Tick- and flea-borne rickettsioses in Tizi-Ouzou, Algeria: Implications for travel medicine

Hayet Bouchaib , Carole Eldin (1) , Maureen Laroche (1) , Didier Raoult (2) , Philippe Parola (1)

1 VITROME - Vecteurs - Infections tropicales et méditerranéennes
2 MEPHI - Microbes évolution phylogénie et infections

Background: In Algeria, Mediterranean spotted fever (MSF), caused by Rickettsia conorii conorii and transmitted by Rhipicephalus sanguineus, is endemic. However, the documentation of cases is rare due to a lack of laboratory facilities. Our aim was to screen for rickettsioses in patients with fever, rash and a possible inoculation eschar. Materials and methods: Between 2013 and 2015, patients with a fever and a rash presenting at hospitals in the Tizi-Ouzou region were prospectively included in our study. Sera were screened using Indirect Immunofluorescence Assay (IFA) and qPCR was performed on swab samples from eschars. Results: One hundred and sixty-six patients were included. For 57 patients, MSF due to R. conorii conorii was diagnosed by serology and qPCR on a swab eschar sample. Three patients were diagnosed with murine typhus, a flea borne rickettsiosis. In addition, two patients had a positive serology in IgM for R. felis. For nine patients, serology for rickettsiosis was positive, but the specific rickettsia involved could not be determined. Nine patients had a severe disease with neurological involvement or multi-organ failure. Conclusion: Clinicians should routinely screen for rickettsioses in patients and travellers presenting with a rash upon return from Algeria. Doxycycline treatment must be given promptly because the prognosis can be severe.

Domaines: Maladies infectieuses

Hayet Bouchaib, Carole Eldin, Maureen Laroche, Didier Raoult, Philippe Parola. Tick- and flea-borne rickettsioses in Tizi-Ouzou, Algeria: Implications for travel medicine. Travel Medicine and Infectious Disease, 2018, 26, pp.51-57. ⟨10.1016/j.tmaid.2018.11.005⟩. ⟨hal-01970228⟩