Fever Rickettsiae Research Articles

Diagnosis of Rickettsioses in Clinically Suspected Cases of Rickettsial Fever by Real-Time PCR in a Tertiary Care Centre

Diagnosis of Rickettsioses in Clinically Suspected Cases of Rickettsial Fever by Real-Time PCR in a Tertiary Care Centre

A Clinical Study of Rickettsial Fever and Factors Affecting Its Outcome.

Rickettsiae comprise a family of obligate intracellular short gram-negative coco-bacilli and are transmitted by insects, mites, fleas, louse, and tick vectors. Scrub typhus, north-Asian tick typhus, rickettsia pox, and boutonniere fevers are common in India and Asia. In the early phase of illness during the initial five days, all these are indistinguishable among themselves; also, they mimic any other self-limiting viral fever. Patients usually present with fever, headache, myalgia, malaise, nausea, vomiting, and anorexia. Rarely do patients present with rash, or give a history of exposure to animals or tick bite. Thus, rickettsial diseases are missed in the early phase, when they are easily treatable, due to lack of suspicion. To study clinical features, investigations, outcomes, and factors affecting the outcome of rickettsial fever. This was an observational study conducted from December 2012 to November 2014 in a tertiary care hospital. The study population consisted of patients above the age of 13 years with a history of any one or more of the following: fever, headache, jaundice, altered sensorium, renal dysfunction, tick bite, a farmer by occupation, exposure to cattle or sheep or dog, multiorgan failure; with serological evidence of rickettsial infection by Weil-Felix test (ox-19/ox-2/ox-k ≥ 1:320) or rickettsial antibody IgM ≥ 1.1) or PCR positive. A sample size of 40 was considered for the final analysis of this study. Statistical analysis was done using inferential statistical tests such as the chi-square test and odds ratio (OR). The most common presenting symptom was fever (100%) seen in almost every patient followed by body aches (72.5%), joint pain (62.5%), andjaundice (62.5%). General examination showed icterus (37.5%), hypotension (30%), edema (22.5%), lymphadenopathy (22.5%), andpallor (15%).On the day of admission, 17 patients were found to have the Weil-Felix test positive with an OR of 0.538462 (CI = 0.151-1.917), while the Weil-Felix test done in the second week was positive in 37 patients with an OR of 5.4 (CI = 0.439-63.11). Rickettsial antibodies were positive only in three patients on the day of admission with an OR of 0.381 (CI = 0.0317-4.58), while in the second week, rickettsial antibodies were positive in 27 patients with an OR of 16.25. The rickettsial PCR test was positive in 13 patients with an OR of 1.48 (CI = 0.3857-5.722). The mortality rate was significantly high in patients presenting with breathlessnessandrespiratory complications like pneumonia, pulmonary edema, and acute respiratory distress syndrome. Similarly, patients presented with hypotension and required Ionotropic support had a high mortality rate. While the clinical presentation of rickettsia infection is similar, the causative species and epidemiology can vary depending on the region. It is important to recognize both the typical symptoms and the epidemiology of a given region to correctly diagnose and treat these infections promptly, as they can be associated with significant morbidity and mortality. Through this study, we attempt to bring awareness about this disease which would help clinicians to suspect and start treatment at the earliest before complications set in.

Molecular detection of rickettsial agents in Amblyomma maculatum ticks (Ixodida: Ixodidae) from Ecuador.

Rickettsiales are obligate intracellular bacteria that need vertebrates and arthropods to maintain their life cycles. Some species of the genera Anaplasma, Ehrlichia, and Rickettsia are transmitted by ticks to both animals and humans and can cause mild to severe and even fatal cases. In the Americas, there is substantial data on rickettsial agents, encompassing both clinical cases and the detection of these agents in ticks, but in Ecuador, the information about them remains poorly understood. Therefore, the objective of this study was to detect molecularly rickettsial agents in Amblyomma maculatum ticks in both parasitic and free-living phases collected from domestic animals and pasture in five localities across three coastal provinces of Ecuador. Rickettsia parkeri, Candidatus Rickettsia andeanae, and Ehrlichia sp. were recorded in A. maculatum for the first time in Ecuador. These records were made in a region where antibodies to the Spotted Fever Rickettsia Group were detected in humans. Additional studies are needed to characterize Ehrlichia sp. at a specific level. Furthermore, recognizing the specific Rickettsiales species circulating in the ticks and the hosts within a region is crucial for assessing potential contact risks.

Ticks (Acari: Ixodidae) and rickettsiae associated with wild boars in a rural area of Minas Gerais, Brazil

Wild boars or feral pigs are classified by the Brazilian Institute for the Environment and Renewable Resources (IBAMA) in “Category I of invasive exotic species”. They cause economic losses, harm the environment, serve as hosts and reservoirs for several zoonotic disease agents, and provide a blood meal for tick species that act as vectors for zoonotic diseases. The objective of this study was to identify tick species on wild boars, assess host-seeking ticks in the related environment, and identify other potential tick hosts coexisting with wild boars on a farm located in the state of Minas Gerais, southeastern Brazil. Additionally, the study aimed to determine the presence of rickettsiae in these arthropods and assess the exposure of wild boars to rickettsiae species from the Spotted Fever Group and Rickettsia bellii through serology. A total of 3585 host-seeking ticks from three species (Amblyomma sculptum – 41.58%; Amblyomma dubitatum – 0.39% and Rhipicephalus microplus – 0.05%) were collected in the environment and A. sculptum was the most abundant species. Thirty-one wild boars were evaluated, resulting in the collection of 415 ticks, all of which were A. sculptum. Rickettsia DNA was not detected in samples of A. sculptum and R. microplus from the environment or in A. sculptum ticks from wild boars. However, all A. dubitatum ticks (n = 14) had Rickettsia bellii DNA confirmed by the species-specific PCR protocol. Out of the 31 serum samples from wild boars, 24 reacted with at least one Rickettsia antigen. Among these, seven individuals exhibited a reaction to a probable homologous antigen (PHA) of three rickettsiae species: R. rickettsii (n = 3), R. amblyommatis (n = 3) and R. rhipicephali (n = 1). Despite the high prevalence of seroreactivity, titers were low, indicating limited exposure to Rickettsia spp. Camera traps generated 874 animal records, capturing a total of 1688 individuals. At least 11 species of birds and 14 species of mammals (12 wild and two domestic) shared the environment with wild boars and potentially shared ticks with them. These findings provide baseline information for understanding the sharing of ticks and tick-borne pathogens between wild boars and other animals within the Cerrado biome. Further studies are necessary to monitor the potential and actual risk of wild boars to harbor infected ticks and their role in the transmission and maintenance cycle of Rickettsia spp.

Histopathological effects of the fruit extract of Citrullus colocynthis on the ovary of the tick Hyalomma dromedarii

Hyalomma dromedarii is the predominant tick species parasitizing camels in Egypt which leads to mortalities in young animals that result in economic losses. It can transmit a lot of pathogens to animals and humans, such as the Crimean-Congo hemorrhagic fever virus, the Dhori virus, Kadam virus, Theileria annulata and spotted fever rickettsia. The continuous use of chemical acaricides has negative impact on the environment and almost led to acaricidal resistance, and hence the plant extracts represent alternative methods for controlling ticks. The present study was carried out to assess the histopathological effects on the ovary of fed female Hyalomma dromedarii following immersion in the ethanolic extract of fruits of Citrullus colocynthis (100 mg/mL). Light, scanning and transmission electron microscopy observations provided evidence that Citrullus colocynthis caused extensive damage to oocytes. Destruction of the internal organelles of oocytes, along with delay and/or inhibition of vitellogenesis were demonstrated. This is the first histological study that points to damage in H. dromedarii ovaries following treatment with the ethanolic extract of fruits of C. colocynthis. The data presented suggest that the plant extract affects the ovary either directly by entering the oocytes and/or indirectly by damaging the gut cells and digestion of blood that interfere with the development of oocytes, so it can be used as a promising agent for tick control.

Post-fever Retinitis With a Positive Weil-Felix Test: A Study From a Tertiary Center in South India.

Background Post-fever retinitis (PFR) is reported two to six weeks after fever and affects one or both eyes. Rickettsial fever is one of the most common causes of PFR. This study aimed to report the clinical features and treatment outcomes of PFR cases with a positive Weil-Felix test. Methodology In this study, we collected demographic data, fever details, eye symptoms, ocular examination findings, optical coherence tomography (OCT) and fundus fluorescein angiography findings, laboratory findings, and length of follow-up of consecutive PFR cases with a positive Weil-Felix test. All cases were treated with oral doxycycline and prednisolone. Final best-corrected visual acuity (BCVA) and ocular examination findings were recorded. Visual field examination and follow-up OCT results were noted if available. Results A total of nine patients (eight males) with a mean age of 39.1 years with fever before ocular symptoms and positive Weil-Felix test were included.Six patients had bilateral disease. The mean initial and final BCVA in the affected eyes was 1.16 and 0.35 logMAR units, respectively (p < 0001). All 15 eyes had typical white retinitis patches and retinal hemorrhages which resolved after treatment. OCT showed hyperreflectivity and inner retinal disorganization over retinitis patches. White subretinal lines were noted in three patients and retinal nerve fiber bundle defect with corresponding visual field defect was seen in one eye. Conclusions In this study, PFR due to rickettsia infections has been reported from our region for the first time. Hence, eye specialists in the region should be aware of this entity.

Investigating the etiologies of non-malarial febrile illness in Senegal using metagenomic sequencing

The worldwide decline in malaria incidence is revealing the extensive burden of non-malarial febrile illness (NMFI), which remains poorly understood and difficult to diagnose. To characterize NMFI in Senegal, we collected venous blood and clinical metadata in a cross-sectional study of febrile patients and healthy controls in a low malaria burden area. Using 16S and untargeted sequencing, we detected viral, bacterial, or eukaryotic pathogens in 23% (38/163) of NMFI cases. Bacteria were the most common, with relapsing fever Borrelia and spotted fever Rickettsia found in 15.5% and 3.8% of cases, respectively. Four viral pathogens were found in a total of 7 febrile cases (3.5%). Sequencing also detected undiagnosed Plasmodium, including one putative P. ovale infection. We developed a logistic regression model that can distinguish Borrelia from NMFIs with similar presentation based on symptoms and vital signs (F1 score: 0.823). These results highlight the challenge and importance of improved diagnostics, especially for Borrelia, to support diagnosis and surveillance.

To Study Clinical Profile and Significance of Rathi Goodman Aghai Score System in Rickettsial Infection in Central Maharashtra

Abstract Introduction: Rickettsial disease has nowadays emerging as one of the most common causes of exanthematous fever with rash with high mortality and morbidity. Rickettsial fever cases are being reported from all over India. Objectives: The study aims to evaluate prevalence, demographic and clinical details of the cases of rickettsial infection in central India and to assess the significance of Rathi Goodman Aghai (RGA) score and Weil Felix test in diagnosis of rickettsial infection. Materials and Methods: It was a retrospective, analytical comparative study. Patients between age group of 2 months to 18 years from endemic area presenting with fever of more than 4 days duration and/or typical rash (maculopapular/necrotic) with eschar and supporting laboratory test were included in the study. Patients’ demographic and clinical data were analyzed by the software STATA software. and Chi square test. Results: The most common age group affected was between 1 and 5 years (38.09%). 76.19% of patients were from rural area. All the patients 21 (100%) presented with fever. The most common complication was meningoencephalitis (42.85%). Rathi Aghai score was positive in 90.47% of the patients. Weil Felix test was positive in 85.71% cases, out of which 33.33% of patients had OXK strain. The sensitivity and specificity of RGA score was found to be 94.44% and 33.33%, respectively, with positive predictive value of 89.47%. Conclusion: RGA score is a good tool for diagnosis of rickettsial infection with sensitivity and specificity of 94.44% and 33.33%, respectively.

Detection of tick-borne bacterial DNA (Rickettsia sp.) in reptile ticks Amblyomma moreliae from New South Wales, Australia

Ticks are major arthropod vectors of disease, transmitting tick-borne pathogens during blood meal episodes. Rickettsia spp. and Borrelia spp. are two tick-borne pathogens of zoonotic concern previously identified in DNA isolates from the tick genera Amblyomma and Bothriocroton associated with reptilian hosts in Australia. Some reports suggest that these reptile ticks bite and attach to humans via accidental parasitism and transmit disease, with the tick Bothriocroton hydrosauri known to transmit Rickettsia honei or Flinders Island Spotted Fever Rickettsia to humans. This descriptive study aims to identify the ticks collected from wild reptiles submitted to veterinary clinics and captured by snake rescuers from New South Wales (NSW), Australia, and detect the presence of tick-borne bacterial DNA using quantitative polymerase chain reaction (qPCR) to detect Rickettsia spp. and Bartonella spp. and conventional nested-PCR to detect Borrelia spp. Morphological identification revealed ticks removed from one eastern blue-tongued lizard (Tiliqua scincoides scincoides) from North-Eastern NSW (Lismore), one eastern blue-tongued lizard from the Greater Sydney area (Canley Heights), one diamond python (Morelia spilota spilota) from the Greater Sydney area (Woronora Heights) and one red-bellied black snake (Pseudechis porphyriacus) from the Greater Sydney Area (Cronulla) in New South Wales were Amblyomma moreliae. No ticks were positive for Bartonella spp. and Borrelia spp. DNA using real-time PCR targeting ssrA gene and nested PCR targeting Borrelia-specific 16S rRNA gene, respectively. Real-time PCR targeting gltA, ompA, ompB and 17kDa gene of Rickettsia spp. revealed 14 out of 16 ticks were positive. The undescribed Rickettsia sp. DNA was identical to that previously recovered from reptile ticks in Australia and closely related to Rickettsia tamurae and Rickettsia monacensis, both of which are aetiologic pathogens of the Spotted Fever Group Rickettsiosis (SFGR). These results accentuate the ongoing need for increased study efforts to understand zoonotic potential of bacteria from reptile ticks and the tick-reptile-human relationship.

New tick records with notes on rickettsial infection from the wildlife of the state of Espírito Santo, southeastern Brazil

This work aimed to report ticks infesting the wildlife among 15 municipalities of the state of Espírito Santo between 2016 and 2021, within the Atlantic Forest biome of southeastern Brazil. A total of 576 tick specimens (187 males, 56 females, 149 nymphs, and 184 larvae) was collected from 41 species of wild vertebrates (two reptiles, nine mammals, and 30 birds). Ticks were identified by morphological or molecular methods into 18 species, being 12, four, one and one of the genera Amblyomma, Ixodes, Rhipicephalus and Ornithodoros, respectively. Amblyomma rotundatum was the only species collected from reptiles. Ticks collected from mammals were identified as Amblyomma brasiliense, Amblyomma calcaratum, Amblyomma dubitatum, Amblyomma longirostre, Amblyomma nodosum, Amblyomma pacae, Amblyomma sculptum, Amblyomma varium and Rhipicephalus microplus. Amblyomma sculptum was the species found on the widest variety of hosts, collected from four mammal orders and five bird orders. Passeriformes birds were infested by Amblyomma fuscum, A. longirostre (also found on non- passerine birds), A. nodosum, Amblyomma parkeri, Amblyomma romarioi, A. varium and Ixodes loricatus. An adult female of Ixodes rio was collected from a Piciformes bird. Seabirds of the order Procellariiformes were infested by Ixodes percavatus sensu lato and Ixodes uriae. The argasid Ornithodoros capensis was collected from an offshore metallic platform that was used by Suliformes seabirds. Rickettsial agents of the spotted fever group, Rickettsia amblyommatis and Rickettsia sp. strain Pampulha, were detected in the ticks A. longirostre [from the Paraguayan hairy dwarf porcupine (Coendou spinosus)] and A. dubitatum [from the capybara (Hydrochoerus hydrochaeris)], respectively. The following nine tick species are reported for the first time in Espírito Santo state: A. calcaratum, A. fuscum, A. pacae, A. parkeri, A. romarioi, I. loricatus, I. rio, I. uriae, and O. capensis. Although it is also the first report of I. uriae in Brazil, we do not consider it established in the country. Multiple new tick-host associations are reported in the present study.

SCRUB TYPHUS - A RE-EMERGING DISEASE: ESTIMATING THE BURDEN AND OUTCOME OF SCRUB TYPHUS IN A TERTIARY CARE CENTRE

Background: Scrub typhus is regarded as an important cause of acute febrile illness. If not diagnosed early, it is often tends to be fatal. Methods: A Prospective Observational study was carried out among patients reporting with fever in a tertiary care hospital at Delhi. Weil Felix test and rapid test for scrub typhus was performed on the patient samples. Results: A total of 265 cases were screened for typhus group of fever, of these 26 (9.1%) patients (18 males and 8 females) were diagnosed having rickettsial fever. Out of these, 24 (92.3%) were diagnosed having scrub typhus fever. Conclusions:In present study, we observed 9.1% seropositivity in acute febrile illness. We conclude that a simple Weil Felix test should be included in routine workup of fever cases and a strong suspicion should be there where other laboratory tests remain inconclusive in endemic areas like Delhi-NCR.

Current Status of Vector-Borne Diseases in Croatia: Challenges and Future Prospects.

Different vector-borne pathogens are present or have (re-)emerged in Croatia. Flaviviruses tick-borne encephalitis (TBEV), West Nile (WNV), and Usutu (USUV) are widely distributed in continental regions, while Toscana virus (TOSV) and sandfly fever viruses are detected at the Croatian littoral. Recently, sporadic clinical cases of Tahyna orthobunyavirus (TAHV) and Bhanja bandavirus infection and seropositive individuals have been reported in continental Croatia. Acute infections and serologic evidence of WNV, TBEV, USUV, and TAHV were also confirmed in sentinel animals and vectors. Autochthonous dengue was reported in 2010 at the Croatian littoral. Lyme borreliosis is the most widely distributed vector-borne bacterial infection. The incidence is very high in northwestern and eastern regions, which correlates with numerous records of Ixodes ricinus ticks. Acute human Anaplasma phagocytophilum infections are reported sporadically, but there are many records of serologic evidence of anaplasmosis in animals. Mediterranean spotted fever (Rickettsia conorii) and murine typhus (Rickettsia typhi) are the main rickettsial infections in Croatia. Human leishmaniasis is notified sporadically, while serologic evidence of leishmaniasis was found in 11.4% of the Croatian population. After the official eradication of malaria in 1964, only imported cases were reported in Croatia. Since vector-borne diseases show a growing trend, continuous monitoring of vectors is required to protect the population from these infections.

Tick-borne infections in the south of Russia: modern epidemiological situation, new approach to create “forecasting” and “explaining” morbidity models (in astrakhan rickettsiosis fever and crimean-congo hemorrhagic fever)

The article presents a description of the current tick-borne infection epidemiological situation in the south of Russia from the years 2013 to 2022, proposes a new approach to develop forecasting models for morbidity dynamics of Astrakhan rickettsial fever (ARF) and Crimean hemorrhagic fever (СCHF) in the Astrakhan region and presents data assessing 2022 explaining models for the Stavropol Territory and Astrakhan Region. Materials and methods. A comprehensive research was performed using epidemiological analysis and non-parametric statistical methods. The data assessing tick-borne infections epidemic process manifestations were retrieved from ARF and CCHF morbidity databases (developed as a project) and documents of infectious disease focus epidemiological examination provided by the departments of Rospotrebnadzor in the subjects of the Southern and North Caucasian Federal Districts. Morbidity models were developed using the Bayes theorem and Walds sequential statistical analysis, with a preliminary calculation of indicators informativeness by the Kullback method. The values of climatic factors from the database of the Center for Collective Use IKI-monitoring of the Space Research Institute of the Russian Academy of Sciences were used. Results. The results of the study indicate persistence of serious epidemiological situation regarding rickettsiosis of the tick-borne spotted fever group, Q fever, tick-borne borreliosis and CCHF in the south of Russia. Almost all tick-borne infections nosological forms in children under 14 years (including young children and infants) were widely involved in the epidemic process, which belong to patients at risk for a complicated disease course due to complicated diagnostics and treatment. The annual registration of tick-borne infections cases in the resort areas, with the subsequent occurrence of imported cases in other, including non-endemic regions poses a serious problem. The proposed forecasting models allow to predict the CСHF and ARF morbidity for each administrative district of the Astrakhan region with up to 91.7% accuracy. The explaining models CСHF accuracy for the Stavropol Territory and Astrakhan Region, when tested in 2022, was 88.5 and 83.3%, respectively, for ARF 91.7%. Conclusions. The further continuation of forecasting and explaining models verification for planning preventive measures and propose similar steps for tick-borne borreliosis and Q fever to epidemiological tick-borne infections to stabilize situation in the south of Russia.

Signatures in in vitro infection of NSC-34 mouse neurons and their cell nucleus with Rickettsia helvetica

BackgroundRickettsia helvetica, a spotted fever rickettsia, is transmitted to humans via ticks in Europe, North Africa, and Asia. The central nervous system is a crucial target for rickettsial diseases, which has been reported for 12 of the 31 species, of which R. helvetica is one. This study aimed, in an experimental model, to identify characteristics of R. helvetica infection in a mouse neuronal cell line, NSC-34.ResultsNSC-34, a fusion cell line of mouse motor spinal cord neurons and neuroblastoma cells, was used as a model. Propagation of R. helvetica in neurons was confirmed. Short actin tails were shown at the polar end of the bacteria, which makes it likely that they can move intracellularly, and even spread between cells. Another protein, Sca4, which with the cell adhesion protein vinculin enables the passage of the cell membrane, was expressed during infection. No significant increase in TNFα levels was seen in the infected neurons, which is of interest because TNFα protects the host cell from infection-induced apoptotic death which is crucial for host cell survival. The bacteria were also shown to invade and grow in the cell nucleus of the neuron.ConclusionsThe findings suggest that a R. helvetica infection may be harmful to NSC-34 neurons under these in vitro conditions, but the full effects of the infection on the cell need to be studied further, also on human neurons, to also understand the possible significance of this infection in relation to pathogenetic mechanisms.

Explanatory models for tick-borne disease incidence (Astrakhan rickettsial fever and Crimean-Congo hemorrhagic fever)

Introduction. The study focuses on methods providing mathematical substantiation of discrepancies between actual incidence rates of Astrakhan rickettsial fever (ARF) and Crimean-Congo hemorrhagic fever (CCHF) and predicted rates due to the indirect impact of weather conditions during the current epidemic season.&#x0D; The purpose of the study was to develop explanatory models for ARF and CCHF incidence using satellite monitoring (remote sensing) data and to present the results of their practical evaluation in the Stavropol Territory and Astrakhan Region.&#x0D; Materials and methods. The materials included climate data provided by the Space Research Institute of the Russian Academy of Sciences as well as epidemiological data on CCHF and ARF incidence from 2005 to 2021. The explanatory models incorporated the Bayes theorem and Wald sequential analysis. All the calculations were completed using the Microsoft Excel 2010-based program developed by the authors.&#x0D; Results. It has been found that the greatest indirect effect on development of the CCHF epidemiological situation is produced by the normalized difference vegetation index and relative air humidity in June-July in the Stavropol Territory and by the maximum, minimum and average air temperature in October as well as the minimum air temperature in July in the Astrakhan Region. ARF incidence rates depend on the indirect effect of the annual average and average annual maximum temperature, maximum temperature and the normalized difference vegetation index in April-July. The match between explanatory model-based results and prediction model-based results ranged within 46.2-100%.&#x0D; Discussion. In addition to projecting incidence rates, which could be reached with the observed values of climatic factors in the current year, the explanatory models can be used for indirect verification of prediction models and for identification of factors causing differences in results.&#x0D; Conclusion. The practical evaluation of explanatory models confirms the prospects and benefits of the study that should be continued, involving other regions highly endemic for tick-borne infections.

Occurrence of Rickettsia spp., Hantaviridae, Bartonella spp. and Leptospira spp. in European Moles (Talpa europaea) from the Netherlands.

The European mole (Talpa europaea) has a widespread distribution throughout Europe. However, little is known about the presence of zoonotic pathogens in European moles. We therefore tested 180 moles from the middle and the south of the Netherlands by (q)PCR for the presence of multiple (tick-borne) zoonotic pathogens. Spotted fever Rickettsia was found in one (0.6%), Leptospira spp. in three (1.7%), Bartonella spp. in 69 (38.3%) and Hantaviridae in 89 (49.4%) of the 180 moles. Infections with Anaplasma phagocytophilum, Babesia spp., Neoehrlichia mikurensis, Borrelia spp., Spiroplasma spp. and Francisella tularensis were not found. In addition, in a subset of 35 moles no antibodies against Tick-borne encephalitis virus were found. The obtained sequences of Bartonella spp. were closely related to Bartonella spp. sequences from moles in Spain and Hungary. The Hantaviridae were identified as the mole-borne Nova virus, with high sequence similarity to sequences from other European countries, and Bruges virus. Though the zoonotic risk from moles appears limited, our results indicate that these animals do play a role in multiple host-pathogen cycles.

Modelling the current and future temperature suitability of the UK for the vector Hyalomma marginatum (Acari: Ixodidae)

Hyalomma marginatum is the main vector of Crimean-Congo haemorrhagic fever virus (CCHFV) and spotted fever rickettsiae in Europe. The distribution of H. marginatum is currently restricted to parts of southern Europe, northern Africa and Asia, and one of the drivers limiting distribution is climate, particularly temperature. As temperatures rise with climate change, parts of northern Europe currently considered too cold for H. marginatum to be able to survive may become suitable, including the United Kingdom (UK), presenting a potential public health concern. Here we use a series of modelling methodologies to understand whether mean air temperatures across the UK during 2000-2019 were sufficient for H. marginatum nymphs to moult into adult stages and be able to overwinter in the UK if they were introduced on migratory birds. We then used UK-specific climate projections (UKCP18) to determine whether predicted temperatures would be sufficient to allow survival in future. We found that spring temperatures in parts of the UK during 2000-2019 were warm enough for predicted moulting to occur, but in all years except 2006, temperatures during September to December were too cold for overwintering to occur. Our analysis of the projections data suggests that whilst temperatures in the UK during September to December will increase in future, they are likely to remain below the threshold required for H. marginatum populations to become established.

First detection and molecular identification of Rickettsia massiliae, a human pathogen, in Rhipicephalus sanguineus ticks collected from Southern Taiwan.

The Rickettsia massiliae was firstly detected and identified in Rhipicephalus sanguineus ticks infested on dogs in Taiwan. A total of 1154 Rh. sanguineus ticks collected from 158 dogs of four districts of Tainan city were examined for Rickettsia infection by nested-PCR assay targeting the citrate synthase (gltA) and outer membrane protein B (ompB) genes of Rickettsia. The Rickettsia infection was detected with a general infection rate of 2.77%, and was detected in male, female and nymphal stage with an infection rate of 2.77%, 3.22% and 1.32%, respectively. Phylogenetic relationships were analyzed by comparing the gltA and ompB sequences obtained from 9 Taiwan strains and 16 other strains representing 13 genospecies of Rickettsia. Results revealed that all Taiwan strains were genetically affiliated to the same clades of R. massiliae (spotted fever group) and R. felis (transitional group), and can be discriminated from other genospecies of Rickettsia. This study provides the first evidence of R. massiliae, a pathogenic spotted fever Rickettsia, identified in Rh. sanguineus ticks and highlight the potential threat for the regional transmission of Rickettsia infection among humans in Taiwan.

Technical Evaluation of qPCR Multiplex Assays for the Detection of Ixodes ricinus-Borne Pathogens.

The extent to which infections with Ixodes ricinus-borne pathogens (TBPs), other than Borrelia burgdorferi s. l. and tick-borne encephalitis virus (TBEV), cause disease in humans remains unclear. One of the reasons is that adequate diagnostic modalities are lacking in routine or research settings. We evaluated the analytical specificity, sensitivity and robustness of qPCR assays for the detection of Anaplasma phagocytophilum, Neoehrlichia mikurensis, Spiroplasma ixodetis, several Babesia species and Spotted Fever Rickettsia species as well as Bartonella species in human samples. The qPCRs were found to perform well, given the difficulties of dealing with microorganisms for which confirmed patient materials are scarce or non-existent, a hurdle that was partially overcome by using synthetic controls. Spiking blood samples with the tested microorganisms showed that the detection of the TBPs was not inhibited by the presence of blood. The acceptable sensitivity when multiplexing the different pathogens, the good inter-assay variability and the absence of cross-reactivity make them potentially suitable as human diagnostics. The qPCRs evaluated in this study are technically suitable for the laboratory diagnostic assessment of clinical samples for infection with tick-borne pathogens. However, clinical validation and independent confirmation are still needed, pending the availability of sufficient human samples for testing in different laboratories.

Increasing Incidence of Spotted Fever Group Rickettsioses in the United States, 2010-2018.

Spotted fever group Rickettsia species are intracellular bacteria transmitted by tick or mite vectors and that cause human diseases referred to as spotted fever group rickettsioses, or spotted fevers. In the United States, the most recognized and commonly reported spotted fevers are Rocky Mountain spotted fever (RMSF) (Rickettsia rickettsii), Rickettsia parkeri rickettsiosis, Pacific Coast tick fever (Rickettsia species 364D), and rickettsialpox (Rickettsia akari). In this study, we summarize and evaluate surveillance data on spotted fever cases reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System from 2010 to 2018. During this period, there were 36,632 reported cases of spotted fevers with 95.83% (N = 35,104) reported as meeting the case definition as probable and 4.17% (N = 1528) reported as meeting the case definition as confirmed. The average national incidence of total cases, both probable and confirmed, was 12.77 cases per million persons per year. The highest statewide incidence was in Arkansas, with 256.84 per million per year, whereas the lowest incidence occurred in California, with 0.32 per million per year (note that spotted fevers were not notifiable in Hawaii and Alaska). Cases of spotted fevers were reported more frequently among males by gender, White by race, and non-Hispanic by ethnicity. The incidence of spotted fevers increased significantly from 2010 to 2018, but it is uncertain how many of the reported cases were RMSF and how many developed from more moderate spotted fevers. Improvement of the ability to differentiate between spotted fever group Rickettsia species is needed.