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1.
Gac. méd. Méx ; 157(1): 61-66, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279075

ABSTRACT

Resumen Introducción: La distinción clínica entre infecciones arbovirales y las provocadas por rickettsias es crucial para iniciar el tratamiento médico apropiado. Objetivo: Comparar las diferencias entre fiebre manchada de las Montañas Rocosas (FMMR) y otras enfermedades transmitidas por vector (dengue y chikungunya) con presentación clínica similar e identificar los datos que pudieran ayudar al diagnóstico rápido de esas enfermedades. Métodos: Se evaluaron datos sociodemográficos, clínicos y de laboratorio de 399 pacientes de cinco hospitales y clínicas en Sonora, México, entre 2004 y 2016, con el diagnóstico confirmado por laboratorio de FMMR, dengue o chikungunya. Resultados: El grupo con FMMR presentó la mayor letalidad (49/63 muertes, 77.8 %), seguido por el de chikungunya (3/161, 1.9 %) y el de dengue (3/161, 1.9 %). Las diferencias clínicas consistieron en la presencia de exantema, edema y prurito; además, se documentaron diferencias en múltiples biomarcadores como plaquetas, hemoglobina, bilirrubina indirecta y niveles de sodio sérico. Conclusión: El exantema en palmas y plantas, edema y ausencia de prurito, aunados a niveles altos de bilirrubina directa y trombocitopenia severa pudieran ser indicadores útiles para diferenciar a pacientes con FMMR en etapas avanzadas de aquellos con dengue y chikungunya.


Abstract Introduction: Clinical distinction between arbovirus infections and those caused by rickettsia is crucial to initiate appropriate medical treatment. Objective: To compare the differences between Rocky Mountain spotted fever (RMSF) and other vector-borne diseases (dengue and chikungunya) with similar clinical presentation, and to identify data that could aid rapid diagnosis of these diseases. Methods: Sociodemographic, clinical and laboratory data of 399 patients from five hospitals and clinics of Sonora, Mexico, with laboratory-confirmed diagnosis of RMSF, dengue, or chikungunya between 2004 and 2016 were evaluated. Results: The RMSF group had the highest lethality (49/63 deaths, 77.8 %), followed by the chikungunya group (3/161, 1.9 %) and the dengue group (3/161, 1.9 %). Clinical differences included the presence of rash, edema, and pruritus; in addition, differences in multiple biomarkers such as platelets, hemoglobin, indirect bilirubin, and serum sodium levels were documented. Conclusion: Rash on the palms and soles, edema and absence of pruritus, together with high levels of direct bilirubin and severe thrombocytopenia could be useful indicators to differentiate patients at RMSF advanced stages from those with dengue and chikungunya.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Rocky Mountain Spotted Fever/diagnosis , Dengue/diagnosis , Chikungunya Fever/diagnosis , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/mortality , Cross-Sectional Studies , Dengue/complications , Dengue/mortality , Diagnosis, Differential , Symptom Assessment , Chikungunya Fever/complications , Chikungunya Fever/mortality , Mexico/epidemiology
2.
Rev. latinoam. enferm. (Online) ; 28: e3375, 2020. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1126957

ABSTRACT

Objective: to develop and validate an interactive educational technology on spotted fever, to offer an innovative teaching method. Method: a methodological study that covered the following stages: analysis and diagnosis; instructional planning, didactic design, review, and validation and production of technology. Results: the analysis and diagnosis were obtained from experiences in education and health activities for spotted fever. In the instructional planning, it was defined that the technology would be presented in the form of an Interactive Laboratory, with learning stations. The production of the Laboratory was carried out by a multidisciplinary team made up of a carpenter, an electrician, and a plastic artist, among others. The review and validation process was subdivided into two stages: appearance and content validation by professionals in the fields of biology, and education and semantic validation by students of the Nursing and Pedagogy courses. The results of the appearance and content validation showed a content validity index over 0.8 for the vast majority of the variables. In the semantic validation, the Laboratory was evaluated positively by the students. Conclusion: the trajectory followed for the construction of the Interactive Laboratory on spotted fever gave academic and scientific support to the product, offering an innovative educational resource with pedagogical potential that values significant learning.


Objetivo: desenvolver e validar uma tecnologia educacional interativa sobre febre maculosa, para oferecer um método inovador de ensino. Método: estudo metodológico desenvolvido nas seguintes etapas: análise e diagnóstico; planejamento instrucional, desenho didático, revisão e validação e produção da tecnologia. Resultados: a análise e diagnóstico foram obtidos a partir de experiências em atividades de educação e saúde para febre maculosa. No planejamento instrucional, definiu-se que a tecnologia seria apresentada em forma de Laboratório Interativo, com estações de aprendizagem. A produção do Laboratório foi realizada por uma equipe multidisciplinar constituída por marceneiro, eletricista, artista plástico, dentre outros. O processo de revisão e validação foi subdividido em duas etapas: validação de aparência e conteúdo por profissionais das áreas de biologia e educação e validação semântica por alunos do curso de enfermagem e pedagogia. Os resultados da validação de aparência e conteúdo mostraram um índice de validade de conteúdo superior a 0,8 para a grande maioria das variáveis. Na validação semântica, o Laboratório foi avaliado de forma positiva pelos alunos. Conclusão: a trajetória percorrida para a construção do Laboratório Interativo sobre febre maculosa conferiu sustentação acadêmica e científica ao produto construído, oferecendo um recurso educativo inovador com potencial pedagógico que valoriza a aprendizagem significativa.


Objetivo: desarrollar y validar una tecnología educativa interactiva sobre fiebre maculosa, para ofrecer un método innovador de enseñanza. Método: estudio metodológico que recorrió las siguientes etapas: análisis y diagnóstico; planificación instructiva, diseño didáctico, revisión y validación y producción de la tecnología. Resultados: el análisis y el diagnóstico se obtuvieron a partir de experiencias en actividades de educación y salud para fiebre maculosa. En la planificación instructiva, se definió que la tecnología se presentaría en forma de Laboratorio Interactivo, con estaciones de aprendizaje. La producción del Laboratorio fue realizada por un equipo multidisciplinario constituido por un carpintero, un electricista y un artista plástico, entre otros. El proceso de revisión y validación se subdividió en dos etapas: validación de aspecto y contenido por profesionales de las áreas de biología y educación, y validación semántica por alumnos de las carreras de Enfermería y Pedagogía. Los resultados de la validación de aspecto y contenido mostraron un índice de validez de contenido superior a 0,8 para la gran mayoría de las variables. En la validación semántica, el Laboratorio fue evaluado de manera positiva por los alumnos Conclusión: la trayectoria recorrida para la construcción del Laboratorio Interactivo sobre fiebre maculosa dio sustentación académica y científica al producto construido, ofreciendo un recurso educativo innovador con potencial pedagógico que valora el aprendizaje significativo.


Subject(s)
Students, Nursing , Baths , Patient Education as Topic , Nursing , Instructional Film and Video , Validation Study , Education, Nursing , Video-Audio Media
3.
Med. leg. Costa Rica ; 36(1): 14-21, ene.-mar. 2019.
Article in Spanish | LILACS | ID: biblio-1002553

ABSTRACT

Resumen Las rickettsiosis representan una zoonosis de etiología bacteriana intracelular, las cuales son transmitidas por vectores como artrópodos a la piel y luego a las células endoteliales microvasculares. La Fiebre de las Montañas Rocosas (FMMR) causada por Rickettsiarickettsiies la más grave, y es una enfermedad reportada en Costa Rica desde 1977, que causa daño endotelial directo asociado a liberación de citocinasproinflamatorias y estrés oxidativo, lo que lleva a un proceso de vasculitis de pequeño y mediano vaso. La enfermedad se manifiesta clínicamente por fiebre acompañada de cefalea y mialgias, síntomas gastrointestinales y un brote cutáneo. El diagnóstico es basado en la clínica, la exposición a vectores y el respaldo de ensayos de laboratorio; y las tetraciclinas son su tratamiento de elección. El objetivo del presente trabajo es documentar un caso clínico confirmado de Fiebre Manchada de las Montañas Rocosas en Costa Rica, para evidenciar la importancia de considerar esta entidad como un diagnóstico diferencial en un síndrome febril agudo.


Abstract Rickettsiosis represents a zoonosis of intracellular bacterial etiology, which is transmitted by vectors such as arthropods to the skin and then to microvascular endothelial cells. Rocky Mountain Fever caused by Rickettsia rickettsii is the most serious, and it is a disease reported in Costa Rica since 1977. It causes direct endothelial damage associated with the release of proinflammatory cytokines and oxidative stress, which leads to a vasculitis of the small and medium vessels. The disease is manifested clinically by fever headache, myalgias, gastrointestinal symptoms and a cutaneous rash. The diagnosis is based on clinical manifestations, exposure to vectors and the support of laboratory tests; and tetracyclines are the treatment of choice. The objective of this work is to document a case of a Rocky Mountain Spotted Fever in Costa Rica, to demonstrate the importance of considerate this entity as a differential diagnosis in an acute febrile syndrome.


Subject(s)
Humans , Male , Middle Aged , Rickettsia rickettsii , Rickettsiaceae Infections , Rickettsia Infections , Rocky Mountain Spotted Fever/diagnosis , Costa Rica
4.
Braz. j. infect. dis ; 23(2): 121-123, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-1011575

ABSTRACT

ABSTRACT During the second half of the twentieth century, neurologic sequelae associated with central nervous system impairment caused by Rickettsia rickettsii were studied widely and exclusively in the United States. We present the case of a Mexican pediatric patient with neurologic sequelae 10 years after an acute infection by R. rickettsii.


Subject(s)
Humans , Female , Child , Rocky Mountain Spotted Fever/complications , Nervous System Diseases/microbiology , Rickettsia rickettsii , Time Factors , Mexico
5.
Bol. méd. Hosp. Infant. Méx ; 75(5): 303-308, sep.-oct. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1001418

ABSTRACT

Resumen: Introducción: La fiebre manchada de las montañas rocosas (FMMR) es causada por Rickettsia rickettsii. En Coahuila, la región de la Comarca Lagunera se considera una zona endémica. No se han reportado casos en la zona sur del estado, específicamente en la ciudad de Saltillo. Métodos: Estudio prospectivo, reporte de casos. Se incluyeron los casos de niños atendidos en el Hospital del Niño Dr. Federico Gómez Santos en la ciudad de Saltillo, Coah., del mes de septiembre de 2012 a septiembre 2017 con diagnóstico confirmado clínicamente y por reacción en cadena de la polimerasa (PCR) de FMMR. Se presentan los antecedentes epidemiológicos, las características clínicas y evolución de los pacientes. Resultados: Se confirmaron 14 pacientes. La relación masculino:femenino fue de 1.8:1, la edad promedio de los pacientes fue de 7.6 años (18 meses a 13 años). El 42.8% de los pacientes refirió el contacto con perros y el 57.1% afirmó tener contacto con garrapatas. En todos los casos hubo fiebre y exantema purpúrico; alrededor del 70% manifestaron mialgias y artralgias; el 28% tuvo sangrado del tubo digestivo, y el 11% alteraciones neurológicas graves. El 64.2% de los casos recibió tratamiento adecuado con doxiciclina. Fallecieron 8 pacientes, con una tasa de letalidad de 57.1%. Conclusiones: La zona sur de Coahuila debe considerarse una zona endémica para FMMR. El retraso en el diagnóstico y tratamiento favorecen una mayor letalidad.


Abstract: Background: Rocky Mountain Spotted Fever (RMSF) is caused by Rickettsia rickettsii. In Coahuila, Comarca Lagunera is considered an endemic zone; no cases have been reported in the southern zone of the state, specifically in the city of Saltillo­. Methods: Prospective study, cases report. Children evaluated in the Hospital del Niño Dr. Federico Gómez Santos from September 2012 to September 2017, with clinically and laboratory (by polymerase chain reaction, PCR) confirmed diagnosis of FMMR were included. The epidemiological antecedents, clinical characteristics and patient's evolution are presented. Results: 14 patients were confirmed. The male: female ratio was 1.8: 1, the average age of the patients was 7.6 years (18 months to 13 years). 42.8% reported contact with dogs and 57.1% confirmed contact with ticks. In all cases, there was fever and purpuric rash; around 70% manifested myalgias and arthralgias; 28% presented digestive tract bleeding and 11% had severe neurological alterations. 64.2% of the cases received adequate treatment with doxycycline. Eight patients died with a case fatality rate of 57.1%. Conclusions: The southern zone of Coahuila should be considered an endemic area for FMMR. The delay in diagnosis and treatment favor a greater lethality.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Rickettsia rickettsii/isolation & purification , Rocky Mountain Spotted Fever/epidemiology , Polymerase Chain Reaction/methods , Rocky Mountain Spotted Fever/diagnosis , Rocky Mountain Spotted Fever/physiopathology , Prospective Studies , Delayed Diagnosis , Hospitals, Pediatric , Mexico/epidemiology
6.
Biomédica (Bogotá) ; 38(1): 69-76, ene.-mar. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-888549

ABSTRACT

Resumen Introducción. La fiebre manchada de las Montañas Rocosas es una infección muy letal, particularmente si no se diagnostica y se trata oportunamente. Objetivo. Describir el perfil clínico de los casos fatales de pacientes con fiebre manchada de las Montañas Rocosas, hospitalizados en Sonora, México. Materiales y métodos. Se analizó una serie de 47 defunciones por fiebre manchada de las Montañas Rocosas en el periodo de 2013 a 2016. El diagnóstico se confirmó mediante reacción en cadena de la polimerasa (PCR) o la cuadruplicación de los títulos de inmunoglobulina G (IgG) en muestras de suero pareadas analizadas mediante inmunofluorescencia indirecta. Se compararon las características clínicas y de laboratorio, estratificando a los sujetos en dos grupos: pediátricos y adultos. Resultados. No hubo diferencias en las manifestaciones clínicas entre los grupos; el exantema petequial fue el signo más frecuente (96 %), seguido por cefalea (70 %) y mialgias (67 %). La muerte ocurrió en el 55 % de los sujetos a pesar de haber recibido doxiciclina antes del quinto día del inicio de los síntomas. Los marcadores de laboratorio más frecuentes fueron trombocitopenia, falla hepática e insuficiencia renal. Conclusión. La fiebre manchada de las Montañas Rocosas es una enfermedad muy letal, lo cual puede estar relacionado con la ausencia de sospecha del diagnóstico y el retraso en la administración de doxiciclina, pero también con características atribuibles a Rickettsia rickettsii que inciden en la variabilidad de los resultados adversos que se han observado en regiones donde la enfermedad es frecuente.


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.


Subject(s)
Adult , Child , Humans , Rickettsia rickettsii/isolation & purification , Immunoglobulin G/immunology , Rocky Mountain Spotted Fever , Spotted Fever Group Rickettsiosis/epidemiology , Rickettsia rickettsii/genetics , Rocky Mountain Spotted Fever/diagnosis , Polymerase Chain Reaction , Cross-Sectional Studies , Spotted Fever Group Rickettsiosis/diagnosis , Mexico/epidemiology
7.
Arch. argent. pediatr ; 115(1): e5-e8, feb. 2017. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-838320

ABSTRACT

La fiebre manchada de las Montañas Rocosas es una enfermedad ocasionada por Rickettsia rickettsii, una bacteria transmitida por garrapatas infectadas, y que se caracteriza por fiebre, exantema, artralgias y mialgias, aunque, ocasionalmente, su presentación es inespecífica. Debido a que su evolución asemeja otras enfermedades exantemáticas, como dengue o chikungunya, su diagnóstico no es de primera intención, a pesar de que países como México tienen las características ecológicas y socioeconómicas propicias para su transmisión, con índices de mortalidad hasta de 30% en pacientes pediátricos. Esta elevada mortalidad se asocia a diagnósticos y terapia retrasados debido al desconocimiento médico acerca de la enfermedad, lo que propicia la aparición de formas atípicas y fulminantes de fiebre manchada de las Montañas Rocosas. El objetivo del presente trabajo es describir un caso clínico fulminante de fiebre manchada de las Montañas Rocosas para que sea considerada en el diagnóstico diferencial, lo cual impactaría directamente en los índices de mortalidad.


Rocky Mountain spotted fever is a disease caused by Rickettsia rickettsii, a bacteria transmitted by infected ticks. It is characterized by fever, exanthema, arthralgias and myalgias; but sometimes its clinical presentation is non specific. Due to its similarities with other exanthematic diseases like dengue or chikungunya, Rocky Mountain spotted fever is not a first line diagnosis, even though countries like Mexico show the ecologic and socioeconomic characteristics that favor its transmission, with a 30% mortality rate among pediatric patients. This mortality rate has been associated to a delayed diagnosis and therapy, due to a poor knowledge among physicians regarding this disease; this favors the occurrence of atypical and fulminant cases. The objective of this work is to describe a fulminant case of Rocky Mountain spotted fever, expecting that this disease could be later considered among the differential diagnosis which could directly impact its mortality rate.


Subject(s)
Humans , Female , Infant , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/diagnosis , Fatal Outcome , Mexico
8.
Salud pública Méx ; 58(3): 385-392, may.-jun. 2016. tab, graf
Article in Spanish | LILACS | ID: lil-793020

ABSTRACT

Resumen: Objetivo: Caracterizar las manifestaciones clínicas y predictores de mortalidad en niños hospitalizados por fiebre maculosa de las Montañas Rocosas (FMMR). Material y métodos: Estudio transversal en 210 sujetos hospitalizados por FMMR en un hospital pediátrico de Sonora, entre el 1 de enero de 2004 y el 30 de junio de 2015. El análisis se sustentó en estadística descriptiva y regresión logística multivariada. Resultados: Se apreció un incremento en la incidencia y mortalidad en los casos hospitalizados por FMMR, con una letalidad de 30%.Tres variables se asociaron con el riesgo de muerte: retraso ≥ 5 días en el inicio del uso de doxiciclina (RMa=2.95, IC95% 1.10-7.95), falla renal aguda (RMa=8.79, IC95% 3.46-22.33) y sepsis severa (RMa=3.71, IC95% 1.449.58). Conclusión: La FMMR provoca resultados fatales en niños, que puede evitarse con la administración oportuna de doxiciclina. La falla renal aguda y la sepsis severa son dos predictores de muerte en niños con FMMR.


Abstract: Objective: Characterize clinical manifestations and predictors of mortality in children hospitalized for spotted fever. Materials and methods: Cross-sectional study in 210 subjects with a diagnosis of Rocky Mountain spotted fever (RMSF) in a pediatric hospital in Sonora, from January 1st, 2004 to June 30th, 2015. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: An upward trend was observed in RMSF morbidity and mortality. Fatality rate was 30%.Three predictors were associated with risk of death: delay ≥ 5 days at the start of doxycycline (ORa= 2.95, 95% CI 1.10-7.95), acute renal failure ((ORa= 8.79, 95% CI 3.46-22.33) and severe sepsis (ORa= 3.71, 95% CI 1.44-9.58). Conclusions: RMSF causes high mortality in children, which can be avoided with timely initiation of doxycycline. Acute renal failure and severe sepsis are two independent predictors of death in children with RMSF.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Rocky Mountain Spotted Fever/epidemiology , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/mortality , Cross-Sectional Studies , Risk Factors , Morbidity/trends , Mortality/trends , Sepsis/etiology , Sepsis/mortality , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Mexico/epidemiology
9.
Rev. Univ. Ind. Santander, Salud ; 47(3): 243-259, sep.-dic. 2015. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: lil-768109

ABSTRACT

El comportamiento epidemiológico de la fiebre manchada por Rickettsia rickettsii constituye un desafío para los sistemas de salud del continente americano. Es un padecimiento de relevancia médica por la letalidad que provoca si no es diagnosticado ni tratado oportunamente. Aunque cualquier persona es susceptible a la infección, algunos grupos poblacionales son más vulnerables debido a un mayor contacto con la garrapata transmisora, entre ellos los niños, quienes tienen mayor morbilidad por lo que se asocian con resultados fatales. En su origen participa una multitud de factores biológicos, ecológicos y sociales, interrelacionados complejamente, y cuyo abordaje requiere de intervenciones integradas y multidisciplinarias. La incidencia de la enfermedad puede continuar aumentando en la región, de modo que su ocurrencia actual constituye un llamado urgente para la acción regional. Acciones preventivas que disminuyan el contacto con garrapatas e incrementen la sospecha temprana de la enfermedad, son prioritarias en la agenda de salud de varias naciones de las Américas.


Rocky mountain spotted fever is a public health problem in America. The disease remains as a challenge for Health Systems at regional level. It is an illness of medical relevance due to its high case-fatality rate when it is not diagnosed and treated early. Although anyone is susceptible to infection, some groups are more vulnerable due to increased exposure to ticks, including children who have higher morbidity and fatal outcomes. A myriad of biological, ecological and social factors, complexly interrelated, are associated with its epidemiological pattern, which requires integrated and multidisciplinary interventions at different levels. The incidence of the disease may continue to increase in the region and its actual occurrence required an urgent call for regional action. Preventive actions that reduce contact with ticks and increase early disease suspicion should be priorities in the health agenda of various nations in America.

10.
An. bras. dermatol ; 90(2): 248-250, Mar-Apr/2015. graf
Article in English | LILACS | ID: lil-741076

ABSTRACT

Brazilian spotted fever is an acute febrile infectious disease caused by Rickettsia rickettsii, transmitted by tick bite. As this disease is rare and has high mortality rates in Brazil, the clinical aspects and epidemiological data may help the diagnosis. We report a case of Brazilian spotted fever in a 19-year-old patient who presented maculopapular exanthema in the palmar region and upper limbs, lymphadenopathy, fever, chills, headache, conjunctival hyperemia, nausea, vomiting, dyspnea, myalgia, developing neurological signs and abdominal pain. He was treated with doxycycline with clinical improvement. We emphasize the importance of the recognition of this disease by dermatologists as cutaneous manifestations are the key findings to establish early diagnosis and prevent complications.


Subject(s)
Humans , Male , Young Adult , Rocky Mountain Spotted Fever/pathology , Skin Diseases, Bacterial/pathology , Anti-Bacterial Agents/therapeutic use , Brazil , Doxycycline/therapeutic use , Early Diagnosis , Rickettsia rickettsii , Rocky Mountain Spotted Fever/drug therapy , Skin Diseases, Bacterial/drug therapy , Skin/pathology
11.
Biomédica (Bogotá) ; 33(supl.1): 38-51, set. 2013. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-695795

ABSTRACT

Introducción. Las rickettsias son bacterias patógenas usualmente transmitidas por ectoparásitos, como garrapatas, piojos o pulgas. En la última década se presentaron tres brotes de rickettsiosis con casos fatales en la región noroccidental de Antioquia y en un municipio limítrofe de Córdoba. Objetivo. Describir la ecología y la epidemiología de las infecciones por Rickettsia spp. en el Urabá antioqueño. Materiales y métodos. Se obtuvieron muestras de 354 roedores y se recolectaron 839 ectoparásitos de estos en los municipios de Apartadó, Turbo y Necoclí. Asimismo, se obtuvieron 220 sueros humanos. Estas muestras fueron estudiadas por reacción en cadena de la polimerasa (PCR) e inmunofluorescencia indirecta (IFI) para la detección de infección por rickettsias. Resultados. Por IFI se detectaron anticuerpos antirickettsias en 130 (43 %) de los roedores y en 53 (24 %) de los sueros humanos estudiados. Además, se amplificaron secuencias del gen gltA específicas del género Rickettsia en 23 (6,8 %) muestras de hígado de roedores, las cuales mostraron una similitud del 98,7 % con R. prowazekii . Una secuencia de gltA obtenida de larvas de garrapatas del género Amblyomma sp., tuvo una identidad mayor de 99 % con las secuencias de R. tamurae . Conclusión. Estos resultados demuestran la circulación de rickettsias en roedores, ectoparásitos y humanos en los municipios estudiados.


Introduction: Rickettsia spp. are tick, flea or lice-borne pathogenic bacterium, usually carried by rodents. In the last decade three outbreaks of rickettsial disease including fatalities, occurred in the provinces of Antioquia and Córdoba in northwestern Colombia. Objective: The purpose of this study was to perform an ecological and epidemiological description of the Rickettsia spp infection in the recently affected region of Colombia. Materials and methods: Samples were obtained from 354 rodents and their parasites captured in the municipalities of Apartadó, Turbo and Necoclí. Likewise, 220 human sera were also collected, for detection of infection by Rickettsia spp. Results: Indirect immunofluorescence assay (IFA) revealed that 130 (43%) of the rodents and 53 (24%) of the humans produced antibodies to Rickettsia spp. Additionally, rickettsial DNA was amplified by PCR from 23 (6.8%) rodent liver samples using primers directed to the genus specific gltA gene. While gltA sequences from rodent samples exhibited a 98.7% similitude with R . prowazekii, a sequence amplified from larvae of Amblyomma sp exhibited identities of >99% similarity with R. tamurae . Conclusion: These results demonstrate the presence of rickettsia in rodents, ectoparasites and humans throughout the municipalities studied.


Subject(s)
Adult , Animals , Child , Female , Humans , Male , Middle Aged , Antibodies, Bacterial/blood , Arachnid Vectors/microbiology , Disease Reservoirs/parasitology , Rickettsia Infections/epidemiology , Rickettsia/isolation & purification , Rodentia/parasitology , Tick Infestations/veterinary , Colombia/epidemiology , Disease Outbreaks , Endemic Diseases , Immunoglobulin G/blood , Immunoglobulin G/immunology , Larva/microbiology , Liver/microbiology , Mites/microbiology , Phylogeny , Rickettsia Infections/blood , Rickettsia Infections/transmission , Rickettsia Infections/veterinary , Rickettsia/genetics , Rickettsia/immunology , Rodentia/blood , Seroepidemiologic Studies , Socioeconomic Factors , Tick Infestations/epidemiology , Ticks/microbiology
12.
Cad. saúde pública ; 27(10): 1969-1976, Oct. 2011. tab
Article in English | LILACS | ID: lil-602693

ABSTRACT

Brazilian spotted fever is the most common rickettsiosis in Brazil, most prevalent in the States of São Paulo and Minas Gerais. The aim of this study was to describe the epidemiological characteristics of Brazilian spotted fever in Minas Gerais from 2000 to 2008. Of the 132 cases of Brazilian spotted fever, 53 patients died, representing a case-fatality rate of 40.2 percent. Males predominated, with 78.8 percent of confirmed cases, and median age was 26.5 years. Absence of rash was associated with increased risk of death (p = 0.005). Greater Metropolitan Belo Horizonte, Rio Doce Valley, and Zona da Mata accounted for 70.6 percent of the cases, which occurred mainly from May to November. There was an increase in the number of cases, which could suggest an expansion of the disease, but probably resulted from an increase in the health system's diagnostic capacity and sensitivity. Despite this improvement, the case-fatality rate remains high and with no apparent tendency to decrease, thus indicating the need for improved prevention and patient care.


A febre maculosa brasileira é a rickettsiose mais comum do território nacional, com maior importância nos estados de São Paulo e Minas Gerais. O objetivo deste estudo foi descrever os aspectos epidemiológicos dos casos de febre maculosa brasileira ocorridos em Minas Gerais no período de 2000 a 2008. Dos 132 casos confirmados, 53 evoluíram para óbito, representando uma letalidade de 40,2 por cento. O sexo masculino foi o mais acometido com 78,8 por cento dos casos confirmados, e mediana de idade de 26,5 anos. Entre os fatores de risco determinantes do óbito, a ausência de exantema apresentou associação significativa (p = 0,005). A Região Metropolitana de Belo Horizonte, o Vale do Rio Doce e a Zona da Mata responderam por 70,6 por cento dos casos, que ocorreram principalmente entre os meses de maio e novembro. Houve crescimento no número de casos, que apesar de sugerir expansão da doença, provavelmente decorreu do aumento da capacidade diagnóstica e sensibilidade do sistema de saúde. Apesar dessa melhora, a letalidade permaneceu alta e sem tendências à diminuição, o que implica a necessidade de medidas preventivas e assistenciais.


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Rocky Mountain Spotted Fever , Brazil , Retrospective Studies , Risk Factors , Rocky Mountain Spotted Fever , Rocky Mountain Spotted Fever/mortality , Seasons , Sensitivity and Specificity
13.
Rev. MVZ Córdoba ; 16(2): 2435-2457, mayo-ago. 2011.
Article in English | LILACS | ID: lil-622000

ABSTRACT

Data on genus and infectious by Rickettsia were retrospectively compiled from the critical review literature regarding all countries in Latin America, Caribbean islands, Portugal and Spain. We considered all Rickettsia records reported for human and/or animal hosts, and/or invertebrate hosts considered being the vector. In a few cases, when no direct detection of a given Rickettsia group or species was available for a given country, the serologic method was considered. A total of 13 Rickettsia species have been recorded in Latin America and the Caribbean. The species with the largest number of country confirmed records were Rickettsia felis (9 countries), R. prowazekii (7 countries), R. typhi (6 countries), R. rickettsii (6 countries), R. amblyommii (5 countries), and R. parkeri (4 countries). The rickettsial records for the Caribbean islands (West Indies) were grouped in only one geographical area. Both R. bellii, R. akari, and Candidatus ‘R. andeane’ have been recorded in only 2 countries each, whereas R. massiliae, R. rhipicephali, R.monteiroi, and R. africae have each been recorded in a single country (in this case, R. africae has been recorded in nine Caribbean Islands). For El Salvador, Honduras, and Nicaragua, no specific Rickettsia has been reported so far, but there have been serological evidence of human or/and animal infection. The following countries remain without any rickettsial records: Belize, Venezuela, Guyana, Surinam, and Paraguay. In addition, except for a few islands, many Caribbean islands remain without records. A total of 12 Rickettsia species have been reported in Spain and Portugal: R. conorii, R. helvetica, R. monacensis, R. felis, R. slovaca, R. raoultii, R. sibirica, R. aeschlimannii, R. rioja, R. massiliae, R. typhi, and R. prowazekii. Amongst these Rickettsia species reported in Spain and Portugal, only R. prowazekii, R. typhi, R. felis, and R. massiliae have also been reported in Latin America. This study summarizes the current...


Subject(s)
Humans , Animals , Mice , Rats , Acari , Epidemiology , Rocky Mountain Spotted Fever , Vector Control of Diseases
14.
Infectio ; 14(4): 264-276, oct.-dic. 2010.
Article in Spanish | LILACS, COLNAL | ID: lil-635652

ABSTRACT

La fiebre manchada de las Montañas Rocosas es una infección producida por Rickettsia rickettsii, un cocobacilo polimorfo perteneciente a la familia Rickettsiaceae. A pesar de que ha pasado más de un siglo desde que fue descrita, continúa siendo una de las zoonosis más importantes en todo el mundo. Aunque los casos se presentan de manera focal y esporádica, en los últimos años se ha notado un incremento de su incidencia en los Estados Unidos y parece estar resurgiendo en varios países de Suramérica. En Colombia, poco se sabía de la enfermedad desde 1937, cuando fue descrita por primera vez, pero, en los últimos años se han presentado nuevos casos con alta tasa de mortalidad. Dado que los hallazgos clínicos y de laboratorio son inespecíficos, la fiebre manchada de las Montañas Rocosas debe incluirse en el diagnóstico diferencial de los síndromes febriles de causa no clara. A continuación se presenta una revisión de la literatura, señalando los aspectos más importantes del resurgimiento de la enfermedad en Colombia y se resaltan su etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento, con el objeto de mejorar el conocimiento local de esta infección, probablemente subdiagnosticada, que puede curarse fácilmente con unas cuantas dosis de antibióticos por vía oral.


Rocky Mountain Spotted Fever (RMSF) is an infection caused by Rickettsia rickettsii, a pleomorphic cocobacillae which belongs to the Rickettsiaceae family. Although it has been more than a century since its first description, this disease is still one of the most important zoonosis in the world. Usually cases occur in focal and sporadic form, but an unusual increase in the frequency of cases during the last few years has drawn the attention of surveillance systems in United States and some South American countries. Little was known about the disease in Colombia when it was first described in 1937, but in recent years new cases have been reported showing high mortality rates. Since clinical and laboratory findings have not been specific, the RMSF must be included in the differential diagnosis of febrile syndromes of unknown origin. A literature review follows herein, pointing out the most important features of the cases diagnosed in Colombia and highlighting their pathogenesis, clinical manifestations, diagnosis, and treatment, and attempting to improve local knowledge of this infection. The disease is probably under-diagnosed and could be treated with a few doses of PO antibiotics.


Subject(s)
Humans , Rickettsia rickettsii , Rocky Mountain Spotted Fever , Hemorrhagic Fevers, Viral , Rickettsiaceae , Therapeutics , Ticks/parasitology , Triacetoneamine-N-Oxyl , Zoonoses , Pathogenesis, Homeopathic , Colombia , Diagnosis, Differential , Fever , Infections , Laboratories , Anti-Bacterial Agents
15.
Rev. panam. salud pública ; 27(6): 461-466, jun. 2010. tab
Article in Portuguese | LILACS | ID: lil-555988

ABSTRACT

Embora no Brasil o número de casos confirmados de febre maculosa esteja em declínio desde 2005, a taxa de mortalidade (20 a 30 por cento) ainda é muito alta quando comparada a outros países. Esse alto índice de mortalidade tem estreita relação com a dificuldade em fazer o diagnóstico e estabelecer a terapia apropriada. Apenas dois grupos de antibióticos têm comprovada eficácia clínica, o cloranfenicol e as tetraciclinas. Até pouco tempo atrás, as tetraciclinas eram reservadas aos pacientes adultos em virtude das alterações dentárias e ósseas em crianças. Recentemente, entretanto, a Academia Americana de Pediatria e diversos autores têm recomendado a utilização da doxiciclina também em crianças. Em casos mais severos, a falta de experiência com uma tetraciclina injetável no Brasil faz com que se opte pelo cloranfenicol injetável. Como o pronto diagnóstico e a escolha adequada do fármaco são fatores determinantes de um prognóstico positivo, todos os profissionais da saúde devem estar melhor preparados para reconhecer e tratar a febre maculosa.


Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20 percent to 30 percent) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.


Subject(s)
Adult , Animals , Child , Female , Humans , Male , Pregnancy , Rocky Mountain Spotted Fever/epidemiology , Animals, Wild/parasitology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Arachnid Vectors/microbiology , Brazil/epidemiology , Delayed Diagnosis , Diagnosis, Differential , Disease Notification , Disease Reservoirs/parasitology , Population Surveillance , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/microbiology , Rickettsia rickettsii/isolation & purification , Rocky Mountain Spotted Fever/diagnosis , Rocky Mountain Spotted Fever/drug therapy , Rocky Mountain Spotted Fever/physiopathology , Rocky Mountain Spotted Fever/prevention & control , Tick Infestations/veterinary , Ticks/microbiology
16.
Gac. méd. Méx ; 141(4): 309-312, jul.-ago. 2005. ilus
Article in Spanish | LILACS | ID: lil-632070

ABSTRACT

La fiebre manchada de las Montañas Rocosas (FMMR) es una enfermedad febril aguda causada por Rickettsia rickettsii, caracterizada por un exantema petequial. A pesar de conocer su etiología y manifestaciones clínicas y de disponer de un tratamiento eficaz, su letalidad aún es elevada. En sus estadios iniciales, la FMMR puede aparentar muchas otras enfermedades infecciosas y dificultar su diagnóstico. El presente trabajo informa dos casos con FMMR que ilustran la importancia de su diagnóstico oportuno y tratamiento adecuado, así como de considerar a la FMMR como diagnóstico diferencial ante un paciente febril con exantema que resida en área endémica.


Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cases underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.


Subject(s)
Child , Child, Preschool , Humans , Male , Rocky Mountain Spotted Fever , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Chloramphenicol/administration & dosage , Chloramphenicol/therapeutic use , Diagnosis, Differential , Doxycycline/administration & dosage , Doxycycline/therapeutic use , Rocky Mountain Spotted Fever/diagnosis , Rocky Mountain Spotted Fever/drug therapy , Time Factors , Treatment Outcome
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