Serosurvey on rickettsiae of the spotted fever group and Rickettsia bellii among dogs in the state of Goiás, Brazil / Inquérito sorológico sobre riquétsias do grupo da febre maculosa e Rickettsia bellii entre cães no estado de Goiás, Brasil

Abstract The purpose of this study was to do a serological survey on three rickettsial species: Rickettsia rickettsii and Rickettsia parkeri, two species of the spotted fever group (SFG) that are considered to be great importance for public health; and Rickettsia bellii, a species of unknown pathogenicity that infects a variety of human-biting ticks. Serum samples from 273 dogs were tested using the indirect immunofluorescence assay (IFA). A total of 52 samples (19.04%) were seropositive for at least one of the three Rickettsia spp. antigens. Thirty-eight (73.07%), twelve (23.07%) and one (1.92%) of these dogs showed homologous reactions to R. bellii, R. rickettsii and R. parkeri, respectively. Our results showed that the seroprevalence of Rickettsia spp. was relatively low. However, the positive serological tests indicated that these dogs had become infected by these agents at some point in their lives. Lastly, our study adds to the previous knowledge on the epidemiology of rickettsiosis in the state of Goiás by doing the first record of detection of anti-R. rickettsii, R. parkeri and R. bellii antibodies by IFA among dogs, thus indicating that these agents may be circulating in the dog population analyzed.

Resumo O objetivo deste estudo foi realizar um levantamento sorológico para três espécies de rickettsias: Rickettsia rickettsii e Rickettsia parkeri, duas espécies do grupo da febre maculosa (GFM) consideradas de grande importância para a saúde pública; e Rickettsia bellii, uma espécie de patogenicidade desconhecida que infecta uma variedade de carrapatos que parasitam seres humanos. Amostras de soro de 273 cães foram testadas, usando-se a técnica de reação de imunofluorescência indireta (RIFI). O total de 52 amostras (19,04%) foram soropositivas para pelo menos um dos três antígenos de Rickettsia spp. Trinta e oito (73,07%), doze (23,07%) e um (1,92%) desses cães apresentaram reações homólogas à R. bellii, R. rickettsii e R. parkeri, respectivamente. Esses resultados demonstraram uma baixa soroprevalência para Rickettsia spp. No entanto, as amostras positivas indicam que esses cães foram infectados por esses agentes em algum momento de suas vidas. Por fim, este estudo contribui para o conhecimento sobre a epidemiologia das rickettsioses no estado de Goiás, realizando a primeira detecção de anticorpos anti-Rickettsia rickettsii, R. parkeri e R. bellii pela RIFI em cães, indicando que esses agentes podem estar circulando na população canina analisada.

Caso probable de fiebre manchada ( Rickettsia felis) transmitida por pulgas / Probable case of flea-borne spotted fever ( Rickettsia felis )

Rickettsia felis es el agente etiológico de la fiebre manchada transmitida por pulgas, cuyo principal vector y reservorio es Ctenocephalides felis . Típicamente, la enfermedad se presenta como fiebre aguda asociada a cefalea, astenia, exantema máculo-papular generalizado y, en algunos casos, con escara de inoculación. En los últimos años, R. felis ha venido adquiriendo un papel importante en la etiología del síndrome febril agudo, calificándola como una enfermedad emergente y subdiagnosticada. La inmunofluorescencia indirecta es actualmente el método diagnóstico de referencia. Sin embargo, esta técnica presenta limitaciones relacionadas con la reacción cruzada que existe entre las diferentes especies del género Rickettsia . En el presente reporte se describe el caso de un paciente de 16 años con síndrome febril agudo secundario a infección probable por R. felis .

Rickettsia felis is the etiologic agent of flea-borne spotted fever, with Ctenocephalides felis as its main vector and reservoir. Typically, the disease presents as acute fever associated with headache, asthenia, generalized maculo-papular rash, and in some cases, an inoculation eschar. In recent years, R. felis has acquired an important role in the etiology of the acute febrile syndrome; it is indeed an emerging infectious disease, albeit underdiagnosed. Indirect immunofluorescence assay (IFA) is currently the reference diagnostic method. However, this technique has limitations related to the cross reactivity among different species of rickettsiae. Herein, we describe a case of a 16 year-old patient with an acute febrile syndrome secondary to probable infection with R. felis.

Ecoepidemiología de la infección por rickettsias en roedores, ectoparásitos y humanos en el noroeste de Antioquia, Colombia / Ecoepidemiology of rickettsial infection in rodents, ectoparasites and humans in northeastern Antioquia, Colombia

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.

Etiología y caracterización epidemiológica del síndrome febril no palúdico en tres municipios del Urabá antioqueño, Colombia / Etiology and epidemiological characterization of non-malarial febrile syndrome in three municipalities of Urabá (Antioquia), Colombia

Introducción. La región de Urabá es endémica para varias enfermedades febriles agudas de origen infeccioso. Sin embargo, solo los pacientes con malaria pueden acceder a un diagnóstico oportuno y rápido, motivo por el cual muchos síndromes febriles no palúdicos quedan sin diagnóstico etiológico claro. Objetivo. Establecer la etiología, describir las manifestaciones clínicas y explorar algunos posibles factores de riesgo relacionados con los síndromes febriles agudos no palúdicos en pacientes procedentes de los municipios de Necoclí, Turbo y Apartadó. Materiales y métodos. Se tomaron muestras de suero en fase aguda y de convalecencia de 220 pacientes febriles negativos para malaria, provenientes de zonas rurales y urbanas de Necoclí, Turbo y Apartadó en los años 2007 y 2008. Se practicaron pruebas para diagnóstico de dengue (detección de anticuerpos IgM por ELISA), leptospirosis (detección de anticuerpos IgM e IgG por IFI), rickettsiosis (detección de anticuerpos IgG por IFI), hantavirus y arenavirus (detección de anticuerpos IgG por ELISA). Resultados. Se encontraron frecuencias de dengue, leptospirosis, rickettsiosis y arenavirus de 37,3 %, 14,1 %, 2,7 % y 0,5 %, respectivamente. Se presentaron 12 casos de coinfección de leptospirosis-dengue y uno de leptospirosis-rickettsiosis-dengue. El sexo masculino y la humedad relativa media, fueron factores de riesgo para dengue. El inicio de signos clínicos en febrero de 2008, se asoció tanto con la infección por dengue como por leptospirosis. Conclusión. Se reafirma la importancia del virus del dengue, Rickettsia spp. y Leptospira spp., como agentes causantes del síndrome febril en la región del Urabá.

Introduction: Urabá, a region on the northern coast of Colombia, is endemic to several acute febrile illnesses of infectious origin; however, only patients with malaria may have access to quick and effective diagnosis. For this reason, many non-malarial febrile patients go without a clear etiologic diagnosis. Aim: To establish the etiology and clinical signs of acute febrile non-malaria syndromes and explore some of the likely risk factors in patients originating in the municipalities of Necocli, Turbo and Apartado who exhibit these symptoms. Materials and methods: We obtained acute and convalescent sera from 220 non-malarial febrile patients from the rural and urban zones of Necocli, Turbo and Apartado during 2007 and 2008. Serologic tests for dengue (IgM by ELISA), leptospirosis (IgM and IgG by IFA), rickettsiosis (IgG by IFI), hanta and arenavirus (IgG by ELISA) were performed. Results: We found that the frequency of infection for dengue, leptospirosis, rickettsiosis and arenavirus, was 37.3%; 14.1%; 2.7% and 0.5%, respectively. There were 12 co-infection cases of leptospirosis-dengue and one of leptospirosis-rickettsiosis-dengue. Male gender and relative humidity were considered risk factors for dengue, and the beginning of clinical signs in February of 2008 was associated with the infection of dengue and leptospirosis. Conclusion: This study confirms previous records that underline the importance of Rickettsia spp, dengue virus and Leptospira spp as causal agents of febrile syndrome in this region of Colombia.

Seroprevalence of Rickettsia bellii and Rickettsia felis in dogs, São José dos Pinhais, State of Paraná, Brazil / Soroprevalência de Rickettsia bellii e Rickettsia felis em cães, São José dos Pinhais, Paraná, Brasil

Brazilian spotted fever (BSF) is a vector-borne zoonosis caused by Rickettsia rickettsii bacteria. Dogs can be host sentinels for this bacterium. The aim of the study was to determine the presence of antibodies against Rickettsia spp. in dogs from the city of São José dos Pinhais, State of Paraná, Southern Brazil, where a human case of BSF was first reported in the state. Between February 2006 and July 2007, serum samples from 364 dogs were collected and tested at 1:64 dilutions by indirect immunofluorescence assay (IFA) against R. rickettsii and R. parkeri. All sera that reacted at least to one of Rickettsia species were tested against the six main Rickettsia species identified in Brazil: R. rickettsii, R. parkeri, R. bellii, R. rhipicephali, R. amblyommii and R. felis. Sixteen samples (4.4 percent) reacted to at least one Rickettsia species. Among positive animals, two dogs (15.5 percent) showed suggestive titers for R. bellii exposure. One sample had a homologous reaction to R. felis, a confirmed human pathogen. Although Rickettsia spp. circulation in dogs in the area studied may be considered at low prevalence, suggesting low risk of human infection, the present data demonstrate for the first time the exposure of dogs to R. bellii and R. felis in Southern Brazil.

A febre maculosa brasileira (FMB) é uma zoonose veiculada por carrapatos e causada pela bactéria Rickettsia rickettsii, podendo os cães ser hospedeiros sentinelas para essa bactéria. O objetivo do estudo foi determinar a presença de anticorpos contra Rickettsia spp. em cães de São José dos Pinhais, estado do Paraná, Sul do Brasil. Entre fevereiro de 2006 e julho de 2007, amostras séricas de 364 cães foram coletadas e testadas na diluição de 1:64 por Reação de Imunofluorescência Indireta (RIFI) contra R. rickettsii e R. parkeri. Todos os soros reagentes para pelo menos uma espécie de Rickettsia foram testados contra as seis principais espécies de Rickettsia identificadas no Brasil: R. rickettsii, R. parkeri, R. bellii, R. rhipicephali, R. amblyommii e R. felis. Dezesseis amostras (4,4 por cento) reagiram para pelo menos uma espécie de Rickettsia. Dos animais positivos, dois cães (15,5 por cento) apresentaram títulos sugestivos de exposição a R. bellii. Uma amostra apresentou reação homóloga frente à R. felis, um agente patogênico confirmado para seres humanos. Muito embora os resultados demonstrem uma baixa prevalência de Rickettsia spp. em cães, sugerindo um baixo risco de infecção humana, este estudo relatou pela primeira vez a evidência de exposição a R. bellii e R. felis em cães no Sul do Brasil.

Serosurvey of antibodies against spotted fever group Rickettsia spp. in horse farms in Northern Paraná, Brazil / Soroprevalência de anticorpos contra Rickettsia spp. do grupo febre maculosa em equinos de haras no Norte do Paraná, Brasil

Brazilian spotted fever (BSF) is an emerging disease most likely caused by Rickettsia rickettsii. The objective of the present study was to estimate the seroprevalence of BSF rickettsia infections in equines from six horse farms located in Londrina County, Paraná, Southern Brazil. Six owners of horse farms situated in Cambé, Santa Fé, Guaraci and Londrina municipalities participated in the study. All farms were located in areas where BSF has not been reported. A total of 273 horses were sampled and their sera were tested by indirect Immunofluorescence assay (IFA) using R. rickettsii and R. parkeri antigens. Titers equal to and greater than 64 were considered positive. Of 273 sera tested, 15 (5.5 percent) reacted to R. rickettsii and 5 (1.8 percent) to R. parkeri. Five out of the six farms studied revealed seropositive animals and seropositivity rate ranged from 0 to 13 percent. The titers ranged from 64 to 512, and four samples had a titer of 512. Nine animals reacted to R. rickettsii with titers four-fold higher than those for R. parkeri. These results suggest that horses in Northern Paraná may have been exposed to rickettsiae identical or closely related to R. rickettsii.

Febre Maculosa Brasileira (FMB) é uma doença emergente, sendo Rickettsia rickettsii o seu principal agente etiológico. O objetivo deste estudo foi determinar a soroprevalência de rickettsia do grupo da febre maculosa em equinos de seis haras localizados nos municípios de Cambé, Santa Fé, Guaraci e Londrina. As propriedades eram localizadas na região Norte do Paraná onde casos de FMB ainda não foram diagnosticados. Foram colhidas amostras de sangue de 273 equinos, e os soros foram testados pela RIFI, usando R. rickettsii e R. parkeri como antígenos, considerando-se como positivos títulos >64. Entre 273 soros, 15 (5,5 por cento) reagiram contra R. rickettsii e 5 (1,8 por cento) para R. parkeri. Cinco de seis haras estudados tinham animais reativos, e a taxa de sororreatividade variou de 0 a 13 por cento. Os títulos variaram de 64 para 512, e três amostras apresentaram título de 512. Nove animais reagiram para R. rickettsii com títulos quatro vezes maiores que para R. parkeri. Esses resultados sugerem que equinos no Norte do Estado do Paraná, Brasil, podem ter sido expostos a uma rickettsia idêntica ou muito próxima a R. rickettsii.

A study of'febrile illnesses on the Thai-Myanmar border: predictive factors of rickettsioses.

We have performed a case-control analysis to determine the significance of clinical, laboratory and epidemiological features as predictive factors of rickettsioses among patients in Sangkhla Buri, Thailand (Thai-Myanmar border). Fifteen serologically-confirmed rickettsiosis patients including Spotted Fever Group (SFG) rickettsioses, scrub typhus, and murine typhus were classified as 'cases'; one hundred and sixty-three acutely febrile patients presenting to the same hospital during the same time period, who had no serological evidence of acute rickettsiosis, were classified as 'controls'. Patients' report of rash/arthropod bite [Odds ratio (OR) 22.90, 95% CI (confidence interval) 6.23, 84.13] and history of jungle trips (OR 5.30, 95% CI 1.69-16.62) were significant risk factors. Elevated ALT (OR 3.04, 95% CI 1.04, 8.88) and depressed platelet count (OR 3.38, 95% CI 1.13, 10.10) were also useful differentiating markers of rickettsioses in this population. Definitive diagnosis of rickettsioses is difficult without specialized diagnostic capabilities that are rarely available in remote areas such as Sangkhla Buri, where other acute febrile illnesses with similar presentation are commonly found. The relative importance of predictive factors presented here may provide clinicians with some useful guidance in distinguishing rickettsioses from other acute febrile illnesses. Timely administration of empiric treatment in highly suspicious cases can deter potential morbidity from these arthropod-borne infections.

Isolation and PCR detection of rickettsiae from clinical and rodent samples in Malaysia.

Isolation of rickettsiae from patients' blood samples and organ samples of wild rodents from areas with high seroprevalence of rickettsial infections was attempted using cell culture assay and animal passages. L929 mouse fibroblast cells grown in 24 well tissue culture plate were inoculated with buffy coat of febrile patients and examined for the growth of rickettsiae by Giemsa, Gimenez staining and direct immunofluorescence assay. No rickettsiae were isolated from 48 patients' blood samples. No symptomatic infections were noted in mice or guinea pigs infected with 50 organ samples of wild rodents. There was no rickettsial DNA amplified from these samples using various PCR detection systems for Orientia tsutsugamushi, typhus and spotted fever group rickettsiae.