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1. Borrelia crociduraeMeningoencephalitis, West Africa

Author

Amina Bourahoui, Annick Bosseray, Natacha Sertour, Martine Garnier, Sandrine Goutier, Elisabeth Ferquel, Hervé Pelloux, Patricia Pavese, G. Couetdic, Bruno Hoen, Isabelle Pelloux, Muriel Cornet, Claudine Pinel, Claire Lapostolle, Centre National de Référence des Borrelia (CNR), Institut Pasteur [Paris], Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de parasitologie-mycologie, CHU Grenoble, Clinique de médecine interne, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire de Bactériologie, Service des Maladies Infectieuses, Thérapeutique Recombinante Expérimentale (TIMC-IMAG-TheREx), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Centre National de Référence des Borrelia ( CNR ), Grenoble Institut des Neurosciences ( GIN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Grenoble-Université Joseph Fourier - Grenoble 1 ( UJF ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Thérapeutique Recombinante Expérimentale ( TIMC-IMAG-THEREX ), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Institut Pasteur [Paris] (IP), Laboratoire Chrono-environnement (UMR 6249) (LCE), and Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Endemic Diseases, relapsing fever, Epidemiology, encephalitis, lcsh:Medicine, spirochete, Disease, Polymerase Chain Reaction, West africa, tick-borne relapsing fever, 0302 clinical medicine, Lyme disease, Meningoencephalitis, RNA, Ribosomal, 16S, Ornithodoros ticks, bacteria, Child, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, Borrelia meningitis, Doxycycline, Travel, 0303 health sciences, Ceftriaxone, Dispatch, Relapsing Fever, meningitis, Middle Aged, Senegal, 3. Good health, RNA, Bacterial, Infectious Diseases, Molecular Diagnostic Techniques, Female, France, medicine.drug, Adult, Microbiology (medical), medicine.medical_specialty, 030231 tropical medicine, Biology, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Borrelia, molecular diagnosis, West Africa, medicine, Humans, lcsh:RC109-216, 030306 microbiology, lcsh:R, Sequence Analysis, DNA, medicine.disease, biology.organism_classification, Dermatology, Borrelia crocidurae, Immunology
Abstract

International audience; Borrelia crocidurae-associated relapsing fever is endemic to West Africa and is considered benign. We report 4 patients with B. crocidurae-associated neurologic symptoms; 2 of their cases had been misdiagnosed. Frequency and severity of this disease could be underestimated; molecular methods and serodiagnostic tests for Lyme disease might be helpful in its detection.

Published
2013

2. Echinococcus ortleppi Infections in Humans and Cattle, France

Author

Francine Arbez-Gindre, Georges Mantion, Eric Delabrousse, Franck Boué, Frédéric Grenouillet, Laurence Millon, Gérald Umhang, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté ( UFC ), Agence Nationale de Sécurité Sanitaire, de l'Alimentation, de l'environnement et du Travail ( ANSES ), ANSES, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Université de Franche-Comté (UFC), and Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)

Subjects
Microbiology (medical), Adult, Male, Veterinary medicine, [ SDV.MP.PAR ] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Epidemiology, lcsh:Medicine, Cattle Diseases, parasites, lcsh:Infectious and parasitic diseases, Echinococcus ortleppi, Echinococcosis, parasitic diseases, medicine, Animals, Humans, lcsh:RC109-216, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Geography, Medical, bacteria, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, Genes, Helminth, biology, Echinococcus ortleppi Infections in Humans and Cattle, France, lcsh:R, Dispatch, tapeworms, Sequence Analysis, DNA, Middle Aged, biology.organism_classification, medicine.disease, Virology, infection, 3. Good health, Echinococcus, Infectious Diseases, cattle, Population Surveillance, Female, France
Abstract

International audience; In 2011 and 2012, liver infections caused by Echinococcus ortleppi tapeworms were diagnosed in 2 humans in France. In 2012, a nationwide slaughterhouse survey identified 7 E. ortleppi infections in cattle. The foci for these infections were spatially distinct. The prevalence of E. ortleppi infections in France may be underestimated.

Published
2014

3. Pasture types and Echinococcus multilocularis, Tibetan communities

Author

Peter M. Schantz, Dominique A. Vuitton, Wen Yang, Yong-fu Xiao, Philip S. Craig, Patrick Giraudoux, Maiza Campos-Ponce, Qian Wang, Francis Raoul, Christine M. Budke, Sichuan Provincial Center for Diseases Control and Prevention, Sichuan Government, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, SERF Unit, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institute of Parasitology, Faculty of Earth and Life Sciences [Amsterdam] (FALW), Vrije Universiteit Amsterdam [Amsterdam] (VU), Division of Parasitic Diseases, Centres for Disease Control and Prevention, Centres for Disease Control and Prevention, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Biomedical Sciences Research Institute, University of Salford, PHS HHS 1565, Nutrition and Health, Health Sciences, Université de Franche-Comté ( UFC ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Faculty of Earth and Life Sciences, Laboratoire Chrono-environnement ( LCE ), and Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC )

Subjects
Disease reservoir, Epidemiology, ECHINOCOCCUS MULTILOCULARIS, OCHOTONA CURZONIAE, PATURAGES, DENSITE POPULATION, cloture, hôte intermédiaire, MESH: DNA, Helminth, Tibet, Polymerase Chain Reaction, MESH: Dogs, Feces, 0302 clinical medicine, MESH : DNA, Helminth, MESH: Animals, Dog Diseases, 0303 health sciences, geography.geographical_feature_category, Ecology, Statistics, MESH: Echinococcosis, Hepatic, MESH: Feces, dispatch, MESH : Lagomorpha, DNA, Helminth, MESH : Dog Diseases, alveolar echinococcosis, Microbiology (medical), MESH: Dog Diseases, Non-P.H.S, Echinococcus multilocularis, Statistics, Nonparametric, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, pastoralist communities, Helminth, Humans, mammals, Nonparametric, chine, MESH: Echinococcus multilocularis, MESH: Disease Reservoirs, MESH: Humans, MESH : Tibet, MESH : Humans, lcsh:R, fungi, MESH: Polymerase Chain Reaction, DNA, Lagomorpha, pasture type, U.S. Gov't, lcsh:Medicine, MESH : Echinococcus multilocularis, Pasture, 030308 mycology & parasitology, MESH : Dogs, Hepatic, MESH : Disease Reservoirs, MESH: Lagomorpha, Non-U.S. Gov't, MESH : Polymerase Chain Reaction, 2. Zero hunger, [SDV.EE]Life Sciences [q-bio]/Ecology, environment, MESH: Statistics, Nonparametric, biology, Research Support, Non-U.S. Gov't, asie, Infectious Diseases, zoonose, Echinococcosis, Hepatic, 030231 tropical medicine, Pastoralism, Small mammal, Research Support, [ SDV.EE ] Life Sciences [q-bio]/Ecology, environment, N.I.H, Dogs, Research Support, N.I.H., Extramural, Echinococcosis, parasitic diseases, Journal Article, Animals, lcsh:RC109-216, petit mammifère, MESH : Statistics, Nonparametric, Disease Reservoirs, geography, MESH: Tibet, Extramural, MESH : Feces, biology.organism_classification, MESH : Animals, MESH : Echinococcosis, Hepatic, Research Support, U.S. Gov't, Non-P.H.S, surpâturage
Abstract

International audience; Our study showed that open pastures had more small mammal burrows than fenced pastures in Tibetan pastoralist communities in 2003. This characteristic was linked to a higher prevalence of Echinococcus multilocularis in dogs and indicates that pasture type may affect E. multilocularis transmission.

Published
2006

4. Westward spread of Echinococcus multilocularis in foxes, France, 2005-2010

Author

Francis Raoul, Gérald Umhang, Charlotte Dunoyer, Stéphanie Favier, Patrick Giraudoux, Vincent Raton, Franck Boué, Benoît Combes, Sebastien Comte, Natacha Woronoff, Entente de lutte interdépartementale contre les zoonoses ( ELIZ ), Etablissement Public Interdépartemental, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire de la rage et pathologie des animaux sauvages ( LERPAS ), ANSES, Fédération Nationale de la Chasse, Association des Gestionnaires de Laboratoires Vétérinaires Départementaux, Association française des Directeurs et cadres de Laboratoires Vétérinaires publics d'Analyses, Institut Universitaire de France ( IUF ), Ministère de l'Éducation nationale, de l’Enseignement supérieur et de la Recherche ( M.E.N.E.S.R. ), Entente de lutte interdépartementale contre les zoonoses (ELIZ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire de la rage et pathologie des animaux sauvages (LERPAS), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Institut Universitaire de France (IUF), and Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche (M.E.N.E.S.R.)

Subjects
Microbiology (medical), fox, Epidemiology, Vulpes, [SDE.MCG]Environmental Sciences/Global Changes, 030231 tropical medicine, prevalence, lcsh:Medicine, Foxes, parasites, Echinococcus multilocularis, Cestode parasite, lcsh:Infectious and parasitic diseases, 030308 mycology & parasitology, [ SDV.EE.SANT ] Life Sciences [q-bio]/Ecology, environment/Health, 03 medical and health sciences, 0302 clinical medicine, Cestod parasite, Echinococcosis, parasitic diseases, medicine, Parasite hosting, Animals, lcsh:RC109-216, human alveolar echinococcosis, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, 0303 health sciences, disease, biology, Ecology, lcsh:R, Dispatch, Echinococcus multilocularis transmission, biology.organism_classification, medicine.disease, 3. Good health, zoonoses, Europe, [ SDE.MCG ] Environmental Sciences/Global Changes, Infectious Diseases, Echinococcus multilocularis infection, France, Seasons
Abstract

International audience; During 2005-2010, we investigated Echinococcus multilocularis within fox populations in a large area in France. The parasite is much more widely distributed than hitherto thought, spreading west, with a much higher prevalence than previously reported. The parasite also is present in the large conurbation of Paris.

Published
2012

5. Brill-Zinsser Disease in Moroccan Man, France, 2011

Author

Catherine Chirouze, Bruno Hoen, Didier Raoult, Laurent Hustache-Mathieu, Cristina Socolovschi, Jean-François Faucher, Camille Aubry, services de maladies infectieuses, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Interactions Bactéries-Cellules (UIBC), Institut National de la Recherche Agronomique (INRA)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), service de maladies infectieuses CHU J Minjoz Besancon, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Interactions Bactéries-Cellules ( UIBC ), Institut National de la Recherche Agronomique ( INRA ) -Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Hôpital Jean Minjoz, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Institut National de la Recherche Agronomique (INRA)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Chrono-environnement (UMR 6249) (LCE), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris]-Institut National de la Recherche Agronomique (INRA), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques

Subjects
Male, Letter, typhus, Epidemiology, [SDV]Life Sciences [q-bio], MESH : Aged, lcsh:Medicine, 0302 clinical medicine, MESH: Doxycycline, Rickettsia prowazekii, MESH : Anti-Bacterial Agents, bacteria, ComputingMilieux_MISCELLANEOUS, MESH: Aged, 0303 health sciences, education.field_of_study, biology, Respiratory infection, MESH : Typhus, Epidemic Louse-Borne, Brill–Zinsser disease, Leptospirosis, Anti-Bacterial Agents, 3. Good health, Morocco, Infectious Diseases, Doxycycline, France, Typhus, Epidemic Louse-Borne, Microbiology (medical), Epidemic typhus, medicine.medical_specialty, MESH : Male, 030231 tropical medicine, Population, [SDU.STU.PE]Sciences of the Universe [physics]/Earth Sciences/Petrography, Q fever, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, MESH: Anti-Bacterial Agents, Internal medicine, medicine, Humans, lcsh:RC109-216, MESH: Typhus, Epidemic Louse-Borne, Letters to the Editor, MESH : France, MESH : Morocco, education, Aged, [ SDU.STU.PE ] Sciences of the Universe [physics]/Earth Sciences/Petrography, Brill-Zinsser disease, MESH : Doxycycline, MESH: Humans, [ SDV ] Life Sciences [q-bio], 030306 microbiology, business.industry, lcsh:R, MESH : Humans, medicine.disease, biology.organism_classification, Virology, MESH: Male, MESH: France, MESH: Morocco, business, Typhus
Abstract

To the Editor: Epidemic typhus is caused by Rickettsia prowazekii and transmitted by human body lice. For centuries, it has been associated with overcrowding, cold weather, and poor hygiene. Brill-Zinsser disease is a recurrent form of epidemic typhus that is unrelated to louse infestation and develops sporadically years after the primary illness. Clinical features are similar to, but milder than, those of epidemic typhus (1). We report a case of Brill-Zinsser disease in a patient who was born in Morocco and had no history of epidemic typhus. A 69-year-old man living in France sought care from his general practitioner on March 7, 2011, after 2 days of high-grade fever (40°C) associated with headache, myalgia, fatigue, and mild cough. Amoxicillin was prescribed for a putative diagnosis of acute respiratory infection. He was admitted to hospital on March 9 for persistent fever. Physical examination results were unremarkable. Blood test results were as follows: C-reactive protein 111 mg/L (reference 0–8 mg/L); procalcitonin 0.49 ng/mL (reference 0.1–0.4 ng/mL), lymphocyte count 0.7 × 103 cells/μL (reference 1–4 × 103 cells/μL), platelet count 92 × 103 cells/μL (reference 150–450 × 103 cells/μL), and lactate dehydrogenase 376 U/L (reference 94–246 U/L). Chest radiograph results were normal. Results of 5 blood cultures and a urine culture were negative. Stupor developed on March 11. Cerebrospinal fluid test results were normal. Because the patient lived near a goat farm, Q fever and tularemia were considered plausible hypotheses, and oral doxycycline was introduced on March 13. The patient became afebrile on March 15, and he was discharged from the hospital and remained well. On the basis of serologic results, the following diagnoses could be ruled out: viral infections (HIV, cytomegalovirus, Epstein-Barr virus); tularemia; Q fever; leptospirosis; salmonellosis; and Legionella, Mycoplasma, and Chlamydia spp. infections. Acute-phase and convalescent-phase serum samples were positive for typhus-group rickettsiae by the microimmunofluorescence assay at the World Health Organization Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases (Marseille, France). A microimmunofluorescence assay showed titers of 100 for IgM and 6,400 for IgG. Western blot analyses and cross-adsorption studies strongly suggested R. prowazekii as the cause of the man’s illness. Quantitative PCR result on DNA extracted from the acute-phase serum was negative (2). The patient had been raised in Morocco. At 19 years of age, he emigrated to France, where he lived in a urban area. He subsequently traveled every 3 years to Morocco for 1-month summer holidays, always in urban areas. He had most recently traveled to Morocco in 2008. He denied any history of hospitalization for a severe febrile illness and any exposure to louse bites. In the weeks before disease onset, he had not taken any new drug. He had no immunoglobulin deficiency. On the basis of serologic analysis with Western blot, we confirmed R. prowazekii infection in a patient with no recent travel and no contact with lice or flying squirrels. R. prowazekii infection may occur rarely in France; it was found in Marseille in 2002 in an asymptomatic homeless person (3). In contrast, the patient in our report was living in a hygienic environment, and an autochthonous infection is therefore highly unlikely. Epidemic typhus was endemic to North Africa until the 1970s (4). Subsequently, this region was thought to be free from epidemic typhus, but 2 cases have been reported since 1999 in Algeria, where 1 case of Brill-Zinsser disease was observed in a man who had had epidemic typhus in 1960 during the Algerian civil war (5–7). Few published data exist about the seroprevalence of R. prowazekii infections in North Africa (4). In Tunisia, no epidemic typhus was found in 2005 among 47 febrile patients (8). However, a seroepidemiologic survey performed in blood donors and hospitalized patients in the Aures, Algeria, found a prevalence of 2% (4). This finding suggests that R. prowazekii infection might have occurred in this population more often than suspected. No recent published data are available from Morocco. Since 1970, reports of only 8 cases of Brill-Zinsser disease have been published (9,10). In all cases, known risk factors were present (overcrowding, poor hygiene, or contact with flying squirrels). Brill and Zinsser described that stress or waning immunity could reactivate R. prowazekii infection (2). Corticosteroids can trigger recurrence of R. prowazekii in mice (2), but no such observations were made in humans. In the case presented here, we found no stress factor, no immunosuppression, and no medical history of epidemic typhus. Brill-Zinsser disease can develop >40 years after acute infection. The mechanism of R. prowazekii latency has not been established. A recently explored reservoir for silent forms of R. prowazekii infection is adipose tissue because it contains endothelial cells, which are the target cells for R. prowazekii infection, and because of its wide distribution throughout the body (2). Brill-Zinsser disease should be considered as a possible diagnosis for acute fever in any patient who has lived in an area where epidemic typhus is endemic.

Published
2012

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