Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group

Kularatne, S.A.M.; Rajapakse, R. P. V. J.; Wickramasinghe, W.M.R.S.; Nanayakkara, Devathri; Budagoda, Sudhara; Weerakoon, Kosala; Edirisinghe, J.S.; Premaratna, R.

doi:10.1016/j.ijid.2013.05.014

Cited by 27 publications

(37 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although R. sibirica mongolitimonae was firstly isolated from Hyalomma asiaticum collected in China [7], to date, human cases of R. sibirica mongolitimonae infection have been never described in Asia. Current serological evidence suggests the presence of scrub typhus and SFG rickettsiosis including Rickettsia conorii [8] in Sri Lanka [9] (Table 1). However, serology makes difficult to identify the infecting rickettsial species because of cross-reactivity among antigens of pathogens within the same genus.…”

Section: Introductionmentioning

confidence: 99%

Rickettsia sibirica mongolitimonae infection, Sri Lanka

Cordier

Tattevin

Leyer

et al. 2017

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction. Rickettsia sibirica mongolitimonae was recently reported as a common rickettsiosis in France. Current serological evidence suggests the presence of scrub typhus and spotted fever group rickettsiosis in Sri Lanka. We detected a human case of R. sibirica mongolitimonae in Sri Lanka. Methodology. A skin biopsy of the eschar was tested for the presence of Rickettsia spp. using qPCR assay targeting a 109-bp fragment of a hypothetical protein and by PCR amplification and sequencing targeting the ompA gene. Results. A 30-year-old woman who had just returned from travel to a jungle in Sri Lanka was evaluated as an outpatient for fever. Examination revealed an enlarged axillary lymph node, a maculopapular rash and an eschar at her left flank and a skin biopsy of the eschar was performed. The skin biopsy was positive for the presence of Rickettsia spp. by qPCR and PCR amplification and sequencing targeting the ompA gene revealed R. sibirica mongolitimonae. Immunofluorescence assay on an acute serum sample for spotted fever group rickettsial antigens (Rickettsia conorii conorii, R. sibirica mongolitimonae, Rickettsia felis) and typhus group rickettsiae (Rickettsia typhi) was negative. The patient was treated by oral doxycycline (200 mg/day) for one week. Conclusions. R. sibirica mongolitimonae should be considered in the differential diagnosis of patients with suspected rickettsiosis in, or returning from, Sri Lanka.

show abstract

Section: Introductionmentioning

confidence: 99%

Rickettsia sibirica mongolitimonae infection, Sri Lanka

Cordier

Tattevin

Leyer

et al. 2017

J Infect Dev Ctries

View full text Add to dashboard Cite

show abstract

“…Classic eschars with thick and dry necrotic tissue have been described in some SFG rickettsioses such as Mediterranian spotted fever (MSF), African tick bite fever and rickettsial pox [14], [15]. Predominance of maculopapular erythematous rash in SFG has been reported earlier and the fern leaf type skin necrosis has not often been described other than in few studies done in the same region in Sri Lanka [2], [4]. However, there are reports of gangrene of digits, ear lobes, scrotum, nose or limbs occurring in rickettsial infections such as RMSF [16], similar to two cases presented in 2012.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical case definition was based on the presence of fever for more than five days, associated skin rash and rapid defervescence with an anti-rickettsial antibiotic treatment [2], [4]. Patients were interviewed and examined, and followed up while in the hospital and after discharge.…”

Section: Methodsmentioning

confidence: 99%

“…Rickettsia cause human infections giving rise to a wider array of clinical features. Rickettsial infections have re-emerged in Sri Lanka where three known disease entities namely spotted fever group (SFG), murine typhus and scrub typhus are being reported from different parts of the island [2]–[4]. Disease spectrum varies mainly depending on the rickettsial species that causes the disease, for example the Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii is known to be the most severe form of tick borne rickettsioses around the globe [1].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the presence of cutanoeus lesions facilitates the clinical diagnosis of the infection. These include eschars, skin eruptions and rash with patchy necrosis [2], [4], [7]. Further, it is important to be familiar with the common cutaneous manifestations as well as uncommon variations of skin lesions.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cutaneous Manifestations of Spotted Fever Rickettsial Infections in the Central Province of Sri Lanka: A Descriptive Study

et al. 2014

View full text Add to dashboard Cite

BackgroundCharacteristic skin lesions play a key role in clinical diagnosis of spotted fever group rickettsioses and this study describes these cutaneous manifestations along with basic histological features.Methods and FindingsStudy was conducted at Medical Unit, Teaching Hospital, Peradeniya, from November 2009 to October 2011, where a prospective data base of all rickettsial infections is maintained. Confirmation of diagnosis was made when IgM and IgG immunofluorescent antibody titre of 1/32 and >1/256 respectively. Of the 210 clinical cases, 134 had cutoff antibody titers for Rickettsia conorii antigen for confirmation. All these 134 patients had fever and skin rash, and of them 132(98%) had discrete maculopapular rash while eight (6%) had fern leaf type skin necrosis. Eight patients (6%) had healed tick bite marks. Average size of a skin lesion was 5 mm and rash involved 52% of body surface, distributed mainly in limbs and back of the chest. Generally the facial and leg skin was slightly oedematous particularly in old aged patients. Sixteen patients (12%) had pain and swelling of ankle joints where swelling extended to feet and leg. Biopsies from skin rash of six patients showed evidence of cutaneous vasculitis and of them, 247 bp region of the 17-kDa spotted fever group specific protein antigen was amplified using PCR.ConclusionsA discrete maculopapular rash and occasional variations such as fern leaf shape necrosis and arthritis are found in spotted fever group. Histology found vasculitis as the pathology of these lesions.

show abstract