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Volume 20, Number 8—August 2014
Letter

Rickettsia felis Infections and Comorbid Conditions, Laos, 2003–2011

Sabine Dittrich, Koukeo Phommasone, Tippawan Anantatat, Phonepasith Panyanivong, GA1/4nther Slesak, Stuart D. Blacksell, Audrey Dubot-PA(c)rA"s, JosA(c)e Castonguay-Vanier, John Stenos, Paul N. Newton, and Daniel H. ParisComments to Author 
Author affiliations: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos (S. Dittrich, K. Phommasone, P. Panyanivong, S.D. Blacksell, A. Dubot-PA(c)rA"s, J. Castonguay-Vanier, P.N. Newton, D.H. Paris); Nuffield Department of Medicine, University of Oxford, Oxford, UK (S. Dittrich, S.D. Blacksell, A. Dubot-PA(c)rA"s, J. Castonguay-Vanier, P.N. Newton, D.H. Paris); Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (T. Anantatat, S.D. Blacksell, D.H. Paris); Service Fraternel d�?(tm)Entraide�?"Laos Medical Projects, Luang Namtha, Laos (G. Slesak); Tropenklinik Paul-Lechler-Krankenhaus, TA1/4bingen, Germany (G. Slesak); Aix Marseille University, Medical University, Marseille, France (A. Dubot-PA(c)rA"s); The Geelong Hospital, Geelong, Victoria, Australia (J. Stenos)

Main Article

Table

Clinical and laboratory findings of 3 patients with Rickettsia felis infections, Laos*

Patient characteristics Signs and symptoms Molecular findings Serologic findings Other laboratory findings
Male, 50 y, Vientiane City, central Laos
Fever, severe headache A- 7 d; contact with cats and dogs 14 d before admission; HIV/AIDS (CD4-count: 34 cell/I1/4L)
qPCR: Orientia tsutsugamushi (CSF, blood): negative; Rickettsia spp. (CSF): positive; Rickettsia spp. (blood): negative; R. typhi (CSF, blood): negative –Conventional PCR and sequencing (CSF):Rickettsia spp. 17 kDa; GenBank accession no: KF489454
Scrub/murine typhus: IgM/IgG static titers (<1:100; negative)–Spotted fever group: IgM/IgG static titers (1:200; negative) –R. felis: IgM/IgG static titers (<1:128; negative)
Increased intracranial pressure (>40 cm H20)–CSF: clear –CSF cellularity: 5 leukocytes/I1/4L (100% lymphocytes) –CSF glucose: 1.1 mmol/L; CSF/blood glucose ratio: 1:5 –CSF protein: 80 mg/L;–CSF Cryptococcus culture: positive/serotyping (PCR/RFLP) C. neoformans var. grubii –HIV rapid tests;† positive
Female, 39 y, Luang Namtha, northern Laos
Fever A- 7 d; diabetes mellitus, treated with glibenclamide; HIV status: unknown
qPCR: O. tsutsugamushi (eschar, blood): positive; Rickettsia spp. (eschar): positive; R. typhi (eschar): negative –Conventional PCR and sequencing (eschar): Rickettsia spp. 17kDa and sca4; GenBank accession no: KF489455, KF489457
Scrub typhus: dynamic IgM/IgG 4-fold rise (1:3,200/1:12,800)–Murine typhus: IgM/IgG static titers (<1:100; negative)–Spotted fever group: IgM/IgG static titers (1:200; negative); –R. felis: IgM/IgG static titers (<1:128; negative)
None
Male, 13 y, Salavan, southern Laos Fever A- 7 d, contact with cat, rat, and fleas 14 d before admission; HIV status: unknown qPCR: O. tsutsugamushi (blood): negative; Rickettsia spp. (blood): positive R. typhi (blood): negative –Conventional PCR and sequencing (blood): Rickettsia spp. 17 kDa GenBank accession no: KF489456 Data not available Malaria microscopy: P. falciparum; –Malaria rapid test: P. falciparum ICT Malaria Combo Cassette Test‡: P. falciparum –PCR: dengue fever positive reverse transcription qPCR: positive–Dengue genotyping PCR: serotype 4

*qPCR, quantitative PCR; CSF, cerebrospinal fluid; leukocyte; RFLP, restriction fragment length polymorphism; ICT, immunochromatographic test.–†Uni-GoldTM HIV, Trinity Biotech, Ireland; Alere Determine HIV-1/2 Ag/Ab Combo, Alere Medical, Japan.–‡ICT Diagnostics, Cape Town, South Africa.

Main Article

Page created: June 30, 2014
Page updated: June 30, 2014
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