Leptospirosis presenting as honeymoon fever.

An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.

EuroTravNet: imported Chagas disease in nine European countries, 2008 to 2009.

In recent years, Chagas disease has emerged as a disease of importance outside of endemic areas, largely as a result of migration. In Europe, clinicians may have to treat infected migrants from endemic areas as well as people with acute infections transmitted congenitally,through organ donation or blood transfusion.We describe here the characteristics of patients diagnosed with chronic Chagas disease at the core clinical sites of the EuroTravNet network during 2008 and 2009. Of the 13,349 people who attended the sites, 124 had chronic Chagas disease. Most (96%) were born in Bolivia and the median number of months in the country of residence before visiting a EuroTravNet core site was 38 months (quartile (Q1)­Q3: 26­55). The median age of the patients was 35 years (Q1­Q3: 29­45) and 65% were female. All but one were seen as outpatients and the most frequent reason for consultation was routine screening. Considering that Chagas disease can be transmitted outside endemic regions and that there is effective treatment for some stages of the infection, all migrants from Latin America (excluding the Caribbean) should be questioned about past exposure to the parasite and should undergo serological testing if infection is suspected.

[Rickettsia africae, the agent of African tick-bite fever: an emerging pathogen in the West Indies and Reunion Island (Indian Ocean)]. / Rickettsia africae, agent de la fièvre a tique africaine: un pathogène emergent dans les Antilles et l'lle de la Réunion.

Rickettsia africae is the agent of African tick bite fever, an emerging disease transmitted by Amblyomma ticks in sub-Saharan Africa. In 1998, we reported the first documented case of R. africae in the New World, in a patient who had returned from Guadeloupe. In order to confirm the presence of R. africae in the West Indies, entomologic surveys were conducted from 1999 to 2003 to collect Amblyomma, which are considered as potential vectors and reservoirs of the bacteria. Ticks were used as epidemiological tools to detect R. africae by molecular tools and/or cultivate the bacteria in shell-vial cell culture. This paper summarizes the results obtained in the West Indies. R. africae was detected and isolated for the first time in Guadeloupe, and then detected by molecular tools in Martinique and St-Kitts and Nevis. These last results confirm our first hypotheses--that is R. africae is prevalent on all the Caribbean islands where A. variegatum ticks have been introduced from Africa in the 18th and 19th centuries. We also present the results of a study conducted on the Reunion Island, a French island in the Indian Ocean. For the first time there, R. africae was detected in A. variegatum ticks, which were probably introduced from the African mainland or Madagascar with the human colonization during the 17th century Thus, clinicians should be aware that patient presenting in the West Indies or on Reunion Island (or after a trip over there) with fever, eschar (often multiple), regional lymphadenopathy and a rash, might be infected by R. africae.

[Molecular tools in the epidemiology of tick-borne bacterial diseases]. / Approche moléculaire de l'épidémiologie des maladies bactériennes transmises par les tiques.

Molecular tools have been used to detect rickettsiae in ticks. In Ixodes ricinus ticks collected in France, we detected for the first time there an emerging pathogen, Rickettsia helvetica, and an Ehrlichia sp, closely related to the agent of human granulocytic ehrlichiosis. In Guadeloupe (French West Indies), we described the occurrence of African tick-bite fever due to Rickettsia africae, which had been previously reported in sub-Saharan Africa only. In Africa, we completed our knowledge about the distribution of R. africae (Mali, Niger, Sudan, Burundi), and detected for the first time Rickettsia mongolotimonae, an emerging pathogen. Anaplasma marginale the agent of bovine anaplasmosis was detected in Mali. Rickettsiae of unknown pathogenicity were detected in Mali and Niger.

Tick-borne rickettiosis in Guadeloupe, the French West Indies: isolation of Rickettsia africae from Amblyomma variegatum ticks and serosurvey in humans, cattle, and goats.

Twenty-seven rickettsiae were isolated and/or detected from 100 Amblyomma variegatum ticks collected on Guadeloupe in the French West Indies. In this study, the polymerase chain reaction procedure appeared to be more sensitive in detecting rickettsiae in ticks than the shell-vial technique. Sequencing a portion of the outer membrane protein A-encoding gene showed that these rickettsiae appeared to be identical to Rickettsia africae, a member of the spotted fever group rickettsiae recently described as an agent of African tick-bite fever occurring in sub-Sahelian Africa. A high seroprevalence of antibodies to R. africae was demonstrated among mammals, particularly humans, cattle, and goats. These results and a recently reported case of an infection due to R. africae on Guadeloupe demonstrate that R. africae is present on this island. Although this disease has been underdiagnosed there, it may be frequent and may exist on other Caribbean islands where A. variegatum has propagated dramatically over recent years.