Borrelia hispanica Relapsing Fever, Morocco | CDC EID

EID Journal Home > Volume 15, Number 10–October 2009

Volume 15, Number 10–October 2009
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Borrelia hispanica Relapsing Fever, Morocco
M'hammed Sarih, Martine Garnier, Najma Boudebouch, Ali Bouattour, Abdelaziz Rihani, Mohammed Hassar, Lise Gern, Danièle Postic, and Muriel Cornet
Author affiliations: Institut Pasteur, Casablanca, Morocco (M. Sarih, N. Boudebouch, M. Hassar); Institut Pasteur, Paris, France (M. Garnier, D. Postic, M. Cornet); Institut Pasteur, Tunis, Tunisia (A. Bouattour); Idrissi Hospital, Kenitra, Morocco (A. Rihani); University of Neuchâtel, Neuchâtel, Switzerland (L. Gern); and Paris Descartes University, Paris (M. Cornet)

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Abstract
We found that 20.5% of patients with an unexplained fever in northwestern Morocco had tick-borne relapsing fever. Molecular detection specific for the 16S rRNA gene identified Borrelia hispanica. The noncoding intergenic spacer sequence domain showed high sensitivity and good resolution for this species.

Tick-borne relapsing fever (TBRF) is caused by Borrelia species transmitted to humans by infected ticks. This condition is frequently undiagnosed and its true incidence is underestimated (1,2). TBRF is endemic to sub-Saharan Africa, and the most prevalent Borrelia species in this region are B. duttonii in the eastern region and B. crocidurae in the western region (3–5). The disease is rarely detected in northern Africa and Mediterranean countries (3,6,7). B. hispanica and B. crocidurae infections have been detected in northern and southern Morocco, respectively, along with the tick vectors responsible for their transmission (Ornithodoros erraticus and O. sonrai, respectively) (8). However, local transmission has not been detected in Morocco since the reports of Baltazard et al. in 1954 (9) and Rodhain in 1976 (10), except for 1 traveler who returned from Spain and Morocco in 2005 with a B. hispanica infection (7).

Conventional diagnosis of TBRF is based on detection of spirochetes in blood smears sampled during the acute febrile phase. However, molecular methods have been shown to be more reliable for diagnosis (6,7,11–13). We conducted retrospective and prospective surveys of patients with unexplained fever (suspected TBRF) in northwestern Morocco during 2000–2006 and used 2 genomic regions of Borrelia spp. to test blood samples from these patients.


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