Urban Transmission of Human African Trypanosomiasis, Gabon
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LETTERS at symptom onset, but results for Acknowledgments 8. Valiente Moro C, De Luna CJ, Tod A, patient serum samples cultured We thank V. Rupeš for parasitologic Guy JH, Sparagano OAE, Zenner L. The poultry red mite (Dermanyssus gallinae): under the same conditions as the analysis, A. Valkoun for serologic analysis a potential vector of pathogenic agents. homogenized parasites remained of specifi c antibodies to Rickettsia and Exp Appl Acarol. 2009;48:93–104. negative. Signifi cant titers of IgG Coxiella spp., D. Kafková for collection doi:10.1007/s10493-009-9248-0 against B. quintana and B. henselae of patient data, and E. Kodytková for 9. Valiente Moro C, Thioulouse J, Chauve C, Normand P, Zenner L. Bacterial taxa asso- or IgG seroconversion in paired serum manuscript review. ciated with the hematophagous mite Der- samples were observed for all patients manyssus gallinae detected by 16S rRNA except the grandfather (Table). Oto Melter, Mardjan Arvand, PCR amplifi cation and TTGE fi ngerprint- Oral clarithromycin and ing. Res Microbiol. 2009;160:63–70. Jiří Votýpka, doi:10.1016/j.resmic.2008.10.006 doxycycline were administered to and Dagmar Hulínská 10. Reeves WK, Dowling APG, Dasch GA. the children and adults, respectively, Author affi liations: Charles University, Rickettsial agents from parasitic Derma- nyssoidea (Acari: Mesostigmata). Exp for 10 days. The apartment was Prague, Czech Republic (O. Melter); repeatedly treated with insecticide, Appl Acarol. 2006;38:181–8. doi:10.1007/ Zentrum für Gesundheitsschutz, Dillenburg, s10493-006-0007-1 and the hole in the roof was repaired, Germany (M. Arvand); and National Institute leading to eradication of the mites. of Public Health, Prague (J. Votýpka, D. Address for correspondence: Oto Melter, The few dead and dry mites that were Hulínská) Department of Medical Microbiology, 2nd available for additional parasitologic Medical Faculty, Charles University, V Úvalu DOI: http://dx.doi.org/10.3201/eid1801.110186 analysis were mounted in Swan 84, 150 06 Prague 5—Motol, Prague, Czech mounting medium (information References Republic; email: [email protected] about the medium is available from the authors), but no characteristics 1. Drancourt M, Mainardi JL, Brouqui P, allowing differentiation between Vandenesch F, Carta A, Lehnert F, et al. species of the genus Dermanyssus Bartonella (Rochalimaea) quintana en- docarditis in three homeless men. N Engl were recognized during examination J Med. 1995;332:419–23. doi:10.1056/ by light microscopy. Failed attempts NEJM199502163320702 were made to trap pigeons that had 2. Comer JA, Paddock CD, Childs JE. Urban lived on the roof of the apartment or in zoonoses caused by Bartonella, Coxiella, Ehrlichia, and Rickettsia species. Vec- Urban Transmission the same city; however, samples from tor Borne Zoonotic Dis. 2001;1:91–118. of Human African trapped synanthropic pigeons from doi:10.1089/153036601316977714 the north (n = 20) and central (n = 3. Breitschwerdt EB, Hegarty BC, Hancock Trypanosomiasis, 33) part of the country were negative SI. Sequential evaluation of dogs naturally infected with Ehrlichia canis, Ehrlichia Gabon for Bartonella spp. by the culture chaffeensis, Ehrlichia equi, Ehrlichia ew- To the Editor: We describe a and amplifi cation methods described ingii, or Bartonella vinsonii. J Clin Micro- above. Recurrent fever reported by biol. 1998;36:2645–51. confi rmed case of human African adult patients resolved in 3 months, 4. Anderson B, Sims K, Regnery R, Robinson trypanosomiasis (HAT) in an L, Schmidt MJ, Goral S, et al. Detection of and all patients made a full clinical expatriate returning to France from Rochalimaea henselae DNA in specimens Gabon after a probable tsetse fl y bite recovery. Laboratory fi ndings for the from cat scratch disease patients by PCR. patients were followed for 6 months J Clin Microbiol. 1994;32:942–8. in the urban setting of Libreville. after symptom onset (Table). 5. Arvand M, Schäd SG. Isolation of Bar- This case indicates a possible urban tonella henselae DNA from the peripheral The fact that the suspected transmission of HAT in Gabon and blood of a patient with cat scratch disease stresses the need for entomologic vector was a hematophagous mite up to 4 months after the cat scratch in- (Dermanyssus sp.), a parasite of jury. J Clin Microbiol. 2006;44:2288–90. studies in Libreville. synanthropic pigeons and a suspected doi:10.1128/JCM.00239-06 HAT is endemic to sub-Saharan 6. Massung RF, Slater KG. Comparison of vector of other bacterial pathogens Africa. Trypanosoma brucei PCR assays for detection of the agent of rhodesiense (eastern Africa) and T.b. (8,9), and that the 16S rRNA Bartonella human granulocytic ehrlichiosis, Ana- spp. gene was detected in mites plasma phagocytophilum. J Clin Mi- gambiense (western Africa) parasites (Steatonyssus sp. from the superfamily crobiol. 2003;41:717–22. doi:10.1128/ are transmitted to humans by tsetse fl ies JCM.41.2.717-722.2003 Dermanyssoidea) (10) remains a of the Glossina morsitans group (T.b. 7. Hulinska D, Votypka J, Plch J, Vlcek E, rhodesiense) and of the G. palpalis challenge for additional study. Pigeons Valešová M, Bojar M, et al. Molecular and probably played the role of accidental microscopical evidence of Ehrlichia spp. group (T.b. gambiense), which are host in this outbreak, but the source of and Borrelia burgdorferi sensu lato in pa- found only in Africa. T.b. gambiense tients, animals and ticks in the Czech Re- represents >90% of all reported cases the infection remains unclear. public. New Microbiol. 2002;25:437–48. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 1, January 2012 165 LETTERS of HAT worldwide. HAT has always and gammaglobulins (23.9 g/L). A case reported here, the tsetse bite been a travel-associated disease. It is a thick-blood smear showed no malaria likely occurred in the urban setting of rare cause of fever, cutaneous lesions, parasites but a few trypomastigotes Libreville. and neurologic signs in travelers of Trypanosoma spp. PCR of The patient did not report returning from disease-endemic areas blood identifi ed T.b. gambiense. A occupational exposure to tsetse bites and involves T.b. rhodesiense in 70% cerebrospinal fl uid sample showed outside Libreville during the previous of the cases, resulting mostly from an moderate elevation of total proteins year. He occasionally went in Pointe exposure during safari in game parks (0.43 g/L) and albumin (291 mg/L), Denis during weekends but did not (1,2). 11 leukocytes, and no IgM elevation. remember having been bitten by a A 58-year-old previously healthy Direct examination and PCR showed tsetse fl y. Although the patient did not Portuguese man who worked in no trypanosome in the cerebrospinal identify the insect in his garden, the Gabon for 13 years for a French fl uid. Specifi c antibodies were chronology of his clinical history and company was admitted to the tropical found in the blood by indirect the presence of a typical chancre at the and infectious diseases ward because immunofl uorescence (titer 200). place of the insect bite that occurred of a 2-month history of intermittent Biopsies of 2 skin lesions (thigh, before symptoms provide strong fever, fatigue, and a 10-kg weight back) showed a lymphoplasmocytic arguments in favor of this hypothesis. loss. The patient recalled a painful vasculitis consistent with cutaneous The bite occurred during the morning unidentifi ed insect bite on his right locations of HAT; no parasite was hours, in the patient’s home garden thigh 2 months before in his garden observed in situ. The patient was in the Lalala area of Libreville in Libreville (Lalala quarter). A 8-cm, treated successfully with a 7-day (0.357568N, 9.475365E) near the indurated, erythematous, and painful course of pentamidine. The case was Ogombié River. This area is located plaque (chancre) progressively reported to World Health Organization 125 km and 75 km from the Bendje developed (Figure) in the following Control of Neglected Tropical and Noya HAT foci, respectively. weeks after the assumed insect bite. Diseases Department. Two studies provided evidence When admitted to the hospital, the A total of 328 HAT cases for urban transmission of HAT in patient had a temperature of 39°C, were reported to the World Health Kinshasa (Democratic Republic of anorexia, insomnia, pruritus of the Organization in Gabon during 2000– Congo) and in Bonon (Côte d’Ivoire) left arm, and paresthesia of the hands 2009; most infections were acquired (7,8). Concurrently, some tsetse and feet. Two additional large annular in the mangrove swamp Atlantic coast species, such as G. palpalis, adapt to erythematous macules, centrally pale focus in Noya (Estuaire Province) and high human densities and are found (trypanids), were found on his back some in the focus of Bendje (Ogooué- in the largest urban centers of western (Figure). A subclavicular 0.5-cm Maritime Province) (3). Four of 6 Africa (9). Entomologic studies in lymph node was observed. There was cases of T.b. gambiense imported Libreville should prompt further no hepatosplenomegaly. to Europe during 2005–2009 were investigation into a possible urban His laboratory results showed in expatriates with a travel history transmission of HAT in Gabon, as we moderate anemia (hemoglobin 11.8 to Gabon (1). In the 4 case-patients suspect in the case reported. g/dL) and thrombopenia (134,000 infected in Gabon, an exposure in platelets/mm3) and elevated levels rural forest areas was assessed (4–6; Fabrice Simon, Marie Mura, of C-reactive protein (30.6 mg/L) D. Malvy, pers. comm.). In the fi fth Frédéric Pagès, Gabriel Morand, Philippe Truc, Francis Louis, and Philippe Gautret Author affi liations: Hôpital d’Instruction des Armées Laveran, Marseille, France (F.