Briefly, DNA from fleas was obtained by grinding the fleas with grinders containing 20 µL of sterile distilled H2O and boiling the lysate for 10 minutes.
The reference isolate was obtained from 1 patient, 3 isolates were obtained from fleas collected in the patients' yard (9 ) (2 were collected before their illness as part of a long-term investigation), and 1 isolate was obtained from the trail flea samples a short time later as part of the same long-term study.
However, because plague is endemic to the region, and flea samples from which isolates were obtained were collected at the home and along a local trail on which the patients hiked, either location could be the source.
In our study, all Bartonella spp. positive fleas harbored B. clarridgeiae only; all were obtained from cats and none from dogs, similar to findings reported from New Zealand (10 ), although B. clarridgeiae has been reported from a flea on a dog in Taiwan (2 ).
Finally, 2 PCR products were obtained and sequenced from 2 fleas.
When PCR was performed with primers for the 16S-23S rDNA interspacer region as described (3 ), products were obtained with DNA of four fleas.
The largest collections were obtained from Waianae (36.6% of flea specimens), Makakilo (20%), and Makaha (11.9%); only 1 sample each was available from Ewa Beach and Hawaii Kai.
Cat fleas (C. felis), identified according to current taxonomic keys (16 ), were obtained from various departments of the Veterinary School of Toulouse, located throughout France.
A total of 316 Ct. felis (Bouché, 1835), identified by using accepted morphologic criteria, were obtained, with each animal yielding one to five fleas.
