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Rickettsia felis: the next mosquito-borne outbreak?

2016; Elsevier BV; Volume: 16; Issue: 10 Linguagem: Inglês

10.1016/s1473-3099(16)30331-0

1474-4457

Philippe Parola, Didier Musso, Didier Raoult,

Vector-borne infectious diseases

It is impossible to predict outbreaks.1Nougairède A Charrel RN Raoult D Models cannot predict future outbreaks: A/H1N1 virus, the paradigm.Eur J Epidemiol. 2011; 26: 183-186Crossref PubMed Scopus (16) Google Scholar However, when an arboviral disease is transmitted by widespread anthropophilic mosquitoes, such as Aedes albopictus and Aedes aegypti, and in the context of the spread of viruses with travellers, fear of related outbreaks is logical. In 2006, we reported cases of chikungunya virus infection imported from the Indian Ocean. We claimed that chikungunya virus outbreaks could occur in other regions where Aedes spp mosquitoes are prevalent, and stated that "we must be prepared for the possibility of similar arboviral epidemics in such places".2Parola P de Lamballerie X Jourdan J et al.Novel chikungunya virus variant in travelers returning from Indian Ocean islands.Emerg Infect Dis. 2006; 12: 1493-1499Crossref PubMed Scopus (283) Google Scholar Subsequently, chikungunya virus spread around the world causing massive outbreaks in the Americas. In 2013, we published on the emergence of Zika virus in French Polynesia and highlighted the risk of diffusion of the virus.3Musso D Gubler DJ Zika virus.Clin Microbiol Rev. 2016; 29: 487-524Crossref PubMed Scopus (970) Google Scholar Following this, Zika virus spread in the Americas, becoming a Public Health Emergency of International Concern, 2 years after our reports. Now, yellow fever is re-emerging in Africa. Such outbreaks usually occur in tropical rainforests, but with cases now reported in Angola's capital city Luanda, the threat of diffusion is serious. Yellow fever virus is transmitted by infected mosquitoes, including Ae aegypti, the same mosquito that spreads the Zika virus.Following dengue virus, chikungunya virus, Zika virus, and yellow fever, we believe that the next pathogen transmitted by Aedes spp mosquitoes that could have a global impact is Rickettsia felis.4Angelakis E Mediannikov O Parola P Raoult D Rickettsia felis: the complex journey of an emergent human pathogen.Trends Parasitol. 2016; 32: 554-564Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Indeed, a growing number of reports implicate this intracellular bacterium as a human pathogen. In sub-Saharan Africa, R felis is responsible for up to 15% of fever of unknown origin and has been also detected in asymptomatic people.4Angelakis E Mediannikov O Parola P Raoult D Rickettsia felis: the complex journey of an emergent human pathogen.Trends Parasitol. 2016; 32: 554-564Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar The cat flea Ctenocephalides felis was first considered the sole confirmed vector of R felis. However, we have recently shown that Anopheles gambiae mosquitoes, the primary malarial vector in sub-Saharan Africa, was a competent vector for R felis.5Dieme C Bechah Y Socolovschi C et al.Transmission potential of Rickettsia felis infection by Anopheles gambiae mosquitoes.Proc Natl Acad Sci USA. 2015; 112: 8088-8093Crossref PubMed Scopus (103) Google Scholar Interestingly, both An gambiae and Ae albopictus mosquito cells support R felis growth.4Angelakis E Mediannikov O Parola P Raoult D Rickettsia felis: the complex journey of an emergent human pathogen.Trends Parasitol. 2016; 32: 554-564Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Additionally, Ae albopictus mosquitoes from Gabon tested positive for R felis by qPCR.4Angelakis E Mediannikov O Parola P Raoult D Rickettsia felis: the complex journey of an emergent human pathogen.Trends Parasitol. 2016; 32: 554-564Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Furthermore, R felis has been detected in febrile patients in tropical areas where Ae albopictus or Ae aegypti mosquitoes readily bite human beings.4Angelakis E Mediannikov O Parola P Raoult D Rickettsia felis: the complex journey of an emergent human pathogen.Trends Parasitol. 2016; 32: 554-564Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Therefore, we think that Aedes spp mosquitoes might be able to transmit R felis. It will be important to test this hypothesis in an experimental model, and look for R felis infection cases in febrile patients in the tropics and in returning travellers. We declare no competing interests.