title: Ectoparasitism and vector-borne diseases in 930 homeless people from Marseilles.
abstract: Homeless people are particularly exposed to ectoparasites, but their exposure to arthropod-borne diseases has not been evaluated systematically. A medical team of 27 persons (7 nurses, 6 infectious disease residents or fellows, 2 dermatologists, and 12 infectious disease specialists) visited the 2 shelters in Marseilles, France, for 4 consecutive years. Homeless volunteers were interviewed, examined, and received care; and blood was sampled for cell counts and detection of bacteremia, antibodies to louse-borne (Rickettsia prowazekii, Bartonella quintana, and Borrelia recurrentis), flea-borne (R. typhi, R. felis), mite-borne (R. akari), and tick-borne (R. conorii) bacterial agents. We selected sex- and age-adjusted controls among healthy blood donors. Over 4 years, 930 homeless people were enrolled. Lice were found in 22% and were associated with hypereosinophilia (odds ratio, 5.7; 95% confidence intervals, 1.46-22.15). Twenty-seven patients (3%) with scabies were treated with ivermectin. Bartonella quintana was isolated from blood culture in 50 patients (5.3%), 36 of whom were treated effectively. The number of bacteremic patient increased from 3.4% to 8.4% (p = 0.02) over the 4 years of the study. We detected a higher seroprevalence to Borrelia recurrentis, R. conorii, and R. prowazekii antibodies in the homeless. Our study shows a high prevalence of louse-borne infections in the homeless and a high degree of exposure to tick-borne diseases and scabies. Despite effective treatment for Bartonella quintana bacteremia and the efforts made to delouse this population, Bartonella quintana remains endemic, and we found hallmarks of epidemic typhus and relapsing fever. The uncontrolled louse infestation of this population should alert the community to the possibility of severe re-emerging louse-borne infections.
authors.affiliation: From Maladies Infectieuses et Tropicales (P Brouqui), Service des Urgences (SB), Service de Dermatologie (P Berbis), CHU Nord, AP-HM; Unité des Rickettsies (P Brouqui, AS, HTD, JMR, JLM, BLS, DR), CNRS UMR 6020, IFR 48, Faculté de Médecine; Service des Maladies Infectieuses (AS, HTD), CHU Conception, AP-HM; Centre National de Transfusion Sanguine (PG); Marseilles, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brouqui
authors.forename: Andreas
authors.initials: A
authors.lastname: Stein
authors.forename: Hervé Tissot
authors.initials: HT
authors.lastname: Dupont
authors.forename: Pierre
authors.initials: P
authors.lastname: Gallian
authors.forename: Sekene
authors.initials: S
authors.lastname: Badiaga
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Rolain
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Mege
authors.forename: Bernard
authors.initials: B
authors.lastname: La Scola
authors.forename: Philippe
authors.initials: P
authors.lastname: Berbis
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D018413:Bartonella quintana / Q000276:immunology; D004478:Ectoparasitic Infestations / Q000453:epidemiology* / Q000382:microbiology; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D010373:Lice Infestations / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012532:Scabies / Q000453:epidemiology; D017282:Tick-Borne Diseases / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial