• 1.

    Petersdorf RG, Beeson PB, 1961. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 40: 130.

  • 2.

    Durack DT, Street AC, 1991. Fever of unknown origin: reexamined and redefined. Curr Clin Top Infect Dis 11: 3551.

  • 3.

    Knockaert DC, Vanderschueren S, Blockmans D, 2003. Fever of unknown origin in adults: 40 years on. J Intern Med 253: 263275.

  • 4.

    Raoult D, Roux V, 1997. Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev 10: 694719.

  • 5.

    Perlman SJ, Hunter MS, Zchori-Fein E, 2006. The emerging diversity of Rickettsia. Proc Biol Sci 273: 20972106.

  • 6.

    Parola P, Paddock CD, Raoult D, 2005. Tick-borne rickettsioses around the world, emerging diseases challenging old concepts. Clin Microbiol Rev 18: 719756.

    • Search Google Scholar
    • Export Citation
  • 7.

    Fournier PE, Raoult D, 2009. Current knowledge on phylogeny and taxonomy of Rickettsia spp. Ann N Y Acad Sci 1166: 111.

  • 8.

    Murray GG, Weinert LA, Rhule EL, Welch JJ, 2016. The phylogeny of Rickettsia using different evolutionary signatures: how tree-like is bacterial evolution? Syst Biol 65: 265279.

    • Search Google Scholar
    • Export Citation
  • 9.

    Shpynov SN, Fournier PE, Pozdnichenko NN, Gumenuk AS, Skiba AA, 2018. New approaches in the systematics of rickettsiae. New Microbes New Infect 23: 93102.

    • Search Google Scholar
    • Export Citation
  • 10.

    Nicholson WL, Paddock CD, 2018. Rickettsial (spotted & typhus fevers) & related infections, including anaplasmosis & ehrlichiosis. Chapter 3: infectious diseases related to travel. In: CDC Yellow Book. Baltimore, MD: CDC.

  • 11.

    International Travel and Health, 2018. TyphusFfever (Epidemic louse-borne typhus). Available at: http://www.who.int/ith/diseases/typhusfever/en. Accessed September 12, 2018.

  • 12.

    CDC, 2018. Murine Typhus. Typhus Fevers Home. Available at: https://www.cdc.gov/typhus/murine/index.html. Accessed September 12, 2018.

  • 13.

    Parola P, Rovery C, Rolain JM, Brouqui P, Davoust B, Raoult D, 2009. Rickettsia slovaca and R. raoultii in tick-borne rickettsioses. Emerg Infect Dis 15: 11051108.

    • Search Google Scholar
    • Export Citation
  • 14.

    Cascio A, Torina A, Valenzise M, Blanda V, Camarda N, Bombaci S, Iaria C, De Luca F, Wasniewska M, 2013. Scalp eschar and neck lymphadenopathy caused by Rickettsia massiliae. Emerg Infect Dis 19: 836837.

    • Search Google Scholar
    • Export Citation
  • 15.

    Zaharia M, Popescu CP, Florescu SA, Ceausu E, Raoult D, Parola P, Socolovschi C, 2016. Rickettsia massiliae infection and SENLAT syndrome in Romania. Ticks Tick Borne Dis 7: 759762.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bartoshevich EN, 1952. To the issue of rickettsioses. Health Care of Kazakhstan 3: 2024 (In Russian).

  • 17.

    Arkhangelskiy DS, 1961. Experimental study of tick-borne rickettsial pathogen in Almaty region. In: Collection of Scientific Papers of the Institute of Microbiology and Virology, Vol. 4. Physiology and Ecology of Microorganisms. Almaty, Kazakhstan: Alma-Ata, 176–185 (In Russian).

  • 18.

    Turebekov N 2019. Prevalence of Rickettsia species in ticks including identification of unknown species in two regions in Kazakhstan. Parasit Vectors 12: 197.

    • Search Google Scholar
    • Export Citation
  • 19.

    2019. Epidemiological Situation of Infectious Diseases in the Republic of Kazakhstan from 2018. Annual Report from Scientific Practical Center of Sanitary Epidemiological Expertise and Monitoring. Almaty: Kazakhstan (In Russian).

  • 20.

    Shpynov S, Parola P, Rudakov N, Samoilenko I, Tankibaev M, Tarasevich I, Raoult D, 2001. Detection and identification of spotted fever group rickettsiae in Dermacentor ticks from Russia and central Kazakhstan. Eur J Clin Microbiol Infect Dis 20: 903905.

    • Search Google Scholar
    • Export Citation
  • 21.

    Shpynov SN, Rudakov NV, Tarasevich IV, Tankibayev MA, 2002. Genotyping of Rickettsia and erlichia from Ixodes ticks in Russia and Kazakhstan. In: Gene Diagnosis of Infectious Diseases. 4th All-Russian Scientific and Practical Conference, Moscow, Russia, 256257 (In Russian).

  • 22.

    Shpynov S, Fournier PE, Rudakov N, Tankibaev M, Tarasevich I, Raoult D, 2004. Detection of a Rickettsia closely related to Rickettsia aeschlimannii, “Rickettsia heilongjiangensis,” Rickettsia sp. strain RpA4, and Ehrlichia muris in ticks collected in Russia and Kazakhstan. J Clin Microbiol 42: 22212223.

    • Search Google Scholar
    • Export Citation
  • 23.

    Shpynov SN 2005. Detection of new genotypes of Rickettsia of a tick-borne spotted fever group in the south of the Urals, in Siberia, in the Far East, and in Kazakhstan. Epidemiology and Infectious Diseases 1: 23–27 (In Russian).

  • 24.

    Yegemberdiyeva R, Shapiyeva Zh, 2008. Clinical and epidemiological characteristic of tick-borne rickettsiosis in Kazakhstan. In: Abstract Book of the International Conference on Zoonoses. Ulaaanbaatar, Mongolia, 4851 (In Russian).

  • 25.

    Kyraubayev K 2014. Study of Dermacentor marginatus ticks for rickettsiae in central Kazakhstan. In: Abstract Book of 114th General Meeting of ASM. Boston, MA, 139.

  • 26.

    Rudakov NV, Shpynov SN, Samoilenko IE, Tankibaev MA, 2003. Ecology and epidemiology of spotted fever group rickettsiae and new data from their study in Russia and Kazakhstan. Ann N Y Acad Sci 990: 1224.

    • Search Google Scholar
    • Export Citation
  • 27.

    Hay J 2016. Biosurveillance in Central Asia: successes and challenges of tick-borne disease research in Kazakhstan and Kyrgyzstan. Front Public Health 4: 16.

    • Search Google Scholar
    • Export Citation
  • 28.

    Sansyzbayev Y, Nurmakhanov T, Berdibekov A, Vilkova A, Yeskhodzhayev O, John HK, Jiang J, Farris CM, Richards AL, 2017. Survey for rickettsiae within fleas of great gerbils, Almaty oblast, Kazakhstan. Vector Borne Zoonotic Dis 17: 172178.

    • Search Google Scholar
    • Export Citation
  • 29.

    Almaty region of Kazakhstan. Available at: http://www.zhetysu.gov.kz/ru/o-regione. Accessed March 9, 2020 (In Russian).

  • 30.

    Kyzylorda region of Kazakhstan. Available at: https://e-kyzylorda.gov.kz/?q=ru/content/prirodno-klimaticheskie-usloviya. Accessed March 9, 2020 (In Russian).

  • 31.

    Abdiyeva K 2019. Seroepidemiological and molecular investigations of infections with Crimean-Congo hemorrhagic fever virus in Kazakhstan. Int J Infect Dis 78: 121127.

    • Search Google Scholar
    • Export Citation
  • 32.

    Tukhanova T 2020. Serological investigation of orthohantaviruses in patients with fever of unknown origin in Kazakhstan. Zoonoses and Public Health 67: 271–279.

  • 33.

    RStudio Team, 2016. RStudio: Integrated Development for R. Boston, MA: RStudio, Inc. Available at: http://www.rstudio.com/. Accessed April 29, 2020.

  • 34.

    La Scola B, Raoult D, 1997. Laboratory diagnosis of rickettsioses:current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol 35: 27152727.

    • Search Google Scholar
    • Export Citation
  • 35.

    Kovácová E, Kazár J, 2000. Rickettsial diseases and their serological diagnosis. Clin Lab 46: 239245.

  • 36.

    Tshokey T, Stenos J, Durrheim DN, Eastwood K, Nguyen C, Graves SR, 2017. Seroprevalence of rickettsial infections and Q fever in Bhutan. PLoS Negl Trop Dis 11: e0006107.

    • Search Google Scholar
    • Export Citation
  • 37.

    Paris DH, Dumler JS, 2016. State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis 29: 433439.

    • Search Google Scholar
    • Export Citation
  • 38.

    Luce-Fedrow A, Mullins K, Kostik AP, St John HK, Jiang J, Richards AL, 2015. Strategies for detecting rickettsiae and diagnosing rickettsial diseases. Future Microbiol 10: 537564.

    • Search Google Scholar
    • Export Citation
  • 39.

    Maina AN, Farris CM, Odhiambo A, Jiang J, Laktabai J, Armstrong J, Holland T, Richards AL, O’Meara WP, 2016. Q fever, scrub typhus, and rickettsial diseases in children, Kenya, 2011–2012. Emerg Infect Dis 22: 883886.

    • Search Google Scholar
    • Export Citation
  • 40.

    Tripathi CDP, Singh M, Agarwal J, Kanta C, Atam V, 2017. Seroepidemiology of spotted fever rickettsiosis in Uttar Pradesh: a prospective study. J Clin Diagn Res 11: DC04DC09.

    • Search Google Scholar
    • Export Citation
  • 41.

    Stephen S, Ambroise S, Gunasekaran D, Hanifah M, Sangeetha B, Pradeep J, Sarangapani K, 2018. Serological evidence of spotted fever group rickettsiosis in and around Puducherry, south India: a three years study. J Vector Borne Dis 55: 144150.

    • Search Google Scholar
    • Export Citation
  • 42.

    Mane A, Kamble S, Singh MK, Ratnaparakhi M, Nirmalkar A, Gangakhedkar R, 2019. Seroprevalence of spotted fever group and typhus group rickettsiae in individuals with acute febrile illness from Gorakhpur, India. Int J Infect Dis 79: 195198.

    • Search Google Scholar
    • Export Citation
  • 43.

    Faccini-Martínez ÁA 2017. Epidemiology of spotted fever group Rickettsioses and acute undifferentiated febrile illness in Villeta, Colombia. Am J Trop Med Hyg 97: 782788.

    • Search Google Scholar
    • Export Citation
  • 44.

    Salmon-Mulanovich G 2019. Seroprevalence and risk factors for Rickettsia and Leptospira infection in four ecologically distinct regions of Peru. Am J Trop Med Hyg 100: 13911400.

    • Search Google Scholar
    • Export Citation
  • 45.

    Zhang L, Shan A, Mathew B, Yin J, Fu X, Zhang J, Lu J, Xu J, Dumler JS, 2008. Rickettsial seroepidemiology among farm workers, Tianjin, People’s Republic of China. Emerg Infect Dis 14: 938940.

    • Search Google Scholar
    • Export Citation
  • 46.

    Tay ST, Ho TM, Rohani MY, Devi S, 2000. Antibodies to Orientia tsutsugamushi, Rickettsia typhi and spotted fever group rickettsiae among febrile patients in rural areas of Malaysia. Trans R Soc Trop Med Hyg 94: 280284.

    • Search Google Scholar
    • Export Citation
  • 47.

    Trung NV 2017. Seroprevalence of scrub typhus, typhus, and spotted fever among rural and urban populations of northern Vietnam. Am J Trop Med Hyg 96: 10841087.

    • Search Google Scholar
    • Export Citation
  • 48.

    Faruque LI 2017. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh. BMC Infect Dis 17: 141.

    • Search Google Scholar
    • Export Citation
  • 49.

    Borawski K, Dunaj J, Czupryna P, Pancewicz S, Świerzbińska R, Żebrowska A, Moniuszko-Malinowska A, 2019. Prevalence of spotted fever group Rickettsia in north-eastern Poland. Infect Dis (Lond) 51: 810814.

    • Search Google Scholar
    • Export Citation
  • 50.

    von Fricken ME, Lkhagvatseren S, Boldbaatar B, Nymadawa P, Weppelmann TA, Baigalmaa BO, Anderson BD, Reller ME, Lantos PM, Gray GC, 2018. Estimated seroprevalence of Anaplasma spp. and spotted fever group Rickettsia exposure among herders and livestock in Mongolia. Acta Trop 177: 179185.

    • Search Google Scholar
    • Export Citation
  • 51.

    Kho KL, Koh FX, Hasan LI, Wong LP, Kisomi MG, Bulgiba A, Nizam QN, Tay ST, 2017. Rickettsial seropositivity in the indigenous community and animal farm workers, and vector surveillance in Peninsular Malaysia. Emerg Microbes Infect 6: e18.

    • Search Google Scholar
    • Export Citation
  • 52.

    Irwin J, Tredoux D, Mills G, 2013. Murine typhus and leptospirosis presenting with undifferentiated symptoms of an acute febrile illness to Waikato Hospital, New Zealand, 2009–2010. N Z Med J 126: 5666.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Occurrence of Anti-Rickettsia spp. Antibodies in Hospitalized Patients with Undifferentiated Febrile Illness in the Southern Region of Kazakhstan

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  • 1 Central Reference Laboratory, National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan;
  • 2 Department of Infectious and Tropical Diseases, Kazakh National Medical University, Almaty, Kazakhstan;
  • 3 National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan;
  • 4 Department of Children’s Infectious Diseases, Kazakh National Medical University, Almaty, Kazakhstan;
  • 5 Scientific Practical Center of Sanitary Epidemiological Expertise and Monitoring, Almaty, Kazakhstan;
  • 6 Scientific Clinical Diagnostic Laboratory, Kazakh National Medical University, Almaty, Kazakhstan;
  • 7 Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany;
  • 8 Al-Farabi Kazakh National University, Almaty, Kazakhstan;
  • 9 Institute of General Genetics and Cytology, Almaty, Kazakhstan;
  • 10 Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, German Center for Infection Research, Munich Partner site, Munich, Germany;
  • 11 Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany;
  • 12 Bundeswehr Research Institute for Protective Technologies and CBRN Protection, Munster, Germany

Abstract.

Undifferentiated febrile illness still represents a demanding medical problem all over the world, but primarily in low- and middle-income countries. Scientific and clinical investigations related to undifferentiated febrile illness and rickettsial diseases in Kazakhstan are lacking. This study reflects the investigation of antibodies against spotted fever group (SFG) and typhus group (TG) rickettsiae in patients with undifferentiated febrile illness in the southern region of Kazakhstan (Almaty and Kyzylorda oblasts). Paired serum samples were gathered from 13 hospitals in these two oblasts and explored for the presence of IgM and IgG antibodies against typhus group and IgG antibodies against spotted fever group rickettsiae using ELISA. Patient’s questionnaires were statistically analyzed. In total, 802 inpatients from Almaty (N = 9) and Kyzylorda (N = 4) hospitals were included in this research. Based on ELISA results, 250 patients out of 802 (31.2%) from both oblasts had IgG antibodies against SFG rickettsiae. Results from 11 (1.4%) patients indicated acute infection with tick-borne rickettsiosis. Regarding TG rickettsiae (R. typhi), a past infection was detected in 248 (30.9%) febrile patients and acute infection in 22 (2.7%) patients in the two selected oblasts. The data indicated that SFG and TG rickettsioses are present in Kazakhstan. Kazakh physicians should be aware of these emerging diseases in both investigated oblasts because the occurrence of these diseases is not suspected during day-to-day clinical practice. The identification of rickettsial pathogens and implementation of modern laboratory methods for the diagnostics of rickettsioses are in need throughout Kazakhstan.

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Author Notes

Address correspondence to Sandra Essbauer, Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Neuherbergstr. 11, 80937 Munich, Germany, E-mail: sandraessbauer@bundeswehr.org

Financial support: This research was funded by the German Federal Foreign Office within the framework of the global partnership German Biosecurity Program. This study was conducted with collaboration between Bundeswehr Institute of Microbiology, Kazakh National Medical University and Scientific Practical Center of Sanitary Epidemiological Expertise and Monitoring.

Disclaimer: All ethical issues were reviewed and approved by the national Kazakh Ethical Committee from Kazakh National Medical University and by the ethical committee from the Ludwig-Maximilians-Universität in Germany. The authors declare that they have no competing interests. The opinions expressed by the authors contributing to this study do not necessarily reflect the opinions of the involved institutes.

Authors’ addresses: Nurkeldi Turebekov and Karlygash Abdiyeva, Central Reference Laboratory, National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan, E-mails: nurkeldi.turebekov@lrz.uni-muenchen.de and karlygash.abdiyeva@lrz.uni-muenchen.de. Ravilya Yegemberdiyeva, Department of Infectious and Tropical Diseases, Kazakh National Medical University, Almaty, Kazakhstan, E-mail: regemberdieva@rambler.ru. Andrey Kuznetsov and Andrey Dmitrovskiy, National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan, E-mails: dr.a.n.kuznetsov@gmail.com and am_dmitr@mail.ru. Lyazzat Yeraliyeva, Department of Children’s Infectious Diseases, Kazakh National Medical University, Almaty, Kazakhstan, E-mail: l.eralieva@mail.ru. Zhanna Shapiyeva, Scientific Practical Center of Sanitary Epidemiological Expertise and Monitoring, Almaty, Kazakhstan, E-mail: z.shapiyeva@gmail.com. Dinara Batyrbayeva, Scientific Clinical Diagnostic Laboratory, Kazakh National Medical University, Almaty, Kazakhstan, E-mail: dinarabat@mail.ru. Nur Tukhanova and Anna Shin, Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany, E-mails: tukhanovanur@gmail.com and annashin86@gmail.com. Lyazzat Musralina, Institute of General Genetics and Cytology, Almaty, Kazakhstan, E-mail: musralinal@gmail.com. Michael Hoelscher, Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, German Center for Infection Research, Munich Partner site, Munich, Germany, E-mail: hoelscher@lrz.uni-muenchen.de. Guenter Froeschl, Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, and German Center for Infection Research, Munich Partner site, Munich, Germany, E-mail: froeschl@lrz.uni-muenchen.de. Gerhard Dobler, Klaus Freimueller, Edith Wagner, and Sandra Essbauer, Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, Munich, Germany, E-mails: gerharddobler@bundeswehr.org, klausfreimueller@bundeswehr.org, edithwagner@bundeswehr.org, and sandraessbauer@bundeswehr.org. Stefan Frey, Bundeswehr Research Institute for Protective Technologies, and CBRN Protection, Munster, Germany, E-mail: stefan1frey@bundeswehr.org.

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