Common epidemiology of Rickettsia felis infection and malaria, Africa
Authors: Georges Diatta
Ogobara Doumbo
Hubert Bassene
Jean Bernard Lekana-Douki
M&#x27;hammed Sarih
Mamadou O Ndiath
Herve Richet
Philippe Parola
Sophie Edouard
Nadjet Mouffok
Pavel Ratmanov
Adama Tall
Cheikh Sokhna
Oleg Mediannikov
Florence Fenollar
Hamidou Niangaly
Didier Raoult
Cristina Socolovschi
Abir Znazen
Journal: Emerging infectious diseases (2013)
Discipline: IMMUNOLOGY
Keywords: Africa; Plasmodium species; Rickettsia felis; arthropod; bacteria
Affiliations: These authors contributed equally to this article.

Abstract:  This study aimed to compare the epidemiology of Rickettsia felis infection and malaria in France, North Africa, and sub-Saharan Africa and to identify a common vector. Blood specimens from 3,122 febrile patients and from 500 nonfebrile persons were analyzed for R. felis and Plasmodium spp. We observed a significant linear trend (p&lt;0.0001) of increasing risk for R. felis infection. The risks were lowest in France, Tunisia, and Algeria (1%), and highest in rural Senegal (15%). Co-infections with R. felis and Plasmodium spp. and occurrences of R. felis relapses or reinfections were identified. This study demonstrates a correlation between malaria and R. felis infection regarding geographic distribution, seasonality, asymptomatic infections, and a potential vector. R. felis infection should be suspected in these geographical areas where malaria is endemic. Doxycycline chemoprophylaxis against malaria in travelers to sub-Saharan Africa also protects against rickettsioses; thus, empirical treatment strategies for febrile illness for travelers and residents in sub-Saharan Africa may require reevaluation. 

Retracted: No

PubPeer comments:
 We can note that this approval number (No. 00.87 MSP DS CNERS) is used by same of the authors for several papers with different types of objectives and different types of designs. In the article [High Prevalence of Mansonella perstans Filariasis in Rural Senegal] , the authors describes a protocol to identify microfilaria in stained blood smears. In this paper, the authors mention that: * The national ethics committee of Senegal approved the project (program of identification of emergent pathogensu2014No. 00.87 MSP DS CNERS, June 2, 2010) *. But in another article with the same ethics approval number, the author attempted an exhaustive exploration of the halophilic microbial diversity. The objective seems to be far from the objective of the identification of emergent pathogens. Indeed, this paper describes the exploration of the human gut microflora in 1 healthy child. the author don t mention any blood sample. Only stool sample has been taken.  [Genome sequence and description of Gracilibacillus timonensis sp. nov. strain Marseilleu2010P2481T, a moderate halophilic bacterium isolated from the human gut microflora]  Furthermore, the same ethic approval number is used in the article * [The detection of vector-borne-disease-related DNA in human stool paves the way to large epidemiological studies]  *. In this article, the same author mention that the recruitment start in 2008, before to get the Senegalese approval in 2010. * feces were collected during a period from 2008 to 2010 * If the authors consider that the same protocol started in 2008, it means the approval number (No. 00.87 MSP DS CNERS) is a retrospective approval number and all papers with this number may be reviewed considering this fact. In accordance with Editors guidances and Helsinki Declaration, retrospective ethics approval cannot be obtained and it may not be possible to consider the manuscript for peer review. Can the authors provide more details about the scope of the protocol approved by Senegalese Ethics Committee with the No. 00.87 MSP DS CNERS: - Did the recruitment start in 2008 ? If not, why one of the study with a recruitment started in 2008 refered to this approval number? - Did the protocol include stools sample in children - Did the protocol include second reuse of the data ? - Have the patients been informed about the second reuse of their data ? - Did the CNERS approve the second reuse of the data ? , 
 Some additional concerns. In addition to samples taken from people in Senegal, samples were obtained from people in other countries as well. Specifically, the paper states:  *In addition, patients from various medical facilities were included: 100 from rural Mali dispensaries: Diankabou-Mali study site M1 and Kole-Mali study site M2; 50 from Franceville, in urban Gabon (pediatric consultation); 183 from Sfax, Tunisia (infectious diseases and pediatric departments); 266 from Oran, Algeria (department of infectious diseases); 48 from the Kenitra region, rural Morocco (dispensaries); and 400 from Marseille, France (hospital emergency units)* The article states that  The national ethics committees of Senegal, Gabon, and France approved this project (No. 0u201300.87MSP DS CNERS and No. 001380MSP DS CNERS) . But the CNERS numbers only refer to the Senegal Ethics Committee, and there is no approval number mentioned for the patients from Mali, Gabon, Tunisia, Algeria, Morocco, or France. Could the authors please list the ethics approval numbers for the other countries? ,