Síntomas gastrointestinales, disfunción respiratoria, hepática y renal, principales factores asociados a letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California, México / Gastrointestinal symptoms, respiratory, hepatic and renal dysfunction, main factors associated with lethality due to tickborne rickettsiosis in Mexicali, Baja California, Mexico

INTRODUCCIÓN: La rickettsiosis, enfermedad potencialmente mortal, es trasmitida por vectores como Rhipicephalus sanguineus, Dermacentor variabilis y D. andersonii, reservorios de Rickettsia rickettsii. En Baja California, México, es endémica, multifactorial, tiene alta letalidad, sus manifestaciones clínicas inespecíficas y ataque multisistémico dificultan el diagnóstico y tratamiento oportuno. OBJETIVO: Identificar los factores de riesgo asociados a la letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California. PACIENTES Y MÉTODOS : Estudio observacional, analítico, transversal, retrospectivo, de 40 registros de pacientes con diagnóstico confirmado de rickettsiosis, periodo 2014 a 2018. Variables analizadas: sociodemográficas, clínicas, laboratorio clínico, evolución y desenlace. Se reportan frecuencias y medidas de asociación. RESULTADOS: 24 defunciones y 16 vivos. Más de 90% tuvo contacto conocido con garrapatas. Afectó en su mayoría a < 45 años en ambos grupos. La evolución antes del ingreso fue similar y la estancia hospitalaria fue mayor en los pacientes vivos (3,2 ± 4.7 vs 10,62 ± 7,6 p = 0,0002). Fiebre, cefalea, mialgias fueron predominantes. Datos asociados con letalidad: disfunción respiratoria (OR 38,33 IC95% 4,06-361,3 p < 0,0001), creatinina elevada (OR 15,4 IC95% 3,08-76,77 p < 0,0003), retardo del llenado capilar (OR 13,0 IC95% 2,73-61,78 p = 0,0005), dolor abdominal (OR 8,33, IC95% 1,90-36,44 p = 0,0029), AST (OR 7,5, IC95% 1,69-33,27 p = 0,005). CONCLUSIÓN: Esta enfermedad requiere de identificación temprana de factores que se asocian con letalidad para un tratamiento oportuno y adecuado.

BACKGROUND: Rickettsiosis, a potentially fatal disease, is transmitted by vectors such as Rhipicephalus sanguineus, Dermacentor variabilis and D. andersonii, reservoirs of Rickettsia rickettsii. In Baja California, Mexico, it is endemic, multifactorial, has high lethality, its nonspecific clinical manifestations and multisystem attack make diagnosis and timely treatment difficult. AIM: Identify the risk factors associated with lethality due to tick-transmitted rickettsiosis in Mexicali, Baja California. METHODS: Observational, analytical, cross-sectional, retrospective study of 40 records of patients with a confirmed diagnosis of rickettsiosis, period 2014 to 2018. Analyzed variables: sociodemographic, clinical, clinical laboratory, evolution and outcome. Frequencies and association measures are reported. RESULTS: 24 patients died and 16 survived. More than 90% had reported contact with ticks. It mostly affected ≤ 45 years in both groups. The evolution before admission was similar, and the hospital stay was longer in patients who lived (3.2 ± 4.7 vs 10.62 ± 7.6 p = 0.0002). Fever, headache, and myalgia are predominant. Data associated with lethality: respiratory dysfunction (OR 38.33 95% CI 4.06-361.3 p < 0.0001), elevated creatinine (OR 15.4 95% CI 3.08-76.77 p < 0.0003), delayed capillary refill (OR 13.0, 95% CI 2.73-61.78 p = 0.0005), abdominal pain (OR 8.33, 95% CI 1.90-36.44 p = 0.0029), AST (OR 7.5, 95% CI 1.69-33.27 p = 0.005). CONCLUSION: This disease requires early identification of factors that are associated with lethality for timely and adequate treatment.

Neurological manifestation of Brazilian spotted fever in childhood

ABSTRACT Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation.

Factors associated with the confirmation and death for Brazilian spotted fever in an important endemic area of the State of São Paulo, 2007-2021

ABSTRACT Background: We evaluated the predictive factors for case confirmation and death from Brazilian spotted fever in an endemic area of Southeastern Brazil. Methods: A cross-sectional study was conducted. All suspected cases reported between 2007 and 2021 were analyzed using two logistic regression models. Results: 60 cases were confirmed. Male sex, age group of 40-59 years, tick parasitism, presence of capybaras or horses, exanthema and hospitalization were positively associated with confirmation. Death was associated with a longer period between first symptom-hospitalization and shorter treatment. Conclusions: Complete clinical evaluation and information on risk exposure are key to early suspicion, diagnosis, treatment and prevention of deaths.

Rickettsiosis de fiebre manchada. Estudio de casos notificados en un hospital pediátrico de segundo nivel en el noreste de México, 2012-2022 / Spotted fever rickettsioses. Study of cases reported in a secondary care pediatric hospital of northeastern Mexico, 2012-2022

Resumen Antecedentes: La rickettsiosis de fiebre manchada es una enfermedad grave y con alta tasa de letalidad si no se identifica oportunamente. Objetivo: Describir las características de los pacientes hospitalizados por rickettsiosis de fiebre manchada, así como los factores de riesgo asociados a mal pronóstico. Material y métodos: Se recabaron los datos del expediente clínico de pacientes hospitalizados entre agosto de 2012 y julio de 2022. Las variables se analizaron mediante prueba U de Mann-Whitney, prueba exacta de Fisher y regresión logística univariada y multivariada. Resultados: Se analizaron 26 pacientes, en quienes se identificó una mortalidad de 57.6 %. En la comparación entre grupos, el número de plaquetas fue menor en los no supervivientes (16.0 × 103/µL versus 25.9 × 103/µL, p = 0.031). El porcentaje de pacientes supervivientes que recibieron tratamiento más de 72 horas después del inicio de la fiebre fue 45.5 % (cinco pacientes) versus 86.7 % de los no supervivientes (13 pacientes), p = 0.034. Recibir tratamiento después de 72 horas del inicio de la fiebre incrementó 7.09 veces la probabilidad de desenlace fatal (RM = 8.09, IC 95 % = 1.1-55.8, p = 0.034). Conclusiones: Iniciar tratamiento adecuado posterior a 72 horas del inicio de la fiebre podría ser un factor de riesgo de mortalidad, de ahí que la importancia del diagnóstico oportuno y tratamiento adecuado de esta enfermedad.

Abstract Background: Spotted fever rickettsiosis is a serious disease with a high mortality rate if not timely detected. Objective: To describe the characteristics of patients hospitalized for spotted fever rickettsiosis, as well as the risk factors associated with poor prognosis. Material and methods: Data from medical records of patients hospitalized between August 2012 and July 2022 were collected. Variables were analyzed using Mann-Whitney's U-test, Fisher's exact test, and univariate or multivariate logistic regression analysis. Results: Twenty-six patients were analyzed, among which a mortality of 57.6% was identified. In the between-group comparison, platelet count was lower in non-survivors (16.0 × 103/µL vs. 25.9 × 103/µL, p = 0.031). The percentage of surviving patients who received treatment more than 72 hours after fever onset was 45.5% (five patients) vs. 86.7% of non-survivors (13 patients) (p = 0.034). Receiving treatment 72 hours after fever onset increased by 7.09 times the probability of a fatal outcome (OR = 8.09, 95% CI = 1.1-55.8, p = 0.034). Conclusions: Starting adequate treatment 72 hours after the onset of fever may be an important risk factor for mortality, hence the importance of timely diagnosis and appropriate treatment of this disease.

Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina / Autochthonous Rickettsia parkeri rickettsiosis in the Paranaense Forest, Misiones, Argentina

Resumen Se informa un caso autóctono de rickettsiosis por Rickettsia parkeri, ocurrido en junio del 2018 en la zona selvática del Parque Provincial Urugua-í, Misiones, Argentina, región sin registros previos de esta enfermedad en humanos. Se describen los aspectos epidemiológicos, ecológicos, clínicos y de laboratorio necesarios para el diagnóstico oportuno y el tratamiento adecuado. Se resalta el hecho de considerar a las rickettsiosis como diagnóstico diferencial ante un paciente con síndrome febril agudo exantemático; el antecedente epidemiológico de exposición al vector característico de la región, garrapatas del género Amblyomma, es un elemento fundamental.

Abstract We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

Construção e validação de Quiz para avaliação de conhecimento cognitivo sobre febre maculosa / Creation and validation of a quiz to assess cognitive knowledge about spotted fever / Construcción y validación de un cuestionario para evaluar los conocimientos cognitivos sobre la fiebre maculosa

Objetivo: construir e validar um Quiz de avaliação cognitiva sobre Febre Maculosa, voltado para avaliar o conhecimento de estudantes que moram e/ou frequentam cidades de risco para a doença. Métodos: estudo metodológico desenvolvido em três etapas: construção do Quiz; validação de aparência e conteúdo com nove juízes, com análise realizada através do cálculo de Índice de Validade de Conteúdo, com valor de corte 0,80; e validação semântica, seguindo a metodologia DISABKIDS® com 12 alunos de cursos técnicos profissionalizantes, com avaliação dos dados realizada por estatística descritiva, tendo sido utilizado o programa Statistical Package for the Social Sciences. Resultados: o processo de validação foi subdividido em duas etapas: validação de aparência e conteúdo por profissionais das áreas de biologia e educação e validação semântica por alunos de cursos profissionalizantes. O Quiz foi elaborado e aplicado e os resultados mostraram um índice de validade de conteúdo superior a 0,80 para todas as variáveis analisadas. Na validação semântica, o Quiz foi considerado como de fácil compreensão e não houve dificuldade para o preenchimento. Conclusão: o Quiz construído foi validado quanto à aparência, ao conteúdo e à semântica, tendo alcançado concordância satisfatória, o que garante ser um instrumento adequado para o processo de avaliação sobre a temática investigada. Com isso, espera-se contribuir para a difusão de conhecimento acerca da identificação dos fatores de risco e da prevenção da saúde relacionados à Febre Maculosa.(AU)

Objective: to create and validate a cognitive assessment Quiz about Spotted Fever, targeted at evaluating what students living in and/or traveling to risk cities know about the disease. Methods: a methodological study developed in three stages: creation of the Quiz; face and content validation with nine judges, with analysis performed by calculating the Content Validity Index, with a cutoff value of 0.80; and semantic validation, following the DISABKIDS®methodology with 12 students from professional technical courses, with data evaluation performed by means of descriptive statistics, using the Statistical Package for the Social Sciences program. Results: the validation process was subdivided into two stages: face and content validation by professionals in the Biology and Education areas, and semantic validation by students attending professional courses. The Quiz was prepared and applied and the results showed a Content Validity Index above 0.80 for all the variables analyzed. In the semantic validation, the Quiz was considered as easy to understand and there were no difficulties filling it in. Conclusion: the Quiz created was validated in terms of face, content and semantics, having achieved satisfactory agreement, which guarantees that it is an adequate instrument for the evaluation process on the theme investigated. With this, the expectation is to contribute to disseminating knowledge about the identification of risk and health prevention factors related to Spotted fever.(AU)

Objetivo: construir y validar un Cuestionario de evaluación cognitiva sobre la Fiebre Maculo-sa, destinado a evaluar los conocimientos de los estudiantes que viven y/o asisten a ciudades con riesgo para la enfermedad. Métodos: estudio metodológico desarrollado en tres etapas: construcción del Cuestionario; validación de apariencia y contenido con nueve jueces con aná-lisis realizado mediante el cálculo del Índice de Validez de Contenido, con un valor de corte de 0.80 y validación semántica, siguiendo la metodología DISABKIDS® con 12 estudiantes de carreras técnicas profesionales, con evaluación de datos realizada mediante estadística des-criptiva, donde se utilizó el programa Statistical Package for the Social Sciences. Resultados: el proceso de validación se subdividió en dos etapas: validación de apariencia y contenido por profesionales de las áreas de biología y educación, y validación semántica por estudiantes de carreras profesionales. El Cuestionario fue diseñado y aplicado. Los resultados mostraron un índice de validez de contenido superior a 0,8 para todas las variables analizadas...(AU)

Construction of a model for early identification of spotted fever and severe fever with thrombocytopenia syndrome / 预防医学

Objective@#To construct a model for clinical identification of spotted fever (SF) and severe fever with thrombocytopenia syndrome (SFTS), so as to provide insights into early identification of SF and SFTS.@*Methods@#The clinical data of laboratory-confirmed SF and SFTS patients in secondary and tertiary hospitals in Lu'an City, Anhui Province from May 2017 to May 2021 were retrieved from Chinese Disease Prevention and Control Information System. Factors affecting SF were identified using a logistic regression model, and the model for early identification of SF and SFTS was created. The model fitting effect was evaluated using Hosmer-Lemeshow test, and the value of the model for identification of SF and SFTS was evaluated using the area under the receiver operating characteristic curve (AUC).@*Results@#Data of 62 SF cases and 115 SFTS cases were included. Multivariable logistic regression analysis showed that rash (β=5.994), C-reactive protein (β=4.409), white blood cell (β=-3.176) and platelet (β=-3.234) were included in the model, which were scored 6, 4, -3 and -3, with a total score ranging from -5 to 10. Hosmer-Lemeshow test revealed a high model fitting effect (χ2=3.245, P=0.662). The AUC of the model was 0.992, and the sensitivity and specificity were 0.935 and 0.991 if the cutoff was 1.@*Conclusion@#A model for early identification of SF and SFTS that includes four variables of rash, C-reactive protein, white blood cell and platelet has been created, which has a high accuracy.

A comparative study of the clinical characteristics of spotted fever and severe fever with thrombocytopenia syndrome / 中国热带医学

@#Abstract: Objective To investigate the differences in epidemiological and clinical characteristics of patients with spotted fever (SF) and severe fever with thrombocytopenia syndrome (SFTS). Methods A total of 86 patients with SF and 113 patients with SFTS who were laboratory-confirmed in the second-level and above hospitals in Lu'an City from January 2017 to January 2022 were selected. The basic data, epidemiological history, clinical data and laboratory test results of the two diseases were retrospectively analyzed for comparison. Results The proportion of male in SF group was 32.56% (28/86), and the proportion of male in SFTS group was 53.98% (61/113), the difference was statistically significant (χ2=9.067, P<0.01). The proportions of abdominal pain and diarrhea in the SF group were (3.49%, 3/83) and (21.24%, 24/113), which were significantly lower than corresponding (6.98%, 6/86) and (46.90%, 53/113) in the SFTS group (χ2=13.121, 37.322, P<0.01). The incidences of rash and eschar in SF group were 95.35% (82/86) and 20.93% (18/86), which were significantly higher than corresponding 1.77% (2/113) and 0.88% (1/113) in SFTS group (χ2=175.311, 22.721, P<0.01). The levels of leukocytes, platelets and C-reactive protein in the SF group were significantly higher than those in the SFTS group, and the levels of transaminase, lactate dehydrogenase and D-dimer were significantly lower than those in the SFTS group, and the differences were statistically significant (all P<0.05). Conclusions The rash and inflammatory reaction are more obvious in SF patients, while the liver function, myocardial function and coagulation function are significantly impaired in SFTS patients.

Clinical and epidemiological analysis of 18 cases of Japanese spotted fever in Zigui County / 中华检验医学杂志

Objective:The epidemiological and clinical characteristics of 18 cases of Japanese spotted fever (JSF) in Zigui County were analyzed in order to improve the prevention and treatment of JSF.Methods:This is a case series analysis. The epidemiological and clinical data, laboratory tests and imaging characteristics of 18 JSF cases with median age of 60 years (54, 68) identified by The People′s Hospital of Zigui from April 2021 to August 2022 were collected and analyzed retrospectively.Results:Most (17/18) of the patients were farmers and all had a field exposure history. The patient′s onset was from April to October. Spring and autumn were the seasons with the highest incidence of JSF. The first symptoms of patients were high fever, headache, and fatigue. Of the 18 cases, 15 had a rash and 12 presented an eschar and 3 had neither rash nor eschar. In addition, 10 of 18 cases experienced edema of both lower extremities, and 3 got disturbance of consciousness. Laboratory tests found that 15 patients had abnormal white blood cells and 11 patients had decreased platelets. C-reactive protein, procalcitonin, D-dimer, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase were elevated in all patients; 13 patients with elevated alanine aminotransferase, 14 patients with elevated aspartate transamination. Kidney damage caused by Rickettsia japonica infection showed by abnormal proteinuria in 11 of the patients. Conclusions:The most common clinical manifestations of JSF are non-specific indications such as high fever, chills, fatigue, headache. The eschar and rash, which are the main features of Rickettsia infection, are not present in all patients, resulting delay of diagnosis or misdiagnosis. Medical workers should be more alert to rickettsial infections in patients with fever of unknown origin, especially in seasons of high incidence of spotted fever. Early diagnosis and correct antibiotic treatment shall be given according to the patient′s clinical manifestations, laboratory results and imaging test to control disease progression.

Avaliação da completitude e oportunidade dos dados no Sistema de Informação de Agravos de Notificação (Sinan) para febre maculosa no estado de São Paulo, 2007-2017 / Evaluación de la completitud y oportunidad de datos en el Sistema de Información sobre Enfermedades de Notificación Obligatoria (Sinan) por fiebre manchada en el estado de São Paulo, Brasil, 2007-2017 / Evaluation of completeness and timeliness of data in the National Information System for Notifiable Diseases for spotted fever in the state of São Paulo, Brazil, 2007-2017

Objetivo: avaliar completitude e oportunidade das notificações de casos de febre maculosa (FM) no Sistema de Informação de Agravos de Notificação (Sinan), no estado de São Paulo, no período de 2007 a 2017. Métodos: estudo descritivo e ecológico dos casos humanos confirmados de FM, mediante análise dos atributos completitude e oportunidade de dez campos da ficha de notificação (boas quando ≥ 90% para a maioria das variáveis); na análise das tendências das séries temporais, utilizou-se a técnica de Prais-Winsten. Resultados: foram analisados 736 registros; dos campos essenciais, apenas "Data da alta" demonstrou baixa completitude (68,5%); "Investigação" e "Encerramento" tiveram boa oportunidade; demais intervalos não foram adequados. Conclusão: no estado de São Paulo, a completitude dos dados foi boa na maioria das variáveis, porém não adequada quanto à oportunidade (exceto para "Encerramento" e "Investigação"), apontando para a necessidade de ações de educação e comunicação em saúde sobre FM.

Objective: to evaluate the completeness and timeliness of notifications of cases of spotted fever (SF) held on the Notifiable Health Conditions Information System (SINAN) in São Paulo State, Brazil, from 2007 to 2017. Methods: this was a descriptive and ecological study of confirmed human cases of SF regarding completeness and timeliness of ten fields of the notification form (good if ≥ 90% for most variables); time series analysis was performed using the Prais-Winsten technique. Results: we analyzed 736 records; among essential fields, only "Discharge date" showed poor completeness (68.5%). Timeliness was good for the "Investigation" and "Closure" fields; other time lapses were not adequate. Conclusion: in São Paulo state, data completeness was good for most variables, whereas timeliness was not adequate (except for "Closure" and "Investigation"), pointing to the need for health education and communication actions about SF.

Objetivo: evaluar la completitud y oportunidad de las notificaciones de casos de fiebre manchada (FM) en el Sistema Nacional de Información sobre Enfermedades de Declaración Obligatoria (Sinan) en el estado de São Paulo, Brasil, de 2007 a 2017. Métodos: estudio descriptivo y ecológico de casos humanos confirmados de FM para completitud y oportunidad de diez campos del formulario (bueno si ≥ 90% para la mayoría de las variables). Se realizó una regresión lineal para analizar las tendencias de las series temporales. Resultados: entre los campos esenciales, solo "Fecha de alta" mostró baja completitud (68,5%). "Investigación" y "Cierre" tuvieron buena oportunidad; otros intervalos no fueron adecuados. Conclusión: en São Paulo, la completitud fue buena para la mayoría de las variables, pero no adecuada en cuanto a la oportunidad, excepto para "Cierre" e "Investigación", lo que apunta a la necesidad de acciones de educación y comunicación en salud sobre FM.

Avaliação de tecnologia educacional sobre febre maculosa: ensaio clínico randomizado / Evaluation of educational technology on spotted fever: randomized clinical trial

O objetivo geral desse estudo foi avaliar a eficácia de um Laboratório Interativo versus uma Aula Expositiva para aquisição de conhecimento cognitivo sobre Febre Maculosa (FM) em alunos do ensino médio e profissionalizante de duas cidades brasileiras de região endêmica. Para alcançá-lo, foi preciso identificar o conhecimento prévio da população, desenvolver uma intervenção (metodológico) e testá-la (ensaio clínico), o que resultou na elaboração de quatro artigos e um relatório científico. O primeiro artigo se trata de um estudo metodológico, em que foi apresentado o percurso da construção, bem como o processo de validação de aparência, conteúdo e semântica. Os resultados da validação mostraram um índice de validade de conteúdo superior a 0,8 para a grande maioria das variáveis e o Laboratório Interativo foi avaliado de forma positiva pelos participantes do estudo. O segundo artigo, também estudo metodológico, teve como objetivo construir e validar um questionário de avaliação cognitiva, chamado de Quiz, para avaliar o conhecimento dos participantes antes e após a participação no Laboratório Interativo. Este Quiz alcançou concordância satisfatória entre os juízes e população alvo, o que garante ser um instrumento adequado para o processo de avaliação sobre a temática investigada. O terceiro artigo foi uma revisão integrativa da literatura, que sintetizou e interpretou estudos sobre as ações de educação em saúde sobre FM. Realizaram-se buscas sistemáticas em seis bases de dados, complementadas por buscas manuais. A amostra final foi composta por cinco artigos, analisados segundo os preceitos da análise de conteúdo dedutiva. Esta revisão permitiu identificar que, apesar das discussões sobre educação em saúde em FM serem de relevância mundial para a Saúde, ainda há uma escassez de trabalhos voltados integralmente para esta prática. O quarto artigo foi referente a avaliação do Laboratório Interativo sobre FM, tratando-se de um ensaio clínico randomizado. Participaram do estudo 458 alunos divididos em quatro grupos: Grupo Intervenção da cidade A que participou do Laboratório Interativo, Grupo Comparação da cidade A que participou da Aula Expositiva (alunos área da saúde); Grupo Intervenção da cidade B que participou do Laboratório Interativo e Grupo Comparação da cidade B que não participou de nenhuma Atividade (alunos de diversos cursos). O conhecimento dos alunos foi avaliado antes e após a intervenção com aplicação do Quiz sobre FM. Os resultados referentes a comparação intergrupos mostrou que os alunos que participaram do Laboratório Interativo apresentaram melhora no conhecimento na maioria das variáveis em comparação aos outros grupos, embora o conhecimento também tenha aumentado no Grupo Comparação-Aula Expositiva. Na comparação intragrupos, os alunos que participaram do Laboratório Interativo apresentaram um ganho significativo de conhecimento em comparação aos alunos que participaram da Aula Expositiva, e bem maior que àqueles que não participaram de nenhuma atividade. Por fim, buscando auxiliar a promoção em saúde em relação a doença FM, compreendemos a importância de elaborar uma Tecnologia Educacional em formato audiovisual. Assim, foi construído um conjunto de quatro vídeos educativos sobre FM para estudantes de 6 a 12 anos, acompanhado de manual pedagógico ao professor/educador. Trata-se de um recurso educativo para ser utilizado em sala de aula, com intuito que o tema seja trabalhado de forma transversal nas escolas para facilitar a construção do conhecimento e fortalecer o empoderamento dos alunos frente as suas decisões em saúde. Tomados em conjunto, os resultados obtidos nesta Tese mostram a urgência de ações voltados para esta temática, evidenciando o pioneirismo e inovação do estudo. Desta maneira, além de contribuir com a literatura, esse trabalho atende a uma demanda social ao elaborar um recurso educativo que contempla as necessidades de saúde de um grupo, mais especificamente, uma população que vive em região considerada endêmica para FM.

The overall objective of this study was to evaluate the effectiveness of an Interactive Laboratory versus an Expository Classroom in acquiring cognitive knowledge about Rocky Mountain Spotted Fever (RMSF) in high school and technical College students from two Brazilian cities in an endemic region. To achieve this, it was necessary to identify the population's prior knowledge, develop an intervention (methodological) and test it (clinical trial), which resulted in four articles and a scientific report. The first article is a methodological study, in which the path of the construction was presented, as well as the process of appearance, content, and semantic validation. The validation results showed a content validity index greater than 0.8 for the vast majority of the variables and the Interactive Lab was rated positively by the study participants. The second paper, also a methodological study, aimed to construct and validate a cognitive assessment questionnaire, called a RMSF Quiz, to assess the knowledge of participants before and after participating in the Interactive Lab. This Quiz achieved satisfactory agreement between the judges and the target population, which guarantees that it is an adequate instrument for the evaluation process on the investigated theme. The third article was an integrative literature review, which synthesized and interpreted studies on health education actions on RMSF. Systematic searches were performed in six databases, complemented by manual searches. The final sample was composed of five articles, analyzed according to the precepts of deductive content analysis. This review allowed us to identify that, despite the fact that discussions about health education in RMSF are of worldwide relevance for Health, there is still a scarcity of studies integrally focused on this practice. The fourth article was a randomized clinical trial evaluating the RMSF Interactive Lab. The study included 458 students divided into four groups: Intervention Group from city A that participated in the Interactive Lab; Comparison Group from city A that participated in the Lecture Class (health students); Intervention Group from city B that participated in the Interactive Lab; and Comparison Group from city B that did not participate in any Activity (students from various courses). The students' knowledge was evaluated before and after the intervention with the application of the RMSF Quiz. The results of the intergroup comparison showed that the students who participated in the Interactive Lab had improved knowledge in most variables compared to the other groups, although knowledge also increased in the Comparison Group - Lecture Class. In the intra-group comparison, the students who participated in the Interactive Lab showed a significant gain in knowledge compared to the students who participated in the Lecture Class, and much greater than those who did not participate in any activity. Finally, in order to help promote health to RMSF, we realized the importance of developing an Educational Technology in audiovisual format. Thus, a set of four educational videos on RMSF for students aged 6 to 12 years, accompanied by a pedagogical manual for the teacher/educator, was built. It is an educational resource to be used in the classroom, so that the theme can be worked in a transversal way in schools to facilitate the construction of knowledge and strengthen the students' empowerment in their health decisions. Taken together, the results obtained in this Thesis show the urgency of actions focused on this theme, evidencing the pioneering and innovation of the study. Thus, in addition to contributing to the literature, this work meets a social demand by developing an educational resource that addresses the health needs of a group, more specifically, a population living in a region considered endemic for RMSF.

Epidemiology of rocky mountain spotted fever in Brazil, 2010-2020 / Epidemiologia da febre das montanhas rochosas no Brasil, 2010-2020 / Epidemiología de la fiebre de las montañas rocosas en Brasil, 2010-2020

Rocky Mountain spotted fever is a tick-borne rickettsiosis. The main clinical signs and symptoms are fever, severe headache, rashes and myalgia. It is considered difficult to diagnose and underreported. The study aims to descriptively analyze the epidemiology of cases of Rocky Mountain spotted fever in Brazil from 2010 to 2021. This is a retrospective cohort study that statisticall analyzes the cases of spotted fever in Brazil between 2010 and 2020 through data obtained by the Information System of Notifiable Diseases. The proportions of spotted fever cases were calculated according to: sex, age, race/color, infection environment and evolution. There are 1967 cases were confirmed. The regions with the most cases were the Southeast (n%=72.24) and the South (n%=24). However, there are 4 deaths in the south while the lethality coefficient from the southeast is 47.78%. The most affected age group was 40-59 years old (n%=34.87), and 20-39 years old (n%=28.98). 71.17% of the cases are male. As for color/race, 60% of the cases are in whites. As for the infection environment, 35.23% are at home, 15.3% are at work, 26.13% are leisure places. The prevalence in males and the predominant age group 20-59 years can be linked to work activity, which leaves hem more exposed to ticks. The high numbers in adulthood can also be related to ecotourism. The lethality of the disease differs between the South and Southeast regions. One explanation for this phenomenon would be the different etiological agents, R. rickettsi, predominant in the Southeast, generating more severe clinical conditions.

A febre maculosa é uma riquetsiose transmitida por carrapatos. Os principais sinais e sintomas clínicos são febre, cefaleia intensa, erupções cutâneas e mialgia. É considerada de difícil diagnóstico e subnotificada. O estudo visa analisar descritivamente a epidemiologia dos casos de febre maculosa do Brasil no período de 2010 até 2021. Trata-se de um estudo de coorte retrospectivo que analisa estatisticamente os casos de febre maculosa no Brasil entre 2010 e 2020 por meio de dados obtidos pelo Sistema de Informação de Agravos de Notificação. As proporções de casos de febre maculosa foram calculadas segundo: sexo, idade, raça/cor, ambiente de infecção e evolução. Foram confirmados 1967 casos. As regiões com mais casos foram Sudeste (n%= 72,24) e Sul (n%= 24). No entanto, há 4 óbitos no Sul enquanto o coeficiente de letalidade do Sudeste é de 47,78%. A faixa etária mais acometida foi de 40 a 59 anos (n%= 34,87) e de 20 a 39 anos (n%= 28,98). 71,17% dos casos são do sexo masculino. Quanto à cor/raça, 60% dos casos são de brancos. Quanto ao ambiente de contágio, 35,23% são em casa, 15,3% são no trabalho, 26,13% são locais de lazer. A prevalência no sexo masculino e a faixa etária predominante de 20 a 59 anos pode estar ligada à atividade laboral, que os deixa mais expostos aos carrapatos. Os altos números na idade adulta também podem estar relacionados ao ecoturismo. A letalidade da doença difere entre as regiões Sul e Sudeste, sendo que uma explicação para esse fenômeno seriam os diferentes agentes etiológicos,

La fiebre maculosa es una rickettsiosis transmitida por garrapatas. Los principales signos y síntomas clínicos son fiebre, cefalea intensa, erupciones cutáneas y mialgias. Se considera difícil de diagnosticar y poco notificada. El estudio tiene como objetivo analizar descriptivamente la epidemiología de los casos de fiebre manchada en Brasil en el período de 2010 a 2021. Se trata de un estudio de cohortes retrospectivo que analiza estadísticamente los casos de fiebre manchada en Brasil entre 2010 y 2020 a través de datos obtenidos del Sistema de Información de Agraves de Notificación. Se calcularon las proporciones de casos de fiebre manchada según: sexo, edad, raza/color, ambiente de infección y evolución. Se confirmaron 1967 casos. Las regiones con más casos fueron el Sudeste (n%= 72,24) y el Sur (n%= 24). Sin embargo, hubo 4 muertes en el Sur, mientras que el coeficiente de letalidad en el Sureste fue del 47,78%. El grupo de edad más afectado fue el de 40 a 59 años (n%= 34,87) y el de 20 a 39 años (n%= 28,98). El 71,17% de los casos eran varones. En cuanto al color/raza, el 60% de los casos son de raza blanca. En cuanto al entorno de la infección, el 35,23% se produce en el domicilio, el 15,3% en el trabajo y el 26,13% en lugares de ocio. La prevalencia en los hombres y el grupo de edad predominante de 20 a 59 años pueden estar relacionados con la actividad laboral, que los deja más expuestos a las garrapatas. El elevado número en la edad adulta también puede estar relacionado con el ecoturismo. La letalidad de la enfermedad difiere entre las regiones Sur y Sudeste, y una explicación para este fenómeno serían los diferentes agentes etiológicos, R. rickettsi, predominante en la región Sudeste, generando cuadros clínicos más severos.

Estudo descritivo de casos notificados de febre maculosa em São Paulo, Rio de Janeiro e Minas Gerais entre 2007 e 2016 / Descriptive study of reported cases of spotted fever in São Paulo, Rio de Janeiro and Minas Gerais between 2007 and 2016

Resumo Introdução A febre maculosa é uma doença infecciosa aguda causada por bactérias do gênero Rickettsia e transmitida por carrapatos que pode levar à hospitalização e, eventualmente, a óbito por causa de quadros mais graves. Objetivo O objetivo deste artigo foi descrever o cenário epidemiológico da doença nas três unidades federativas de maior número de notificações e óbitos pela doença no Brasil entre 2007 e 2016. Método Estudo epidemiológico descritivo com base nos dados das fichas de investigação para a doença, sendo analisados dados demográficos, geográficos, ambientais e de hospitalização, diagnóstico e desfecho dos casos na área de estudo. Resultados Foram confirmados 953 casos da doença, em sua maioria por critérios laboratoriais, sendo observada maior prevalência entre homens com idade média de 35 anos, pouco relacionados ao ambiente de trabalho, mas amplamente relacionados ao meio urbano. Do total de casos confirmados, 64% pacientes afirmaram ter tido algum contato com carrapato, assim como com cães (36%), capivaras (20%) e equinos (19%). Conclusão Existem questionamentos a respeito da doença que não foram elucidados neste artigo, entretanto abordagens criativas, validadas e ancoradas na associação de áreas de conhecimento distintas poderão dar bons resultados se objetivamente aplicadas em ações estratégicas da gestão da saúde.

Abstract Background Spotted fever is an acute infectious disease caused by bacteria of the genus Rickettsia and transmitted by ticks, which can lead to hospitalization and, eventually, death due to more severe conditions. Objective The purpose of this article was to describe the epidemiological scenario of the disease in the three federal states with the highest number of notifications and deaths due to the disease in Brazil between 2007 and 2016. Method A descriptive epidemiological study was carried out based on data from the investigation forms for the disease, with data being analyzed on demographic, geographic, environmental, and hospitalization, diagnosis, and outcome of cases in the study area. Results 953 cases of the disease were confirmed, mostly by laboratory criteria, with a higher prevalence being observed among men with an average age of 35 years, little related to the work environment, but largely related to the urban environment. Of the total confirmed cases, 64% of patients said that they had had some contact with ticks, as well as with dogs (36%), capybaras (20%), and horses (19%). Conclusion We believe that there are questions about the disease that were not elucidated in this article, however, creative approaches, validated and anchored in the association of different areas of knowledge can give good results if objectively applied in strategic health management actions.

Historical geographic overlap of human rickettsiosis with animal reservoirs in Juiz de Fora, Minas Gerais, Brazil / Sobreposição geográfica histórica da riquetsiose humana com reservatórios animais em Juiz de Fora, Minas Gerais, Brasil

Background and objectives: we investigated the existence of a historical geographic overlap between the location of spotted fever group rickettsiosis human cases, a disease caused by the gram-negative bacterium Rickettsia sp., and that of mammalian reservoirs, specifically domestic horses and capybaras, in the urban perimeter of the city of Juiz de Fora, Minas Gerais, Brazil. Methods: cases of human rickettsiosis that occurred during a period of 17 years (2003-2020) were geolocated and the distribution of cases in time and geographic space was assessed using 1st and 2nd order geospatial association indicators. We also analyzed the overlap between the locations of human rickettsiosis cases and the area of occurrence of domestic horses and capybaras. Results: men were diagnosed more often than women, but a large proportion of affected women died. The results indicate an aggregation of human rickettsiosis cases in time (cases tend to occur close to each other at each epidemic event) and in geographic space (cases are concentrated in a specific geographic region of the urban perimeter). Human cases seem to be more associated with city regions with: i) higher local frequency of domestic horses and not capybaras; ii) lower rates of family development. Conclusion: it is suggested that, in the local epidemiological scenario, domestic horses appear to be the main sources of the rickettsia infecting humans, not capybaras.(AU)

Justificativa e objetivos: foi investigada a existência de uma sobreposição geográfica histórica entre a localização dos casos de riquetsiose humana do grupo da febre maculosa, um grupo de doenças causadas pela bactéria Gram-negativa Rickettsia sp., e dos reservatórios mamíferos, especificamente cavalos domésticos e capivaras, no perímetro urbano do município de Juiz de Fora, Minas Gerais, Brasil. Métodos: foram geolocalizados os casos de riquetsiose humana ocorridos durante um período de 17 anos (2003-2020), sendo avaliada a distribuição dos casos no tempo e espaço geográfico através de indicadores de associação geoespacial de 1a e 2a ordem. Também analisamos a superposição dos locais dos casos de riquetsiose humana com a área de ocorrência de cavalos domésticos e capivaras. Resultados: homens foram diagnosticados mais frequentemente que as mulheres, mas grande proporção das mulheres acometidas faleceu. Os resultados indicam uma agregação dos casos de riquetsiose humana no tempo (os casos tendem a ocorrer próximos entre si a cada evento epidêmico) e no espaço geográfico (os casos se concentram em uma região geográfica específica do perímetro urbano). Os casos humanos aparentam ser mais associados às regiões da cidade com: i) maior frequência local de cavalos domésticos e não das capivaras; ii) menores índices de desenvolvimento familiar. Conclusão: sugere-se que, no cenário epidemiológico local, são os cavalos domésticos que aparentam ser as principais fontes da riquétsia infectando os humanos, não as capivaras.(AU)

Justificación y objetivos: investigamos la existencia de una superposición geográfica histórica entre la localización de casos de rickettsiosis exantemáticas humana, enfermedad causada por la bacteria gramnegativa Rickettsia sp., y la de mamíferos reservorios, específicamente caballos domésticos y capibaras, en el perímetro urbano de la ciudad de Juiz de Fora, Minas Gerais, Brasil. Métodos: se geolocalizaron los casos de rickettsiosis humana ocurridos durante un período de 17 años (2003-2020), y se evaluó la distribución de casos en el tiempo y espacio geográfico utilizando indicadores de asociación geoespacial de 1er y 2do orden. También analizamos la superposición entre las ubicaciones de los casos de rickettsiosis humana y el área de ocurrencia de los caballos domésticos y capibaras. Resultados: los hombres fueron diagnosticados con más frecuencia que las mujeres, pero una gran proporción de mujeres afectadas fallecieron. Los resultados indican una agregación de casos de rickettsiosis humana en el tiempo (los casos tienden a ocurrir cerca uno del otro en cada evento epidémico) y en el espacio geográfico (los casos se concentran en una región geográfica específica del perímetro urbano). Los casos humanos parecen estar más asociados con regiones urbanas con: i) mayor frecuencia local de caballos domésticos y no de capibaras; ii) menores tasas de desarrollo familiar. Conclusión: se sugiere que, en el escenario epidemiológico local, los caballos domésticos parecen ser las principales fuentes de la rickettsia que infecta a los humanos, no los capibaras.(AU)

A case of Mediterranean spotted fever mimicking severe sepsis

Mediterranean spotted fever (MSF) is a tick-borne acute endemic infectious disease caused by Rickettsia conorii. While MSF may progress asymptomatically, it may lead to clinical pictures like severe hemorrhagic fever. In this article, we are presenting an MSF case with signs of high fever, headache, nausea, weakness and generalized maculopapular rash. The diagnosis of the female patient who had a history of contact with a tick-infested dog was confirmed with her clinical and laboratory data. The clinical and laboratory findings of the patient who was given doxycycline by 200 mg/day for 7 days were improved in a short time. Rickettsia conorii serology by indirect immunofluorescence assay method confirmed the diagnosis of MSF. In cases of severe sepsis accompanied by high fever and generalized maculopapular rash where the source of the infection cannot be determined in the short term, carefully questioning exposure to ticks by considering the existing geographical, seasonal and endemic environmental factors may be life-saving in terms of early diagnosis and treatment of MSF, which may become fatal even in the absence of eschars (tache noire). The symptomatology of hemorrhagic fever associated with Rickettsia conorii may be confused with that of sepsis in clinical practice.

Rickettsiosis: La importancia de realizar un diagnóstico precoz y manejo temprano / Rickettsiosis: The importance of making an early diagnosis and early management

La rickettsia es una bacteria transmitida por vectores como la garrapata, piojos, ácaros entre otros. El ser humano es un hospedero accidental, la rickettsia se transmite al ser humano por medio de la saliva de la garrapata infectada inoculando la bacteria a la piel. Existen diferentes especies de rickettsia, la especie más importante en América es la Rickettsia rickettsii, reportándose casos en diferentes partes del mundo. Esta enfermedad se caracteriza por un daño al endotelio de los vasos sanguíneos de pequeño calibre, ocasionando lesiones en piel, a nivel pulmonar, cerebral y renal principalmente. Sus manifestaciones clínicas iniciales son inespecíficas y se pueden confundir con otras enfermedades por lo cual una historia clínica detallada es lo que nos puede llevar a una sospecha diagnóstica temprana. Esta patología se considera una enfermedad reemergente, debido a que en muchos lugares existe un subregistro de la misma, esto como resultado de una falta de sospecha clínica y aplicación de medidas de prevención. En Panamá desde los años 1950 se diagnosticaron los primeros casos. En este año en curso (2021), se diagnosticaron dos casos pediátricos en el Hospital del Niño Dr. José Renan Esquivel, los cuales serán objetos de revisión en este artículo.

Rickettsia are bacteria transmitted by vectors such as ticks, lice, mites. The human being is an accidental host, the rickettsia is transmitted to the human being through the saliva of the infected tick inoculating the bacteria to the skin. There are different species of Rickettsia, the most important species in America is Rickettsia rickettsii. This disease is characterized by damage to the endothelium of small caliber blood vessels, causing lesions mainly in the skin, lung, brain, and kidney. Its initial clinical manifestations are nonspecific and can be confused with other diseases, which is why a detailed clinical history is what can lead us to an early diagnostic. This disease is considered a reemerging disease in spite of having a wide distribution and knowledge of the disease due to lack of suspicion and prevention. In Panama, the first cases were diagnosed in the 1950s and this year 2021 two cases were diagnosed in children at the Hospital del Niño Dr. José Renán Esquivel.

A new record of Rickettsia japonica in ticks infesting a Burmese ferret-badger in Thailand

@#Ticks are important vectors of arthropod-borne diseases and they can transmit a wide variety of zoonotic pathogens to humans, domestic and wild animals. Rickettsia japonica is a member of SFG rickettsiae causing Japanese spotted fever (JSF) and can transmit to humans via infected ticks. In this study, we report the first case of Rickettsia japonica in Haemaphysalis hystricis tick collected from a roadkill Burmese ferret-badger (Melogale personata) in Loei province, northeastern Thailand. According to the DNA sequences and phylogenetic analyses of the outer membrane protein A and B genes (ompA and ompB), the detected R. japonica was identical to those found in JSF patients in Korea, Japan, and China, and closely related to Rickettsia detected by ompA in a tick from Thailand. Further study on the prevalence of R. japonica and diversity of mammalian reservoir hosts will be useful to gain a better understanding of JSF epidemiology.

Investigation on the infection of spotted fever group Rickettsiae and Rickettsia mooseri of wild rodents in the field of plague foci in Western Yunnan / 中华地方病学杂志

Objective:To investigate the infection of spotted fever group Rickettsiae (SFGR) and Rickettsia mooseri ( R.mooseri) of wild rodents in the field of plague foci in Western Yunnan. Methods:The DNA of liver samples of 2 512 wild rodents captured from the plague foci in Lianghe County, Jianchuan County and Yulong County in Western Yunnan from 2015 to 2016 was extracted by magnetic bead method, and the heat shock protein groEL gene primers were used for nested PCR amplification. Gene sequence splicing and Blast homology comparison were performed using DNAStar 7.1 software and GenBank of the National Center for Biotechnology Information (NCBI) of the United States, respectively, and DNAStar 7.1 and MEGA 6.0 softwares were used to construct phylogenetic trees.Results:The wild rodents infected with SFGR were Mus pahari, Rattus steini, Crocidura attenuata and Suncus murinus (one for each), with a total infection rate of 0.16% (4/2 512); no R.mooseri infection was detected. The SFGR infection rates of wild rodents in the plague foci of Lianghe County and Jianchuan County were 0.49% (3/611) and 0.10% (1/1 029), respectively; no SFGR infection was detected in the wild rodents in the plague foci of Yulong County. The homology analysis showed that the homology between SFGR positive samples and reference sequences was 95.45%-100.00%; some of the groEL gene sequences were highly similar among the four positive samples, and the homology was 89.60%-97.40%. Sequence evolution analysis showed that the sequences of three SFGR positive samples from the plague focus in Lianghe County were clustered in the same branch, and the homology reached 94.40%-97.40%; one positive sample sequence from the plague focus in Jianchuan County was clustered in one branch. Conclusion:SFGR infection rate of wild rodents in the field of plague foci in Western Yunnan is low, and no R.mooseri infection is found.

Fatal Brazilian spotted fever in a healthy military man during field training in Rio de Janeiro city, southeastern Brazil

ABSTRACT Brazilian spotted fever, a zoonotic disease transmitted by ticks, is caused by Rickettsia rickettsii. We report a fulminant case of this zoonosis in a healthy 46-year-old military man in the urban region of Rio de Janeiro city, in October, 2021. Ticks and capybaras (Amblyomma sculptum, Hydrochoerus hydrochaeris, respectively) were identified in the military fields, pointing to the participation of this large synanthropic rodent, recognized as an efficient amplifier host of Rickettsia rickettsii in Brazil. As the military population is considered a risk group for spotted fever, it is necessary to alert health professionals to the importance of the early detection of the disease and its adequate management, mainly in populations that are particularly at risk of exposure to ticks, in order to avoid fatal outcomes.

Características clínicas de los pacientes con fiebre manchada de las Montañas Rocosas, infección por dengue y chikungunya / Clinical features of patients with Rocky Mountain spotted fever, dengue and chikungunya infection

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.