Rickettsia felis Infection in Febrile Children, Ghana

Peter Sothmann Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

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Christian Keller Institute of Virology, University Hospital Giessen and Marburg, Marburg, Germany.

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Ralf Krumkamp Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany.

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Benno Kreuels Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany.

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Cassandra Aldrich Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

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Nimako Sarpong Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

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Stefanie Steierberg Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

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Doris Winter Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

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Kennedy Gyau Boahen Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

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Ellis Owusu-Dabo Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

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Jürgen May Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany.

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Daniel Eibach Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

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Rickettsial infections are an underrecognized cause of febrile illness in sub-Saharan Africa. To evaluate the epidemiology and clinical features of rickettsial disease in pediatric patients in Ghana, we screened blood samples from febrile children aged less than 15 years presenting to an outpatient department in Ghana's Ashanti Region for the presence of rickettsial DNA. We detected Rickettsia felis in 7/470 (1.5%) blood samples, using two independent real-time polymerase chain reactions. No other Rickettsia species were found. R. felis was detected repeatedly in one patient, and coinfection with Plasmodium falciparum was found in 3/7 samples. Symptoms apart from fever included cough (6/7) and vomiting (4/7). None of the R. felis-positive patients reported a rash. This study is the first report on R. felis in Ghana and adds to the growing evidence for its widespread occurrence with and without malaria coinfection in sub-Saharan Africa.

Author Notes

* Address correspondence to Peter Sothmann, Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail: p.sothmann@uke.de
† These authors contributed equally to this work.

Financial support: This work was supported by grants from the German Center for Infection Research (Deutsches Zentrum für Infektionsforschung, DZIF, www.dzif.de) to Ralf Krumkamp (grant number: 80 00 201-3, TI 03.001) and Benno Kreuels (grant number: TI 07.001).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors' addresses: Peter Sothmann, Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, E-mail: p.sothmann@uke.de. Christian Keller, Institute of Virology, University Hospital Giessen and Marburg, Marburg, Germany, E-mail: christian.keller@staff.uni-marburg.de. Ralf Krumkamp and Juergen May, Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, and German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany, E-mails: krumkamp@bnitm.de and may@bnitm.de. Benno Kreuels, Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, and German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany, E-mail: kreuels@bnitm.de. Cassandra Aldrich, Stefanie Steierberg, Doris Winter, and Daniel Eibach, Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, E-mails: aldrich@bnitm.de, stefanie@steierberg.de, winter@bnitm.de, and eibach@bnitm.de. Nimako Sarpong, Kennedy Gyau Boahen, and Ellis Owusu-Dabo, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, E-mails: nimakosarpong@yahoo.com, gyaukennedy@yahoo.com, and owusudabo@kccr.de.

  • 1.

    Reddy EA, Shaw AV, Crump JA, 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417432.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Prasad N, Murdoch DR, Reyburn H, Crump JA, 2015. Etiology of severe febrile illness in low- and middle-income countries: a systematic review. PLoS One 10(6): e0127962.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Maina AN, Knobel DL, Jiang J, Halliday J, Feikin DR, Cleaveland S, Ng'ang'a Z, Junghae M, Breiman RF, Richards AL, Njenga MK, 2012. Rickettsia felis infection in febrile patients, western Kenya, 2007–2010. Emerg Infect Dis 18: 328331.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Mediannikov O, Socolovschi C, Edouard S, Fenollar F, Mouffok N, Bassene H, Diatta G, Tall A, Niangaly H, Doumbo O, Lekana-Douki JB, Znazen A, Sarih M, Ratmanov P, Richet H, Ndiath MO, Sokhna C, Parola P, Raoult D, 2013. Common epidemiology of Rickettsia felis infection and malaria, Africa. Emerg Infect Dis 19: 17751783.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Angelakis E, Mediannikov O, Parola P, Raoult D, 2016. Rickettsia felis: the complex journey of an emergent human pathogen. Trends Parasitol 32: 554564.

  • 6.

    Mediannikov O, Fenollar F, Bassene H, Tall A, Sokhna C, Trape J-F, Raoult D, 2013. Description of “yaaf”, the vesicular fever caused by acute Rickettsia felis infection in Senegal. J Infect 66: 536540.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Crump JA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, Galloway RL, Ooi EE, Maro VP, Saganda W, Kinabo GD, Muiruri C, Bartlett JA, 2013. Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 7: e2324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    UNICEF, 2013. At a glance: Ghana—Statistics. Available at: http://www.unicef.org/infobycountry/ghana_statistics.html. Accessed February 8, 2015.

  • 9.

    Mediannikov O, Diatta G, Fenollar F, Sokhna C, Trape JF, Raoult D, 2010. Tick-borne rickettsioses, neglected emerging diseases in rural Senegal. PLoS Negl Trop Dis 4: e821.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Henry KM, Jiang J, Rozmajzl PJ, Azad AF, Macaluso KR, Richards AL, 2007. Development of quantitative real-time PCR assays to detect Rickettsia typhi and Rickettsia felis, the causative agents of murine typhus and flea-borne spotted fever. Mol Cell Probes 21: 1723.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Schriefer ME, Sacci JB, Dumler JS, Bullen MG, Azad AF, 1994. Identification of a novel rickettsial infection in a patient diagnosed with murine typhus. J Clin Microbiol 32: 949954.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Brown LD, Macaluso KR, 2016. Rickettsia felis, an Emerging Flea-Borne Rickettsiosis. Curr Trop Med Rep 3: 2739.

  • 13.

    Dieme C, Bechah Y, Socolovschi C, Audoly G, Berenger J-M, Faye O, Raoult D, Parola P, 2015. Transmission potential of Rickettsia felis infection by Anopheles gambiae mosquitoes. Proc Natl Acad Sci USA 112: 80888093.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Labruna MB, Walker DH, 2014. Rickettsia felis and changing paradigms about pathogenic rickettsiae. Emerg Infect Dis 20: 17681769.

  • 15.

    Socolovschi C, Mediannikov O, Sokhna C, Tall A, Diatta G, Bassene H, Trape JF, Raoult D, 2010. Rickettsia felis-associated uneruptive fever, Senegal. Emerg Infect Dis 16: 11401142.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Mourembou G, Lekana-Douki JB, Mediannikov O, Nzondo SM, Kouna LC, Essone JCBB, Fenollar F, Raoult D, 2015. Possible role of Rickettsia felis in acute febrile illness among children in Gabon. Emerg Infect Dis 21: 18081815.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Mediannikov O, Socolovschi C, Million M, Sokhna C, Bassene H, Diatta G, Fenollar F, Raoult D, 2014. Molecular identification of pathogenic bacteria in eschars from acute febrile patients, Senegal. Am J Trop Med Hyg 91: 10151019.

    • PubMed
    • Search Google Scholar
    • Export Citation
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