Molecular and serological evidence of flea-associated typhus group and spotted fever group rickettsial infections in Madagascar
Abstract
Background: Rickettsiae are obligate intracellular bacteria responsible for many febrile syndromes around the world,
including in sub-Saharan Africa. Vectors of these pathogens include ticks, lice, mites and fleas. In order to assess
exposure to flea-associated Rickettsia species in Madagascar, human and small mammal samples from an urban
and a rural area, and their associated fleas were tested.
Results: Anti-typhus group (TGR)- and anti-spotted fever group rickettsiae (SFGR)-specific IgG were detected in
24 (39%) and 21 (34%) of 62 human serum samples, respectively, using indirect ELISAs, with six individuals seropositive
for both. Only two (2%) Rattus rattus out of 86 small mammals presented antibodies against TGR. Out of 117
fleas collected from small mammals, Rickettsia typhi, a TGR, was detected in 26 Xenopsylla cheopis (24%) collected from
rodents of an urban area (n = 107), while two of these urban X. cheopis (2%) were positive for Rickettsia felis, a SFGR. R.
felis DNA was also detected in eight (31%) out of 26 Pulex irritans fleas.
Conclusions: The general population in Madagascar are exposed to rickettsiae, and two flea-associated Rickettsia
pathogens, R. typhi and R. felis, are present near or in homes. Although our results are from a single district, they
demonstrate that rickettsiae should be considered as potential agents of undifferentiated fever in Madagascar.
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