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Backus L, Foley P, Foley J. A compartment and metapopulation model of Rocky Mountain spotted fever in southwestern United States and northern Mexico. Infect Dis Model 2024; 9:713-727. [PMID: 38659493 PMCID: PMC11039326 DOI: 10.1016/j.idm.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/25/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Rocky Mountain spotted fever (RMSF) is a fatal tick-borne zoonotic disease that has emerged as an epidemic in western North America since the turn of the 21st century. Along the US south-western border and across northern Mexico, the brown dog tick, Rhipicephalus sanguineus, is responsible for spreading the disease between dogs and humans. The widespread nature of the disease and the ongoing epidemics contrast with historically sporadic patterns of the disease. Because dogs are amplifying hosts for the Rickettsia rickettsii bacteria, transmission dynamics between dogs and ticks are critical for understanding the epidemic. In this paper, we developed a compartment metapopulation model and used it to explore the dynamics and drivers of RMSF in dogs and brown dog ticks in a theoretical region in western North America. We discovered that there is an extended lag-as much as two years-between introduction of the pathogen to a naïve population and epidemic-level transmission, suggesting that infected ticks could disseminate extensively before disease is detected. A single large city-size population of dogs was sufficient to maintain the disease over a decade and serve as a source for disease in surrounding smaller towns. This model is a novel tool that can be used to identify high risk areas and key intervention points for epidemic RMSF spread by brown dog ticks.
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Affiliation(s)
- Laura Backus
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, CA, USA
| | - Patrick Foley
- Department of Biological Sciences, California State University, Sacramento, CA, USA
| | - Janet Foley
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, CA, USA
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Álvarez-Hernández G, Rivera-Rosas CN, Calleja-López JRT, McCormick DW, Paddock CD, Álvarez-Meza JB, Correa-Morales F. Rocky Mountain Spotted Fever Mimicking Multisystem Inflammatory Syndrome in Hospitalized Children, Sonora, Mexico. Emerg Infect Dis 2024; 30:1463-1466. [PMID: 38861505 PMCID: PMC11210667 DOI: 10.3201/eid3007.240033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
We describe 5 children who had Rocky Mountain spotted fever (RMSF) and manifested clinical symptoms similar to multisystem inflammatory syndrome in Sonora, Mexico, where RMSF is hyperendemic. Physicians should consider RMSF in differential diagnoses of hospitalized patients with multisystem inflammatory syndrome to prevent illness and death caused by rickettsial disease.
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Dzul-Rosado K, Panti-Balam C, Lavín-Sánchez D, Palma-Chan A, Caamal-Poot M, Achach-Medina K, Quiñones-Vega C, Lugo-Caballero C, Noh-Pech H, Tello-Martín R, López-Ávila K, Arias-León J, González-Reynoso A, Puerto-Manzano F. Clinical and laboratory features of rickettsioses in Yucatan, Mexico. Acta Trop 2024; 249:107048. [PMID: 37931342 DOI: 10.1016/j.actatropica.2023.107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
Rickettsia species are obligate intracellular bacteria that can cause mild to severe human disease. Based on phylogeny, clinical symptoms, and antigenic properties, rickettsiae are classified into four groups. Infections by these agents are characterized by clinical symptoms ranging from self-limited to severe and even fatal febrile illnesses, depending on the Rickettsia spp. involved, the patient's predisposition, and timely medical care. The present study aimed to characterize rickettsial diseases in Yucatan according to clinical and laboratory features appearing in medical records corresponding to 427 samples taken between 2015 and 2018. A study was conducted over the period 2015-2018 on 427 samples. Clinical and laboratory features were documented from the patients' medical records. For molecular diagnosis, blood was collected in 3.8 % sodium citrate as anticoagulant, and DNA was extracted. Single-step and nested PCR amplification was performed using genus-specific primers for the rickettsial 17kDa and ompB genes. The amplicons obtained were purified and sequenced. A total of 22.7 % (97/427) positive cases of Rickettsia spp. were identified by PCR from 14.15 % (15/106) of the municipalities in Yucatan. 75.2 % (73/97) of the cases were from the city of Merida during the autumn (September-December). The age groups with the highest frequency of confirmed cases were pediatric (5-14 years) (57.7 %) and adults (25-49 years) (42.2 %). There were six fatal cases in children, one associated with R. typhi and five with R. rickettsii. In non-fatal cases, 32.9 % (32/97) corresponded to the spotted fever group (SFG), and 60.8 % (59/97) to the typhus group (TG). Significant differences in signs, and laboratory data, were observed between the pediatric and adult populations. For the treatment of patients, oral and intravenous doxycycline was used in severe hospitalized cases. Typhus group and spotted fever group Rickettsiae are endemic pathological agents found in urban and rural areas of our region. Molecular identification allows for greater diagnostic accuracy and timely treatment and consequently a better prognosis. It is necessary to implement or reinforce measures focused on the dissemination of knowledge regarding rickettsial diseases and their prevention.
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Affiliation(s)
- Karla Dzul-Rosado
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico.
| | - Candi Panti-Balam
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Dayana Lavín-Sánchez
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | | | | | | | | | - Cesar Lugo-Caballero
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Henry Noh-Pech
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Raúl Tello-Martín
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Karina López-Ávila
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Juan Arias-León
- Inter-Institutional Unit of Epidemiologic and Clinical Research, Medicine Faculty, Autonomous University of Yucatan, Yucatan, Mexico
| | | | - Fernando Puerto-Manzano
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
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Wang J, Handel AS. Serologic Testing for Rocky Mountain Spotted Fever in a Low-Incidence Region. J Pediatric Infect Dis Soc 2023; 12:445-450. [PMID: 37467350 DOI: 10.1093/jpids/piad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Tick-borne diseases have grown in incidence over recent decades. As a result, diagnostic testing has become more common, often performed as broad antibody-based panels for multiple tick-transmitted pathogens. Rocky Mountain spotted fever (RMSF) is rare in our region yet may cause severe morbidity, leading to diagnostic screening in low-risk patients. We sought to describe trends in RMSF diagnostic testing, rate of IgG seropositivity, and clinical features of those tested. METHODS We performed a retrospective chart review of patients ≤21 years old undergoing testing for RMSF and/or with an ICD-9/10 code for RMSF. Patients were categorized by infection likelihood based on clinical and laboratory criteria adapted from Centers for Disease Control and Prevention's (CDC) case definition of spotted fever rickettsioses. Clinical data were collected and analyzed with descriptive statistics. RESULTS One hundred and seventy patients were included. 5.8% met CDC criteria for rickettsial infection, 6.5% had an elevated IgG titer but lacked suggestive symptoms, and 87.6% had a negative IgG titer. Many patients tested were unlikely to have RMSF, including 50% lacking fever, 20% lacking any RMSF "classic triad" symptoms, 13% without acute illness, and 22% tested during months with low tick activity. Convalescent serology was performed in 7.6% of patients and none underwent Rickettsia rickettsii polymerase chain reaction (PCR) testing. CONCLUSIONS Diagnostic testing was frequently performed in patients unlikely to have RMSF. We identified many opportunities for improving test utilization. Reserving testing for those with higher pretest probability, performing convalescent serology, and utilizing PCR may improve the accuracy of RMSF diagnosis and reduce clinical challenges stemming from inappropriate testing.
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Affiliation(s)
- Joye Wang
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York, USA
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Andrew S Handel
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
- Division of Infectious Diseases, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York, USA
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Vázquez-Guerrero E, Reyes-Solís GC, Cano-Ravell AE, Machain-Williams C, Leyva-Gastélum M, Estrada-de Los Santos P, Álvarez-Hernández G, Ibarra JA. Detection of Rickettsia amblyommatis and Rickettsia bellii in ticks collected from pet dogs in peri-urban and rural areas in Yucatan, Mexico. EXPERIMENTAL & APPLIED ACAROLOGY 2023:10.1007/s10493-023-00825-z. [PMID: 37498401 DOI: 10.1007/s10493-023-00825-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Rickettsia species are bacteria that may cause multiple diseases in animals and humans, via transmission through multiple arthropod vectors. Routine surveillance of Rickettsia spp. within vectors is critical to determine their presence and risk to mammalian hosts within human populations. Therefore, to better characterize the circulating Rickettsia species in an understudied region we targeted pet dogs to survey. Ticks were collected from pet dogs in three populations of the Yucatan where we tested for the presence of Rickettsia spp. by PCR in metagenomic DNA. In these ticks removed from pet dogs we detected Rickettsia amblyommatis and Rickettsia bellii in Amblyomma auriculatum, Amblyomma ovale and Amblyomma mixtum ticks obtained in a rural community in the Mexican state of Yucatan. This is the first report detecting both species for this state in Mexico, underpinning the importance of more routine surveillance.
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Affiliation(s)
- Edwin Vázquez-Guerrero
- Laboratorio de Genética Microbiana, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Guadalupe C Reyes-Solís
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico.
| | - Alan E Cano-Ravell
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Carlos Machain-Williams
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Mexico
| | - Marcia Leyva-Gastélum
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Sonora, Mexico
| | - Paulina Estrada-de Los Santos
- Laboratorio de Genética Microbiana, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | | | - J Antonio Ibarra
- Laboratorio de Genética Microbiana, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico.
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Immune Monitoring of Paediatric Patients Infected with Rickettsia rickettsii, Ehrlichia canis and Coinfected. Pathogens 2022; 11:pathogens11111351. [PMID: 36422602 PMCID: PMC9696171 DOI: 10.3390/pathogens11111351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
In 2021, 273 Rocky Mountain spotted fever cases were reported nationwide in Mexico. In Chihuahua City, fourteen samples were obtained from children suspected of rickettsial infection. The analysis of samples (January to December 2021) showed prevalence rates of 28.5%, 43%, and 28.5% for Rickettsia rickettsii, Ehrlichia canis, and both pathogens in coinfection, respectively. The analysis of clinical haematological and biochemistry analytes showed alterations; 100% of the children had elevated liver enzymes and coagulation times, 64% showed leukocytosis due to neutrophilia, 55% had thrombocytopenia, lymphopenia, and hypoalbuminemia, and 45% showed normocytic normochromic anaemia. Statistically significant differences were observed in the expression of the chemokines IL-8, RANTES, CXCL9/MIG, and CXCL10/IP-10 across the coinfected and control groups, and the difference in IP-10 expression was significant for patients infected by R. rickettsii compared to the control group. Additionally, significant differences were observed for expression levels of IL-1β, IL-6, IL-17, IFNγ, and TNFα among the R. rickettsii-positive group compared to the control group. On the other hand, the coinfected group exhibited modified levels of IL-6, IL-8, and IL-10 compared with the control group. Finally, significant differences were observed for CD8+ T lymphocyte subpopulations between individuals positive for R. rickettsii and those positive for E. canis.
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Drexler NA, Close R, Yaglom HD, Traeger M, Parker K, Venkat H, Villarroel L, Brislan J, Pastula DM, Armstrong PA. Morbidity and Functional Outcomes Following Rocky Mountain Spotted Fever Hospitalization-Arizona, 2002-2017. Open Forum Infect Dis 2022; 9:ofac506. [PMID: 36324320 PMCID: PMC9605701 DOI: 10.1093/ofid/ofac506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 10/07/2023] Open
Abstract
Background Rocky Mountain spotted fever (RMSF) is a deadly tickborne disease disproportionately affecting Arizona tribal communities. While the acute clinical effects of RMSF are well-documented, more complete understanding of the long-term health consequences is needed to provide guidance for providers and patients in highly impacted areas. Methods We performed a retrospective review of hospitalized RMSF cases from 2 tribal communities in Arizona during 2002-2017. Medical records from acute illness were abstracted for information on clinical presentation, treatment, and status at discharge. Surviving patients were interviewed about disease recovery, and patients reporting incomplete recovery were eligible for a neurologic examination. Results Eighty hospitalized cases of RMSF met our inclusion criteria and were reviewed. Of these, 17 (21%) resulted in a fatal outcome. Among surviving cases who were interviewed, most (62%) reported full recovery, 15 (38%) reported ongoing symptoms or reduced function following RMSF illness, and 9 (23%) had evidence of neurologic sequelae at the time of examination. Sequelae included impaired cognition, weakness, decreased deep tendon reflexes, seizures, and cranial nerve dysfunction. Longer hospitalization (25.5 days vs 6.2 days, P < .001), a higher degree of disability at discharge (median modified Rankin score 1 vs 0, P = .03), and delayed doxycycline administration (6.2 days vs 4.1 days, P = .12) were associated with long-term sequelae by logistic regression. Conclusions Although the etiology of sequelae is not able to be determined using this study design, life-altering sequelae were common among patients surviving severe RMSF illness. Delayed administration of the antibiotic doxycycline after day 5 was the strongest predictor of morbidity.
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Affiliation(s)
- Naomi A Drexler
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Close
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona, USA
| | - Hayley D Yaglom
- Pathogen and Microbiome Division, Translational Genomics Research Institute, Flagstaff, Arizona, USA
- Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona, USA
| | - Marc Traeger
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona, USA
| | - Kristen Parker
- Whiteriver Indian Hospital, Indian Health Service, Whiteriver, Arizona, USA
| | - Heather Venkat
- Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona, USA
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Villarroel
- Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona, USA
| | - Jeanette Brislan
- Gila River Healthcare Public Health Nursing, Sacaton, Arizona, USA
| | - Daniel M Pastula
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, Colorado, USA
| | - Paige A Armstrong
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Backus LH, Pascoe EL, Foley J. Will new ticks invade North America? How to identify future invaders. Trends Parasitol 2022; 38:805-814. [PMID: 35820944 DOI: 10.1016/j.pt.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/19/2022]
Abstract
Invasive tick species and the pathogens they transmit pose increasing threats to human and animal health around the world. Little attention has been paid to the characteristics enabling tick species to invade. Here we analyze examples of tick invasion events in North America to identify factors that facilitated the invasion. Commonalities among invasive ticks are that they thrive in anthropogenically modified habitats, feed on either domestic animals or wildlife occurring in high density, and can survive across a broad range of climatic conditions. Invasive tick species varied widely in life history and reproductive habits, suggesting that invasion occurs when multiple characteristics converge. The combination of potential characteristics leading to invasion, however, improves our ability to predict future invaders and inform surveillance.
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Affiliation(s)
- Laura H Backus
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Emily L Pascoe
- Laboratory of Entomology, Wageningen University & Research, 6708, PB, Wageningen, The Netherlands
| | - Janet Foley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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Brown Dog Tick ( Rhipicephalus sanguineus Sensu Lato) Infection with Endosymbiont and Human Pathogenic Rickettsia spp., in Northeastern México. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106249. [PMID: 35627785 PMCID: PMC9141927 DOI: 10.3390/ijerph19106249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Of the documented tick-borne diseases infecting humans in México, Rocky Mountain spotted fever (RMSF), caused by the Gram-negative bacterium Rickettsia rickettsii, is responsible for most fatalities. Given recent evidence of brown dog tick, Rhipicephalus sanguineus s.l., as an emerging vector of human RMSF, we aimed to evaluate dogs and their ticks for rickettsiae infections as an initial step in assessing the establishment of this pathosystem in a poorly studied region of northeastern México while evaluating the use of dogs as sentinels for transmission/human disease risk. We sampled owned dogs living in six disadvantaged neighborhoods of Reynosa, northeastern México to collect whole blood and ticks. Of 168 dogs assessed, tick infestation prevalence was 53%, composed of exclusively Rh. sanguineus s. l. (n = 2170 ticks). Using PCR and sequencing, we identified an overall rickettsiae infection prevalence of 4.1% (n = 12/292) in ticks, in which eight dogs harbored at least one infected tick. Rickettsiae infections included Rickettsia amblyommatis and Rickettsia parkeri, both of which are emerging human pathogens, as well as Candidatus Rickettsia andeanae. This is the first documentation of pathogenic Rickettsia species in Rh. sanguineus s.l. collected from dogs from northeastern México. Domestic dog infestation with Rickettsia-infected ticks indicates ongoing transmission; thus, humans are at risk for exposure, and this underscores the importance of public and veterinary health surveillance for these pathogens.
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Modeling of Control Efforts against Rhipicephalus sanguineus, the Vector of Rocky Mountain Spotted Fever in Sonora Mexico. INSECTS 2022; 13:insects13030263. [PMID: 35323561 PMCID: PMC8951036 DOI: 10.3390/insects13030263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023]
Abstract
Rocky Mountain spotted fever (RMSF) is a significant health problem in Sonora, Mexico. The tick vector, Rhipicephalus sanguineus, feeds almost exclusively on domestic dogs that, in this region, also serve as the reservoir for the tick-borne pathogen, Rickettsia rickettsii. A process-based mathematical model of the life cycle of R. sanguineus was developed to predict combinations of insecticidal dog collars and long-lasting insecticidal wall treatments resulting in suppression of indoor tick populations. Because of a high burden of RMSF in a rural community near the Sonora state capital of Hermosillo, a test area was treated with a combination of insecticidal dog collars and long-lasting insecticidal wall treatments from March 2018 to April 2019, with subsequent reduction in RMSF cases and deaths. An estimated 80% of the dogs in the area had collars applied and 15% of the houses were treated. Data on tick abundance on walls and dogs, collected during this intervention, were used to parameterize the model. Model results show a variety of treatment combinations likely to be as successful as the one carried out in the test community.
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Zazueta OE, Armstrong PA, Márquez-Elguea A, Hernández Milán NS, Peterson AE, Ovalle-Marroquín DF, Fierro M, Arroyo-Machado R, Rodriguez-Lomeli M, Trejo-Dozal G, Paddock CD. Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico-United States Border, 2009-2019. Emerg Infect Dis 2021; 27. [PMID: 34014151 PMCID: PMC8153879 DOI: 10.3201/eid2706.191662] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Longevity, high prevalence, and multifocal distribution of this disease pose unprecedented public health challenges. Epidemic levels of Rocky Mountain spotted fever (RMSF) have persisted in Mexicali, Mexico, since the initial outbreak was first reported in December 2008. We compared clinical and epidemiologic data of cases in Mexicali during 2009–2019 between patients with an IgG titer reactive with Rickettsia rickettsii bacteria by indirect immunofluorescence antibody (IFA) assay and those who demonstrated DNA of R. rickettsii in a whole blood sample when tested by PCR. We identified 4,290 patients with clinical and epidemiologic features compatible with RMSF; of these, 9.74% tested positive by IFA and 8.41% by PCR. Overall, 140 patients died (11-year case-fatality rate 17.97%). Substantial differences in the frequency of commonly recognized clinical characteristics of RMSF were identified between PCR-positive and IFA-positive cases. The Mexicali epidemic is unique in its size and urban centralization. Cases confirmed by PCR most accurately reflect the clinical profile of RMSF.
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Alvarez-Hernandez G, Drexler N, Paddock CD, Licona-Enriquez JD, la Mora JDD, Straily A, Del Carmen Candia-Plata M, Cruz-Loustaunau DI, Arteaga-Cardenas VA. Community-based prevention of epidemic Rocky Mountain spotted fever among minority populations in Sonora, Mexico, using a One Health approach. Trans R Soc Trop Med Hyg 2021; 114:293-300. [PMID: 31819997 DOI: 10.1093/trstmh/trz114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rocky Mountain spotted fever (RMSF) is a significant public health problem in Sonora, Mexico, resulting in thousands of cases and hundreds of deaths. Outbreaks of RMSF are perpetuated by heavy brown dog tick infestations in and around homes. During 2009-2015, there were 61 RMSF cases and 23 deaths in a single community of Sonora (Community A). METHODS An integrated intervention was carried out from March-November 2016 aimed at reducing tick populations with long-acting acaricidal collars on dogs, environmental acaricides applied to peri-domestic areas and RMSF education. Tick levels were measured by inspection of community dogs to monitor efficacy of the intervention. A similar neighborhood (Community B) was selected for comparison and received standard care (acaricide treatment and education). RESULTS The prevalence of tick-infested dogs in Community A declined from 32.5% to 8.8% (p<0.01). No new cases of RMSF were identified in this area during the subsequent 18 mo. By comparison, the percentage of tick-infested dogs in Community B decreased from 19% to 13.4% (p=0.36) and two cases were reported, including one death. CONCLUSIONS Community-based interventions using an integrated approach to control brown dog ticks can diminish the morbidity and mortality attributable to RMSF.
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Affiliation(s)
- Gerardo Alvarez-Hernandez
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Naomi Drexler
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Jesus D Licona-Enriquez
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Jesus Delgado-de la Mora
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Anne Straily
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Maria Del Carmen Candia-Plata
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Denica I Cruz-Loustaunau
- Ministry of Public Health Sonora, General Directorate for Health Promotion and Disease Prevention, Paseo del Canal y Comonfort, Col. Centro, C.P. 83000, Hermosillo,Mexico
| | - Vanessa A Arteaga-Cardenas
- Ministry of Public Health Sonora, General Directorate for Health Promotion and Disease Prevention, Paseo del Canal y Comonfort, Col. Centro, C.P. 83000, Hermosillo,Mexico
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Álvarez-López DI, Ochoa-Mora E, Nichols Heitman K, Binder AM, Álvarez-Hernández G, Armstrong PA. Epidemiology and Clinical Features of Rocky Mountain Spotted Fever from Enhanced Surveillance, Sonora, Mexico: 2015-2018. Am J Trop Med Hyg 2021; 104:190-197. [PMID: 33146112 DOI: 10.4269/ajtmh.20-0854] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF), caused by Rickettsia rickettsii, is a severe and potentially fatal tick-borne disease. In 2015, Mexico issued a declaration of epidemiologic emergency in response to ongoing outbreaks of RMSF in northern Mexico. Sonora state is one of the most heavily impacted states in Mexico, with historic case fatality rates (CFRs) of 18%. We summarized data from enhanced surveillance to understand demographic, clinical, and treatment factors associated with the high mortality. We conducted a retrospective review of confirmed and probable RMSF cases reported to the General Directorate of Health Promotion and Disease Prevention in Sonora. A case of RMSF is defined as fever (> 38.5°C), plus two symptoms, and epidemiologic criteria. A confirmed case requires laboratory evidence. During 2015-2018, a total of 510 cases of RMSF were reported; 252 (49%) were in persons aged ≤ 18 years. Case fatality rate was 44% (n = 222). Older age and being confirmed by PCR were associated with fatal outcome (P-value < 0.01). The mean time from onset of symptoms to treatment with doxycycline was 7.9 days (SD ± 5.5). Hot spot analysis revealed neither areas of inordinately high nor low incidence, rather clusters of disease in population centers. The CFR for RMSF in Sonora remains high, and a large proportion of cases are seen in persons aged ≤ 18 years. Whereas previously children experienced a disproportionately high CFR, interventions have reversed this trend. Disease clusters in urban nuclei, but location remains a predictor of fatal outcome.
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Affiliation(s)
- Diego I Álvarez-López
- 1Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Hermosillo, México
| | - Estefanía Ochoa-Mora
- 1Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Hermosillo, México
| | - Kristen Nichols Heitman
- 2Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison M Binder
- 2Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paige A Armstrong
- 2Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Sánchez-Montes S, Colunga-Salas P, Lozano-Sardaneta YN, Zazueta-Islas HM, Ballados-González GG, Salceda-Sánchez B, Huerta-Jiménez H, Torres-Castro M, Panti-May JA, Peniche-Lara G, Muñoz-García CI, Rendón-Franco E, Ojeda-Chi MM, Rodríguez-Vivas RI, Zavala-Castro J, Dzul-Rosado K, Lugo-Caballero C, Alcántara-Rodríguez VE, Delgado-de la Mora J, Licona-Enríquez JD, Delgado-de la Mora D, López-Pérez AM, Álvarez-Hernández G, Tinoco-Gracia L, Rodríguez-Lomelí M, Ulloa-García A, Blum-Domínguez S, Tamay-Segovia P, Aguilar-Tipacamú G, Cruz-Romero A, Romero-Salas D, Martínez-Medina MA, Becker I. The genus Rickettsia in Mexico: Current knowledge and perspectives. Ticks Tick Borne Dis 2020; 12:101633. [PMID: 33388556 DOI: 10.1016/j.ttbdis.2020.101633] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
The genus Rickettsia encompasses 35 valid species of intracellular, coccobacilli bacteria that can infect several eukaryotic taxa, causing multiple emerging and re-emerging diseases worldwide. This work aimed to gather and summarise the current knowledge about the genus Rickettsia in Mexico, updating the taxonomy of the bacteria and their hosts by including all the records available until 2020, to elucidate host-parasite relationships and determine the geographical distribution of each Rickettsia species present in the country. Until now, 14 species of Rickettsia belonging to four groups have been recorded in Mexico. These species have been associated with 26 arthropod species (14 hard ticks, three soft ticks, two sucking lice, and seven fleas) and 17 mammal species distributed over 30 states in Mexico. This work highlights the high biological inventory of rickettsias for Mexico and reinforces the need to approach the study of this group from a One Health perspective.
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Affiliation(s)
- Sokani Sánchez-Montes
- Facultad de Ciencias Biológicas y Agropecuarias región Tuxpan, Universidad Veracruzana, Veracruz, Mexico; Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - Pablo Colunga-Salas
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Yokomi N Lozano-Sardaneta
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Héctor M Zazueta-Islas
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Gerardo G Ballados-González
- Facultad de Medicina Veterinaria y Zootecnia, Rancho Torreón del Molino, Universidad Veracruzana, Veracruz, Mexico
| | - Beatriz Salceda-Sánchez
- Laboratorio de Entomología, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Ciudad de México, Mexico
| | - Herón Huerta-Jiménez
- Laboratorio de Entomología, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Ciudad de México, Mexico
| | - Marco Torres-Castro
- Laboratorio de Enfermedades Emergentes y Reemergentes, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Yucatán, Mexico
| | - Jesús Alonso Panti-May
- Campus de Ciencias Biológicas y Agropecuarias, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Gaspar Peniche-Lara
- Laboratorio de Enfermedades Infecciosas y Parasitarias, Facultad de Medicina, Universidad Autónoma de Yucatán, Mexico
| | - Claudia I Muñoz-García
- Departamento de Producción Agrícola y Animal, Universidad Autónoma Metropolitana Unidad Xochimilco, Ciudad de México, Mexico
| | - Emilio Rendón-Franco
- Departamento de Producción Agrícola y Animal, Universidad Autónoma Metropolitana Unidad Xochimilco, Ciudad de México, Mexico
| | - Melina M Ojeda-Chi
- Campus de Ciencias Biológicas y Agropecuarias, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Roger I Rodríguez-Vivas
- Campus de Ciencias Biológicas y Agropecuarias, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Jorge Zavala-Castro
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Yucatán, Mexico
| | - Karla Dzul-Rosado
- Laboratorio de Enfermedades Emergentes y Reemergentes, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Yucatán, Mexico
| | - César Lugo-Caballero
- Laboratorio de Enfermedades Emergentes y Reemergentes, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Yucatán, Mexico
| | | | - Jesús Delgado-de la Mora
- Departamento de Anatomía Patológica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Jesús D Licona-Enríquez
- Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
| | - David Delgado-de la Mora
- Departamento de Patología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Andrés M López-Pérez
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, CA, United States; Laboratorio de Ecología de Enfermedades y una Salud. Departamento de Etología, Fauna Silvestre y Animales de Laboratorio, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Luis Tinoco-Gracia
- Laboratorio de Salud Pública Veterinaria, Instituto de Investigaciones en Ciencias Veterinarias, Universidad Autónoma de Baja California, Baja California, Mexico
| | | | | | - Selene Blum-Domínguez
- Laboratorio de Enfermedades Tropicales, Centro de Investigaciones Biomédicas de la Universidad Autónoma de Campeche, Campeche, Mexico
| | - Paulino Tamay-Segovia
- Laboratorio de Enfermedades Transmitidas por Vectores y Zoonosis, Centro de Investigaciones Biomédicas de la Universidad Autónoma de Campeche, Campeche, Mexico
| | - Gabriela Aguilar-Tipacamú
- C. A. Salud Animal y Microbiología Ambiental, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Anabel Cruz-Romero
- Facultad de Medicina Veterinaria y Zootecnia, Rancho Torreón del Molino, Universidad Veracruzana, Veracruz, Mexico
| | - Dora Romero-Salas
- Facultad de Medicina Veterinaria y Zootecnia, Rancho Torreón del Molino, Universidad Veracruzana, Veracruz, Mexico
| | | | - Ingeborg Becker
- Centro de Medicina Tropical, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
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Reyes-Castro PA, Ernst KC, Walker KR, Hayden MH, Alvarez-Hernandez G. Knowledge, Attitudes, and Practices Related to Rocky Mountain Spotted Fever in Hermosillo, México. Am J Trop Med Hyg 2020; 104:184-189. [PMID: 33219641 DOI: 10.4269/ajtmh.20-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF) is a serious disease in northwest Mexico, particularly in low-income communities. This study aimed to evaluate RMSF-related knowledge, attitudes, and practices in an endemic urban area with a high burden of the disease. A cross-sectional study design using a non-probabilistic household survey was conducted with 400 residents in Hermosillo, Mexico. Primary themes assessed included dog and tick-related exposure, RMSF knowledge, healthcare-seeking behavior, sociodemographic data, and household information. The majority (59%) of those surveyed had heard about RMSF, although only 36% of RMSF-aware respondents knew any RMSF symptoms. Among RMSF-aware respondents, 26% did not know or were unsure of prevention strategies. Individuals in the low socioeconomic status (SES) stratum were less likely to have heard about RMSF (odds ratio [OR]: 0.39; 95% CI: 0.25-0.59), use dog collars or any other product to avoid ticks (OR: 0.40; 95% CI: 0.17-0.99), or check their dogs for ticks (OR: 0.25; 95% CI: 0.09-0.74). The likelihood of observing high numbers of free-roaming dogs in their neighborhood was four times higher in the low SES stratum (OR: 4.19; 95% CI: 2.10-8.38) than in the high SES stratum. These findings emphasize the need for an integrative community approach to improve early recognition of symptoms and knowledge of prevention strategies, particularly in low SES neighborhoods.
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Affiliation(s)
- Pablo A Reyes-Castro
- 1Center of Studies on Health and Society, El Colegio de Sonora, Hermosillo, Mexico
| | | | | | - Mary H Hayden
- 3National Center for Human Resilience, University of Colorado, Colorado Springs, Colorado
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16
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Pieracci EG, De La Rosa JDP, Rubio DL, Perales MES, Contreras MV, Drexler NA, Nicholson WL, De La Rosa JJP, Chung IH, Kato C, Barton Behravesh C, Enríquez MAG, Roldan JFG, Villarino ME. Seroprevalence of spotted fever group rickettsiae in canines along the United States-Mexico border. Zoonoses Public Health 2019; 66:918-926. [PMID: 31441594 DOI: 10.1111/zph.12642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
Portions of northern Mexico are experiencing a re-emergence of Rocky Mountain spotted fever (RMSF), a tickborne disease caused by Rickettsia rickettsii, a member of the spotted fever group of rickettsiae (SFGR). Infection with R. rickettsii can result in serious and life-threatening illness in people and dogs. Canine seroprevalence has been used as a sentinel for human RMSF in previous studies. This study aims to quantify SFGR seroprevalence in canines in three northern Mexican states and identify risk factors associated with seropositivity. A total of 1,136 serum samples and 942 ticks were obtained from dogs participating in government sterilization campaigns and from animal control facilities in 14 Mexican cities in three states. SFGR antibodies were detected using indirect immunofluorescence antibody assays at titre values ≥1/64. Six per cent (69 dogs) showed antibodies to SFGR, with the highest seroprevalence reported in Baja California (12%), Coahuila (4%) and Sonora (4%). Dogs from Baja California had three times higher odds of having SFGR antibodies compared to dogs from Sonora (OR = 3.38, 95% CI, 1.81-6.37). Roughly one quarter (25%) of surveyed dogs were parasitized by ticks (Rhipicephalus sanguineus sensu lato) at the time of sample collection. A portion of collected ticks were tested for rickettsial DNA using polymerase chain reaction. Positive samples were then sequenced, showing evidence of SFGR including R. massiliae, R. parkeri and R. rickettsii. Dogs that spent the majority of time on the street, such as free-roaming or community-owned dogs, showed a greater risk of tick infestation, seropositivity, bearing seropositive ticks, and may play a pivotal role in the spread of SFGR among communities. Estimating the seroprevalence of SFGR in the canine population can help public health campaigns target high-risk communities for interventions to reduce human RMSF cases.
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Affiliation(s)
- Emily G Pieracci
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
| | | | - Daniel Luna Rubio
- Programa de Zoonosis y Rickettsiosis, de Isesalud en el Estado de Baja California, Tijuana, Mexico
| | | | | | - Naomi A Drexler
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - William L Nicholson
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Ida H Chung
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Cecilia Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Casey Barton Behravesh
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Jesús Felipe González Roldan
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Margarita E Villarino
- US-Mexico Unit, Division of Global Migration and Quarantine, NCEZID, CDC, Atlanta, Georgia
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17
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Yaglom HD, Nicholson WL, Casal M, Nieto NC, Adams L. Serologic assessment for exposure to spotted fever group rickettsiae in dogs in the Arizona-Sonora border region. Zoonoses Public Health 2018; 65:984-992. [PMID: 30133168 DOI: 10.1111/zph.12517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/10/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
Rocky Mountain spotted fever (RMSF) is a severe tick-borne rickettsial illness. In the south-western United States and Mexico, RMSF displays unique epidemiologic and ecologic characteristics, including Rhipicephalus sanguineus sensu lato (brown dog tick) as the primary vector. Expansion and spread of the disease from hyperendemic regions of Arizona or Mexico to new areas is a key public health concern. Dogs are thought to play an important role in the emergence and circulation of R. rickettsii in these regions and are often one of earliest indicators of RMSF presence. A canine serosurvey was conducted in 2015 among owned and stray dogs at rabies clinic and animal shelters in three southern Arizona counties where RMSF had not previously been identified. Of the 217 dogs sampled, 11 (5.1%) tested positive for spotted fever group rickettsia (SFGR) IgG antibodies, with seropositivity ranging from 2.9% to 12.2% across the three counties. Large dogs were significantly more likely than small dogs to have positive titres reactive with R. rickettsii; no additional statistically significant relationships were observed between seropositivity of canine age, sex, neuter or ownership status. In addition, 17 (7.8%) dogs had ticks attached at the time of sampling, and stray dogs were significantly more likely to have ticks present than owned dogs (p < 0.001). All 57 ticks collected were identified as Rh. sanguineus s.l., and four (7%) had DNA evidence of genera-wide Rickettsia species. The results of this project demonstrated canine seroprevalence levels lower than those previously reported from dogs in highly endemic areas, indicating a low risk of SFGR transmission to humans in the southern Arizona border region at this time. Continued surveillance is critical to identify SFGR emergence in new geographic regions and to inform prevention efforts for humans and dogs in those areas.
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Affiliation(s)
- Hayley D Yaglom
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, Arizona
| | - William L Nicholson
- Centers for Disease Control and Prevention, Rickettsial Zoonoses Branch, Atlanta, Georgia
| | - Mariana Casal
- Arizona Department of Health Services, Office of Border Health, Tucson, Arizona
| | - Nathan C Nieto
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Laura Adams
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, Arizona.,Centers for Disease Control and Prevention, Career Epidemiology Field Officer Program, Atlanta, Georgia
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Infections and the kidney: a tale from the tropics. Pediatr Nephrol 2018; 33:1317-1326. [PMID: 28879600 DOI: 10.1007/s00467-017-3785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
Tropical infections are caused by a variety of bacteria, viruses and parasitic organisms across varying geographical regions and are more often reported in adults than in children. Most of the infections are acute, presenting as a febrile illness with involvement of multiple organ systems, including the kidney. The gamut of renal manifestations extends from asymptomatic urinary abnormalities to acute kidney injury and-albeit rarely-chronic kidney disease. Tropical infections can involve the glomerular, tubulointerstitial and vascular compartments of the kidney. Leptospirosis, malaria, dengue, rickettsial fever and schistosomiasis are the most prevalent tropical infections which affect the kidneys of children living in the tropics. In this review we discuss renal involvement in these most prevalent tropical infections.
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Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Rocky Mountain Spotted Fever in the Emergency Department: a Review of the Literature. J Emerg Med 2018; 55:42-50. [DOI: 10.1016/j.jemermed.2018.02.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/11/2018] [Accepted: 02/23/2018] [Indexed: 11/17/2022]
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Drexler NA, Yaglom H, Casal M, Fierro M, Kriner P, Murphy B, Kjemtrup A, Paddock CD. Fatal Rocky Mountain Spotted Fever along the United States-Mexico Border, 2013-2016. Emerg Infect Dis 2018; 23:1621-1626. [PMID: 28930006 PMCID: PMC5621527 DOI: 10.3201/eid2310.170309] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although these cases are uncommon, early recognition and prompt initiation of appropriate treatment are vital for averting severe illness and death. Rocky Mountain spotted fever (RMSF) is an emerging public health concern near the US–Mexico border, where it has resulted in thousands of cases and hundreds of deaths in the past decade. We identified 4 patients who had acquired RMSF in northern Mexico and subsequently died at US healthcare facilities. Two patients sought care in Mexico before being admitted to US-based hospitals. All patients initially had several nonspecific signs and symptoms, including fever, headache, nausea, vomiting, or myalgia, but deteriorated rapidly without receipt of a tetracycline-class antimicrobial drug. Each patient experienced respiratory failure late in illness. Although transborder cases are not common, early recognition and prompt initiation of appropriate treatment are vital for averting severe illness and death. Clinicians on both sides of the US–Mexico border should consider a diagnosis of RMSF for patients with rapidly progressing febrile illness and recent exposure in northern Mexico.
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21
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Descriptions of two new cases of Rocky Mountain spotted fever in Panama, and coincident infection with Rickettsia rickettsii in Rhipicephalus sanguineus s.l. in an urban locality of Panama City, Panama. Epidemiol Infect 2018; 146:875-878. [DOI: 10.1017/s0950268818000730] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractThe clinical and pathologic characterisation of two fatal cases of tick-borne rickettsiosis in rural (El Valle) and urban (City of Panama) Panama are described. Clinical and autopsy findings were non-specific, but the molecular analysis was used to identify Rickettsia rickettsii in both cases. No ticks were collected in El Valle, while in the urban case, R. rickettsii was detected in Rhipicephalus sanguineus s.l., representing the first molecular finding in this tick in Panama and Central America.
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22
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[A fatal case series of Rocky Mountain spotted fever in Sonora, México]. BIOMEDICA 2018; 38:69-76. [PMID: 29668136 DOI: 10.7705/biomedica.v38i0.3507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/18/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Rocky Mountain spotted fever is a highly lethal infectious disease, particularly if specific treatment with doxycycline is given belatedly. OBJECTIVE To describe the clinical profile of fatal Rocky Mountain spotted fever cases in hospitalized patients in the state of Sonora, México. MATERIALS AND METHODS We conducted a cross-sectional study on a series of 47 deaths caused by Rickettsia rickettsii from 2013 to 2016. The diagnosis of Rocky Mountain spotted fever was confirmed in a single blood sample by polymerase chain reaction (PCR) or by a four-fold increase in immunoglobulin G measured in paired samples analyzed by indirect immunofluorescence. Clinical and laboratory characteristics were compared stratifying subjects into two groups: pediatric and adult. RESULTS There were no differences in clinical characteristics between groups; petechial rash was the most frequent sign (96%), followed by headache (70%) and myalgia (67%). Although that doxycycline was administered before the fifth day from the onset of symptoms, death occurred in 55% of patients. In clinical laboratory, thrombocytopenia, and biomarkers of liver acute failure and acute kidney failure were the most frequent. CONCLUSION Rocky Mountain spotted fever remains as one of the most lethal infectious diseases, which may be related not only to the lack of diagnostic suspicion and delayed administration of doxycycline, but to genotypic characteristics of Rickettsia rickettsii that may play a role in the variability of the fatality rate that has been reported in other geographical regions where the disease is endemic.
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23
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Alvarez-Hernandez G, Ernst K, Acuña-Melendrez NH, Vargas-Ortega AP, Candia-Plata MDC. Medical knowledge related to Rocky Mountain spotted fever in Sonora, Mexico. Trans R Soc Trop Med Hyg 2018; 112:109-114. [PMID: 29617892 DOI: 10.1093/trstmh/try030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/09/2018] [Indexed: 11/14/2022] Open
Abstract
Background Rocky Mountain spotted fever (RMSF) is a tick-borne disease with a high case-fatality rate unless diagnosed promptly and treated timely with doxycycline. Physician knowledge about presentation and treatment can improve outcomes of RMSF in endemic regions, such as Sonora in northern Mexico, where RMSF has caused 1348 non-fatal cases and 247 deaths from 2003 to 2016. Methods A cross-sectional study was conducted with 343 physicians working in medical facilities in Sonora, Mexico. A 25-item questionnaire explored physician knowledge of clinical, epidemiological and preventive aspects of RMSF. Results Only 62% of physicians agreed that doxycycline should be used as the first choice treatment for children under 8 years with suspected RMSF. Additionally, 40% of primary care physicians correctly identified the time to initiate doxycycline, and 32% correctly identified the case-fatality rate of untreated RMSF in all patients. Conclusions Inadequate medical knowledge may adversely affect how patients infected with Rickettsia rickettsii are diagnosed and treated. Educational programs that improve the risk perception and medical knowledge about RMSF should be targeted at physicians most likely to have initial contact with diseased patients.
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Affiliation(s)
- Gerardo Alvarez-Hernandez
- Department of Medicine and Health Sciences, University of Sonora, Mexico; Hermosillo, Sonora, México, C.P. 83000
| | - Kacey Ernst
- Epidemiology and Biostatistics Department, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States 85724
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24
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Kato C. Variables affecting laboratory diagnosis of acute rickettsial infection. MICROBIOLOGY AUSTRALIA 2018. [DOI: 10.1071/ma18068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The reference standard for the confirmation of a recent rickettsial infection is by the observation of a four-fold or greater rise in antibody titres when testing paired acute and convalescent (two to four weeks after illness resolution) sera by serological assays (Figure 1). At the acute stage of illness, diagnosis is performed by molecular detection methods most effectively on DNA extracted from tissue biopsies (eschars, skin rash, and organs) or eschar swabs. Less invasive and more convenient samples such as blood and serum may also be used for detection; however, the low number of circulating bacteria raises the possibility of false negative results. Optimal sampling practices and enhanced sensitivity must therefore be considered in order to provide a more accurate laboratory diagnosis.
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Licona-Enriquez JD, Delgado-de la Mora J, Paddock CD, Ramirez-Rodriguez CA, Candia-Plata MDC, Hernández GÁ. Rocky Mountain Spotted Fever and Pregnancy: Four Cases from Sonora, Mexico. Am J Trop Med Hyg 2017; 97:795-798. [PMID: 28722584 DOI: 10.4269/ajtmh.16-0917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We present a series of four pregnant women with Rocky Mountain spotted fever (RMSF) that occurred in Sonora, Mexico, during 2015-2016. Confirmatory diagnoses were made by polymerase chain reaction or serological reactivity to antigens of Rickettsia rickettsii by using an indirect immunofluorescence antibody assay. Each patient presented with fever and petechial rash and was treated successfully with doxycycline. Each of the women and one full-term infant delivered at 36 weeks gestation survived the infection. Three of the patients in their first trimester of pregnancy suffered spontaneous abortions. RMSF should be suspected in any pregnant woman presenting with fever, malaise and rash in regions where R. rickettsii is endemic.
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Affiliation(s)
| | | | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rocky Mountain spotted fever in Mexico: past, present, and future. THE LANCET. INFECTIOUS DISEASES 2017; 17:e189-e196. [PMID: 28365226 DOI: 10.1016/s1473-3099(17)30173-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/17/2017] [Accepted: 02/01/2017] [Indexed: 11/22/2022]
Abstract
Rocky Mountain spotted fever, a tick-borne zoonosis caused by Rickettsia rickettsii, is among the most lethal of all infectious diseases in the Americas. In Mexico, the disease was first described during the early 1940s by scientists who carefully documented specific environmental determinants responsible for devastating outbreaks in several communities in the states of Sinaloa, Sonora, Durango, and Coahuila. These investigators also described the pivotal roles of domesticated dogs and Rhipicephalus sanguineus sensu lato (brown dog ticks) as drivers of epidemic levels of Rocky Mountain spotted fever. After several decades of quiescence, the disease re-emerged in Sonora and Baja California during the early 21st century, driven by the same environmental circumstances that perpetuated outbreaks in Mexico during the 1940s. This Review explores the history of Rocky Mountain spotted fever in Mexico, current epidemiology, and the multiple clinical, economic, and social challenges that must be considered in the control and prevention of this life-threatening illness.
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Arango CA, Shah N, Nalamalapu SR. Selected Infectious Diseases. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua. PLoS Negl Trop Dis 2016; 10:e0005185. [PMID: 28036394 PMCID: PMC5201229 DOI: 10.1371/journal.pntd.0005185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background Rickettsial infections and Q fever present similarly to other acute febrile illnesses, but are infrequently diagnosed because of limited diagnostic tools. Despite sporadic reports, rickettsial infections and Q fever have not been prospectively studied in Central America. Methodology/Principal Findings We enrolled consecutive patients presenting with undifferentiated fever in western Nicaragua and collected epidemiologic and clinical data and acute and convalescent sera. We used ELISA for screening and paired sera to confirm acute (≥4-fold rise in titer) spotted fever and typhus group rickettsial infections and Q fever as well as past (stable titer) infections. Characteristics associated with both acute and past infection were assessed. Conclusions/Significance We enrolled 825 patients and identified acute rickettsial infections and acute Q fever in 0.9% and 1.3%, respectively. Clinical features were non-specific and neither rickettsial infections nor Q fever were considered or treated. Further study is warranted to define the burden of these infections in Central America. Rickettsial infections and Q fever cause illness characterized by fever and non-specific symptoms and signs. Not only are these infections difficult to recognize, they are also difficult to diagnose because of limitations in existing tests for them. Despite sporadic reports, rickettsial infections and Q fever have not been prospectively studied in Central America. We enrolled consecutive patients presenting with undifferentiated fever in western Nicaragua and collected data regarding potential risk factors as well as symptoms and signs associated with the illnesses. Additionally, we collected blood samples at the initial visit and 2 to 4 weeks thereafter. We used serologic assays to differentiate new (rising antibody titers) vs. old (stable antibody titers) infections. Characteristics associated with both acute and past infection were assessed. We enrolled 825 patients and identified acute (new) rickettsial infections and acute Q fever in 0.9% and 1.3%, respectively. Clinical features were non-specific and neither rickettsial infections nor Q fever were considered nor treated. Further study is warranted to define the burden of these infections in Central America.
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Herrick KL, Pena SA, Yaglom HD, Layton BJ, Moors A, Loftis AD, Condit ME, Singleton J, Kato CY, Denison AM, Ng D, Mertins JW, Paddock CD. Rickettsia parkeri Rickettsiosis, Arizona, USA. Emerg Infect Dis 2016; 22:780-5. [PMID: 27089251 PMCID: PMC4861524 DOI: 10.3201/eid2205.151824] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In the United States, all previously reported cases of Rickettsia parkeri rickettsiosis have been linked to transmission by the Gulf Coast tick (Amblyomma maculatum). Here we describe 1 confirmed and 1 probable case of R. parkeri rickettsiosis acquired in a mountainous region of southern Arizona, well beyond the recognized geographic range of A. maculatum ticks. The likely vector for these 2 infections was identified as the Amblyomma triste tick, a Neotropical species only recently recognized in the United States. Identification of R. parkeri rickettsiosis in southern Arizona demonstrates a need for local ecologic and epidemiologic assessments to better understand geographic distribution and define public health risk. Education and outreach aimed at persons recreating or working in this region of southern Arizona would improve awareness and promote prevention of tickborne rickettsioses.
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Paddock CD, Sanders JH, Denison AM, Muehlenbachs A, Zaki SR. Routine argyrophil techniques detect Rickettsia rickettsii in tissues of patients with fatal Rocky Mountain spotted fever. J Histotechnol 2016; 39:116-122. [PMID: 32636574 PMCID: PMC7340092 DOI: 10.1080/01478885.2016.1196868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rickettsia rickettsii, a bacterial tickborne pathogen that causes Rocky Mountain spotted fever (RMSF), stains poorly or not at all with conventional tissue Gram techniques, and contemporary visualization of the pathogen in formalin-fixed, paraffin-embedded tissues has relied almost entirely on immunohistochemical staining methods that are generally limited to specialized research laboratories or national reference centers. To our knowledge, previously described argyrophil-based histochemical techniques have not successfully detected rickettsiae in formalin-fixed, paraffin-embedded tissues. To investigate the ability of standard silver impregnation techniques to demonstrate the occurrence and distribution of R. rickettsii in tissues of patients with RMSF confirmed by molecular and immunohistochemical methods, three widely recognized and commercially available silver impregnation methods (Warthin-Starry, Steiner, and Dieterle's) were applied to various tissues obtained at autopsy from 10 patients with fatal RMSF. R. rickettsii bacteria were demonstrated in one or more tissues of all patients, using each of the argyrophil-based methods, and appeared as small, dark brown-to-black lanceolate rods, often in pairs and occasionally surrounded by a faint halo. Rickettsiae were identified most consistently in small arteries and arterioles of liver, kidney, and leptomeninges, and were localized predominantly to the cytoplasm of endothelial cells and less often within the internal elastic lamella and smooth muscle of the media. This validation of argyrophilic techniques to detect R. rickettsii demonstrates the utility of inexpensive core histochemical methods in the diagnosis of infectious agents in pathology specimens and may have utility in certain resource-limited settings where RMSF is endemic.
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Affiliation(s)
- Christopher D. Paddock
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanine H. Sanders
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy M. Denison
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Atis Muehlenbachs
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherif R. Zaki
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Allen HC, Welliver RC, Fogarty MW, Gessouroun M, Henry ED. Intravenous Immunoglobulin Therapy for Cerebral Vasculitis Associated with Rocky Mountain Spotted Fever. J Pediatr Intensive Care 2016; 6:142-144. [PMID: 31073439 DOI: 10.1055/s-0036-1587327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 07/03/2016] [Indexed: 10/21/2022] Open
Abstract
Rocky Mountain spotted fever is a tick-borne illness that is prevalent in the south and the central United States, primarily during the summer months. Patients with delayed diagnosis can experience increased mortality and morbidity, particularly poor neurological outcome. We present a case of a 7-year-old girl with Rocky Mountain spotted fever who was admitted with severe neurological changes and septic shock on day 8 of illness. She was initially diagnosed with Kawasaki disease and treated with intravenous immunoglobulin. Her treatment also included doxycycline, vancomycin, and ceftriaxone due to concerns regarding Rocky Mountain spotted fever and bacterial sepsis. During hospitalization, the patient required mechanical ventilation for respiratory distress, inotropic support, and fluid resuscitation for hypotension. Titers for Rocky Mountain spotted fever were ultimately positive, with magnetic resonance imaging of the brain demonstrating numerous punctate foci of restricted diffusion within the supratentorium, including the corpus callosum and basal ganglia. Although the patient presented late in the disease course, she ultimately had a good neurological outcome. We theorized that administration of intravenous immunoglobulin prevented ongoing neurological injuries from the cerebral vasculitis, which are associated with Rocky Mountain spotted fever.
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Affiliation(s)
- H Christine Allen
- Section of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Robert C Welliver
- Section of Infectious Diseases, Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Monica W Fogarty
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Morris Gessouroun
- Section of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Emilie D Henry
- Section of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma, United States
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Biggs HM, Behravesh CB, Bradley KK, Dahlgren FS, Drexler NA, Dumler JS, Folk SM, Kato CY, Lash RR, Levin ML, Massung RF, Nadelman RB, Nicholson WL, Paddock CD, Pritt BS, Traeger MS. Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States. MMWR Recomm Rep 2016; 65:1-44. [PMID: 27172113 DOI: 10.15585/mmwr.rr6502a1] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.
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Affiliation(s)
- Holly M Biggs
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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Abstract
The kidney is involved in a wide range of bacterial, viral, fungal, and parasitic diseases. In most systemic infections, renal involvement is a minor component of the illness, but in some, renal failure may be the presenting feature and the major problem in management. Although individual infectious processes may have a predilection to involve the renal vasculature, glomeruli, interstitium, or collecting systems, a purely anatomic approach to the classification of infectious diseases affecting the kidney is rarely helpful because most infections may involve several different aspects of renal function. In this chapter, a microbiological classification of the organisms affecting the kidney is adopted. Although they are important causes of renal dysfunction in infectious diseases, urinary tract infections and hemolytic uremic syndrome (HUS) are not discussed in detail because they are considered separately in chapters XX and XX, respectively.
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Affiliation(s)
- Ellis D. Avner
- Department of Pediatrics, Medical College of Wisconsin, Children’s Research Institute, Children’s Hospital, Health System of Wisconsin, Milwaukee, Wisconsin USA
| | - William E. Harmon
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Patrick Niaudet
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Université Paris-Descartes, Paris, France
| | | | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, Ohio USA
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Arango CA, Shah N, Nalamalapu SR. Selected Infectious Diseases. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_46-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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