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Wohlfahrtiimonas Chitiniclastica Bacteremia in Homeless Woman

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Wohlfahrtiimonas Chitiniclastica Bacteremia in Homeless Woman LETTERS sequences clustered within the Europe/ mission emphasizes the need for rapid 5. Papa A, Drosten C, Bino S, Papadimitriou Turkey clade. The genetic distance be- diagnosis of CCHF, especially in cases E, Panning M, Velo E, et al. Viral load in Crimean-Congo hemorrhagic fever. tween the 2 strains was 1.15%, but the with atypical clinical manifestations. Emerg Infect Dis. 2007;13:805–6. 2 sequences were identical at the amino 6. Rodriguez LL, Maupin GO, Ksiazek TG, acid level. Sequences from the present Acknowledgments Rollin PE, Khan AS, Schwarz TF, et al. Molecular investigation of a multisource study showed 96.4%–98.8% similar- We thank Licia Bordi, Eleonora Lalle, outbreak of Crimean-Congo hemorrhagic ity with respective CCHFV sequences Silvia Meschi, and Roberta Chiappini for fever in the United Arab Emirates. Am J from Bulgaria from a former study valuable help in tick investigations. Trop Med Hyg. 1997;57:512–8. (BUL10/02 and BUL1/03) (3) but 7. Kunchev A, Kojouharova M. Probable differed from the Kosovo 9553/2001 This work was partially funded by cases of Crimean-Congo-haemorrhagic fever in Bulgaria: a preliminary report. strain by 0.8%–2.0% and from the RiViGene (contract no. SSPE-CT-2005- 022639). Euro Surveill. 2008;13. pii: 18845. Greek 66/08 strain by 1.2%–2.4%. 8. Papa A, Maltezou HC, Tsiodras S, Dalla Two additional suspected CCHF VG, Papadimitriou T, Pierroutsakos I, et cases occurred in the same area, on Iva Christova, Antonino Di Caro, al. A case of Crimean-Congo haemor- rhagic fever in Greece, June 2008. Euro March 30 and April 9 (7). Both per- Anna Papa, Concetta Castilletti, Surveill. 2008;13. pii: 18952. sons were negative for CCHFV infec- Lubena Andonova, tion. All 119 ticks of various species Nikolay Kalvatchev, Address for correspondence: Iva Christova, (Hyalomma marginatum, Dermacen- Evangelia Papadimitriou, National Center of Infectious and Parasitic tor marginatus, Rhipicephalus bursa, Fabrizio Carletti, Diseases, Blvd Yanko Sakazov 26, Sofia 1504, Ixodes ricinus) collected from the Emad Mohareb, Bulgaria; email: [email protected] area and tested by reverse transcrip- Maria R. Capobianchi, tion–nested PCR were negative for Giuseppe Ippolito, CCHFV. and Giovanni Rezza This cluster of CCHF cases has Author affiliations: National Centre of In- several important highlights. First, it fectious and Parasitic Diseases, Sofia, occurred in a region that was consid- Bulgaria (I. Christova, N. Kalvachev); Na- ered to have low CCHF endemicity; tional Institute for Infectious Diseases “L. however, the area is only a few kilo- Spallanzani,” Rome, Italy (A. Di Caro, C. Wohlfahrtiimonas meters from Greece, where a human Castilletti, F. Carletti, M.R. Capobianchi, chitiniclastica fatal case was observed in June 2008 G. Ippolito); Aristotelian University of Thes- Bacteremia in (8). The index case was observed ear- saloniki, Thessaloniki, Greece (A. Papa, lier in the year than in previous years, E. Papadimitriou); Infectious Diseases Homeless Woman and clinical manifestations of the Hospital, Sofia (L. Andonova); US Naval To the Editor: In May 2006, a cases were unusual (absence of cran- Medical Research Unit 3, Cairo, Egypt (E. 60-year-old homeless woman with a iopharyngeal syndrome and bleeding Mohareb); and Istituto Superiore di Sanità, history of alcoholism was admitted to from gastrointestinal tract that are Rome (G. Rezza). the emergency department of the Con- typical for CCHF patients from Bul- DOI: 10.3201/eid1506.081567 ception Hospital, Marseille, France. garia); in the fatal case, autopsy of the Firefighters had just found her in an patient showed hemorrhages only in References abandoned container in the outskirts the lungs. Two cases were attributable of the city, beside the body of her com- to tick exposure, whereas the other 2 1. Ergonul O, Whitehouse CA. Crimean- panion, who had died several days ear- were most likely secondary cases at- Congo hemorrhagic fever, a global per- lier. She described no symptoms other tributable to contact with the index spective. New York: Springer; 2007. 2. Ergonul O. Crimean-Congo haemorrhagic than fatigue. On examination, she was case-patient (in this regard, CCHFV fever. Lancet Infect Dis. 2006;6:203–14. found to be dirty and covered with sequences of the secondary cases were DOI: 10.1016/S1473-3099(06)70435-2 thousands of body and hair lice; doz- almost identical). Finally, the longer 3. Papa A, Christova I, Papadimitriou E, ens of insect larvae were in her hair. incubation period of the wife of the Antoniadis A. Crimean-Congo hemor- rhagic fever in Bulgaria. Emerg Infect Dis. She was mildly febrile (38°C) and had index case-patient might be associated 2004;10:1465–7. widespread excoriations but no sign with administration of hyperimmune 4. Monev V, Dikov I, Kamarinchev B. of localized bacterial infection. Head gamma globulin against CCHFV. Crimean-Congo-haemorrhagic fever. In: shaving exposed superficial ulcers In conclusion, CCHF emerged in Serbezov V and Kalvatchev Z, editors. Arbovirus infections viral haemorrhagic on her scalp but no maggots. Blood southwestern Bulgaria near the border fevers and biol-terrorism [in Bulgarian]. analysis showed marked neutropenia with Greece. Person-to-person trans- Sofia; 2005. p. 130–42. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 6, June 2009 985 LETTERS (0.44 ×109/L), thrombocytopenia (28 with W. magnifica larvae (4), which are of particular interest because they × 109/L), a marked but well-tolerated cause severe wound myiasis in cattle transmit 3 bacterial bloodstream in- iron deficiency anemia (hemoglobin (5). Because of its strong chitinase fections: trench fever (B. quintana), 6.8g/dL), and a C-reactive protein activity, I. larvae may play a role in epidemic typhus (R. prowazekii), and level of 182 mg/L. Louse infestation the metamorphosis of its host fly, as louse-borne relapsing fever (Borre- was treated with a single dose of iver- has been observed for other fly sym- lia recurrentis) (1). Myiasis should mectin (12 mg), and the woman was bionts, and thus may be a symbiont of also be considered as a relevant type hospitalized. On day 3, she was still W. magnifica flies (6). The bacterium of ectoparasitism in homeless and febrile. Louse-borne borreliosis had was later discovered in swine waste hygiene-deficient persons. In addition, been ruled out by a negative blood in Quebec (7). In 2007, three publica- like body lice, ticks, and fleas, fly lar- smear, and results of serologic testing tions renewed researchers’ interest in vae should also be regarded as another and molecular screening of lice for I. larvae. First it was reclassified as potential source of specific arthropod- the other 2 louse-transmitted bacteria, the only species within the genus Ig- borne bacterial systemic infections. Rickettsia prowazekii and Bartonella natzschineria (4). Then 2 case reports quintana (1), were negative. demonstrated that it plays a role as a Stanislas Rebaudet, In contrast, 2 cultures of blood human pathogen (8,9). Both described Séverine Genot, taken at the time of admission grew an I. larvae bacteremia in adults with Aurélie Renvoise, gram-negative rods susceptible to myiasis in southeastern France. The Pierre-Edouard Fournier, amoxicillin, ceftriaxone, imipen- first patient was an elderly farmer with and Andreas Stein em, ciprofloxacin, amikacin, and diabetes and myiasis of the leg, scro- Author affiliations: Hôpital Universitaire de trimethoprim/sulfamethoxazole. How- tum, and anus (8). The second patient la Conception, Marseille, France (S. Re- ever, phenotypic tests failed to identify was a middle-aged homeless man with baudet, S. Genot, A. Stein); and Unité des this bacterium with accuracy. Intrave- a history of alcoholism who also had Rickettsies, Marseille (A. Renvoise, P.-E. nous therapy with ceftriaxone at 2 g/d foot wound myiasis (9). Fournier, A. Stein) was initiated, and the patient’s fever, We report W. chitiniclastica bac- DOI: 10.3201/eid1506.080232 neutropenia, and thrombocytopenia teremia also in a homeless woman improved. Scalp wounds healed with from southeastern France. Although References local care. Using 16S rRNA gene am- we did not test body lice for W. chitini- plification and sequencing as previ- clastica, we believe that the bactere- 1. Brouqui P, Stein A, Dupont HT, Gallian ously described (2), we identified the mia originated from the patient’s scalp P, Badiaga S, Rolain JM, et al. Ectopara- sitism and vector-borne diseases in 930 bacilli as Wohlfahrtiimonas chitini- maggots. Unfortunately, as previously homeless people from Marseilles. Medi- clastica and determined its similarity reported for cases of I. larvae bacte- cine (Baltimore). 2005;84:61–8. DOI: to be 99.5% with strain E43 (Gen- remia, the maggots had been rapidly 10.1097/01.md.0000152373.07500.6e Bank accession no. AJ517825). The discarded, permitting neither bacterial 2. Drancourt M, Raoult D. Sequence-based identification of new bacteria: a proposition 16S rRNA sequence obtained from analysis nor entomologic identifica- for creation of an orphan bacterium repos- the patient’s strain was deposited in tion. However, these larvae may have itory. J Clin Microbiol. 2005;43:4311–5. GenBank under no. EU484335. The been from W. magnifica flies. These DOI: 10.1128/JCM.43.9.4311-4315.2005 strain was deposited in the Collec- flies are present in southern France, 3. Toth EM, Schumann P, Borsodi AK, Keki Z, Kovacs AL, Marialigeti K. Wohlfahrtii- tion de Souches de l’Unité des Rick- and although they are not typically monas chitiniclastica gen. nov., sp. nov., ettsies (CSUR; World Data Center found at low altitude and in a semiur- a new gammaproteobacterium isolated for Microorganisms 875, http://ifr48. ban environment, their distribution is from Wohlfahrtia magnifica (Diptera: timone.univ-mrs.fr/portail2/index. known to be progressively expanding, Sarcophagidae). Int J Syst Evol Micro- biol. 2008;58:976–81. DOI: 10.1099/ php?option = com_content&task = vi in part because of their broad adapta- ijs.0.65324-0 ew&id = 96&Itemid = 52) under refer- tion capacities.
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