Spotted fever group rickettsiae in Ticks, Morocco.
A total of 370 ticks, encompassing 7 species from 4 genera, were collected during 2002-2006 from domestic animals and vegetation in the Taza region of northeastern Morocco. Rickettsial rickettsial /rick·ett·si·al/ (ri-ket´se-al) pertaining to or caused by rickettsiae.
Relating to, or caused by a member of the genus Rickettsia. DNA DNA: see nucleic acid.
or deoxyribonucleic acid
One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. was identified in 101 ticks (27%) by sequencing PCR PCR polymerase chain reaction.
polymerase chain reaction
Polymerase chain reaction (PCR) products of fragments of the citrate synthase The enzyme citrate synthase (E.C. 184.108.40.206 [previously 220.127.116.11]) is a pace-maker enzyme, as it controls the first committed step of the Krebs cycle, also called the citric acid cycle. and outer membrane The outer membrane refers to the outside membranes of Gram-negative bacteria, the chloroplast, or the mitochondria. It is used to maintain the shape of the organelle contained within its structure, and it acts as a barrier against certain dangers. protein genes of Rickettsia rickettsia (rĭkĕt`sēə), any of a group of very small microorganisms, many disease-causing, that live in vertebrates and are transmitted by bloodsucking parasitic arthropods such as fleas, lice (see louse), and ticks. spp. Seven rickettsiae of the spotted fever spot·ted fever
A tick typhus caused by Rickettsia rickettsii, such as Rocky Mountain spotted fever.
spotted fever Rocky Mountain spotted fever, see there group were identified, including 4 pathogens: R. aeschlimannii in Hyalomma marginatum marginatum, R. massiliae in Rhipicephalus sanguineus, R. slovaca in Dermacentor marginatus, and R. monacensis in Ixodes ricinus. Two suspected pathogens were also detected (R. raoultii in D. marginatus and R. helvetica in I. ricinus). An incompletely described Rickettsia sp. was detected in Haemaphysalis spp. ticks.
Tick-borne rickettsioses Rickettsioses
Often severe infectious diseases caused by several diverse and specialized bacteria, the rickettsiae and rickettsia-like organisms. The best-known rickettsial diseases infect humans and are usually transmitted by parasitic arthropod vectors. are infections caused by obligate obligate /ob·li·gate/ (ob´li-gat) pertaining to or characterized by the ability to survive only in a particular environment or to assume only a particular role, as an obligate anaerobe. intracellular gram-negative bacteria of the spotted fever group (SFG SFG StanCorp Financial Group
SFG San Francisco Giants (baseball team)
SFG Special Forces Group
SFG Sum Frequency Generation
SFG Square Foot Gardening
SFG Symmetrical Field Geometry (JBL speaker technology) ) in the genus Rickettsia Noun 1. genus Rickettsia - can cause typhus and Rocky Mountain spotted fever in humans
bacteria genus - a genus of bacteria
family Rickettsiaceae, Rickettsiaceae - microorganism resembling bacteria inhabiting arthropod tissues but capable of causing disease and the order Rickettsiales Noun 1. order Rickettsiales - pleomorphic Gram-negative microorganisms
animal order - the order of animals
division Eubacteria - one-celled monerans having simple cells with rigid walls and (in motile types) flagella . These zoonoses Zoonoses
Infections of humans caused by the transmission of disease agents that naturally live in animals. People become infected when they unwittingly intrude into the life cycle of the disease agent and become unnatural hosts. are now recognized as emerging vector-borne infections worldwide (1,2). They share characteristic clinical features, including fever, headache, rash, and occasional eschar eschar /es·char/ (es´kahr)
1. a slough produced by a thermal burn, by a corrosive application, or by gangrene.
2. tache noire.
n. formation at the site of the tick bite. Although these diseases have been known for a long time, they have been poorly investigated in northern Africa, including Morocco (2).
Two human tick-borne SFG rickettsioses are known to occur in Morocco. Mediterranean spotted fever, caused by Rickettsia conorii Rickettsia co·no·ri·i
A bacterium that causes boutonneuse fever in humans. conorii, is transmitted by the brown dog tick brown dog tick
see rhipicephalussanguineus. , Rhipicephalus sanguineus, which is well adapted to urban environments and is endemic to the Mediterranean area (2). In Morocco, clinicians usually consider patients with spotted fever as having Mediterranean spotted fever. However, in 1997, Beati et al. isolated a new rickettsia, R. aeschlimannii, from Hyalomma marginatum marginatum ticks collected in Morocco (3). In 2002, human infection with this rickettsia was reported in a patient returning from Morocco to France (4).
To date, all studies on rickettsioses conducted in Morocco have been based on only clinical and serologic se·rol·o·gy
n. pl. se·rol·o·gies
1. The science that deals with the properties and reactions of serums, especially blood serum.
2. features. However, the number of representatives of the genus Rickettsia and the number of newly described rickettsioses have increased in recent decades because of improved cell culture isolation techniques and extensive use of bacterial detection and identification by molecular biologic techniques (2). Comparison of the sequences of PCR-amplified fragments of genes encoding 16S rRNA, citrate synthase (gltA), or outer membrane protein (ompA) has become a reliable method for identifying rickettsiae in arthropods, including ticks (1). Therefore, our aim was to detect and characterize rickettsiae in hard ticks collected in Morocco by using PeR and sequence analysis of amplified products and to discuss their potential threat for humans and animals.
Materials and Methods
Collection and Identification of Ticks
From April 2002 through March 2006, ticks were collected from domestic animals (livestock and dogs) and by flagging vegetation at sites in the Taza region in northeastern Morocco. These sites were located between the towns of Babboudir and Babezhare, (34[degrees]12'48.81"N, 4[degrees]0'55.63"W) in the Atlas Mountains Atlas Mountains, system of ranges and plateaus in NW Africa, extending c.1,500 mi (2,410 km) from SW Morocco, through N Algeria, to N Tunisia; Jebel Toubkal (13,671 ft/4,167 m), in SW Morocco, is the highest peak. The Atlas Mts. , situated 40 km from the city of Taza and 90 km from the city of Fez Fez: see Fès, Morocco. . All ticks collected were adults and morphologically identified to the species or genus level by using standard taxonomic keys. Ticks were kept in ethanol at room temperature until DNA was extracted in the Laboratoire des Maladies Vectorielles, Institut Pasteur du Maroc, Casablanca, Morocco. DNA samples were thereafter sent to the Unite des Rickettsies in Marseille, France.
PCR Detection and Identification of Rickettsia spp.
Ticks were rinsed with distilled water Noun 1. distilled water - water that has been purified by distillation
H2O, water - binary compound that occurs at room temperature as a clear colorless odorless tasteless liquid; freezes into ice below 0 degrees centigrade and boils above 100 degrees centigrade; for 10 min, dried on sterile filter paper in a laminar flow laminar flow
Fluid flow in which the fluid travels smoothly or in regular paths. The velocity, pressure, and other flow properties at each point in the fluid remain constant. hood, and crushed individually in sterile Eppendorf (Hamburg, Germany) tubes. DNA was extracted by using the QIAamp Tissue Kit (QIAGEN, Hilden, Germany) according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the manufacturer's instructions. Rickettsial DNA was detected by PCR by using primers Rp CS.409p and Rp CS. 1258n (Eurogentec, Seraing, Belgium), which amplify a 750-bp fragment of the gltA gene of Rickettsia spp. as described (5). All ticks positive for gltA were tested for the ompA gene of Rickettsia spp. by using primers Rr. 190.70 and Rr. 190.701, which amplify a 629-632-bp fragment (5). A negative control (distilled water instead of tick DNA template) and a positive control (DNA from R. montanensis) were included in each test. All PCRs were conducted in Marseille by using the GeneAmp PCR System 2400 and 9700 thermal cyclers (PerkinElmer, Waltham, MA, USA). Amplification products were analyzed after electrophoresis on a 1% agarose agarose
more highly purified form of agar with similar uses to agar and widely used in the separation of nucleic acid fragments. gel stained with ethidium bromide Ethidium bromide (sometimes abbreviated as EtBr) is an intercalating agent commonly used as a nucleic acid stain in molecular biology laboratories for techniques such as agarose gel electrophoresis. . To identify detected Rickettsia spp., PCR products were purified and sequencing was performed as described (5). All sequences obtained were assembled and edited with Auto Assembler software version 1.4 (PerkinElmer). Sequences were analyzed by BLAST (www.ncbi.nlm.nih. gov/blast/Blast.cgi) sequencing analysis of sequences in the GenBank database.
Molecular Identification of Ticks
To help identify the ticks at the species level, molecular tools were used for some ticks that had not been morphologically identified at the species level and that were positive for rickettsiae. Amplification by PCR with T1B and T2A T2A Total Terrain Avionics primers and sequencing of a 338-bp amplified fragment of the 12S rRNA gene of the ticks were performed as described (6).
A total of 370 specimens representing 7 species and 4 genera of ticks were collected. Tick species identified by taxonomic keys included Rh. sanguineus (106 specimens), Rh. bursa Bursa, city, Turkey
Bursa (brsä`), city (1990 pop. 838,323), capital of Bursa prov., NW Turkey. (76), Rh. turanicus (25), Haemaphysalis sulcata (79), Ha. punctata (6), Ixodes ricinus (14), and Dermacentor marginatus (11) (Figure). Some ticks, including engorged en·gorge
v. en·gorged, en·gorg·ing, en·gorg·es
1. To devour greedily.
2. To gorge; glut.
3. To fill to excess, as with blood or other fluid.
v.intr. females or damaged specimens, were identified to genus only (18 Haemaphysalis sp. and 35 Hyalomma sp.). Most ticks (337) were collected from domestic animals; the rest were collected by flagging of vegetation (Table).
Rickettsial DNA was detected in 101 (27%) of 370 ticks by using a gltA PCR. Three (8.6%) of 35 Hyalomma spp. ticks contained rickettsia DNA with a gltA gene fragment that was 99.1% (765/772 bp) similar to that of R. aeschlimannii and 100% similar to the ompA gene of R. aeschlimannii. A 237-bp fragment of tick mitochondrial mitochondrial
pertaining to mitochondria.
a unique set of tRNAs, mRNAs, rRNAs, transcribed from mitochondrial DNA by a mitochondrial-specific RNA polymerase, that account for about 4% of the total cell RNA that 12S rDNA gene was obtained from one of the R. aeschlimannii--infected ticks. The sequence of this fragment enabled definitive identification of the tick to the species level, with 100% similarity to H. marginatum marginatum (GenBank accession no. AF150034).
Five (4.7%) of 106 Rh. sanguineus ticks were positive for rickettsial DNA by PCR. For all samples, sequence analyses showed 99.8% (636/637) similarity with the gltA sequence and 100% similarity with the ompA sequence of R. massiliae. One R. massiliae--infected tick was evaluated by PCR amplification of the tick mitochondrial 12S rDNA gene; sequence analyses showed 99.6% (235/236) similarity to the corresponding 12S rDNA of Rh. sanguineus (GenBank accession no. AF133056).
A total of 5 (45.5%) of 11 D. marginatus ticks contained a rickettsia with a nucleotide sequence of gltA that was 99.2% (635/640 bp) similar to R. slovaca and 100% (533/533 bp) similar to the ompA sequence of R. slovaca. Rickettsial DNA was detected in 1 other specimen of D. marginatus. Amplified gltA and ompA fragments were se quenced and showed 99.3% (560/564 bp) similarity with the gltA gene of R. raoultii and 100% similarity with the ompA gene ofR. raoultii.
Five (35.7%) of 14 specimens of I. ricinus were positive by gltA PCR. Sequence analyses showed 100% homology homology (hōmŏl`əjē), in biology, the correspondence between structures of different species that is attributable to their evolutionary descent from a common ancestor. with the corresponding gltA sequence of R. monacensis. OmpA sequences were obtained and showed 99.7% (585/587 bp) similarity with the corresponding sequence of R. monacensis. Four (28.6%) of 14 L ricinus ticks contained rickettsia with nucleotide sequences of gltA with 99.8% (633/634 bp) similarity to R. helvetica. The primer set Rr.190.70p-Rr.190.701n failed to amplify an ompA product in any specimens that were positive for the gltA gene of R. helvetica.
Sixty-one (77.2%) of 79 Ha. sulcata ticks, 3 (50%) of 6 Ha.punctata ticks, and 14 (77.7%) of 18 Haemaphysalis spp. ticks were positive by PCR for the primer set Rp CS.409p and Rp CS.1258n for the gltA gene. The gltA sequences obtained were different from all known Rickettsia spp. sequences deposited in GenBank. The most closely related sequence of gltA was designated "Ricketttsia endosymbiont An endosymbiont is any organism that lives within the body or cells of another organism, i.e. forming an endosymbiosis (Greek: endo = inner, sym = together and biosis = living). of Haemaphysalis sulctata" (99.4% similarity; 484/487 bp). The next most closely related sequence of gltA, with 96% similarity, was R. felis. Results of the PCR with the ompA primer set Rr. 190.70p-Rr. 190.701 n were negative for all Haemaphysalis spp. ticks that were positive for the gltA gene.
None of the Rh. bursa and Rh. turanicus ticks harbored rickettsiae. All GenBank accession numbers used to compare sequences obtained from ticks are shown in the Table.
Before this study, only 2 SFG rickettsiae pathogenic to humans had been described in Morocco, R. conorii conorii, the agent of Mediterranean spotted fever, and the recently described R. aeschlimannii (2,3). In our study, in addition to R. aeschlimannii, we identified 3 other SFG pathogenic rickettsiae in Morocco: R. massiliae, R. slovaca, and R. monacensis. Furthermore, 2 tick-borne SFG Rickettsia spp. presumptively pre·sump·tive
1. Providing a reasonable basis for belief or acceptance.
2. Founded on probability or presumption.
pre·sump associated with human illnesses, R. helvetica and R. raoultii, and an undescribed bacterium have been identified.
DNA extraction DNA extraction is a routine procedure to collect DNA for subsequent molecular or forensic analysis. Outline of a DNA extraction
There are three basic steps in a DNA extraction, the details of which may vary depending on the type of sample and any substances that may and PCR were performed in different locations (Morocco and France), and all results were supported by 2 sets of primers. The gltA primers used in the first screening are known to amplify all known tick-borne rickettsiae (7). A second set of primers targeting the ompA gene was used to confirm positive results, although some rickettsia (e.g., R. helvetica) cannot be amplified by using this set. There were no cases in which multiple species of rickettsiae were detected in an infected tick, as in most of the similar molecular surveys published (1,2). Our results did not address prevalence and distribution of rickettsiae detected. Systematic sampling was not conducted. Also, some tick samples tested with rickettsial primers have not been tested with tick primers in parallel. Therefore, inhibitors that could be responsible for false-negative results and underestimation of infection rates cannot be ruled out.
R. aeschlimannii was isolated from H. marginatum marginatum ticks collected in Morocco in 1997 (3). This rickettsia has also been detected in H. marginatum rufipes ticks in Zimbabwe, Niger, and Mali; in H. marginatum marginatum in Portugal, Croatia, Spain, Greece, Algeria, and Egypt; and in both ticks in Corsica (2,8,9). H. marginatum marginatum is also known as the Mediterranean Hyalomma and may represent up to 42% of ticks found on cattle in Morocco. This tick is also a suspected reservoir of R. aeschlimannii because transstadial and transovarial transmission Transovarial transmission occurs in certain arthropod vectors as they transmit disease-causing bacteria from parent arthropod to offspring arthropod. For instance, Rickettsia rickettsii have been reported (8). As a result, the distribution of R. aeschlimannii may parallel that of H. marginatum marginatum.
In 2002, the pathogenic role of infection with R. aeschlimannii was demonstrated by PCR and serologic testing in a patient who returned to France from Morocco (4). Clinical signs in this 36-year-old man were fever, generalized maculopapular rashes, and a vesicular vesicular /ve·sic·u·lar/ (ve-sik´u-ler)
1. composed of or relating to small, saclike bodies.
2. pertaining to or made up of vesicles on the skin.
3. lesion of the ankle that became necrotic and resembled the typical tache tache (tahsh) [Fr.] a spot or blemish.tachet´ic
tache blanche (blahnsh) a white spot on the liver in certain infectious diseases. noire of Mediterranean spotted fever. A second case was identified in a patient in South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. in 2002 (10). This patient had an eschar around the attachment site. No additional symptoms developed, and treatment with antimicrobial drugs may have prevented progression of the syndrome.
A total of 4.7% of the Rh. sanguineus ticks tested were infected by R. massiliae. This rickettsia was isolated from Rh. sanguineus ticks collected near Marseille, France, in 1992 (11). It has been also found in Rh. sanguineus and Rh. turanicus in Greece, Spain, Portugal, Switzerland, central Africa, and Mali (2,12,13). Eremeeva et al. (14) recently reported detection and isolation of R. massiliae from 2 of 20 Rh. sanguineus ticks collected in eastern Arizona in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . R. massiliae may be commonly associated with these ticks, which are distributed worldwide. Transstadial and transovarial transmission of rickettsia in ticks has been reported (13).
In 2003, serologic findings from Spain showed that in 5 of 8 serum samples titers against R. massiliae were higher than those against R. conorii, the agent of Mediterranean spotted fever (12). The authors analyzed clinical symptoms of patients with strong serologic reactions against R. massiliae antigens but did not find relevant clinical differences between these patients and those with Mediterranean spotted fever. However, it is generally recognized that there are relatively few clinical differences among the different spotted fever diseases, and these differences are occasionally not taken into account by clinicians when reporting clinical data of patients (12). The only confirmed case of a person infected with R. massiliae was a patient hospitalized in Sicily, Italy. This patient had fever, a maculopapular rash on the palms of his hands and the soles of his feet, an eschar, and hepatomegaly hepatomegaly /hep·a·to·meg·a·ly/ (hep?ah-to-meg´ah-le) enlargement of the liver.
The abnormal enlargement of the liver. Also called megalohepatia. . The strain of R. massiliae was isolated in Vero cells in 1985 and stored for 20 years in Sicily, but was not definitively identified until 2005 at the Unite de Rickettsies in Marseille, France (15).
The third SFG pathogenic rickettsia found in our study was R. slovaca in 5 (45.5%) of 11 D. marginatus. R. slovaca, which was identified in Dermacentor spp. ticks in Slovakia in 1968, has been subsequently found in D. marginatus and D. reticulatus in France, Switzerland, Portugal, Spain, Armenia, Poland, Bulgaria, Croatia, Russia, and Germany (2,16). These ticks may act as vectors and reservoirs of R. slovaca, which is maintained in ticks through transstadial and transovarial transmission (17). Human infection with R. slovaca was reported in France in 1997. Patients with similar clinical signs were observed in Spain, Bulgaria, and Hungary, where the syndrome was known as tick-borne lymphadenopathy lymphadenopathy /lym·phad·e·nop·a·thy/ (-op´ah-the) disease of the lymph nodes.
angioimmunoblastic lymphadenopathy , angioimmunoblastic lymphadenopathy with dysproteinemia or Dermacentor-borne necrosis erythema erythema (ĕr'əthē`mə), more or less diffuse redness of the skin due to concentration of an abnormally large amount of blood within the small vessels of the skin (hyperemia), as in burns. lymphadenopathy because of eschar at the tick bite site in the scalp and cervical lymphadenopathy cervical lymphadenopathy Cervical adenopathy, cervical lympadenitis ENT Enlarged and inflammed LNs of neck Etiology Viral, bacterial–eg, Streptococcus infection, or tonsillitis, pharyngitis, dental infections Clinical Pain, tenderness, lymphadenopathy (2,18-20). The incubation period incubation period
1. See latent period.
2. See incubative stage.
Incubation period ranges from 4 to 15 days. Low-grade fever In medicine, low-grade fever is a continuous or fluctuating low fever, typically defined as never exceeding 38.5 degrees Celsius (about 101 degrees Fahrenheit). It is a non-specific finding, but occurs in many diseases, ranging from infectious (viral infections or infective and rash were present. The acute disease can be followed by fatigue and residual alopecia alopecia (ăl'əpē`shēə): see baldness. at the bite site (16,21). Recently, Gouriet et al. reported 14 new cases with tick-borne lymphadenopathy and Dermacentor-borne necrosis erythema lymphadenopathy in southern France Southern France (or the South of France), colloquially known as Le Midi, is a loosely defined geographical area consisting of the regions of France that border the Atlantic Ocean south of the Gironde, Spain, the Mediterranean Sea, Italy, and Switzerland south of the during January 2004--May 2005 (22). In this group, tick-borne lymphadenopathy occurred mainly in young children and women and during the colder months (22). Overall, data in our study indicate that clinicians should be aware that this tick-related disorder may be found in Morocco.
R. raoultii is a recently described SFG rickettsia (23). In 1999, three new rickettsial genotypes, RpA4, DnS14, and DnS28, were identified in ticks collected in Russia by using PCR amplification and sequencing of 16S rDNA, gltA, and ompA genes. Genotypes identical to DnS14, DnS28, and RpA4 were thereafter detected in various areas in Russia and Kazakhstan in D. reticulatus, D. marginatus, and D. silvarum (24), in Germany and Poland in D. reticulatus (25,26), and in Spain, France, and Croatia in D. marginatus (23). Recently, cultivation of 2 rickettsial isolates genetically identical to Rickettsia sp. genotype DnS14, two rickettsial isolates genetically identical to Rickettsia sp. genotype RpA4, and 1 rickettsial isolate genetically identical to Rickettsia sp. genotype DnS28 was described (23). These isolates have been shown to fulfill the requirements for their classification within a new species, R. raoultii, by using multigene sequencing (16S rDNA, gltA, ompA, ompB, sca4, ftsY, and rpoB genes) and serotyping techniques (23,27). In our study, we detected R. raoultii in D. marginatus in Morocco. This tick is found in the cooler and more humid areas of the Mediterranean region associated with the Atlas Mountains. It is restricted to small areas of Morocco and Tunisia (28). Detection of R. raoultii in Morocco is of clinical relevance because it is suspected to be a human pathogen. In 2002, it was detected in D. marginatus obtained from a patient in France in whom typical clinical symptoms of tick-borne lymphadenopathy developed (23).
R. helvetica is another species identified in Morocco in this study. It is one of the few SFG species in which a commonly used ompA primer set does not amplify a PCR product (7,29). However, sequencing gltA enabled definitive identification. R. helvetica was isolated in Switzerland from I. ricinus in 1979 and has been identified in many European countries, where the tick is both a vector and a reservoir (2). The distribution of R. helvetica is not limited to Europe but extends into Asia (30). Our data show that the distribution of this bacterium extends into northern Africa. A small population of I. ricinus is present in Tunisia, Algeria, and Morocco. Our study was conducted in Taza, a humid area in the middle of the Atlas Mountains, which was the only site in Morocco that contained I. ricinus ticks (2).
R. helvetica was considered to be a nonpathogenic rickettsia for [approximately equal to] 20 years after its discovery. However, in 1999 it was implicated im·pli·cate
tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates
1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot.
2. in fatal perimyocarditis in patients in Sweden (31). The authors of this study subsequently reported a controversial association between R. helvetica and sarcoidosis Sarcoidosis Definition
Sarcoidosis is a disease which can affect many organs within the body. It causes the development of granulomas. Granulomas are masses resembling little tumors. They are made up of clumps of cells from the immune system. in Sweden (32) and found R. helvetica DNA in human aortic valves (33). However, the validity of these associations has been questioned by some rickettsiologists (2), and additional studies did not detect antibodies to rickettsia in a group of Scandinavian sarcoidosis patients (34). In 2000, seroconversion seroconversion /se·ro·con·ver·sion/ (-con-ver´zhun) the change of a seronegative test from negative to positive, indicating the development of antibodies in response to immunization or infection. for R. helvetica was described in a patient in France with a nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik)
1. not due to any single known cause.
2. not directed against a particular agent, but rather having a general effect.
1. febrile febrile /feb·rile/ (feb´ril) pertaining to or characterized by fever.
Of, relating to, or characterized by fever; feverish. illness (35). Serologic data, including cross-absorption and Western blotting, supported R. helvetica as the cause of disease. During 2003-2007, serologic findings in tickbite patients or in patients with fever of unknown origin Fever of Unknown Origin Definition
Fever of unknown origin (FUO) refers to the presence of a documented fever for a specified time, for which a cause has not been found after a basic medical evaluation. from Switzerland, Italy, France, and Thailand were suggestive of suggestive of Decision making adjective Referring to a pattern by LM or imaging, that the interpreter associates with a particular–usually malignant lesion. See Aunt Millie approach, Defensive medicine. acute or past R. helvetica infection (5,36). The few patients with a serology-based diagnosis had relatively mild, self-limited illnesses associated with headache and myalgias, and had a rash or eschar less frequently. Additional evaluation and isolation of the bacterium from clinical samples are needed to confirm the pathogenicity of R. helvetica.
We have detected in I. ricinus ticks a bacterium known as R. monacensis that was isolated from L ricinus collected in 1998 in a park in Munich, Germany (37). This rickettsia is also found in the literature by other names such as the Cadiz agent found in Spain and Rickettsia IRS An abbreviation for the Internal Revenue Service, a federal agency charged with the responsibility of administering and enforcing internal revenue laws. 3 and IRS4, detected in Slovakia and Bulgaria. More recently, it has been identified in I. ricinus in Hungary (38). Recently, 2 human cases of infection with R. monacensis were documented in Spain (39). Investigators isolated this agent from the blood of 2 patients with Mediterranean spotted fever-like illnesses. The first patient was an 84-year-old man from La Rioja La Rioja
Autonomous community (pop., 2001: 276,702), province, and historical region, north-central Spain. Covering 1,944 sq mi (5,035 sq km), it was known until 1980 as Logroño; its capital is Logroño city. , Spain. He had fever and maculopapular rash without any inoculation inoculation, in medicine, introduction of a preparation into the tissues or fluids of the body for the purpose of preventing or curing certain diseases. The preparation is usually a weakened culture of the agent causing the disease, as in vaccination against eschar. The second patient was a 59-year-old woman from the Basque region of Spain. She had a history of a tickbite, fever, and a rash at the tickbite site (39). With our results, R. monacensis joins the list of autochthonous autochthonous /au·toch·tho·nous/ (aw-tok´thah-nus)
1. originating in the same area in which it is found.
2. denoting a tissue graft to a new site on the same individual. Rickettsia spp. confirmed as human pathogens in Morocco.
A total of 69% of Haemaphysalis spp. ticks tested harbored an incompletely described rickettsia. A closely related gltA sequence was found in GenBank as Rickettsia endosymbiont of Haemaphysalis sulctata. Duh duh
Used to express disdain for something deemed stupid or obvious, especially a self-evident remark.
[Imitative of an utterance attributed to slow-witted people.] et al. detected this bacterium in Ha. sulcata ticks collected from sheep and goats in southern Croatia (40). Using molecular analysis of the complete gltA gene and a portion of ompB, these authors detected this bacterium in 795 (22.8%) ticks tested. Similar to our findings, these researchers could not amplify DNA by PCR for the ompA gene with the primers Rr. 190.70-Rr. 190.701. Identification and isolation of this bacterium are needed until the name provisionally proposed by Dub et al, "R. kastelanii" (40), is accepted (41).
These findings demonstrate that species of ticks and several pathogens causing tick-transmitted diseases may be prevalent in the same area. Our study also detected R. slovaca, R. helvetica, R. monacensis, R. raoultii, and an incompletely described rickettsia in Morocco. Clinicians in Morocco and those who may see patients returning from this country should be aware that many species of rickettsiae are present in this region and should consider a range of spotted fever rickettsial diseases in differential diagnosis differential diagnosis
Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering. Also called differentiation. of patients with febrile illnesses. Our data increase information on distribution of SFG rickettsiae in Morocco. Additional studies are needed to determine the epidemiologic and clinical relevance of different rickettsioses in this region.
DOI (Digital Object Identifier) A method of applying a persistent name to documents, publications and other resources on the Internet rather than using a URL, which can change over time. : 10.3201/eid 1407.070096
We thank Christopher D. Paddock for editing the manuscript.
Dr Sarih is chief of the Laboratory of Medical Entomology The discipline of medical entomology, or public health entomology, is devoted to the study of insects and closely related arthropods that impact human health. This includes the study of information gained from scientific research on the behavior, ecology, and epidemiology of at the Pasteur Institute The Pasteur Institute (French: Institut Pasteur) is a French non-profit private foundation dedicated to the study of biology, microorganisms, diseases and vaccines. in Casablanca, Morocco. His research interests include emerging tick-borne diseases.
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Address for correspondence: Philippe Parola, Unite des Rickettsies, Centre National de la Recherche Scientifique--Institut de Recherche re·cher·ché
1. Uncommon; rare.
2. Exquisite; choice.
3. Overrefined; forced.
4. Pretentious; overblown. pour le Developpement, Unite Mixte de Recherche 6236, World Health Organization Collaborative Center for Rickettsioses and Other Arthropod arthropod
Any member of the largest phylum, Arthropoda, in the animal kingdom. Arthropoda consists of more than one million known invertebrate species in four subphyla: Uniramia (five classes, including insects), Chelicerata (three classes, including arachnids and horseshoe Borne Bacterial Diseases, Faculte de Medecine, 27 Bd Jean Moulin, 13005 Marseille, France; email: firstname.lastname@example.org
Mhammed Sarih, * (1) Cristina Socolovschi, ([dagger]) (1) Najma Boudebouch, * Mohammed Hassar, * Didier Raoult, ([dagger]) and Philippe Parola ([dagger])
* Institut Pasteur du Maroc, Casablanca, Morocco; and ([dagger]) World Health Organization Collaborative Center for Rickettsioses and Other Arthropod Borne Bacterial Diseases, Marseille, France (1) These authors contributed equally to this article.
Table. Detection and identification of spotted fever group Rickettsia spp. from ticks collected in Morocco, by PCR and DNA sequencing Rickettsial gene targeted/no. ticks positive Tick species (no. specimens by PCR/no. tested) Host examined * Dermacentor marginatus (11) Vegetation gltA/6/11 ompA/6/6 Hyalomma marginatum Domestic animals gltA/3/35 marginatum (35) ompA/3/3 Haemaphysalis sulctata (79) Domestic animals gltA/61/79 ompA/0/61 Ha. punctata (6) Domestic animals gltA/3/6 ompA/0/3 Haemaphysalis sp. (18) Vegetation gltA/14/18 ompA/0/14 Ixodes ricinus (14) Vegetation gltA/9/14 ompA/5/9 Rhipicephalus sanguineus (106) Domestic animals gltA/5/106 ompA/5/5 Rh. bursa (76) Domestic animals gltA/0/76 Rh. turanicus (25) Domestic animals gltA/0/25 Rickettsial gene targeted/no. ticks positive Identification by by PCR/no. gene sequence GenBank accession examined * (no. identified/no. tested) no. gltA/6/11 R. slovaca (5/6), U59725, D0365803 R. raoultii (1/6) ompA/6/6 R. slovaca (5/6), U43808, DQ365799 R. raoultii (1 /6) gltA/3/35 R. aeschlimannii U59722 ompA/3/3 R. aeschlimannii DQ379982 gltA/61/79 "Rickettsia endosymbiont of DQ081187 Ha. Sulctata" ("R. kastelanii") ompA/0/61 -- -- gltA/3/6 "Rickettsia endosymbiont of DQ081187 Ha. Sulctata" ("R. kastelanii") ompA/0/3 gltA/14/18 "Rickettsia endosymbiont of DQ081187 Ha. Sulctata" ("R. kastelanii") ompA/0/14 -- -- gltA/9/14 R. monacensis (5/9), AF140706, U59723 R. helvetica (4/9) ompA/5/9 R. monacensis (5/9) AJ427885 gltA/5/106 R. massiliae U59720 ompA/5/5 R. massiliae U43792 gltA/0/76 -- -- gltA/0/25 -- -- * gltA, citrate synthase A; ompA, outer membrane protein A. Only ticks positive for the gltA gene were tested for the ompA gene.