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Letter
First Isolation of Rickettsia
slovaca from a Patient, France
C. Cazorla,* M. Enea,† F. Lucht,* and D. Raoult†
*Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France;
and †Université de la Méditerranée, Marseille, France
Suggested citation for this article: Cazorla
C, Enea M, Lucht F, Raoult D. First isolation of Rickettsia solvaca
from a patient, France. Emerg Infect Dis [serial online] 2003 Jan [date
cited]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no1/02-0192.htm
To the Editor: Rickettsia slovaca is a bacterium that infects
Dermacentor marginatus ticks in central and western Europe. First
detected in ticks, the bacterium was subsequently identified with genomic
amplification by using polymerase chain reaction (PCR) followed by sequencing
in a skin biopsy from a French patient (1). We describe
the first isolation of the organism from a patient.
A 79-year-old woman from St. Etienne, France, found a tick on the parietal
area of her scalp 6 days after she returned from a trip to rural southern
Burgundy. The tick was removed and subsequently identified as an adult
female D. marginatus tick. The patient saw a physician 1 day later
for low-grade fever (38°C) and myalgia. She was given amoxicillin (3 g
once a day), but the fever worsened. She was examined at University Hospital
on September 24, 2001, 4 days later. At that time, the patient had a fever;
the site of the tick bite showed a necrotic black lesion surrounded by
an erythematous halo 4 cm in diameter. Right cervical lymphadenopathy
and a papular rash consisting of 10 pink spots on the thorax and arms
were observed. Routine blood tests were within normal ranges but asparate
aminotransferase (53 IU; normal <45), creatine phosphokinases (140,
normal <120), and lactate dehydrogenases (890, normal <620) were
elevated. A skin biopsy from the patient’s scalp, serum, and the tick
were sent to Marseille to test for possible rickettsial infection. The
patient was treated with doxycycline (200 mg once a day, 15 d), and her
condition improved. At a check-up 1 month later, she complained of fatigue
and insomnia; 2 months later, she had recovered completely, although alopecia
still appeared at the site of the tick bite.
R. slovaca was demonstrated in the tick and the biopsy by using
PCR with primers derived from the citrate synthase and the rOmpA
genes as previously reported (2). R. slovaca was
found in human embryonic lung cells (2), 3 days after
the cells were injected with the skin-biopsied material. Seroconversion,
determined by indirect immunofluorescence, occurred with titers to both
R. slovaca and R. conorii of <1/8 and 1/128 in acute-
and convalescent-phase sera (sampled 2 months later), respectively.
R. slovaca, first identified in dermacentor ticks from Slovakia,
has subsequently been found in both D. marginatus and D. reticulatus
in France, Switzerland, Portugal, Spain, Armenia, and Germany (3).
Since the first human infections with R. slovaca were reported,
patients with similar clinical signs have been observed in France and
Hungary (4). Some of these cases have been confirmed
by PCR and others by serology (3), although serologic
titers are frequently low and show cross-reactions with other Rickettsiae.
We have described the isolation of R. slovaca from a patient, which
provides the first definitive evidence that R. slovaca is a human
pathogen. Clinical signs of infection consist of a skin lesion at the
site of a tick bite on the scalp (often a dermacentor tick) and regional
lymphadenopathy that may be painful. Fever and rash develop subsequently,
and the acute disease can be followed by fatigue and residual alopecia
at the bite site. The disease may be prevalent within the distribution
range of D. marginatus and D. reticulatis in southern, western,
and central Europe. This new spotted rickettsiosis should be added to
the list of recognized rickettsial diseases, mainly those caused by R.
africae (5), R. felis (6)
and R. mongolotimonae (7,8).
References
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