Mycobacterium tuberculosis Complex in Remains of 18th–19th Century Slaves, Brazil

Obtained sequences were aligned and analyzed by using Bioedit software (Ibis Biosciences, Carlsbad, CA, USA) and ClustalW version 2.0.10 (www.ebi.ac.uk/clustalw). DAMBE (http://dambe.bio.uottawa. ca/dambe.asp) and MEGA (www. megasoftware.net) software were used to obtain similarity percentages among analyzed sequences. To characterize Rickettsia spp., we used nucleotide sequence identity to reference strains (10). Convalescent-phase serum was positive for R. conorii; IgG titer was 64. Sequence analysis of purified PCR products obtained from the eschar identified the isolate as R. massiliae. With respect to the reference strain R. massiliae, pairwise nucleotide sequence identity was 99% for the gltA gene (GenBank accession no. JN043507), 99% for the ompA gene (accession no. JQ480842), and 97% for the ompB gene (accession no. AF123714). Phylogenetic analysis (online Technical Appendix, wwwnc.cdc.gov/EID/article/ 19/5/12-1169-Techapp1.pdf) also confirmed the identity of the Rickettsia species. Considering the diagnosis of R. massiliae infection and the patient who had acute vision loss (5), this patient was called back for a fundus examination, which showed no changes. At the time of this visit, a small area of alopecia at the eschar site was observed (Figure). Unfortunately, the tick had been discarded and was not available for genus and species identification. The presence of R. massiliae in Italy demonstrates that this Rickettsia species can cause scalp eschar and neck lymphadenopathy. Further studies are needed to complete the list of microorganisms that can cause this condition and to understand if they can be associated with minor findings (e.g., alopecia, painful eschar, high fever). Antonio Cascio, Alessandra Torina, Mariella Valenzise, Valeria Blanda, Natalia Camarda, Sara Bombaci, Chiara Iaria, Filippo De Luca, and Malgorzata Wasniewska