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4. Dani CMC, Mota FK, Sanchonette VP, Zoonotic We tested for the presence of DNA Maceira JP, Maia APC. Gnathostomiasis from spotted fever group Rickettsia in Brazil: case report. An Bras Dermatol. Transmission of 2009;84:400–4. http://dx.doi.org/10.1590/ spp., Anaplasma spp., Francisella S0365-05962009000400012 by tularensis, and Babesia spp. in 147 I. 5. Katchanov J, Sawanyawisuth ricinus ricinus collected from roe K, Chotmongkol V, Nawa Y. and goats at 2 sites in eastern Romania: Neurognathostomiasis, a neglected Ticks, Romania parasitosis of the central nervous system. Bacau (46°35′0″N, 26°55′0″E) and Emerg Infect Dis. 2011;17:1174–80. To the Editor: The Ixodes ricinus Galati (45°26′22″N, 28°2′4″E). http://dx.doi.org/10.3201/eid1707.101433 is a predominant vector of a large Specimens were tested by PCR, using 6. Intapan PM, Khotsri P, Kanpittaya J, specifi c primers for each or Chotmongkol V, Sawanyawisuth K, variety of pathogens of veterinary and Maleewong W. Immunoblot diagnostic medical consequence in (1). group of pathogens, as described (4). test for neurognathostomiasis. Am J Trop The most prevalent I. ricinus–borne Sequences obtained from Eurofi ns Med Hyg. 2004;83:927–9. http://dx.doi. infection of persons in Europe is Lyme MWG Operon (Ebersberg, Germany) org/10.4269/ajtmh.2010.10-0113 were identifi ed by using BLAST 7. Nontasut P, Claesson BA, Dekumyoy borreliosis, a multisystemic disorder P, Pakdee W, Chullawichit S. Double- caused by spirochetes of the (www.ncbi.nlm.nih.gov/BLAST) and dose ivermectin vs albendazole for the burgdorferi sensu lato complex (2). compared with sequences available treatment of gnathostomiasis. Southeast Persons bitten by ticks can also become in GenBank. Asian J Trop Med Public Health. DNA from Rickettsia spp. was 2005;36:650–2. infected with many other pathogens, 8. Strady C, Dekumyoy P, Rigolet CM, Danis such as (Anaplasma spp., detected in 20 (13.6%) ticks. Sequence M, Bricaire F, Caumes E. Long-term Francisella spp., , analyses revealed that 9 (6.1%) follow-up of imported gnathostomiasis Bartonella spp., Rickettsiae spp., and sequences were related to the R. shows frequent treatment failure. Am J monacensis strain IRd/Serbia glta gene Trop Med Hyg. 2009;80:33–5. Neoerhlichia mikurensis); parasites 9. Suntharasamai P, Riganti M, Chittamas (Babesia spp., Theileria spp.); and (99%–100% nt similarity) (GenBank S, Desakorn V. Albendazole stimulates (tick-borne encephalitis accession no. GQ925820) and 11 outward migration of Gnathostoma virus, Crimean-Congo hemorrhagic (7.48%) were related to R. helvetica spinigerum to the dermis in man. gltA gene (99%–100% nt similarity) Southeast Asian J Trop Med Public fever virus, and Eyach virus) (1). Health. 1992;23:716–22. Symptoms induced by such pathogens (GenBank accession no. AM418450). 10. Herman JS, Wall EC, van Tulleken C, are often diverse and nonspecifi c, DNA from Anaplasma spp. was Godfrey-Faussett P, Bailey RL, Chiodini complicating accurate diagnosis of the identifi ed in 33 (22.4%) ticks. Analysis PL. Gnathostomiasis acquired by British revealed that 30 of the 33 amplifi ed tourists in Botswana. Emerg Infect Dis. disease. 2009;15:594–7. http://dx.doi.org/10.3201/ In Romania, cases of Lyme fragments showed 100% identity to eid1504.081646 disease and tick-borne encephalitis the 16S rDNA gene of a symbiont (caused by tick-borne encephalitis in the family Anaplasmataceae, Address for correspondence: Thiago Jeunon virus) have been identifi ed (3). Candidatus mitochondrii de Sousa Vargas, Hospital Federal de However, little is known about the (GenBank accession no. EU780455), Bonsucesso—Dermatology and Anatomical public health impact of these diseases, and the remaining 3 were related to Pathology, Av. Londres 616, Bonsucesso Rio de and none of the other tick-borne known pathogenic species identifi ed Janeiro, Rio de Janeiro CEP:21041-030, Brazil; pathogens present in Europe have in Romania: 2 (1.4%) exhibited email: [email protected] been reported as causes of infection 100% identity to Anaplasma in Romania. Although I. ricinus is the phagocytophilum (GenBank accession most abundant and widespread tick in no. EU982548), and 1 (0.7%) showed Romania (3), the public health impact 99% similarity to Ehrlichia muris of I. ricinus–borne disease is likely (GenBank accession no. GU358691). to be underestimated. Therefore, the Francisella tularensis–specifi c DNA fi rst step in evaluating the distribution was amplifi ed from 4 DNA extracts of these potential pathogens is to (2.7%). All 4 sequences were identical establish their presence in ticks from and shared 99% similarity with the F. previously unexplored areas. tularensis peptidyl-propyl cis-trans We conducted a study to identify isomerase gene (GenBank accession the main tick-borne bacterial and no. CP003048). Babesia spp.–specifi c parasitic pathogens known DNA was amplifi ed in 1 DNA extract to be present in Europe but not (0.7%), and it shared 99% sequence previously detected in Romania. identity with the Babesia sp. EU1 18S

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 12, December 2012 2089 LETTERS rDNA gene (GenBank accession no. Acknowledgments 3. Coipan EC, Vladimirescu AF. Ixodes HQ830266). We thank the members of the Tiques ricinus ticks (: ): vectors for spirochetes in Romania. This is a report on the identifi cation et Maladies à Tiques group of Réseau Exp Appl Acarol. 2011;54:293–300. of the human pathogens R. monacensis, Ecologie des Interactions Durables for http://dx.doi.org/10.1007/s10493-011- R. helvetica, A. phagocytophilum, E. stimulating discussions and support. 9438-4 muris, and Babesia EU1 in Romania. 4. Reis C, Cote M, Paul RE, Bonnet This study was partly funded S. Questing ticks in suburban R. monacensis (also known as the by the European Union grant FP7- are infected by at least six tick-borne Cadiz agent or Rickettsia IRS3 and 261504 EDENext and is catalogued by pathogens. Vector Borne Zoonotic IRS4) was fi rst identifi ed in I. ricinus Dis. 2011;11:907–16. http://dx.doi. the EDENext Steering Committee as tick samples from Germany (5) and org/10.1089/vbz.2010.0103 EDENext 043 (www.edenext.eu). Funding 5. Simser JA, Palmer AT, Fingerle V, Wilske was recently recognized as the cause was also provided by the Project Programul B, Kurtti TJ, Munderloh UG. Rickettsia of Mediterranean spotted fever-like Operational Sectorial Dezvoltarea monacensis sp. nov., a spotted fever group rickettsiosis in Spain (6). R. helvetica Rickettsia, from ticks (Ixodes ricinus) Resurselor Umane /88/1.5/S/52176 was isolated from I. ricinus ticks in collected in a European city park. Appl Universitatea de Ştiinţe Agricole şi Environ Microbiol. 2002;68:4559–66. Switzerland in 1979, and, since then, Medicină Veterinară, Iasi, Romania. http://dx.doi.org/10.1128/AEM.68. it has been isolated in many other 9.4559-4566.2002 European countries (7). R. helvetica 6. Jado I, Oteo JA, Aldamiz M, Gil H, was associated with human infections Oana Alina Paduraru, Escudero R, Ibarra V, et al. Rickettsia Jean Philippe Buffet, monacensis and human disease, Spain. in the late 1990s (8). Emerg Infect Dis. 2007;13:1405–7. http:// The role of as reservoirs Martine Cote, Sarah Bonnet, dx.doi.org/10.3201/eid1309.060186 for these pathogens is unknown. A. Sarah Moutailler, 7. Radulović Z, Chochlakis D, Tomanovic phagocytophilum is the causative Vlad Paduraru, S, Milutinovic M, Tselentis Y, Psaroulaki Françoise Femenia, Marc Eloit, A. First detection of spotted fever group agent of granulocytic in Rickettsiae in ticks in Serbia. Vector , , , and , and Gheorghe Savuta, Borne Zoonotic Dis. 2011;11:111–5. is widespread throughout Europe (8). and Muriel Vayssier-Taussat http://dx.doi.org/10.1089/vbz.2009.0254 E. muris has been detected in ticks Author affi liations: USC Bipar, Bartonella 8. Parola P. Tick-borne rickettsial diseases: et Tiques, Maisons-Alfort, France (O.A. emerging risks in Europe. Comp Immunol from Finland and European Russia Microbiol Infect Dis. 2004;27:297–304. and from ticks and from Paduraru, J.P. Buffet, M. Cote, S. Bonnet, http://dx.doi.org/10.1016/j.cimid.2004. Slovakia. In 2009, E. muris was also S. Moutailler, F. Femenia, M. Vayssier- 03.006 detected in patients with febrile illness Taussat); Universitatea de Ştiinţe Agricole 9. Pritt BS, Sloan LM, Johnson DK, şi Medicină Veterinară, Iasi, Romania Munderloh UG, Paskewitz SM, in the United States (9). Babesia sp. McElroy KM, et al. Emergence of a EU1 has been detected in roe deer and (O.A. Paduraru, V. Paduraru, G. Savuta); new pathogenic Ehrlichia species, ticks in several countries, and in 2003 Pathoquest, Paris, France (O.A. Paduraru, Wisconsin and Minnesota, 2009. N Engl was associated with human disease in M. Eloit); Ecole Nationale Vétérinaire J Med. 2011;365:422–9. http://dx.doi. d’Alfort, Maisons-Alfort (M. Eloit); and org/10.1056/NEJMoa1010493 Italy and Austria (4,10). is 10. Herwaldt BL, Caccio S, Gherlinzoni F, known to be present in Romania and is Institut Pasteur, Paris (M. Eloit) Aspock H, Slemenda SB, Piccaluga P, thought to be exclusively and directly et al. Molecular characterization of a transmitted by hares. However, References non- organism causing zoonotic in Europe. Emerg detection of F. tularensis DNA in 1. Heyman P, Cochez C, Hofhuis A, van Infect Dis. 2003;9:942–8. http://dx.doi. I. ricinus ticks suggests that this der Giessen J, Sprong H, Porter SR, et org/10.3201/eid0908.020748 bacterium might also be tick-borne. al. A clear and present danger: tick-borne In conclusion, the detection of diseases in Europe. Expert Rev Anti Address for correspondence: Muriel Vayssier- DNA of various human pathogens in Infect Ther. 2010;8:33–50. http://dx.doi. Tassat, AFSSA-UMR BIPAR, 23 Rue du org/10.1586/eri.09.118 ticks in Romania strongly suggests 2. Richter D, Postic D, Sertour N, Livey I, General de Gaulle, Maisons-Alfort 94700, that these microorganisms circulate Matuschka FR, Baranton G. Delineation France; email: [email protected] in the country. Because all of these of sensu lato pathogens affect humans, our study species by multilocus sequence analysis and confi rmation of the delineation of The opinions expressed by authors highlights the urgent requirement for sp. nov. Int J Syst contributing to this journal do not further research to assess their impact Evol Microbiol. 2006;56:873–81. http:// necessarily refl ect the opinions of the on public health in Romania. dx.doi.org/10.1099/ijs.0.64050-0 Centers for Disease Control and Prevention or the institutions with which the authors are affi liated.

2090 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 12, December 2012