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Updated: Aug 6, 2025
An Electroporation Method to Transform Rickettsia spp. with a Fluorescent Protein-Expressing Shuttle Vector in Tick Cell Lines
Published on: October 11, 2022
Imported rickettsial infections to the United Kingdom, 2015-2020
Clare E Warrell1, Jane Osborne2, Laura Nabarro3
1Rare and Imported Pathogens Laboratory, Salisbury, UK; London School of Hygiene and Tropical Medicine, London, UK.
Objective:
The burden of imported rickettsial infection in the UK is not previously described. This retrospective review identifies rickettsial cases diagnosed at the national reference laboratory between 2015 and 2022.
Methods:
Samples testing positive for spotted fever group, typhus group, and scrub typhus IgG/IgM on acute and convalescent blood samples, and/or PCR on tissue/blood were categorized as suspected, confirmed or past infection.
Results:
220 patients had rickettsioses, and the commonest import was acute spotted fever group infection (61%, 125/205), 54% (62/114) from South Africa. In acute typhus group cases, 60% (40/67) were from Southeast Asia. One patient with Rickettsia typhi bacteremia died. Scrub typhus group infections (5%, 10/205) were exclusively from Asia and the Western Pacific regions. Overall, 43% of confirmed cases (39/91) had not received doxycycline prior to results.
Conclusions:
Rickettsial infections are important and under-recognized causes of imported fever in the UK. Thorough history, examination, and timely treatment with doxycycline should be considered if there is suspicion of Rickettsia infection before testing.
Insights
Imported rickettsial infections are an under-recognized cause of fever in the UK. Spotted fever and typhus groups are most common, with many cases undiagnosed before treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Rickettsial infections represent a significant global health concern.
- The epidemiological burden of imported rickettsial diseases in the United Kingdom remains largely undescribed.
- This study addresses the knowledge gap regarding rickettsial infections diagnosed in the UK.
Purpose of the Study:
- To characterize the burden and patterns of imported rickettsial infections diagnosed in the UK.
- To identify the primary etiological groups and geographical origins of these infections.
- To assess treatment patterns in confirmed rickettsial cases.
Main Methods:
- Retrospective review of rickettsial cases diagnosed at a national reference laboratory from 2015 to 2022.
- Categorization of infections based on serological (IgG/IgM) and molecular (PCR) testing.
- Analysis of patient demographics, travel history, and treatment data.
Main Results:
- A total of 220 patients were diagnosed with rickettsioses.
- Spotted fever group infections were the most frequent (61%), predominantly imported from South Africa.
- Typhus group infections (60% from Southeast Asia) and scrub typhus group infections (exclusively from Asia/Western Pacific) were also identified. One fatal case of Rickettsia typhi bacteremia occurred.
- Notably, 43% of confirmed cases did not receive doxycycline before diagnosis.
Conclusions:
- Rickettsial infections are an important, under-recognized cause of imported fever in the UK.
- Prompt clinical suspicion, thorough patient history, and timely doxycycline treatment are crucial for managing potential Rickettsia infections.
- Enhanced surveillance and awareness are needed to address the burden of these diseases.
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