LETTERS

8. Tamura K, Peterson D, Peterson N, Stech- The patient was confined to bed for (Table). SFG rickettsiae were detected er G, Nei M, Kumar S. MEGA5: Molecu- several weeks after surgical place- by specific quantitative PCR. Species lar Evolutionary Genetics Analysis using maximum likelihood, evolutionary dis- ment of a knee prosthesis when his identification was confirmed by spe- tance, and maximum parsimony methods. disease occurred; the domestic cat cific quantitative PCR forR. massiliae Mol Biol Evol. 2011;28:2731–9. http:// was suspected to have introduced and sequencing of outer membrane dx.doi.org/10.1093/molbev/msr121 into the home. protein A gene for others species (5). 9. Mushahwar IK. Hepatitis E virus: molec- ular virology, clinical features, diagnosis, In April, his wife (67 years of A negative control (sterile water) and transmission, epidemiology, and preven- age) (patient 2) became febrile, had positive control (DNA from R. monta- tion. J Med Virol. 2008;80:646–58. http:// popliteal lymphadenopathies associ- nensis or R. massiliae) were included dx.doi.org/10.1002/jmv.21116 ated with lymphangitis, and had an in each PCR. 10. World Health Organization. International Health Regulations (2005). Geneva: The eschar on the leg from which a swab Ticks were morphologically iden- Organization; 2005. specimen was obtained. Patient 3 was tified as adult Rhipicephalus sanguin- their neighbor; he had the same symp- eus. Molecular identification of these Address for correspondence: Mirdad Kazanji, toms in March 2011 but samples were ticks harboring rickettsiae was per- Institut Pasteur de Bangui, BP 923, Bangui, not collected from him. formed by amplification of the 12S Central African Republic; email: mirdad. None of patients reported rRNA gene. DNA from R. massiliae [email protected] bites, but they were in regular con- was found in 3 ticks collected from tact with animals, including a cat, a the dog and near the cat litter morpho- dog, horses, and birds. Both patients logically identified as Rh. sanguineus. who lived with the cat reported that it This DNA showed 98% homology would return home with ticks. Infec- with the sequence in GenBank (acces- Clustered Cases of tions in these patients were success- sion no. AY559843). R. sibirica mon- sibirica fully treated with doxycycline. golitimonae with 99.8% homology An immunofluorescence assay for the outer membrane protein gene mongolitimonae for antibodies against SFG antigens sequence in GenBank (accession no. Infection, France showed IgG/IgM titers of 128/0 for DQ097082) was isolated from 1 tick patient 1 and 64/16 for patient 2 (3). collected from the cat. This tick was To the Editor: Rickettsia si- DNA was extracted from the skin identified as Rh. pusillus and showed birica mongolitimonae, a member of swab specimen of patient 2 by us- 99.7% homology with the sequence in the tick-borne group ing the QIAamp Mini Kit (QIAGEN, GenBank (accession no. FJ536547). (SFG) of rickettsia, was first isolated Hilden, Germany). A fragment of the R. massiliae was cultured from an Rh. from Hyalomma asiaticum ticks in citrate synthase gene of Rickettsia spp. sanguineus tick, and R. sibirica mon- China (1). The first human case was was amplified by PCR and sequenced. golitimonae was cultured from an Rh. described in France in 1996, and 7 The sequence show 99.7% homology pusillus tick. new cases were described in 2005 with that of the same gene sequence A cluster of 1 documented case (1). This was named of R. sibirica mongolitimonae in Gen- and 2 probable cases of lymphangitis- lymphangitis-associated rickettsiosis Bank (accession no. DQ423370) (4). associated rickettsiosis in southern because lymphangitis was observed Ticks were collected from the France was linked to a cat and Rh. in 50% of the patients (1). Only 17 property of the 2 patients: from the pusillus ticks. Infection with R. mas- cases have been reported, for which garden by flagging vegetation (3), siliae for the 2 probable case-patients 7 patients had lymphangitis, and 13 from animals, and near the cat litter was unlikely because clinical findings had inoculation eschars, including 2 patients with 2 eschars (1,2). We re- Table. Ticks collected from property of 2 patients infected with Rickettsia sibirica port a cluster of cases of R. sibirica mongolitimonae, France, 2011* mongolitimonae infection. No. ticks (Rickettsia species) Location of No. ticks Tick species Harboring From which rickettsiae Patient 1, a 73-year-old man in tick collection collected identification† rickettsial DNA were cultured France, had fever, rash, lymphade- Garden 2 ND 0 0 nopathies, and an axillary inoculation Dog 21 Rhipicephalus 2 (R. massiliae) 0 sanguineus eschar in February 2011. A diagnosis Cat litter 7 ND 1 (R. massiliae) 1 (R. massiliae) of lymphangitis-associated rickett- Cat 9 Rh. pusillus 1 (R. sibirica 1 (R. sibirica siosis was suspected because of the mongolitimonae) mongolitimonae) season (most cases occur in spring in Scrub land 5 ND 0 0 *ND, not done. France) and clinical manifestations. †Based on 12S rRNA gene. All adult ticks were morphologically identified as Rh. sanguineus.

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013 337 LETTERS were typical of lymphangitis-associ- References Address for correspondence: Didier Raoult, ated rickettsiosis, and most cases of Unité des Rickettsies, Unité de Recherche 1. Fournier PE, Gouriet F, Brouqui P, Lucht sur les Maladies Infectieuses et Tropicales rickettsioses in southern France in F, Raoult D. Lymphangitis-associated the spring are caused by R. sibirica rickettsiosis, a new rickettsiosis caused by Émergentes, Centre National de la Recherche mongolitimonae. Clustered cases of Rickettsia sibirica mongolotimonae: sev- Scientifique–Institut de Recherche pour le SFG rickettsiae infection have been en new cases and review of the literature. Développement, Unités Mixtes de Recherché Clin Infect Dis. 2005;40:1435–44. http:// 6236, Faculté de Médecine et de Pharmacie, 27 reported in Europe, including south- dx.doi.org/10.1086/429625 ern France (3,6). In 2007, R. conorii 2. Socolovschi C, Barbarot S, Lefebvre M, Blvd Jean Moulin 13385 Marseille Cedex 05, and R. massiliae infections in humans Parola P, Raoult D. Rickettsia sibirica France; email: [email protected] were reported (3). In 2010, cases for mongolitimonae in traveler from Egypt. Emerg Infect Dis. 2010;16:1495–6. http:// which we were unable to discriminate dx.doi.org/10.3201/eid1609.100258 between R. conorii and R. massiliae 3. Parola P, Socolovschi C, Jeanjean L, Bi- infections occurred in a family (6). In tam I, Fournier PE, Sotto A, et al. Warmer these 2 studies, clustered cases of SFG weather linked to tick attack and emer- Rickettsiae gence of severe rickettsioses. PLoS Negl rickettsiosis involved Rh. sanguineus Trop Dis. 2008;2:e338. http://dx.doi. in Ticks, Japan, ticks. Clustered cases appeared to be org/10.1371/journal.pntd.0000338 2007–2011 related to an increase in aggressive- 4. Mediannikov O, Diatta G, Fenollar F, ness of ticks toward humans during Sokhna C, Trape JF, Raoult D. Tick- To the Editor: Japanese spot- borne rickettsioses, neglected emerging warmer periods (3). In our study, no diseases in rural Senegal. PLoS Negl ted fever (JSF), caused by Rickettsia correlation was identified with warm- Trop Dis. 2010;4:pii:e821 . http://dx.doi. japonica, is the most prevalent tick- er weather. org/10.1371/journal.pntd.0000821 borne infectious disease in Japan (1), R. sibirica mongolitimonae is 5. Renvoisé A, Rolain JM, Socolovschi C, occurring most frequently in central Raoult D. Widespread use of real-time most frequently associated with Hya- PCR for rickettsial diagnosis. FEMS Im- and western regions (http://idsc.nih. lomma spp. ticks (1,2,4). However, 1 munol Med Microbiol. 2012;64:126–9 . go.jp/idwr/CDROM/Main.html [in case of infection with this bacterium http://dx.doi.org/10.1111/j.1574-695X.20 Japanese]). Cases of unknown fever was associated with Rh. pusillus ticks 11.00899.x with rickettsiosis-like symptoms not 6. Renvoisé A, Delaunay P, Blanchouin E, collected in Portugal (7); DNA from Cannavo I, Cua C, Socolovschi C, et al. associated with JSF have been report- this was also identified in Urban family cluster of spotted fever rick- ed in JSF-endemic regions of Japan an Rh. pusillus tick collected from a ettsiosis linked to Rhipicephalus sanguin- (2). Several spotted fever group (SFG) mongoose. The European wild rab- eus infected with subsp. rickettsiae (R. japonica, R. heilongji- caspia and . Ticks bit is the primary host of Rh. pusillus Tick Borne Dis 2012; 3:389–92.http:// angensis, R. helvetica, R. tamurae, R. ticks. However, these ticks have been dx.doi.org/10.1016/j.ttbdis.2012.10.008. asiatica, Candidatus R. tarasevich- found on wild carnivorous animals, 7. de Sousa R, Barata C, Vitorino L, San- iae) and other related Rickettsia spp. dogs, and domestic cats (8); these tos-Silva M, Carrapato C, Torgal J, et al. have been identified in Japan (1,3–6). Rickettsia sibirica isolation from a patient ticks can bite humans (8). Moreover, and detection in ticks, Portugal. Emerg Human infections with R. heilongji- R. massiliae and R. sibirica mon- Infect Dis. 2006;12:1103–8. http://dx.doi. angensis and R. tamurae have been golitimonae were found in Rh. pu- org/10.3201/eid1207.051494 confirmed (3,5), and Anaplasma sillus ticks from Spain (9), and SFG 8. Santos-Silva MM, Beati L, Santos AS, phagocytophilum and Ehrlichia de Sousa R, Nuncio MS, Melo P, et al. rickettsiae were found in ticks from The hard-tick fauna of mainland Portu- chaffeensis, known human , Sardinia (10). Therefore, Rh. pusillus gal (Acari: Ixodidae): an update on geo- have been detected in ticks and deer ticks appear to be an emerging vec- graphical distribution and known associa- in Japan. We conducted this study to tor for R. sibirica mongolitimonae tions with hosts and pathogens. Exp Appl determine the risk in central and west- Acarol. 2011;55:85–121. http://dx.doi. in Europe. org/10.1007/s10493-011-9440-x ern Japan for human exposure to ticks 9. Toledo A, Olmeda AS, Escudero R, Jado harboring SFG rickettsiae, A. phago- Sophie Edouard, I, Valcarcel F, Casado-Nistal MA, et al. cytophilum, or Ehrlichia spp. Philippe Parola, Tick-borne zoonotic bacteria in ticks col- In 2007–2011, we collected 827 Cristina Socolovschi, lected from central Spain. Am J Trop Med Hyg. 2009;81:67–74. , Amblyomma, and Bernard Davoust, 10. Satta G, Chisu V, Cabras P, Fois F, Ma- Ixodes spp. ticks (392 adults, 435 Bernard La Scola, sala G. Pathogens and symbionts in ticks: nymphs) by flagging vegetation in the and Didier Raoult a survey on tick species distribution and prefectures of Shizuoka, Mie, Wakaya- Author affiliation: Aix-Marseille Université, presence of tick-transmitted micro-organ- isms in Sardinia, Italy. J Med Microbiol. ma, Kagoshima, Nagasaki (Goto Is- Marseille, France 2011;60:63–8. http://dx.doi.org/10.1099/ land), and Okinawa (the main island DOI: http://dx.doi.org/eid1902.120863 jmm.0.021543-0 and Yonaguni Island) (Technical

338 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013