Three-Toed Sloth As Putative Reservoir of Coxiella Burnetii

LETTERS

Three-Toed Sloth (13 goats, 8 sheep, 7 bats, 34 birds, 2 targeting the IS30a repeated sequence. opossums, 4 iguanas, and 17 geckos); DNA samples with Ct values <35 in as Putative all samples were negative for C. bur- both assays were considered positive Reservoir of netii by qPCR. In addition, serologic for C. burnetii. A standard calibration Coxiella burnetii, tests for C. burnetii were negative for curve quantifying the target IS1111 samples from all 37 small ruminants was generated by using 10-fold se- Cayenne, maintained near the outbreak area. rial dilutions of C. burnetii Nine French Guiana In January 2014, a dead (acciden- Mile strain. The number of IS1111 tal death) female 3-toed sloth (Brad- intergenic sequences found in the To the Editor: Q fever is an ypus tridactylus) (Figure, panel A) was genome of strain C. burnetii MST17 emerging zoonosis and a major pub- found on the road near the residence was identical to that for the Nine Mile lic health concern in French Guiana, a of a Q fever patient. We retrieved the strain (F. D’Amato, unpub. data); thus, French overseas region located on the sloth and collected feces, spleen, liver, the qPCR that we used was valid for northeastern coast of South America kidney, lung, and uterus samples and quantifying the number of C. burnetii (1,2). Most cases occur in the city of a vaginal swab sample. A total of 16 MST17 IS1111 copies/mL in samples Cayenne (3), specifically in the sub- ticks were removed from the sloth and we collected (5). urbs, where houses are near wooded stored in 70% alcohol. qPCR analysis showed that the hills (4). Genotyping performed by DNA was extracted from the fe- feces were highly positive for C. bur- using multispacer sequence typing ces, organs, and ticks by using the netii; the sample had a low Ct value showed that MST17, a unique geno- BioRobot EZ1 Workstation (QIA- of 23, corresponding to 7 log10 DNA type of C. burnetii, circulates in Cay- GEN, Courtaboeuf, France). qPCR copies/mL (9). The spleen was also enne and is responsible for epidemics targeting the repeated insertion se- positive for C. burnetii; the Ct value of Q fever (5). C. burnetii transmission quence IS1111 was performed by us- was 34, corresponding to 3.6 log10 peaks during the rainy season, and the ing a CFX96 Touch Real-Time PCR DNA copies/mL. Results for the other incidence of Q fever usually increases Detection System (Bio-Rad, Marne samples were negative. 1–3 months later (6). The animal res- la Coquette, France) as described Using morphologic criteria, we ervoir of C. burnetii in French Guiana (8). We confirmed all positive re- identified all 16 ticks collected from is unknown; previous studies have sults by performing a second qPCR the sloth as Amblyomma geayi (Figure, excluded domestic ruminants, which are known to be C. burnetii reservoirs elsewhere in the world (6). Four serologic surveys showed few C. burnetii– positive opossums, dogs, rodents (Proechimys spp.), bovines, or birds in French Guiana (7). In 2013, using real- time PCR (qPCR) analysis of vaginal swab samples, we showed that 6/158 (3.8%) dogs from Cayenne and 0/206 bats from the coastal area of French Guiana were positive for C. burnetii

(Cycle threshhold [Ct]<35). One of the positive samples was identified as genotype MST17 (5). A case–control study among humans identified sev- eral risk factors for Q fever, including living near a forest and the presence of wild animals near the house (6). During January–April 2013, a Q fever outbreak occurred in Tiger Figure. Putative reservoir of Coxiella burnetii in Cayenne, French Guiana A) A 3-toed sloth Camp, a military residential area locat- (Bradypus tridactylus) in its natural habitat in Tiger Camp, a military residential area located at the top of a wooded hill in Cayenne, French Guiana (photograph by S. Fernandes). B) ed at the top of a wooded hill in Cay- A male tick (Amblyomma geayi) found on the 3-toed sloth in this study (photograph by enne. Vaginal swab samples were col- J.M. Berenger). A color version of this figure is available online (http://wwwnc.cdc.gov/eid/ lected from animals living in the area article/20/10/14-0694-F1.htm).

1760 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 10, October 2014 LETTERS panel B). We performed C. burnetii– Bernard Davoust,1 7. Escher M, Flamand C, Ardillon V, specific qPCR on the ticks; 14 (88%) Jean-Lou Marié,1 Demar M, Berger F, Djossou F, et al. Epidé- miologie de la fièvre Q en Guyane: connais- were positive. Vincent Pommier de Santi, sances, incertitudes et perspectives. Bulletin We genotyped C. burnetii–positive Jean-Michel Berenger, de Veille Sanitaire. CIRE Antilles Guyane. DNA from the feces and from 6 of the Sophie Edouard, 2011;7:6–10. 16 ticks by using multispacer sequence and Didier Raoult 8. Edouard S, Mahamat A, Demar M, Abboud P, Djossou F, Raoult D. Com- typing as described (5). All samples Author affiliations: Aix-Marseille Université, parison between emerging Q fever in were identified as MST17, the unique Marseille, France (B. Davoust, J.-L. Marié, French Guiana and endemic Q fever in genotype circulating in Cayenne (5). J.-M. Berenger, S. Edouard, D. Raoult); Marseille, France. Am J Trop Med Hyg. 2014;90:915–9. http://dx.doi.org/10.4269/ After obtaining the laboratory re- Groupe de Travail en Épidémiologie ajtmh.13-0164 sults, we confirmed that a local group in Animale du Service de Santé des Armées, 9. Eldin C, Angelakis E, Renvoisé A, charge of the collection and treatment Toulon, France (J.-L. Marié); Direction Raoult D. Coxiella burnetii DNA, but not of injured animals usually released Interarmées du Service de Santé en viable bacteria, in dairy products in France. Am J Trop Med Hyg. 2013;88:765–9. rehabilitated 3-toed sloths into Tiger Guyane, Cayenne, France (V. Pommier http://dx.doi.org/10.4269/ajtmh.12-0212 Camp. Residents of Tiger Camp regu- de Santi); and Centre d’Épidémiologie et 10. Porter SR, Czaplicki G, Mainil J, Guattéo R, larly observed and came into contact de Santé Publique des Armées, Marseille Saegerman C. Q Fever: current state of with the sloths, and ticks were frequent- (V. Pommier de Santi). knowledge and perspectives of research ly observed on the fur of the animals. of a neglected zoonosis. Int J Microbiol. DOI: http://dx.doi.org/10.3201/eid2010.140694 2011;2011:248418. Furthermore, 3 Q fever patients from Cayenne reported contact with sloths. References Address for correspondence: Didier Raoult, Feces from the sloth in this study Unité de Recherche en Maladies Infectieuses et were highly infectious for C. burnetii. 1. Grangier C, Debin M, Ardillon V, Tropicales Emergentes (URMITE) CNRS UMR Mahamat A, Fournier P, Simmonnet C, Because sloths live in tall trees and can 7278 IRD 198 INSERM U1095 Aix-Marseille shed this bacterium in their feces, human et al. Epidemiologie de la fièvre Q en Guyanne, 1990–2006. Le Bulletin de Université, Faculté de Médecine, 27 bd Jean contamination might occur through in- Veille Sanitaire.CIRE Antilles Guyane. Moulin, 13385 Marseille Cedex 5, France; halation of infectious aerosols from fe- 2009;10:2–4. http://www.invs.sante.fr/ email: [email protected] ces. The high prevalence of C. burnetii publications/bvs/antilles_guyane/2009/ infection in ticks also suggests possible bvs_ag_2009_10.pdf 2. Epelboin L, Chesnais C, Boullé C, transmission through tick bites or from Drogoul AS, Raoult D, Djossou F, et al. Q aerosols of tick feces that have been de- fever pneumonia in French Guiana: preva- posited on the skin of animal hosts; such lence, risk factors and prognostic score. feces can be extremely rich in bacteria Clin Infect Dis. 2012;55:67–74. http:// dx.doi.org/10.1093/cid/cis288 and highly infectious (10). 3. Pfaff F, Francois A, Hommel D, Jeanne I, In this 2013 outbreak of Q fever, Margery J, Guillot G, et al. Q fever in epidemiologic studies led to the iden- French Guiana: new trends. Emerg Infect Marburgvirus tification of 3-toed sloths as a putative Dis. 1998;4:131–2. http://dx.doi.org/10. 3201/eid0401.980124 Resurgence in source of C. burnetii infection. Further 4. Tran A, Gardon J, Weber S, Polidori L. Kitaka Mine investigations are needed to confirm Mapping disease incidence in suburban the role of sloths as a reservoir for C. areas using remotely sensed data. Am J Bat Population burnetii in French Guiana and to im- Epidemiol. 2002;156:662–8. http://dx.doi. org/10.1093/aje/kwf091 after Extermination plement efficient measures to prevent 5. Mahamat A, Edouard S, Demar M, Attempts, Uganda transmission to humans. Abboud P, Patrice JY, La Scola B, et al. Unique clone of Coxiella burnetii caus- ing severe Q fever, French Guiana. Emerg To the Editor: Marburg virus Acknowledgments Infect Dis. 2013;19:1102–4. http://dx.doi. (MARV) and Ravn virus (RAVV), We thank the French Forces Medi- org/10.3201/eid1907.130044 collectively called marburgviruses, cal Service for its support. We also thank 6. Gardon J, Heraud JM, Laventure S, cause Marburg hemorrhagic fever G. Hyvert, T. Lamour, M. Sophie, and D. Ladam A, Capot P, Fouquet E, et al. Sub- urban transmission of Q fever in French (MHF) in humans. In July 2007, 4 cas- Blanchet for their excellent assistance dur- Guiana: evidence of a wild reservoir. es of MHF (1 fatal) occurred in miners ing field work and A. Abeille, T. Ameur, J Infect Dis. 2001;184:278–84. http:// at Kitaka Mine in southern Uganda. and C. Nappez for processing the samples. dx.doi.org/10.1086/322034 Later, MHF occurred in 2 tourists who visited Python Cave, ≈50 km from Funding was provided by the Foun- 1These authors contributed equally to this Kitaka Mine. One of the tourists was dation Méditerranée Infection. article. from the United States (December

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