Estudio clínico-epidemiológico de las rickettsiosis del grupo de las fiebres exantemáticas en Albacete

Spatial and temporal trends of Mediterranean spotted fever in Spain, 2005-2015

BACKGROUND

Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii and transmitted by Rhipicephalus sanguineus sensu lato. The aim of this study is to understand the epidemiology and trends regarding the disease in Spain, based on notifications to the Spanish National Epidemiology Surveillance Network (RENAVE) and the National Hospital Discharge Database (CMBD) between 2005 and 2015.

METHODS

We carried out a retrospective cross-sectional study of the cases and the outbreaks reported to the RENAVE and of those found in the CMBD between January 1^st, 2005 and December 31^st, 2015. We studied the characteristics of the cases and analyzed their spatio-temporal distribution.

RESULTS

1603 cases notified to the RENAVE and 1789 cases registered in the CMBD were analyzed. The most affected group were men between 45 and 64. There were 8 MSF outbreaks during the study period. RENAVE registered lower rates until 2012, when it was decided that MSF in Spain would become a notifiable disease. Across the temporal series we saw that there was seasonality with an increase in cases in summer, and an overall upward trend according to the RENAVE data and descending according to the CMBD. The geographic distribution was heterogeneous throughout the territory, with maximum rates in La Rioja at 1.87 cases and 2.01 cases per 100,000 inhabitants according to the RENAVE and the CMBD, respectively.

CONCLUSIONS

It is of great importance to continue monitoring the disease since it appears to be endemic throughout Spain. There is a need for a common strategy on monitoring and reporting, which would facilitate a more accurate picture on the MSF epidemiological scenario. Entomological information will be of added value.

Molecular and serological study of rickettsial infection in humans, and in wild and farm animals, in the province of Burgos, Spain

Limited information is available on the presence of rickettsial infection in humans and animal reservoirs in Spain. Exposure to spotted fever group rickettsia in healthy humans and in farm and wild animals in the Province of Burgos, Spain, was examined by serological methods. Rickettsial DNA was also sought by PCR in animal samples. Of 102 human serum samples examined by indirect immunofluorescence assays (IFA), 5.88% were positive for antibodies against Rickettsia conorii (titers 1/128-1/512). Significant differences were detected in human seroprevalence with respect to age. In further IFAs, 102 out of 375 (27.2%) serum samples from the wild animals reacted with R. conorii antigens (titers 1/64-1/1024); 32 out of 281 (11.38%) samples from farm animals were also positive for R. conorii (titers 1/64-1/2048). The prevalence detected among total wild animals was significantly higher than among total farm animals. No rickettsial DNA was found by PCR in any farm or wild animal sample.

Intraocular inflammation as the main manifestation of Rickettsia conorii infection

Objective

To report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.

Methods

Rickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.

Results

Seven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2–3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.

Conclusion

Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.

Spotted fever group Rickettsia in ticks from southeastern Spain natural parks

During an 8-years study, we collected from vegetation or domestic and wild mammals 1246 ticks (624 males, 511 females and 111 nymphs) belonging to 13 species in Jaen province (Andalusia) and we analyzed these ticks by PCR and sequencing for the presence of rickettsiae. Specific rickettsiae DNA was detected in 243 (19.5%) of the ticks tested. Sequence analysis of amplicons of gltA, ompA and ompB genes revealed that Ixodes ricinus were infected with R. monacensis, including strain IRS3, and R. helvetica (prevalences of 27.0% and 2.7%, respectively), while in I. ventalloi we found only this last species (12.5%). Moreover, Dermacentor marginatus presents R. slovaca (24.7%) and R. raoultii (59.9%). In Rhipicephalus sanguineus group ticks (Rh. sanguineus, Rh. turanicus and Rh. pusillus) only R. massiliae (15.2%) was found. Haemaphysalis punctata and Ha. sulcata were infected with a Rickettsia sp. near R. hoogstraalii (prevalence of 3.1% and 16.1%, respectively). In addition, Ha. punctata appeared infected with R. monacensis-like Rickettsia (1.0%) and R. raoultii (9.3%). None of I. hexagonus, Hyalomma lusitanicum, Hyalomma sp., Ha. hispanica or Rh. bursa studied ticks contained rickettsiae.