title: Molecular diagnosis of Rickettsia infection in patients from Tunisia.
abstract: Diagnosis of rickettsioses had largely benefited from the development of molecular techniques. Unfortunately, in Tunisia, despite the large number of rickettsial cases registered every year, the Rickettsia species remain unidentified. In this study, we aimed to detect the Rickettsia species in clinical samples using molecular tests. A study was established to analyze skin biopsies, cutaneous swabs, and cerebrospinal fluid samples taken from clinically suspected patients to have rickettsial infection. Two molecular techniques were used to detect Rickettsia DNA: quantitative real time PCR (qPCR) and reverse line blot test (RLB). An analysis of the RLB hybridization assay results revealed the presence of Rickettsia DNA in skin biopsies (40.6%) and swabs (46.7%). Rickettsia conorii was the most prevalent identified species among tested samples. Other species of interest include Rickettsia typhi and Rickettsia massiliae. Using qPCR positivity rates in skin biopsies was 63.7% against 80% in swabs. R. conorii was the most frequently detected species, followed by R. typhi. The agreement between the two techniques was 68.6% (kappa=0.33). Molecular tests, especially using specific probes qPCR, allow for a rapid, better and confident diagnosis in clinical practice. They improve the survey of Mediterranean spotted fever which is considered to be the most important rickettsial infection in humans in Tunisia.
authors.affiliation: Laboratory of Entomology, Pasteur Institute of Tunis, Tunis, Tunisia.
authors.forename: Fatma
authors.initials: F
authors.lastname: Khrouf
authors.affiliation: Laboratory of Microbiology, Research Laboratory "MPH", Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia.
authors.forename: Hanene
authors.initials: H
authors.lastname: Sellami
authors.affiliation: Infectious Diseases Department, Hedi Chaker University Hospital of Sfax, Sfax University, Sfax, Tunisia.
authors.forename: Emna
authors.initials: E
authors.lastname: Elleuch
authors.affiliation: Infectious Diseases Department, Farhat Hached University Hospital of Sousse, Sousse, Tunisia.
authors.forename: Zouhour
authors.initials: Z
authors.lastname: Hattab
authors.affiliation: Infectious Diseases Department, La Rabta University Hospital of Tunis, Tunis University, Tunisia.
authors.forename: Lamia
authors.initials: L
authors.lastname: Ammari
authors.affiliation: Infectious Diseases Department, Menzel Bourguiba Regional Hospital, Bizerte, Tunisia.
authors.forename: Moncef
authors.initials: M
authors.lastname: Khalfaoui
authors.affiliation: Infectious Diseases Department, Farhat Hached University Hospital of Sousse, Sousse, Tunisia.
authors.forename: Jihed
authors.initials: J
authors.lastname: Souissi
authors.affiliation: Infectious Diseases Department, La Rabta University Hospital of Tunis, Tunis University, Tunisia.
authors.forename: Hejer
authors.initials: H
authors.lastname: Harrabi
authors.affiliation: Laboratory of Entomology, Pasteur Institute of Tunis, Tunis, Tunisia.
authors.forename: Youmna
authors.initials: Y
authors.lastname: M'ghirbi
authors.affiliation: Infectious Diseases Department, La Rabta University Hospital of Tunis, Tunis University, Tunisia.
authors.forename: Hanene
authors.initials: H
authors.lastname: Tiouiri
authors.affiliation: Infectious Diseases Department, Hedi Chaker University Hospital of Sfax, Sfax University, Sfax, Tunisia.
authors.forename: Mounir
authors.initials: M
authors.lastname: Ben Jemaa
authors.affiliation: Laboratory of Microbiology, Research Laboratory "MPH", Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia.
authors.forename: Adnene
authors.initials: A
authors.lastname: Hammami
authors.affiliation: Infectious Diseases Department, Farhat Hached University Hospital of Sousse, Sousse, Tunisia.
authors.forename: Amel
authors.initials: A
authors.lastname: Letaief
authors.affiliation: Laboratory of Entomology, Pasteur Institute of Tunis, Tunis, Tunisia. Electronic address: ali.bouattour@pasteur.rns.tn.
authors.forename: Ali
authors.initials: A
authors.lastname: Bouattour
authors.affiliation: Laboratory of Microbiology, Research Laboratory "MPH", Habib Bourguiba University Hospital of Sfax, Sfax University, Sfax, Tunisia.
authors.forename: Abir
authors.initials: A
authors.lastname: Znazen
mesh_terms: D002555:Cerebrospinal Fluid / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009693:Nucleic Acid Hybridization / Q000379:methods; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012281:Rickettsia / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012282:Rickettsia Infections / Q000175:diagnosis*; D012867:Skin / Q000382:microbiology; D014416:Tunisia
keywords: Cerebrospinal fluid RLB; Rickettsia; Skin biopsy; Swab; qPCR