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. 2021 Nov 14;10(11):1482.
doi: 10.3390/pathogens10111482.

Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar

Christian Keller  1   2 , Raphaël Rakotozandrindrainy  3 , Vera von Kalckreuth  4 , Jean Noël Heriniaina  3 , Norbert Georg Schwarz  5 , Gi Deok Pak  4 , Justin Im  4 , Ligia Maria Cruz Espinoza  4 , Ralf Matthias Hagen  6 , Hagen Frickmann  7   8 , Jean Philibert Rakotondrainiarivelo  3 , Tsiry Razafindrabe  3 , Denise Dekker  2 , Jürgen May  2   9   10 , Sven Poppert  2 , Florian Marks  3   4   11
Affiliations

Molecular Evidence for Flea-Borne Rickettsiosis in Febrile Patients from Madagascar

Christian Keller et al. Pathogens. .

Abstract

Rickettsiae may cause febrile infections in humans in tropical and subtropical regions. From Madagascar, no molecular data on the role of rickettsioses in febrile patients are available. Blood samples from patients presenting with fever in the area of the capital Antananarivo were screened for the presence of rickettsial DNA. EDTA (ethylenediaminetetraacetic acid) blood from 1020 patients presenting with pyrexia > 38.5 °C was analyzed by gltA-specific qPCR. Positive samples were confirmed by ompB-specific qPCR. From confirmed samples, the gltA amplicons were sequenced and subjected to phylogenetic analysis. From five gltA-reactive samples, two were confirmed by ompB-specific qPCR. The gltA sequence in the sample taken from a 38-year-old female showed 100% homology with R. typhi. The other sample taken from a 1.5-year-old infant was 100% homologous to R. felis. Tick-borne rickettsiae were not identified. The overall rate of febrile patients with molecular evidence for a rickettsial infection from the Madagascan study site was 0.2% (2/1020 patients). Flea-borne rickettsiosis is a rare but neglected cause of infection in Madagascar. Accurate diagnosis may prompt adequate antimicrobial treatment.

Keywords: Madagascar; Rickettsia felis; Rickettsia typhi; flea-borne rickettsiosis; murine typhus.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
An amplicon of 116 bp from the rickettsial citrate synthase gene (gltA) was aligned with gltA sequences from rickettsial reference strains retrieved from the NCBI database, using Clustal W (BioEdit 7.0.5.3). A phylogenetic analysis was performed in MEGA7 using the maximum likelihood method (Tamura-Nei model). The percentage of trees in which the associated taxa clustered together is shown next to the branches.
See this image and copyright information in PMC

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