Common Epidemiology of Rickettsia felis Infection and Malaria, Africa - Vol. 19 No. 11 - November 2013 - Emerging Infectious Disease journal - CDC
Volume 19, Number 11—November 2013
Common Epidemiology of Rickettsia felis Infection and Malaria, Africa
Investigations examining the etiologic spectrum of fever of unknown origin in Africa rapidly progressed during 2008–2011 (1–3), providing increased knowledge about bacterial infections. Bacterial agents that have been most frequently identified in North and sub-Saharan Africa by culture are non-typhoidal Salmonella, Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Mycobacterium tuberculosis (2). Several studies have assessed the effect of fastidious bacterial infections in systemic febrile illness, including Rickettsia felis (4–6), Coxiella burnetii (7), Tropheryma whipplei (3), and Borrelia spp. (1,8). Tourism, immigration, international business travel, international aid work, and the deployment of troops overseas were documented as contributors to a tremendous increase in international travel during 1996–2004 (9). International tourist arrivals reached 940 million worldwide during 2010, an increase of 6.6% over 2009, and the current total number of international migrants has increased to an estimated 214 million persons in 2012 (10). Consequently, physicians in the Western hemisphere increasingly encounter febrile patients returning from international travel who were exposed to tropical infections that the physicians are unfamiliar with (9,10). Among international travelers, malaria, dengue, and rickettsiosis are among the most identified etiologies of febrile illness, and exposure to mosquitoes is reported as the most common source of fever (11).