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Kyasanur Forest Disease Virus Alkhurma Subtype in Ticks, Najran

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Kyasanur Forest Disease Virus Alkhurma Subtype in Ticks, Najran LETTERS Author affi liations: Institut de Recherche 8. Pradines B, Pistone T, Ezzedine K, Brio- showed >89% identity with KFDV. Biomédicale des Armées, Marseille, France lant S, Bertaux L, Receveur MC, et al. Ten other cases were confi rmed Quinine-resistant malaria in traveler re- (L. Bertaux, N. Taudon, M. Martelloni, D. turning from Senegal, 2007. Emerg In- among patients who had leukopenia, Parzy, B. Pradines); and Laveran Military fect Dis. 2010;16:546–8. doi:10.3201/ thrombocytopenia, and elevated liver Teaching Hospital, Marseille (P. Kraemer, eid1603.091669 enzymes. Observations of patients in A. Trignol, R. Saidi, F. Simon) 9. Andriantsoanirina V, Menard D, Rabeari- the original study or in a subsequent manana S, Hubert V, Bouchier C, Tichit analysis (2) suggested that Alkhurma DOI: 10.3201/eid1705.101424 M, et al. Association of microsatellite vari- ations of Plasmodium falciparum Na+/H+ hemorrhagic fever (AHF) disease was exchanger (pfnhe-1) gene with reduced associated with contact with blood References in vitro susceptibility to quinine: lack of from infected animals, bites from confi rmation in clinical isolates from Af- 1. Société de Pathologie Infectieuse de rica. Am J Trop Med Hyg. 2010;82:782–7. infected ticks, or the drinking of raw Langue Française, Collège des Universita- doi:10.4269/ajtmh.2010.09-0327 milk. However, the exact mode of ires de Maladies Infectieuses et Tropicales, 10. Zalis MG, Pang L, Silveira MS, Milhous transmission to humans has still not Société de Médeine des Armées, Société WK, Wirth D. Characterisation of Plas- been fully elucidated. More recently, Française de Parasitologie, Société Fran- modium falciparum isolated from the çaise de Pédiatrie, Société de Médeine des Amazon region of Brazil: evidence for AHFV RNA was detected in a single Voyages, et al. Management and preven- quinine resistance. Am J Trop Med Hyg. pool of sand tampans (Ornithodoros tion of imported Plasmodium falciparum 1998;58:630–7. savignyi, soft ticks), collected in malaria: recommendations for clinical practice 2007 (revision 2007 of the 1999 western Saudi Arabia (3), which consensus conference) [in French]. Med Address for correspondence: Bruno Pradines, suggests a link with these ticks. Mal Infect. 2008;38:68–117. Institut de Recherche Biomédicale des Armées, To analyze the virus association 2. Demar M, Carme B. Plasmodium fal- Allée du Médecin-Colonel Jamot, Parc du with arthropods further, we collected ciparum in vivo resistance to quinine: Pharo, BP 60109, 13262 Marseille CEDEX 07, description of two RIII responses in and identifi ed ticks and mosquitoes French Guiana. Am J Trop Med Hyg. France; email: [email protected] in Najran Province, southern Saudi 2004;70:125–7. Arabia, during May and June 2009 3. Dedet JP, Germanetto P, Cordoliani G, from different sites close to where Bonnevie O, Le Bras J. In vitro activity of various antimalarials (chloroquine, amo- human AHF cases had been recently diaquine, quinine and mefl oquine) against confi rmed (4,5). Camel ticks 32 isolates of Plasmodium falciparum in (Hyalomma dromedarii) (130 adults) French Guiana [in French]. Bull Soc Trop were collected while they fed on Pathol Exot Filiales. 1988;81:88–93. 4. Legrand E, Volney B, Meynard JB, Kyasanur camels, and O. savignyi sand tampans Mercereau-Puijalon O, Esterre P. In vitro (243 adults) were collected from monitoring of Plasmodium falciparum Forest Disease the ground in camel resting places drug resistance in French Guiana: a syn- (except 1 collected while feeding on opsis of continuous assessment from Virus Alkhurma 1994 to 2005. Antimicrob Agents Che- Subtype in Ticks, a camel). Mosquitoes were collected mother. 2008;52:288–98. doi:10.1128/ by using light traps (203 Culex decens AAC.00263-07 Najran Province, females) or as larvae that were then 5. Parola P, Pradines B, Simon F, Carlotti raised in the laboratory (9 Culiseta sp. MP, Minodier P, Ranjeva MP, et al. An- Saudi Arabia timalarial drug susceptibility and point females). Ticks and mosquitoes were mutations associated with Plasmodium To the Editor: The lineage of stored at room temperature and killed falciparum drug resistance of 248 isolates Kyasanur Forest disease virus (KFDV) by overnight freezing the day before imported from Comoros to Marseilles, found in the Kingdom of Saudi Arabia shipping to the Centers for Disease France in 2004–2006. Am J Trop Med is commonly referred to as Alkhurma Hyg. 2007;77:431–7. Control and Prevention (Atlanta, GA, 6. Pradines B, Dormoi J, Briolant S, Bogreau hemorrhagic fever virus (AHFV). This USA). All arthropods were processed H, Rogier C. La résistance aux antipalu- virus was fi rst isolated from a specimen in the BioSafety Level 4 laboratory diques. Revue Francophone des Labo- collected in 1994 from a butcher by injecting Vero E6 cells and by ratoires. 2010;422:51–62. doi:10.1016/ living in Makkah Province, who was S1773-035X(10)70510-4 intracerebrally inoculating suckling 7. Henry M, Briolant S, Zettor A, Pelleau S, hospitalized for a hemorrhagic fever mice with ground pools of either 5 Baragatti M, Baret E, et al. Plasmodium from which he died (1). The virus ticks or 10 mosquitoes. All the tick falciparum Na+/H+ exchanger 1 trans- was assigned to the genus Flavivirus material was used for the tested pools. porter is involved in reduced susceptibil- on the basis of reactivity with genus- ity to quinine. Antimicrob Agents Che- Isolates of AHFV were obtained from mother. 2009;53:1926–30. doi:10.1128/ specifi c monoclonal antibodies and 1 of 13 pools of H. dromedarii ticks AAC.01243-08 sequencing of a fragment of the and 1 of 6 pools of O. savignyi sand nonstructural 5 (NS5) gene, which tampans, both from Al Mishaaliyia Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 5, May 2011 945 LETTERS district, and from 5 of 8 pools of O. can survive for long periods without divergence ≈33 years ago (10). The savignyi sand tampans from the Al feeding, fulfi lling perfectly the role data reported here clearly strengthen Balad Magan camel market. Virus of reservoir for AHFV. This tick has the position of AHFV in the tick- identity was confi rmed by sequencing been reported in arid biotopes of borne fl avivirus complex, although the a 390-nt fragment from the virus northeastern, eastern, and southern numbers and species of mosquitoes core protein C and preM genes. No Africa (7) and from Arabia to India tested were limited. Expanded virus was isolated from any mosquito and Sri Lanka, which suggests a epidemiologic and molecular studies suspensions. potential wide distribution of AHFV should provide insight into the Phylogenetic analysis of the 7 tick or related viruses. In India, KFDV has distribution and evolution of the virus isolates and the available homologous been isolated from Ornithodoros spp. and identify at-risk regions within sequences of AHFV are presented in ticks collected in a bat-inhabited cave Saudi Arabia. Laboratory infection the Figure. The tick AHFV sequences (8), and experimental transtadial and and transmission studies in colonized are closely related but distinct from transovarial transmission of KFDV in ticks should clarify the role of O. previously reported AHFV sequences O. crossi ticks has been reported (9). savignyi and H. dromedarii ticks in the from human isolates or from the only The isolation of AHFV from the ecology of AHFV. Currently, public sequence reported from ticks collected camel tick (H. dromedarii) also has health messages are being developed in 2004 in Jeddah Province. The public health implications. The capital for the community at risk and local observed sequences are clustered by city of Najran serves as a market for health care workers. site of collection but not by tick species. camels and other livestock from Saudi In this report, we confi rm that Arabia and Yemen. Adult camel ticks Mustafa Mahdi, the sand tampan (O. savignyi tick) infest mainly camels, and infected Bobbie Rae Erickson, is a vector and reservoir of AHFV ticks can feed on and infect animals J. Andy Comer, Stuart T. Nichol, in Saudi Arabia. Of all arthropods, just before sale or slaughter. AHF in Pierre E. Rollin, this tick is one of the most highly persons working in the Najran market Mohammed A. AlMazroa, adapted to the desert. It can be found has been described (5). Unfortunately, and Ziad A. Memish in the shade of trees, beside rock no AHFV sequence is available from Author affi liations: Najran Preventive fences, on livestock, and in livestock those cases. Medicine Department, Najran, Saudi Arabia yards, particularly camel yards (6). The genetic diversity of the (M. Mahdi); Centers for Disease Control It can feed rapidly during the day or isolated viruses from ticks is quite and Prevention, Atlanta, Georgia, USA night on camels, goats, sheep, wild low. Previous analysis of KFDV and (B.R. Erickson, J.A. Comer, S.T. Nichol, mammals, and humans. Sand tampans AHFV suggested slow evolution with P.E. Rollin); and Ministry of Health, Riyadh, Saudi Arabia (M.A. AlMazroa, Z.A. Memish) DOI: 10.3201/eid1705.101824 References 1. Zaki AM. Isolation of a fl avivirus related to the tick-borne encephalitis complex from human cases in Saudi Arabia. Trans R Soc Trop Med Hyg. 1997;91:179–81. doi:10.1016/S0035-9203(97)90215-7 2. Charrel RN, de Lamballerie X. The Alkhurma virus (family Flaviviridae, genus Flavivirus): an emerging patho- gen responsible for hemorrhage fever in the Middle East [in French]. Med Trop (Mars). 2003;63:296–9. 3. Charrel RN, Fagbo S, Moureau G, Alqa- Figure. Phylogenetic analysis of Alkhurma viruses isolated from Ornithodoros savignyi htani MH, Temmam S, de Lamballerie and Hyalomma dromedarii ticks in Najran Province, Kingdom of Saudi Arabia.
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