LETTERS

Richard Reithinger,*† domestic and wild animals that also products obtained by PCR with Khoksar Aadil,† Samad Hami,† feeds readily on people. Recent stud- primers for the 17-kDa protein (4), and Jan Kolaczinski*† ies have implicated the cat flea as a citrate synthase (4), and PS 120 pro- *London School of Hygiene and Tropical vector of new and emerging infectious tein (5) genes. R. felis has been estab- Medicine, London, United Kingdom; and diseases (1). To determine the lished in tissue culture (XTC-2 and †HealthNet International, Peshawar, pathogens in C. felis in New Zealand, Vero cells) (6), and serologic testing Pakistan we collected 3 cat fleas from each of has been used to diagnose infections 11 dogs and 21 cats at the Massey (5). Reports indicate that patients References University Veterinary Teaching respond rapidly to doxycycline thera- 1. Ashford R, Kohestany K, Karimzad M. Hospital from May to June 2003. The py (5), and in vitro studies have Cutaneous leishmaniasis in Kabul: observa- fleas were stored in 95% alcohol until shown the organism is susceptible to tions on a prolonged epidemic. Ann Trop Med Parasitol 1992;86:361–71. they were identified by using morpho- rifampin, thiamphenicol, and fluoro- 2. Griffiths WDA. Old World cutaneous leish- logic criteria and washed in sterile quinolones. maniasis. In: Peters W, Killick-Kendrick R, phosphate-buffered saline. The DNA B. henselae is an agent of cat- editors. The leishmaniases in biology and from each flea was extracted individ- scratch disease, bacillary angiomato- medicine. London: Academic Press; 1987. p. 617–43. ually by using the QiaAmp Tissue Kit sis, bacillary peliosis, endocarditis, 3. Trouiller P, Torreele E, Olliaro P, White N, (QIAGEN Ltd., Hilden, Germany), bacteremia, and various neurologic Foster S, Wirth D, et al. Drugs for neglect- according to the manufacturer’s and ocular conditions. Cats are the ed diseases: a failure of the market and a instructions. When polymerase chain reservoir hosts, and contact with cats public health failure? Trop Med Int Health 2001;6:945–51. reaction (PCR) was performed with and their fleas is an established risk 4. Reithinger R, Mohsen M, Aadil K, Sidiqi primers for gltA and rOmpAas factor for most infections. Although M, Erasmus P, Coleman PG. The burden of described (2), products were obtained B. henselae has been isolated from anthroponotic cutaneous leishmaniasis in with DNA from 15 (15%) of the fleas. 17% of domestic cats in New Zealand Kabul, Afghanistan. Emerg Infect Dis 2003;9:727–9. The sequences of the products were (7), only two human infections have 5. Reyburn H, Rowland M, Mohsen M, Khan identical to those of Rickettsia felis been reported in the country; neurore- B, Davies CR. The prolonged epidemic of (GenBank AF191026) with infected tinitis was diagnosed in both patients anthroponotic cutaneous leishmaniasis in fleas taken from both dogs (3/11; (8). In neighboring Australia, howev- Kabul, Afghanistan: “bringing down the neighbourhood.” Trans R Soc Trop Med 27%) and cats (7/21; 33%). When er, cat-scratch disease, bacillary Hyg 2003;97,170–6. PCR was performed with primers for angiomatosis, and endocarditis have the 16S-23S rDNA interspacer region been diagnosed in numerous patients. Address for correspondence: Richard as described (3), products were Cats are also the reservoir hosts of B. Reithinger, Disease Control and Vector Biology obtained with DNA of four fleas. The clarridgeiae which has been implicat- Unit, Department of Infectious and Tropical sequences of the products from three ed as an agent of cat-scratch disease in Medicine, London School of Hygiene and fleas (from two cats) were identical to humans and aortic valve endocarditis Tropical Medicine, Keppel Street, London that of Bartonella henselae (GenBank and hepatic disease in dogs (9). The WC1E 7HT, UK; fax: +44 207 927 2164; AF312495), and the sequence of the organism has been found in cat fleas email: [email protected] product of one flea (from a cat) was (as great as 17%) in Europe (1), and identical to that of B. clarridgeiae although we found only one flea (GenBank AF167989). infected with B. clarridgeiae in New Our study is the first to identify R. Zealand, this description is the first of felis in Oceania. The organism is a the organism in Oceania. However, B. Rickettsia felis, recently described human pathogen, clarridgeiae has been found in and infections with this spotted fever domestic cats in nearby Indonesia and Bartonella group rickettsia have already been the Philippines (10). henselae, and reported in 11 persons: 4 persons in Our findings add to the accumulat- B. clarridgeiae, the United States, 2 persons in Brazil, ing data on R. felis, B. henselae, and 4 persons in Europe, and 1 person in B. clarridgeiae and should alert med- New Zealand Thailand. The symptoms of the ical workers in New Zealand, a com- To the Editor: The cat flea patients were nonspecific and includ- mon tourist destination, to the possi- (Ctenocephalides felis felis Bouché, ed fever, headache, and rash. bility that their patients may be infect- 1935) is a ubiquitous parasite of Diagnoses were made by sequencing ed with these organisms.

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 5, May 2004 967 LETTERS

Patrick J. Kelly,* Natalie Meads,* Enterohemorrhagic phenotypically confirmed cytotoxici- Anita Theobald,* ty of these isolates, with most of them Pierre-Edouard Fournier,† Escherichia coli being seroneutralized by rabbit antis- and Didier Raoult† O157, Kinshasa era against Shiga toxin (3). Thus, all *Massey University, Palmerston North, E. coli isolates responded to the defi- New Zealand; and †Faculté de Médecine, To the Editor: During the rainy nition of enterohemorrhagic E. coli. Marseille, France season, from April to September ≤ Before 2003, sporadic infections 2003, 463 children 15 years of age or outbreaks caused by enterohemor- References (median 10 months) with severe rhagic E. coli were not reported as a diarrhea were admitted to the 1. Rolain JM, Franc M, Davoust B, Raoult D. cause of bloody diarrhea in the Molecular detection of Bartonella quin- Pediatric Hospital of Kalembelembe Democratic Republic of Congo. A tana, B. koehlerae, B. henselae, B. clar- in Kinshasa, the capital of the case-control study could not be per- ridgeiae, Rickettsia felis, and Wolbachia Democratic Republic of Congo. The formed because of political unrest in pipientis in cat fleas, France. Emerg Infect population of the outbreak area was Dis 2003;9:338–42. Kinshasa. Although reported out- 2. Roux V, Raoult D. Inter- and intraspecies approximately one million. breaks of E. coli O157 in sub-Saharan identification of Bartonella (Rochalimaea) Several children with bloody Africa have been few to date, avail- species. J Clin Microbiol 1995;33:1573–9. diarrhea without fever were treated. able information indicates that the 3. Fournier PE, Roux V, Raoult D. They came from six districts of Phylogenetic analysis of spotted fever pathogen has wide geographic distri- group rickettsiae by study of the outer sur- Kinshasa (Bumbu, Selembao, bution. E. coli O157–related diarrhea face protein rOmpA. Int J Syst Bacteriol Makala, Kimbanseke, Masina, and outbreaks that occurred before 2003 1998;48:839–49. Ndjili). Abdominal cramps, nausea, have been reported in South Africa, 4. Schriefer ME, Sacci JB Jr., Dumler JS, vomiting, and dehydration were Bullen MG, Azad AF. Identification of a Swaziland (4), and Malawi (5) in novel rickettsial infection in a patient diag- uncommon. The duration of illness 1992; Central African Republic (6) nosed with murine typhus. J Clin Microbiol ranged from 5 days to 2 weeks. and Kenya (7) in 1996; Cameroon in 1994;32:949–54. Available antiparasitic drugs, 1998 (8); and Nigeria (9) and Ivory 5. Richter J, Fournier PE, Petridou J, trimethoprim-sulfamethoxazole, and Haussinger D, Raoult D. Rickettsia felis Coast (10) in 2000. In the Central infection acquired in Europe and docu- ampicillin showed no effect against African Republic and in Zémio, a mented by polymerase chain reaction. the illness. Fifty-six infants died small village located on the Emerg Infect Dis 2002;8:207–8. between June and July. Symptoms of Democratic Republic of Congo bor- 6. Raoult D, La Scola B, Enea M, Fournier hemolytic uremic syndrome deve- PE, Roux V, Fenollar F, et al. A flea-associ- der, outbreaks of bloody diarrhea in ated Rickettsia pathogenic for humans. loped in most of them. 1996 were attributed to E. coli O157 Emerg Infect Dis 2001;7:73–81. Stool samples from 32 patients from molecular test results (6). 7. Joseph AK, Wood CW, Robson JM, Paul were screened for parasites, Since 2001, an increasing number SL, Morris AJ. Bartonella henselae bac- enteropathogenic bacteria, rotavirus, teremia in domestic cats from Auckland. N of cases of acute bloody diarrhea have Z Vet J 1997;45:185–7. and adenovirus. Three samples were been reported in Kinshasa between 8. Dai S, Best S, St John M. Bartonella hense- positive for rotavirus. In contrast, all June and August. During this 2003 lae neuroretinitis in cat scratch disease. N Z stool cultures were positive for outbreak, an investigation could not Med J 2001;114:360–1. Escherichia coli which always grew 9. Gillespie TN, Washabau RJ, Goldschmidt be conducted; possible routes of MH, Cullen JM, Rogala AR, Breitschwerdt as pure cultures on purple bromocre- transmission would include person- EB. Detection of Bartonella henselae and sol agar, a nonselective medium con- to-person contact related to lack of Bartonella clarridgeiae DNA in hepatic taining lactose. The E. coli isolates hygiene, and contaminated food and specimens from two dogs with hepatic dis- appeared sorbitol negative when test- ease. J Am Vet Med Assoc 2003;222:47–51. water. 10. Chomel BB, Carlos ET, Kasten RW, ed on MacConkey sorbitol; they were In 1996 in the Central African Yamamoto K, Chang CC, Carlos RS, et al. agglutinated by O157 and H7 antisera Republic and in 1998 in Cameroon, Bartonella henselae and Bartonella clar- (Difco Laboratories, Detroit, MI) and the major contributing factors of the ridgeiae infection in domestic cats from the lacked expression of β-glucuronidase. Philippines. Am J Trop Med Hyg E. coli O157 outbreak were consump- 1999;60:593–7. All E. coli isolates were sent to the tion of smoked zebu meat and con- Pasteur Institute in Bangui, Central taminated drinking water. Studies of Address for correspondence: Patrick Kelly, African Republic, for further charac- E. coli O157 carriage rates among Institute of Veterinary, Animal and Biomedical terization. Polymerase chain reaction livestock, food, and environment in Sciences, Massey University, Private Bag 11 allowed detection of Shiga-like toxin this central African area might be use- 222, Palmerston North, New Zealand; fax: 64- slt-1 and slt-2 genes (1,2) in isolates ful in assessing the potential for future 6- 350-5616; email: [email protected] from all patients. The Vero cell assay outbreaks.

968 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 5, May 2004