LETTERS

Bartonella spp. were examined for Bar- genogroup A, which was obtained tonella spp. DNA by using a PCR from Oryzomis palustris rats in the and Yersinia pestis and primers CS443f and CS1210r southeastern United States (7). One Reservoirs, specific for a 767-bp fragment of the genotype (isolate B259) was identified Cusco, citrate synthase gene (5). Screening in H. perenensis rats, and 2 other geno- for plague was performed by using types were identified in 1 H. perenen- To the Editor: Bartonella spp. PCR primers Yp1 and Yp2 specific sis and 1 spp. rodent are gram-negative alphaproteobacte- for a plasminogen activator protein (isolates B273 and B280, respective- ria that are transmitted between the (pla) encoded by the Y. pestis–specific ly).We propose that the genotype of reservoir and host by he- pPLA plasmid (6). isolates B273 and B280 is variant A6 matophagous insects (1). The genus New and published Bartonella and the genotype of isolate B259 is Yersinia comprises 11 species, of spp. and Y. pestis sequences were ob- variant A7. A previous study reported which Y. pestis is the causative agent tained from GenBank and compared that the A, B, and C genogroups con- of plague, a deadly rodent-associated, by using the nucleotide-nucleotide tain independent species (8). fleaborne zoonosis (2). Despite the basic local sequence alignment tool The pla amplicons (GenBank ac- large number of plague cases report- (BLAST) (blastn) program (www. cession nos. KF214264–KF214266) ed in humans and the large amount of ncbi.nlm.nih.gov/Class/MLACourse/ had 98% sequence identity with Y. data about human-infecting Bartonel- Modules/BLAST/nucleotide_blast. pestis reference sequences. Plague la spp. in Peru (3), no data have been html). The χ2 test was used to deter- prevalence was higher in H. perenen- published about which rodent species mine statistical differences in the sis rats than in R. rattus rats (p<0.05). are reservoirs of these pathogens in prevalence of both pathogens among Infected rodents were found in all this country. host species and villages. villages studied except Yomentoni, La Convención Province, where Overall prevalences for Y. pes- and prevalence in Aguas Calientes cases of bartonellosis occurred during tis and Bartonella spp. were 17.9% was higher than in Alto Ivochote 1998 (4), is located in the northeast- and 21.4%, respectively (Table). (p<0.01). Two (25%) of 8 rodents ern part of Cusco, Peru. Although, Co-infections with both bacteria trapped inside houses were infected to our knowledge, no human cases were found in 3 (10.7%) rodents: 2 with Y. pestis. of plague have been reported in this perenensis rodents and This study suggests that infec- province, a plague outbreak was re- 1 Oecomys spp. rodent. Bartonella tions of rodents with Bartonella cently detected in Junin Province prevalence was higher in H. perenen- spp. and Y. pestis are common and (M.A. Quispe-Riclade, pers. comm.), sis rats than in Rattus rattus rodents widespread throughout the Echarate which is located northwest of La Con- (p<0.001). Rodents positive for Bar- District. It also shows the role of H. vención Province. tonella spp. were found in the 3 study perenensis and Oecomys spp. rodents A total of 28 rodents were cap- villages, and prevalence for Aguas as reservoirs of both pathogens. This tured during 2010–2011 in 3 villages Calientes was higher than that for role was confirmed by amplifying (Alto Ivochote, Aguas Calientes, and Alto Ivochote (p<0.001). One of 8 ro- the chromosomal ferric iron uptake Yomentoni) in the Echarate District, dents trapped inside houses and 1 of 2 regulation gene by using PCR primers La Convención Province. Traps had rodents trapped at peridomestic sites Ypfur1 and Ypfur2, as described by been set in intradomiciliary, peridomi- were positive for Bartonella spp. Hinnebusch et al. (9). The epidemio- ciliary, and extradomiciliary settings. Sequence analysis identified logic role of rodent-borne Bartonella Spleens of were obtained, and 3 citrate synthase gene sequences spp. as a cause of disease in humans DNA was isolated by using the Illustra (GenBank accession nos. KF021602– is emerging in the Americas. This role Tissue and Cells Genomic Prep Mini KF021604) that had 98% and 99% se- has been suggested by identification Spin Kit (GE Healthcare, Little Chal- quence similarity to genotypic variant of a novel rodent-associated Barton- font, UK). A3 of the undescribed Bartonella ella strain causing febrile illness in the

Table. Prevalence of Bartonella spp. and Yersinia pestis in rodents from Echarate District, Cusco, Peru Study area Rodent host species (no.) No. (%) positive for Yersinia pestis No. (%) positive for Bartonella spp. Alto Ivochote Rattus rattus (20) 3 (15) 0 (0) Alto Ivochote Hylaeamys perenensis (1) 0 1 (100) Aguas Calientes Hylaeamys perenensis (2) 2 (100) 2 (100) Aguas Calientes Oecomys spp. (1) 1 (100) 1 (100) Yometoni Rattus rattus (4) 0 1 (25) Total (28) 6 (21.4) 5 (17.9)

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 6, June 2014 1069 LETTERS rural southwestern United States (10) References Address for correspondence: Pilar Foronda, and a strain of pathogenic B. elizabe- Institute of Tropical Diseases and Public 1. Kamani J, Morick D, Mumcuoglu Y, Health of the Canary Islands, University of thae, a bacteria that can cause human Harrus S. Prevalence and diversity of endocarditis, in the Huayllacallán Val- Bartonella species in commensal rodents La Laguna, Avda. Fco. Sanchez s/n, 38203, ley in Peru (3). and ectoparasites from Nigeria, west Tenerife, Canary Islands, Spain; email: Because most identified Barton- Africa. PLoS Negl Trop Dis. 2013;7: [email protected] e2246. http://dx.doi.org/10.1371/journal. ella spp. have been reported as infec- pntd.0002246 tious agents for humans, our results 2. Gage KL, Kosoy MY. Natural his- should prompt public health concern. tory of plague: perspectives from However, our findings require further more than a century of research. Annu Rev Entomol. 2005;50:505–28. investigation about the pathogenic- http://dx.doi.org/10.1146/annurev. ity of these Bartonella genotypes. ento.50.071803.130337 The detection of both pathogens in 3. Birtles RJ, Canales J, Ventosilla P, intradomestic and peridomestic areas Alvarez E, Guerra H, Llanos-Cuentas A, et al. Survey of Bartonella species Buruli Ulcer where humans are in close contact infecting intradomicillary animals in with rodents could indicate that the the Huayllacallán Valley, Ancash, Peru, Disease in Republic incidence of both diseases in humans a region endemic for human bartonel- of the Congo from Echarate District might be un- losis. Am J Trop Med Hyg. 1999;60: 799–805. To the Editor: Buruli ulcer, which derestimated. 4. Parola P, Shpynov S, Montoya M, Lopez M, Houpikian P, Zeaiter Z, et al. is caused by the Mycobacterium ulcer- This study was supported by Agen- First molecular evidence of new Barton- ans bacterium, is a severe disabling cia Española para la Cooperación In- ella spp. in fleas and a tick from Peru. Am necrotic disease of the skin, occur- J Trop Med Hyg. 2002;67:135–6. ternacional y el Desarrollo under Pro- ring mainly in swampy rural areas of 5. Billeter SA, Gundi VA, Rood MP, grama de Cooperación Interuniversitaria Kosoy MY. Molecular detection and western and central Africa. This tropi- (A1/037176/11), the Spanish Ministry of identification of Bartonella species cal disease is neglected, despite being Foreign Affairs and Cooperation (proj- in Xenopsylla cheopis (Siphonaptera: the third most common mycobacterial Pulicidae) collected from Rattus norvegicus ect Red de Investigación Colaborativa disease of humans, after tuberculosis in Los Angeles, California. Appl Environ de Centros de Enfermedades Tropicales; Microbiol. 2011;77:7850–2. http://dx.doi. and leprosy. The disease has become RD06/0021/0005); and the Spanish Min- org/10.1128/AEM.06012-11 substantially more frequent over the istry of Health, Madrid. A.M.-A. was 6. Hinnebusch J, Schwan TG. New meth- past decade, particularly around the od for plague surveillance using poly- supported by a PhD grant from Agencia Gulf of Guinea, and has been detected merase chain reaction to detect Yer- Canaria de Investigación, Innovación y sinia pestis in fleas. J Clin Microbiol. or suspected in at least 31 countries Sociedad de la Información. M.A.Q.-R. 1993;31:1511–4. (1). Clinical diagnosis of Buruli ulcer was supported by a research contract from 7. Kosoy MY, Regnery R, Tzianabos T. disease should be confirmed by PCR, Distribution, diversity, and host specificity Centro de Excelencia Internacional–Plata- as recommended by the World Health of Bartonella in rodents from the south- forma Atlantica para el Control de las En- eastern United States. Am J Trop Med Organization (WHO); and case-pa- fermedades Tropicales. Hyg. 1997;57:578–88. tients should be treated with rifampin/ 8. Chan KS, Kosoy M. Analysis of streptomycin daily for 8 weeks (thera- multi-strain Bartonella pathogens py available since 2004), combined, if Aarón Martin-Alonso, in natural host populationdo they Mayday Soto, Pilar Foronda, behave as species or minor genetic necessary, with surgery. Elsa Aguilar, variants? Epidemics. 2010;2:165–72. Although confirmed cases of http://dx.doi.org/10.1016/j.epidem.2010. Guillermo Bonnet, Buruli ulcer disease have been re- 08.002 ported in all countries neighboring Rosa Pacheco, 9. Hinnebusch BJ, Gage KL, Schwan TG. Basilio Valladares, Estimation of vector infectivity rates for the Republic of the Congo (hereafter and Maria A. Quispe-Ricalde plague by means of a standard curve- called Congo) (2–4), only 1 report of based competitive polymerase chain Author affiliations: University of La Laguna, a confirmed case in Congo has been reaction method to quantify Yersinia published (5) (Figure, panel A). Dur- Canary Islands, Spain (A. Martin-Alonso, P. pestis in fleas. Am J Trop Med Hyg. Foronda, G. Bonnet, B. Valladares, M. A. 1998;58:562–9. ing 2007–2012, a total of 573 clinical 10. Iralu J, Bai Y, Crook L, Tempest B, Quispe-Ricalde); and National University of cases of Buruli ulcer disease were re- Simpson G, McKenzie T, et al. Rodent- San Antonio Abad, Cusco, Peru (M. Soto, ported to WHO by the National Lep- associated Bartonella febrile illness, rosy, Buruli Ulcer and Yaws Control E. Aguilar, R. Pacheco) southwestern United States. Emerg Infect Dis. 2006;12:1081–6. http://dx.doi. Program in Congo. We report 108 DOI: http://dx.doi.org/10.3201/eid2006.131194 org/10.3201/eid1207.040397 cases (19% of all cases reported) that

1070 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 6, June 2014