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Rickettsia Sibirica Subsp. Mongolitimonae Infection And

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Rickettsia Sibirica Subsp. Mongolitimonae Infection And LETTERS 8. Pawlotsky JM, Belec L, Gresenguet G, were otherwise within normal limits. for 10 days, under close surveillance. Deforges L, Bouvier M, Duval J, et al. No tick bite was reported by the pa- After 2 days of treatment, she was afe- High prevalence of hepatitis B, C and E markers in young sexually active adults tient, although she had been walking a brile and the rash completely resolved. from the Central African Republic. J Med few days before in Camargue (south- No obstetric complications occurred Virol. 1995;46:269–72. ern France). Serologic results for R. and she gave birth to a healthy boy at 9. Guthmann JP, Klovstad H, Boccia D, conorii, R. typhi, Brucella spp., Bor- term. Two years later, the right sco- Hamid N, Pinoges L, Nizou J, et al. A large outbreak of hepatitis E among dis- relia spp., and Coxiella burnetii were toma remained unchanged. placed population in Darfur, Sudan, 2004: negative. Serologic tests for rickettsiosis The role of water treatment methods. Clin One day after admission, she re- were performed with an acute-phase Infect Dis. 2006;42:1685–91. ported loss of vision (scotoma) in her serum sample and a convalescent- 10. Bile K, Isse A, Mohamud O, Allebeck P, Nilsson L, Norder H, et al. Contrasting right eye. She underwent a complete phase serum sample (1 month after roles of rivers and wells as sources of ophthalmic evaluation. Measurement onset of symptoms). Samples were drinking water on attack and fatality rates of visual acuity and results of a slit- sent to the World Health Organization in hepatitis E epidemic in Somalia. Am J lamp examination were within normal Collaborative Center in Marseille for Trop Med Hyg. 1994;51:466–74. limits, but a funduscopic examination rickettsial reference and research. Im- Address for correspondence: Josep M. Escribà, showed a white retinal macular lesion munoglobulin (Ig) G and IgM titers Medical Department, Médecins sans Frontières, that corresponded in a fl uorescein an- were estimated by using a microim- C/ Nou de la Rambla 23, E-08001 Barcelona, giograph to an area of retinal ischemia munofl uorescence assay; results were Spain; email: [email protected] induced by vascular infl ammation and negative. Culture of a skin biopsy subsequent occlusion (Figure). The specimen from the eschar showed following day, a rash with a few macu- negative results. lopapular elements developed, which DNA was extracted from eschar involved only the palms of the hands biopsy specimen and used as template and soles of the feet. Mediterranean in a PCR with primers complementary spotted fever was suspected. Cyclines to portions of the coding sequences of and fl uoroquinolones were contraindi- the rickettsial outer membrane protein Rickettsia cated because of her pregnancy, and the A and citrate synthase genes as de- sibirica subsp. patient had a history of maculopapular scribed (5). Nucleotide sequences of rash after taking josamycin. She was the PCR products were determined. mongolitimonae treated with azithromycin, 500 mg/day All sequences shared 100% similar- Infection and Retinal Vasculitis To the Editor: Rickettsia sibirica subsp. mongolitimonae is an intracel- lular bacterium that belongs to the spe- cies R. sibirica (1). To date, only 11 cases of infection with this bacterium have been reported (2–6). We report a case in a pregnant woman with ocular vasculitis. A 20-year-old woman in the 10th week of her pregnancy was admit- ted in June 2005 to St. Eloi Hospital in Montpellier, France, with an 8-day history of fever, eschar, hemifacial edema, and headache. On examina- tion the day of admission, she had a fever of 38.5°C, headache, and frontal eschar surrounded by an infl amma- tory halo. Painful retroauricular and cervical lymphadenopathies were not- Figure. Fluorescein angiograph of the right eye of the patient showing retinal occlusive ed. Results of a clinical examination vasculitis with arteriolar leakage at late phase. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 4, April 2008 683 LETTERS ity with R. sibirica subsp. mongoloti- with rickettsiosis caused by R. conorii, 8. Parola P, Inokuma H, Camicas JL, Brouqui monae when compared with those in R. rickettsii, and R. typhi (10). Most P, Raoult D. Detection and identifi cation of spotted fever group rickettsiae and eh- the GenBank database. of these posterior segment manifes- rlichiae in African ticks. Emerg Infect Dis. Infections caused by R. sibirica tations are usually asymptomatic in 2001;7:1014–7. subsp. mongolitimonae have been patients with acute Mediterranean 9. Stallings SP. Rocky Mountain spotted reported as lymphangitis-associated spotted fever (10) and can be easily fever and pregnancy: a case report and review of the literature. Obstet Gynecol rickettsiosis (4). Our case-patient had overlooked. Retinal vasculitis was re- Surv. 2001;56:37–42. the clinical symptoms reported for ported in 45%–55% of the patients, 10. Khairallah M, Ladjimi A, Chakroun M, this disease: fever, maculopapular but retinal artery occlusion secondary Messaoud R, Yahia SB, Zaouali S, et al. rash, eschar, enlarged satellite lymph to vasculitis has been described in only Posterior segment manifestations of Rick- ettsia conorii infection. Ophthalmology. nodes, and lymphangitis. Seasonal oc- 2 cases of infection with R. conorii 2004;111:529–34. currence of this disease in the spring and R. rickettsii (10) without details is common and has been reported in 9 of clinical symptoms. Because ocular Address for correspondence: Didier Bessis, of 12 cases, including the case-patient involvement could be asymptomatic Service de Dermatologie, Hôpital Saint-Eloi, reported here (2–6). A total of 75% and easily overlooked, an ophthalmic 80 Ave Augustin-Fliche, 34295 Montpellier of these R. sibirica subsp. mongoliti- evaluation should be conducted when CEDEX 5, France; email: d-bessis@chu- monae infections occurred in southern rickettsiosis is suspected. montpellier.fr France; other cases have been recently reported in Greece (5), Portugal (6), Julie Caron,* Jean-Marc Rolain,† and South Africa (7). However, the Frédéric Mura,* vector of R. sibirica subsp. mongoliti- Bernard Guillot,* Didier Raoult,† monae has not been identifi ed (7). This and Didier Bessis* rickettsia has been isolated from Hy- *Université Montpellier 1, Montpellier, alomma asiaticum ticks in Inner Mon- France; and †Université de la Méditer- Rickettsia felis in golia, from H. truncatum in Niger (8), ranée, Marseilles, France Fleas, France and from H. anatolicum excavatum in Greece (5). Hyalomma spp. ticks are References To the Editor: Rickettsia felis suspected of being the vector and are 1. Fournier PE, Zhu Y, Yu X, Raoult D. Pro- belongs to the spotted fever group of widespread in Africa, southeastern posal to create subspecies of Rickettsia rickettsia. The pathogenic role of this Europe (including France), and Asia. sibirica and an amended description of intracellular Proteobacteria in humans Rickettsiosis caused by R. rick- Rickettsia sibirica. Ann N Y Acad Sci. has been reported in patients from the ettsii and R. conorii during pregnancy 2006;1078:597–606. 2. Raoult D, Brouqui P, Roux V. A new United States (Texas) (1), Mexico (2), has been reported without risk for ver- spotted-fever-group rickettsiosis. Lancet. Germany (3), Brazil, and France (4). tical transmission (9). First-line anti- 1996;348:412. R. felis is widely distributed, is asso- microbial drugs used to treat rickettsi- 3. Fournier PE, Tissot-Dupont H, Gallais H, ciated with blood-sucking arthropods, al disease are cyclines and quinolones, Raoult D. Rickettsia mongolotimonae: a rare pathogen in France. Emerg Infect Dis. and has been isolated from fl eas in but they are contraindicated during 2000;6:290–2. several countries (5). pregnancy. Chloramphenicol is an 4. Fournier PE, Gouriet F, Brouqui P, Lucht To obtain new information about alternative drug for pregnant women F, Raoult D. Lymphangitis-associated the distribution of R. felis in France but it is not available in France. Mac- rickettsiosis, a new rickettsiosis caused by Rickettsia sibirica mongolotimonae: sev- and potential vectors/ reservoirs of this rolides (azithromycin, clarithromycin, en new cases and review of the literature. emerging pathogen, 550 fl eas were and josamycin) are effective against Clin Infect Dis. 2005;40:1435–44. collected from 82 dogs and 91 cats in 7 rickettsial disease and can be used 5. Psaroulaki A, Germanakis A, Gikas A, widely distributed locations in France safely during pregnancy. Scoulica E, Tselentis Y. Simultaneous de- tection of “Rickettsia mongolotimonae” in (Bordeaux, Toulouse, Cosnes-Cours No ocular complications were a patient and in a tick in Greece. J Clin sur Loire, Dijon, Moulins, Limoges, reported in the 11 previous cases of Microbiol. 2005;43:3558–9. and Aix-en-Provence). Specimens rickettsiosis caused by R. subsp. mon- 6. de Sousa R, Barata C, Vitorino L, Santos- were collected by combing, recorded, golitimonae. However, ocular lesions, Silva M, Carrapato C, Torgal J, et al. Rick- ettsia sibirica isolation from a patient and and stored at –20°C. Samples were including optic disk staining, white detection in ticks, Portugal. Emerg Infect shipped on dry ice to the entomologic retinal lesions, retinal hemorrhages, Dis. 2006;12:1103–8. laboratory of the Institute of Compara- multiple hypofl uorescent choroidal 7. Pretorius AM, Birtles RJ. Rickettsia mon- tive Tropical Medicine and Parasitol- dots, mild vitritis, and retinal vascu- golotimonae infection in South Africa. Emerg Infect Dis. 2004;10:125–6. ogy in Munich, Germany, and species litis, have been described in patients identifi cation was performed by using 684 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 4, April 2008.
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