettsia felis, was found to be associated with cat fleas and is an emerging human pathogen. Finally, the mite-transmitted Rickettsia akari, the agent of Rickettsialpox, is also known to be prevalent in Europe. We present here an overview of these rickettsioses, focusing on emerging diseases.
Cristina Socolovschi - One of the best experts on this subject based on the ideXlab platform.
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detection of Rickettsia Sibirica mongolitimonae by using cutaneous swab samples and quantitative pcr
Emerging Infectious Diseases, 2014Co-Authors: Julie Solary, Philippe Brouqui, Cristina Socolovschi, Didier Raoult, Camille Aubry, Philippe ParolaAbstract:To the Editor: Tick-borne rickettsioses are caused by the obligate intracellular bacteria spotted fever group (SFG) Rickettsia spp. These zoonoses are now recognized as emerging or reemerging human infections worldwide, with ≈15 new tick-borne Rickettsial species or subspecies recognized as human pathogens during the 30 past years (1). New approaches have emerged in recent years to definitively identify the causative agents, including emerging pathogens. Using cutaneous swab specimens from patients for quantitative PCR (qPCR) testing rather than cutaneous biopsy specimens is a major innovation in the diagnosis of SFG rickettsioses (2–4). Using this approach, we report 1 of the few documented infections caused by Rickettsia Sibirica mongolitimonae. A 16-year-old boy with no medical history was admitted to the Department of Infectious diseases at University Hospital in Marseille on May 25, 2012, with a fever (40°C) and skin lesions on his lower right eyelid. He had been fishing 7 days earlier at a pond situated in southern France near Marseille (43°26′N, 5°6′E). He had been given amoxicillin/clavulanic acid by his family doctor and showed no improvement after 2 days. The only sign on physical examination was the presence of 2 eschars on his lower right eyelid, associated with right periorbital edema (Figure) and painful right-sided cervical lymphadenopathies. Results of standard laboratory tests were normal except for the C-reactive protein level (21 mg/L; reference value <10 mg/L). He reported that the black spots on his lower eyelid were most likely related to bites from ticks that he got while fishing. He removed the ticks the next day. Because a tick-borne rickettsiosis was suspected, oral empirical treatment with doxycycline (200 mg/daily) was started. The patient improved in 48 hours and remained well (Figure). Figure Palpebral eschars caused by Rickettsia Sibirica mongolitimonae infection in a 16-year-old febrile boy with fever, southern France, spring, 2012 (left). He recovered after doxycycline treatment (right). The first serologic test result for Rickettsia spp. was negative. Because of the location of the eschars, it was not possible to obtain biopsy specimens from them. Nevertheless, real-time qPCR that was performed on 2 eschar swab specimens showed positive results for Rickettsia spp in 24 hours. The specific qPCR test results were positive for Rickettsia Sibirica mongolitimonae in both samples (1). Amplification and sequencing of a fragment of ompA gene on these samples showed 100% (533/533) identity with R. Sibirica mongolitimonae HA-91 ({"type":"entrez-nucleotide","attrs":{"text":"RHU43796","term_id":"1174120"}}RHU43796). Four days later, after doxycycline treatment, 1 additional swab specimen was positive by specific qPCR for R. Sibirica mongolitimonae. The convalescent-phase serum specimen (obtained 14 days after admission) was positive by indirect immunofluorescence assay for Rickettsial antigens against SFG, suggesting seroconversion. R. Sibirica mongolitimonae is an intracellular bacterium that was recognized as a human pathogen in 1996 (1). The inoculation eschar at the tick bite site is a hallmark of many tick-borne SPG rickettsioses. However, because lymphangitis was also observed in a few of the patients reported subsequently, R. Sibirica mongolitimonae infection was named lymphangitis-associated rickettsiosis (5). To date, 24 cases have been reported in Europe (France, Spain, Portugal, Greece) and 3 in Africa (Egypt, Algeria, South Africa) (6,7). Vectors include ticks in the genus Hyalomma and also Rhipicephalus pusillus, a species of tick found on the European wild rabbit (also can be found on wild carnivorous animals, dogs, and domestic cats), which may bite humans (7). The life-threatening Mediterranean spotted fever caused by R. conorii peaks in the warmer months of July and August because of a heat-mediated increase in the aggressiveness and, therefore propensity to bite humans, of the brown dog tick vector, R. sanguineus (8). In contrast, R. Sibirica mongolitimonae infection is more frequently reported in the spring (7). The diagnosis of rickettsioses is most commonly based on serologic testing (1). However, serologic evidence of infection generally appears in the second and third weeks of illness, as in the case-patient described here. The use of molecular tools or cell culture on a skin biopsy specimen from an eschar is the best method of identifying Rickettsia spp. However, this invasive and painful procedure needs to be performed in sterile conditions with local anesthesia. Swabbing an eschar is easy and painless; the physician only needs a dry sterile swab that must be directed, while being rotated vigorously, to the base of the eschar, after the crust is removed (4). The sensitivity of this technique is comparable with that of Rickettsial detection on skin biopsy samples by molecular tools. If the eschar lesion is dry, a wet compress, previously humidified with sterile water, should be placed on the inoculation eschar for 1 minute before swabbing, to increase the quantity of material swabbed. In addition, the crust eschar also can be used for Rickettsial diagnosis. Because sufficient material can be obtained during swabbing, this test can be used by any practitioner at the patient’s bedside. As soon as the samples are sent to a laboratory with qPCR capability, results can be obtained quickly. In any case, when a physician is confronted with a patient with a fever and an eschar, doxycycline treatment should be initiated immediately because β-lactam antimicrobial drugs are inefficient for the treatment of rickettsioses (9).
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Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2014Co-Authors: Grégory Dubourg, Cristina Socolovschi, P. Del Giudice, P.-e. Fournier, Didier RaoultAbstract:The clinical and epidemiological features of 56 patients with scalp eschar associated with neck lymphadenopathy after a tick bite (SENLAT) syndrome were evaluated at the National French Rickettsial Center. Eschar swabs, crusts, and biopsies as well as ticks and blood samples were acquired for molecular and serological assays. SENLAT predominantly affects children (p < 0.05), followed by 40- to 70-year-olds, and it is found mostly in women (p < 0.05). The seasonal distribution has two peaks: one in the spring (55%) and one in the autumn (30%). The etiological agent was identified in 18 cases, which include Rickettsia slovaca in 13 cases with incidences of two co-infections with Rickettsia raoultii and one case caused by Rickettsia Sibirica mongolitimonae. Other possible agents that were found in attached ticks were Candidatus R. rioja, Coxiella burnetii, and Borrelia burgdorferi. The tick vector was Dermacentor marginatus in almost all cases, with the exception of one case, in which Ixodes ricinus was identified as the vector. Our findings show that SENLAT is a clinical entity characterized as a local infection controlled by the immune system and is neither pathogen- nor vector-specific.
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lymphangitis associated rickettsiosis due a Rickettsia Sibirica mongolitimonae
Annales De Dermatologie Et De Venereologie, 2013Co-Authors: Matthieu J Foissac, Cristina Socolovschi, Didier RaoultAbstract:Summary Rickettsia Sibirica mongolitimonae was first isolated 20 years ago in Asia but has now been identified on three continents. Hyalomma spp. and Rhipicephalus pusillus ticks are vectors but only a small number of cases have been reported to date, mainly on the Mediterranean coast. This bacterium induces the lymphangitis-associated rickettsiosis, a still unfamiliar rickettsiosis that is mainly characterized by fever with a rope-like lymphangitis and/or lymphadenopathy and skin eschar occurring after tick bites. These features are especially evocative if they occur in spring. Sequellae are very rare and treatment with doxycycline is recommended. Choose an option to locate/access this article: " " Mots cles " Adenopathie; " Rickettsiose; " Escarre d'inoculation; " Lymphangite; " Rickettsia Sibirica mongolitimonae; " Tique Keywords " Adenopathy; " Rickettsiosis; " Eschar; " Lymphangitis; " Rickettsia Sibirica mongolitimonae; " Tick ________________________________________ Figures and tables from this article: Figure 1. Escarre d'inoculation et quelques elements de l'eruption maculopapuleuse associee a une lymphangite chez un patient espagnol presentant une infection a R. Sibirica mongolitimonae[22]. Figure options Tableau 1. Repartition geographique, hotes preferentiels et saisonnalite des vecteurs potentiels de Rickettsia Sibirica mongolitimonae.
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clustered cases of Rickettsia Sibirica mongolitimonae infection france
Emerging Infectious Diseases, 2013Co-Authors: Sophie Edouard, Cristina Socolovschi, Philippe Parola, Bernard Davoust, Bernard La Scola, Didier RaoultAbstract:To the Editor: Rickettsia Sibirica mongolitimonae, a member of the tick-borne spotted fever group (SFG) of Rickettsia, was first isolated from Hyalomma asiaticum ticks in China (1). The first human case was described in France in 1996, and 7 new cases were described in 2005 (1). This rickettsiosis was named lymphangitis-associated rickettsiosis because lymphangitis was observed in 50% of the patients (1). Only 17 cases have been reported, for which 7 patients had lymphangitis, and 13 had inoculation eschars, including 2 patients with 2 eschars (1,2). We report a cluster of cases of R. Sibirica mongolitimonae infection. Patient 1, a 73-year-old man in France, had fever, rash, lymphadenopathies, and an axillary inoculation eschar in February 2011. A diagnosis of lymphangitis-associated rickettsiosis was suspected because of the season (most cases occur in spring in France) and clinical manifestations. The patient was confined to bed for several weeks after surgical placement of a knee prosthesis when his disease occurred; the domestic cat was suspected to have introduced ticks into the home. In April, his wife (67 years of age) (patient 2) became febrile, had popliteal lymphadenopathies associated with lymphangitis, and had an eschar on the leg from which a swab specimen was obtained. Patient 3 was their neighbor; he had the same symptoms in March 2011 but samples were not collected from him. None of patients reported tick bites, but they were in regular contact with animals, including a cat, a dog, horses, and birds. Both patients who lived with the cat reported that it would return home with ticks. Infections in these patients were successfully treated with doxycycline. An immunofluorescence assay for antibodies against SFG antigens showed IgG/IgM titers of 128/0 for patient 1 and 64/16 for patient 2 (3). DNA was extracted from the skin swab specimen of patient 2 by using the QIAamp Mini Kit (QIAGEN, Hilden, Germany). A fragment of the citrate synthase gene of Rickettsia spp. was amplified by PCR and sequenced. The sequence show 99.7% homology with that of the same gene sequence of R. Sibirica mongolitimonae in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"DQ423370","term_id":"90657243","term_text":"DQ423370"}}DQ423370) (4). Ticks were collected from the property of the 2 patients: from the garden by flagging vegetation (3), from animals, and near the cat litter (Table). SFG Rickettsiae were detected by specific quantitative PCR. Species identification was confirmed by specific quantitative PCR for R. massiliae and sequencing of outer membrane protein A gene for others species (5). A negative control (sterile water) and positive control (DNA from R. montanensis or R. massiliae) were included in each PCR. Table Ticks collected from property of 2 patients infected with Rickettsia Sibirica mongolitimonae, France, 2011* Ticks were morphologically identified as adult Rhipicephalus sanguineus. Molecular identification of these ticks harboring Rickettsiae was performed by amplification of the 12S rRNA gene. DNA from R. massiliae was found in 3 ticks collected from the dog and near the cat litter morphologically identified as Rh. sanguineus. This DNA showed 98% homology with the sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"AY559843","term_id":"45594402","term_text":"AY559843"}}AY559843). R. Sibirica mongolitimonae with 99.8% homology for the outer membrane protein gene sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"DQ097082","term_id":"73620201","term_text":"DQ097082"}}DQ097082) was isolated from 1 tick collected from the cat. This tick was identified as Rh. pusillus and showed 99.7% homology with the sequence in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"FJ536547","term_id":"257783763","term_text":"FJ536547"}}FJ536547). R. massiliae was cultured from an Rh. sanguineus tick, and R. Sibirica mongolitimonae was cultured from an Rh. pusillus tick. A cluster of 1 documented case and 2 probable cases of lymphangitis-associated rickettsiosis in southern France was linked to a cat and Rh. pusillus ticks. Infection with R. massiliae for the 2 probable case-patients was unlikely because clinical findings were typical of lymphangitis-associated rickettsiosis, and most cases of rickettsioses in southern France in the spring are caused by R. Sibirica mongolitimonae. Clustered cases of SFG Rickettsiae infection have been reported in Europe, including southern France (3,6). In 2007, R. conorii and R. massiliae infections in humans were reported (3). In 2010, cases for which we were unable to discriminate between R. conorii and R. massiliae infections occurred in a family (6). In these 2 studies, clustered cases of SFG rickettsiosis involved Rh. sanguineus ticks. Clustered cases appeared to be related to an increase in aggressiveness of ticks toward humans during warmer periods (3). In our study, no correlation was identified with warmer weather. R. Sibirica mongolitimonae is most frequently associated with Hyalomma spp. ticks (1,2,4). However, 1 case of infection with this bacterium was associated with Rh. pusillus ticks collected in Portugal (7); DNA from this bacteria was also identified in an Rh. pusillus tick collected from a mongoose. The European wild rabbit is the primary host of Rh. pusillus ticks. However, these ticks have been found on wild carnivorous animals, dogs, and domestic cats (8); these ticks can bite humans (8). Moreover, R. massiliae and R. Sibirica mongolitimonae were found in Rh. pusillus ticks from Spain (9), and SFG Rickettsiae were found in ticks from Sardinia (10). Therefore, Rh. pusillus ticks appear to be an emerging vector for R. Sibirica mongolitimonae in Europe.
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widespread use of real time pcr for Rickettsial diagnosis
Fems Immunology and Medical Microbiology, 2012Co-Authors: Aurelie Renvoise, Jean-marc Rolain, Cristina SocolovschiAbstract:We report 2 years of experience with Rickettsial molecular diagnosis using real-time PCR at the French National Reference Center. All Rickettsia genomes available were compared to discover specific sequences to design new sets of primers and probes. The specificity was verified in silico and against a panel of 30 Rickettsial species. Sensitivity was determined using 10-fold serial dilutions. Finally, primers and probes that were both specific and sensitive were routinely used for the diagnosis of Rickettsial infections from clinical specimens. We retained sets of primers and probes to detect spotted fever group Rickettsia , typhus group Rickettsia , Rickettsia conorii , Rickettsia slovaca , Rickettsia africae and Rickettsia australis ; 643 clinical samples were screened for the presence of Rickettsia DNA. Overall, 45 positive samples were detected, including 15 Rickettsia africae , nine R.conorii , five Rickettsia Sibirica mongolitimonae , four R.slovaca , two R.australis , four Rickettsia massiliae , one Rickettsia honei , one Rickettsia typhi and eight Rickettsia sp. Positive samples were detected mainly from cutaneous biopsies and swabs (31/45). Widespread use of real-time PCR is inexpensive and reduces delay in the diagnosis of Rickettsial infections. These real-time PCR assays could be implemented easily in laboratories that have molecular facilities and may be added to existing molecular tools as a point-of-care strategy.
