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Sennetsu Neorickettsiosis: A Probable Fish-Borne Cause of Fever Rediscovered in Laos

Neorickettsia sennetsu has been described from Japan and Malaysia, causing a largely forgotten infectious mononucleosis-like disease. Because it is believed to be contracted from eating raw fish, frequently consumed in the Lao PDR, we looked for evidence of N. sennetsu among Lao patients and fish. A buffy coat from 1 of 91 patients with undifferentiated fever was positive by 16S rRNA amplification and sequencing and real-time polymerase chain reactions (PCR) targeting two N. sennetsu genes. Lao blood donors and patients with fever, hepatitis, or jaundice (N = 1,132) had a high prevalence (17%) of immunofluorescence assay IgG anti-N. sennetsu antibodies compared with 4% and 0% from febrile patients (N = 848) in Thailand and Malaysia, respectively. We found N. sennetsu DNA by PCR, for the first time, in a fish (Anabas testudineus). These data suggest that sennetsu may be an under-recognized cause of fever and are consistent with the hypothesis that it may be contracted from eating raw fish.

Received January 31, 2009. Accepted for publication May 7, 2009.

Acknowledgments: The authors thank all the patients who participated in this study, the doctors and nursing staff, the staff of the LARReC, the Mekong River Commission, and the Microbiology Laboratory of Mahosot Hospital, especially Vilada Chansamouth, Kaviphone Phouthavongs, Suriyasak Thongpaseuth, Anisone Changthongthip, Viengmone Davong, Olay Lattana, Manivanh Vongsouvath, Sengkham Symanivong, and Sengmani Symanivong. We are especially indebted to Christopher Barlow of the Mekong River Commission for his help in the collection of fish specimens, Kenichiro Yamada for translating Japanese papers, Drs. Seigo Yamamoto and Yoichi Minanishima for their advice in Myazaki, Dr. G. Dasch for the sennetsu isolate, and Professors Nicholas White and Nicholas Day and Dr. Stuart Blacksell, anonymous referees, and all the staff of the Mahidol Oxford Research Unit for support. We are very grateful to the Minister of Health, His Excellency Dr. Ponmek Dalaloy, and the Director of the Curative Department, Ministry of Health, Professor Sommone Phounsavath for support for this study.

Financial support: The work in Laos was a part of the Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration funded by the Wellcome Trust of Great Britain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclaimer: The authors declare that they have no conflict of interest.

^* Address correspondence to Paul Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, E-mail: paul{at}tropmedres.ac or Didier Raoult, Unité des Rickettsies, CNRS-IRD UMR 6020, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France, E-mail: didier.raoult{at}gmail.com.

Note: Supplementary material appears online at www.ajtmh.org.

Authors’ addresses: Paul N. Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK, Tel/Fax: 856-21-242168, E-mail: paul{at}tropmedres.ac. Jean-Marc Rolain, Unité des Rickettsies, Université de la Méditerranée, Marseille, France, Tel: 33-4-91-32-43-75, Fax: 33-4-91-38-77-72, E-mail: jean-marc.rolain{at}univmed.fr. Bouachanh Rasachak, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, Tel/Fax: 856-21-242168, E-mail: rbouachanh{at}yahoo.com. Mayfong Mayxay, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Faculty of Medicine, University of Health Sciences, Vientiane, Lao PDR, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK, Tel/Fax: 856-21-242168, E-mail: mayfong{at}tropmedres.ac. Khamtanh Vathanatham, Living Aquatic Resources Research Centre (LARReC), Vientiane, Lao PDR, Tel/Fax: 856-21-242168, E-mail: khamtanhv{at}yahoo.com. Piseth Seng, Unité des Rickettsies, Université de la Méditerranée, Marseille, France, Tel: 33-4-91-32-43-75, Fax: 33-4-91-38-77-72, E-mail: sengpiseth{at}yahoo.fr. Rattanaphone Phetsouvanh, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK, Tel/Fax: 856-21-242168, E-mail: rphetsouvanh{at}yahoo.co.uk. Te Thammavong, Lao Red Cross, Blood Transfusion Service, Vientiane, Lao PDR, Tel/Fax: 856-21-242168, E-mail: redblood{at}laotel.com. Jamaayah Zahidi, Institute of Medical Research, Kuala Lumpur, Malaysia, E-mail: jamazahidi{at}yahoo.com. Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, E-mail: ysuputtamongkol{at}gmail.com. Bounkong Syhavong, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, Tel/Fax: 856-21-242168, E-mail: bounkongs{at}yahoo.com. Didier Raoult, Unité des Rickettsies, Université de la Méditerranée, Marseille, France, Tel: 33-4-91-32-43-75, Fax: 33-4-91-38-77-72, E-mail: didier.raoult{at}gmail.com.

Reprint requests: Paul Newton, Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, E-mail: paul{at}tropmedres.ac.

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