Serologic Evidence of the Geographic Distribution of Bacterial Zoonotic Agents in Kenya, 2007

Diseases of zoonotic origin contribute to the burden of febrile illnesses in developing countries. We evaluated serologic evidence of exposure to Bacillus anthracis, Brucella spp., spotted fever group rickettsioses (SFGR), and typhus group rickettsioses (TGR) from samples of persons aged 15–64 years collected during a nationwide human immunodeficiency virus (HIV) serosurvey conducted in 2007 in Kenya. The seropositivity observed for pathogens was B. anthracis 11.3%, Brucella spp. 3.0%, SFGR 23.3%, and TGR 0.6%. On univariate analysis, seropositivity for each pathogen was significantly associated with the following risk factors: B. anthracis with province of residence; Brucella spp. with sex, education level, and wealth; SFGR with age, education level, wealth, and province of residence; and TGR with province of residence. On multivariate analysis, seropositivity remained significantly associated with wealth and province for B. anthracis; with sex and age for Brucella spp; and with sex, education level, and province of residence for SFGR whereas TGR had no significance. High IgG seropositivity to these zoonotic pathogens (especially, B. anthracis and SFGR) suggests substantial exposure. These pathogens should be considered in the differential diagnosis of febrile illness in Kenya.     

Epidemiology of Spotted Fever Group and Typhus Group Rickettsial Infection in the Amazon Basin of Peru

A seroprevalence study for IgG antibodies against spotted fever group (SFGR) and typhus group (TGR) Rickettsia among humans and domestic pets was conducted in the city of Iquitos, located in the Amazon basin of Peru. Of 1,195 human sera analyzed, 521 (43.6%) and 123 (10.3%) were positive for SFGR and TGR antibodies, respectively. District of residence and participant age were associated with antibody positivity for both groups, whereas rodent sightings in the home were associated with TGR antibody positivity. Of the 71 canines tested, 42 (59.2%) were positive for SFGR antibodies, and two (2.8%) were positive for TGR antibodies; one active SFGR infection was detected by polymerase chain reaction. An uncharacterized SFGR species was detected in 95.9% (71/74) of Ctenocephalides felis pools collected from domestic pets. These data suggest that rickettsial transmission is widespread in Iquitos. Rickettsia species should be further explored as potential causes of acute febrile illnesses in the region.     

Antibody prevalence of Orientia tsutsugamushi,Rickettsia typhi and TT118 spotted fever group rickettsiae among Malaysian blood donors and febrile patients in the urban areas

The seroprevalence of Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) among blood donors and febrile Malaysian patients in the urban areas was determined. Of the 240 blood donors, 5.4%, 9.2% and 1.7% had either present or previous exposure to OT, RT and SFG rickettsiae, respectively. Patients admitted to an urban hospital had high seroprevalences of OT (43.5%) and RT (22.9%), as compared to SFGR (11.6%). Antibody levels suggestive of recent infections of scrub typhus, murine typhus and tick typhus were detected in 16.8%, 12.7% and 8.2% of patients respectively. No significant difference was noted in the distribution of rickettsial antibodies among urban patients from 2 geographical locations. However, the serologic patterns of rickettsial infection in the urban areas were different form those of rural areas.     

Multispacer Typing (MST) of Spotted Fever Group Rickettsiae Isolated from Humans and Rats in Chengmai County,Hainan Province,China

Spotted fever caused by spotted fever group rickettsiae (SFGR) is found throughout China. During 2007–2008, 28 human SFGR isolates and 34 rat SFGR isolates including 15 isolates from Rattus fulvescens, 5 isolates from R. edwardsi, 7 isolates from Callosciurus erythraeus roberti and 7 isolates from Dremomys rufigenis) were obtained from L929 cell culture. Previous research indicated that the 62 strains of SFGR mentioned above shared not only the same serophenotype but also 100% of identity sequences of 16S rRNA, gltA, ompA, groEL and 17KD, which enabled us to apply multispacer typing (MST) to the 62 SFGR isolates in the study. Six primer pairs, which were used for typing of Rickettsia rickettsii and Rickettsia conorii, were chosen, and the results exhibited greater nucleotide polymorphisms among the 62 isolates tested. A total of 48 distinct genotypes were identified. The dominant genotype, represented by h3 isolates, accounted for 21.7% (13/60) of the isolates tested, and the remaining 47 genotypes were all unique. Phylogenetic analysis showed that all the 48 genotypes could be classified in the same clade, while the genetically related strain, R. heilongjiangensis, was close but not the same as the cluster. We concluded that the genetically diverse of spotted fever group rickettsiae strains are endemic in Chengmai County, Hainan Province, China.     

Spotted fever group rickettsiae in ticks collected from wild animals in Israel

We report molecular evidence for the presence of spotted fever group rickettsiae (SFGR) in ticks collected from roe deer, addax, red foxes, and wild boars in Israel. Rickettsia aeschlimannii was detected in Hyalomma marginatum and Hyalomma detritum while Rickettsia massiliae was present in Rhipicephalus turanicus ticks. Furthermore, a novel uncultured SFGR was detected in Haemaphysalis adleri and Haemaphysalis parva ticks from golden jackals. The pathogenicity of the novel SFGR for humans is unknown; however, the presence of multiple SFGR agents should be considered when serological surveillance data from Israel are interpreted because of significant antigenic cross-reactivity among Rickettsia. The epidemiology and ecology of SFGR in Israel appear to be more complicated than was previously believed.     

斑点热群立克次体新种──虎林－93株的分离和鉴定

本文用鸡胚卵黄囊培养法及实验动物感染法从黑龙江省虎林县境内采集的嗜群血蜱中分离到了一株立克次体。命名为ＨＬ－９３株立克次体。经形态学及血清学试验证实为斑点热群立克次体。分别用微量免疫荧光法、十二烷基硫酸钠－聚丙烯酰胺凝胶不连续电泳法、单克隆抗体免疫酶斑点法、单克隆和多克隆抗体免疫印迹法、聚合酶链反应和限制性片段长度多态性分析法对该分离株进行鉴定并同已知国际标准株、国际及国内参考株进行比较。结果表明;ＨＬ－９３株立克次体无论在抗原性多肽上,还是在基因水平上在斑点热群立克次体中都是独特的。根据目前立克次体分类法,ＨＬ－９３株立克次体可以考虑是斑点热群立克次体的新种。     

Detection of antibodies against spotted fever group Rickettsia (SFGR), typhus group Rickettsia (TGR), and Coxiella burnetii in human febrile patients in the Philippines

A total of 157 sera from febrile patients in the Philippine General Hospital in Manila, Luzon, and the Northern Samar Provincial Hospital, the Philippines, were used. Serum antibodies against spotted fever group Rickettsia (SFGR) and typhus group Rickettsia (TGR) were detected by indirect immunofluorescence test. Antibody positive rates were 1.3% for SFGR (Rickettsia japonica) and 2.5% for TGR (R. typhus), respectively. Rickettsial antibodies in humans in the Philippines were found for the first time. These results underscore the need for further epidemiological study of clinical rickettsioses in the Philippines.     

Absence of Rickettsia rickettsii and Occurrence of Other Spotted Fever Group Rickettsiae in Ticks from Tennessee

Rocky Mountain spotted fever (RMSF) is the most common tick-borne illness in Tennessee. Little is known about the occurrence of R. rickettsii, the causative agent, in ticks in Tennessee. To better understand the prevalence and distribution of rickettsial agents in ticks, we tested 1,265 Amblyomma, Dermacentor, and Ixodes adult and nymphal ticks. Additionally, we tested 231 Amblyomma americanum larvae. Ticks were collected from 49 counties from humans, wild animals, domestic canines, and flannel drags. Spotted fever group rickettsiae (SFGR) DNA was detected by polymerase chain reaction (PCR) in 32% of adult and nymphal ticks. A total minimum infection rate of 85.63 was found in larval pools tested. Three rickettsial species, Rickettsia montana, Rickettsia amblyommii, and Rickettsia cooleyi were identified by molecular analysis. Rickettsia rickettsii was not detected. This study suggests that some RMSF cases reported in Tennessee may be caused by cross-reactivity with other SFGR antigenically related to R. rickettsii.     

Coxiella burnetii Infection in a Community Operating a Large-Scale Cow and Goat Dairy,Missouri, 2013

Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans and is transmitted primarily from infected goats, sheep, or cows. Q fever typically presents as an acute febrile illness; however, individuals with certain predisposing conditions, including cardiac valvulopathy, are at risk for chronic Q fever, a serious manifestation that may present as endocarditis. In response to a cluster of Q fever cases detected by public health surveillance, we evaluated C. burnetii infection in a community that operates a large-scale cow and goat dairy. A case was defined as an individual linked to the community with a C. burnetii phase II IgG titer ≥ 128. Of 135 participants, 47 (35%) cases were identified. Contact with or close proximity to cows, goats, and their excreta was associated with being a case (relative risk 2.7, 95% confidence interval 1.3–5.3). Cases were also identified among individuals without cow or goat contact and could be related to windborne spread or tracking of C. burnetii on fomites within the community. A history of injection drug use was reported by 26/130 (20%) participants; follow-up for the presence of valvulopathy and monitoring for development of chronic Q fever may be especially important among this population.     

广东连平县存在新的蜱传斑点热立克次体

目的对采自广东省连平县的3种硬蜱进行蜱传斑点热立克次体检测分析。方法斑点热立克次体的ompA基因片段扩增并测定扩增片段的DNA序列。结果20只蜱分为17组,其中15组PCR检测阳性。对4个测序成功的标本进行聚类分析,证实其中3个序列单独聚为一类,与引起Flinders岛蜱传斑点热的弗诺立克次体(R.honei)、非洲蜱咬热的非洲立克次体(R.africa)、未定名斑点热的斯洛伐克立克次体(R.slovaca)以及西伯利亚立克次体BJ-90株等亲缘关系较近,另一序列与我国长白山地区检测到的JL-02具有较高的同源性。结论本研究提示该地区除了已证实的西伯利亚斑点热外,还存在新的蜱传斑点热。     

Tick-borne rickettiosis in Guadeloupe, the French West Indies: isolation of Rickettsia africae from Amblyomma variegatum ticks and serosurvey in humans, cattle, and goats.

Twenty-seven rickettsiae were isolated and/or detected from 100 Amblyomma variegatum ticks collected on Guadeloupe in the French West Indies. In this study, the polymerase chain reaction procedure appeared to be more sensitive in detecting rickettsiae in ticks than the shell-vial technique. Sequencing a portion of the outer membrane protein A-encoding gene showed that these rickettsiae appeared to be identical to Rickettsia africae, a member of the spotted fever group rickettsiae recently described as an agent of African tick-bite fever occurring in sub-Sahelian Africa. A high seroprevalence of antibodies to R. africae was demonstrated among mammals, particularly humans, cattle, and goats. These results and a recently reported case of an infection due to R. africae on Guadeloupe demonstrate that R. africae is present on this island. Although this disease has been underdiagnosed there, it may be frequent and may exist on other Caribbean islands where A. variegatum has propagated dramatically over recent years.     

黑龙江逊克地区森林革蜱斑点热立克次体DNA的检测

目的 调查黑龙江逊克地区蜱传斑点热自然疫源地,发现该地区蜱携带斑点热立克次体的种类。方法 采用斑点热立克次体ompA和gltA基因特异的PCR,检测该地区森林革蜱的DNA样本,并对扩得阳性产物进行测序和聚类分析。结果 从60只森林革蜱中检测有14只扩得斑点热立克次体ompA和gltA基因片段,阳性率为23.33%。随机选择2只蜱的阳性片段进行测序,二者同源性为100%,ompA基因序列与Rickettsia sp.JL-02同源性为99.30%, 与Rickettsia raoultii为99.18%。结论 黑龙江省逊克地区森林革蜱携带与Rickettsia sp.JL-02株亲缘关系相近的斑点热群立克次体。     

Imported arbovirus infections in Canada 1974-89

From 1974 to 1989, sera from symptomatic patients with histories of recent travel outside Canada were tested for antibodies to several arboviruses, principally of the alphavirus and flavivirus families. Diagnostic seroconversions were documented in 84 individuals from six provinces, including one alphavirus (Chikungunya) and 83 flavivirus seroconvertors. Dengue 1 virus was isolated from the blood of one patient. Most flavivirus seroconvertors were likely infected with dengue virus, but infections with tick-borne encephalitis, St Louis encephalitis and Powassan viruses were also recognized. Patients had histories of recent travel to the Caribbean, South America, Asia, Africa, North America (outside Canada), Tahiti, Fiji and Europe. Possible imported infections due to Japanese encephalitis, Ross River, western equine encephalitis and Colorado tick fever viruses were also encountered.     

Imported arbovirus infections in Canada 1974�C89

From 1974 to 1989, sera from symptomatic patients with histories of recent travel outside Canada were tested for antibodies to several arboviruses, principally of the alphavirus and flavivirus families. Diagnostic seroconversions were documented in 84 individuals from six provinces, including one alphavirus (Chikungunya) and 83 flavivirus seroconvertors. Dengue 1 virus was isolated from the blood of one patient. Most flavivirus seroconvertors were likely infected with dengue virus, but infections with tick-borne encephalitis, St Louis encephalitis and Powassan viruses were also recognized. Patients had histories of recent travel to the Caribbean, South America, Asia, Africa, North America (outside Canada), Tahiti, Fiji and Europe. Possible imported infections due to Japanese encephalitis, Ross River, western equine encephalitis and Colorado tick fever viruses were also encountered.     

Hepatitis E Virus Prevalence and Associated Risk Factors in High-Risk Groups: A Cross-Sectional Study

Background:Seroepidemiology, risk factors to hepatitis E virus exposure, and prevalence of hepatitis E virus viremia have not yet been investigated among patients under immunosuppression or with liver disease that are high risk for infection in Turkey.Methods:In this cross-sectional study, 292 consecutive serum samples from renal transplant recipients, allogeneic hematopoietic stem cell transplant recipients, patients with acute hepatitis, and patients with chronic hepatitis C were prospectively collected in a tertiary university hospital. Sera were tested for hepatitis E virus immunoglobulin G/immunoglobulin M and hepatitis E virus ribonucleic acid using commercial enzyme-linked immunosorbent assay and in-house nested polymerase chain reaction with Sanger sequencing, respectively. Sociodemographic, clinical, laboratory data, and risk factors were collected using a questionnaire and hospital database. Multiple logistic regression analysis was employed to identify independent predictors for anti-hepatitis E virus seropositivity.Results:Among all patients, only 2 patients (1 renal transplant recipient and 1 patient with acute hepatitis) were identified as having hepatitis E virus genotype 3 viremia. Hepatitis E virus viremia rate was 0.6% in whole group. These patients showed no signs of chronic hepatitis E virus infection for 6 months and were spontaneously seroconverted 6 months after enrollment. Anti-hepatitis E virus IgG was positive in 29 patients yielding a hepatitis E virus seroprevalence of 9.9%. Older age (adjusted odds ratio: 1.03, 95% CI, 1.00-1.06; P = .022) and eating undercooked meat (adjusted odds ratio: 3.11, 95% CI, 1.08-8.92; P = .034) were independent risk factors to anti-hepatitis E virus seropositivity in all patients. Similarly, multiple logistic regression analysis demonstrated that age (adjusted odds ratio: 1.03, 95% CI, 0.99-1.07, P = .058) and eating undercooked meat (adjusted odds ratio: 5.77, 95% CI, 1.49-22.25, P = .011) were independent risk factors for anti-hepatitis E virus IgG positivity in the liver disease subgroup consisting of acute hepatitis and chronic hepatitis C patients.Conclusion:The hepatitis E virus seroprevalence rate was high (9.9%), despite low viremia rate (0.6%) in high-risk patients. The emergence of hepatitis E virus genotype 3 might indicate a serious problem for these patients. Future investigations are needed to elucidate foodborne transmission routes of hepatitis E virus in Turkey.     

Seroepidemiologic Survey for Coxiella burnetii Among US Military Personnel Deployed to Southwest and Central Asia in 2005

We used a seroepidemiologic study to estimate Q fever (Coxiella burnetii) seroprevalence, seroincidence, and risk factors for seroconversion in two deployed military populations in 2005. The first study group resided in an area with a known Q fever outbreak history (Al Asad, Iraq). Of this population, 7.2% seroconverted for an incidence rate of 10.6 seroconversions per 1,000 person-months. The second population included personnel transiting through Qatar on mid-deployment leave from southwest/central Asia. In this group, we found 2.1% prevalence with 0.92 seroconversions per 1,000 person-months. However, no significant risk factors for Q fever seroconversion were found in either population.     

A survey for spotted fever group rickettsiae and ehrlichiae in Amblyomma variegatum from St. Kitts and Nevis

Eighty-nine Amblyomma variegatum ticks were collected from the islands of St. Kitts and Nevis in the Caribbean and preserved in 70% ethanol or local rum. After being washed in sterile water, their DNA was extracted and analyzed by a polymerase chain reaction (PCR) for DNA of spotted fever group rickettsiae and ehrlichiae. None of the tested ticks was positive in a PCR assay using the primers 16S EHRD and 16S EHRR for the 16S rRNA gene of Ehrlichia spp.. Forty-one percent of the A. variegatum (36 of 89 of which 34 [47%] of 72 were adult males, 2 (13%) of 16 were adult females, and 0 (0%) of 1 were nymphs) were positive in a PCR assay using the primer pair 190-70 and 190-701 for the outer membrane protein A (ompA) gene of spotted fever group rickettsiae. All PCR amplification products obtained had 100% sequence homology with Rickettsia africae, the agent of African tick-bite fever.     

Emerging viral pathogens in long-term expatriates (II): dengue virus

Dengue virus infections have been well known for many years; still dengue virus is regarded as an ‘emerging’ pathogen, as the disease profile is changing. Its geographical range and oveall incidence, and the incidence of the associated complications, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), are on the increse. Modern-day travel and increasing urbanization seem to be the main contributing factors. In order to estimate the risk of infection during long-term stays in dengue-endemic countries, we tested sera obtained from 323 development aid workers and their family members who had spent on average 9.8 years in dengue-endemic regions for the presence of dengue virus antibodies. Dengue virus antibody screening was done by a commercially available immunofluorescence test (IF). Reactive samples were re-tested by an in-house IF and also tested for cross-reactivity to yellow fever virus using yellow fever IF and neutralization test (NT). Evaluation of the results revealed that the screening test has a specificity of at least 63.2%. In 12 of 19 initially positive cases crossreacting antibodies against yellow fever virus could be ruled out. Three cases remained indeterminable, whereas four of the reactive and 10 (out of 12) of the borderline reactive cases showed crossreactivity with yellow fever virus, probably due to previous vaceination. We found seroprevalence rates of 4.3% with no significant differences related to gender or area of upbringing. Scroprevalence rates were evaluated according to region of suspected or confirmed infection. In two cases the dengue infection had taken a classical clinical course; in another three cases an extraordinary febrile illness was reported in the history. None of the other seropositive individuals had a history of an illness possibly attributable to dengue virus infection. Our results show that there definitely is a risk for long-term expatriates to acquire (mostly non- or oligo-symptomatic) dengue infection, which might be important especially in the light of the supposed aetiology of DHF or DSS as a secondary infection with another dengue virus serotype.     

The seroprevalence and seroincidence of dengue virus infection in western Kenya

Epidemics of dengue fever have been documented throughout the African continent over the past several decades, however little is known about the prevalence or incidence of dengue virus infection in the absence of an outbreak. No studies have analyzed the prevalence of dengue infection in western Kenya to date. This study describes the seroincidence and seroprevalence of dengue infection in western Kenya. Banked sera obtained from 354 healthy, afebrile children ages 12–47 months from Kisumu District, Kenya, were analyzed for antibodies to dengue virus using an IgG indirect ELISA. We found a seroprevalence of 1.1% (4 of 354 samples) and incidence of 8.5 seroconversions per 1000 persons per year in this study population. This appears to be similar to that previously reported in coastal regions of the country outside of known epidemic periods. Since there has never been a reported dengue epidemic in western Kenya, continued investigation and evaluation in a patient population presenting with fever is necessary to further confirm this finding.     

Prevalence of seropositivity to spotted fever group rickettsiae and Anaplasma phagocytophilum in a large, demographically diverse US sample.

BACKGROUND: Most epidemiologic studies of tick-borne rickettsial diseases in the United States are small and have limited demographic scope, making broader risk assessment difficult. METHODS: We conducted a seroprevalence study of spotted fever group rickettsiae and Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis. Specimens were selected randomly from the Department of Defense Serum Repository for 10,000 diverse military personnel at various stages in their careers who were serving with active duty status in 1997. Antibody testing included enzyme-linked immunosorbent assay for Rickettsia rickettsii and A. phagocytophilum, and Western blot confirmation for A. phagocytophilum. Risk factors were assessed using logistic regression. RESULTS: Subjects were mostly male and young and were diverse ethnically and geographically. Spotted fever group rickettsiae seropositivity was 6.0% (95% confidence interval, 5.5%-6.4%). In univariable logistic regression, seroprevalence was significantly higher among older subjects, men (6.5%, compared with 3.3% among women), black individuals (8.7%, compared with 5.6% among white individuals), subjects from states with above-average Rocky Mountain spotted fever incidence, and subjects in ground combat specialties. Associations remained significant in multivariable analysis for age, sex, black versus white race, home state with high incidence, and ground combat specialty. Among 696 subjects with serum samples obtained within 7 days after entering the military, the rate of seropositivity was 3.4% (95% confidence interval, 2.1%-4.8%). Seroprevalence was nonsignificantly lower in men (3.4%, compared with 3.7% in women ) and in black individuals (3.4%, compared with 4.1% in white individuals). A. phagocytophilum seropositivity, as determined by by enzyme-linked immunosorbent assay and Western blot, was 2.6% and 0.11% (95% confidence interval, 0.05%-0.18%), respectively. Western blot seropositivity was not significantly associated with subject characteristics in univariable analysis. CONCLUSIONS: Spotted fever group rickettsiae exposure was common and A. phagocytophilum exposure was rare in a US population with broad demographic diversity.