Guías Latinoamericanas de la RIICER para el diagnóstico de las rickettsiosis transmitidas por garrapatas / Latinamerican guidelines of RIICER for diagnosis of tick-borne rickettsioses

Tick-borne rickettsioses are worldwide infectious diseases that are considered emerging and re-emerging. Until recently the only tick-borne rickettsiosis present in Latin America was Rickettsia rickettsii infection, but to date, with the incorporation of new tools as PCR and sequencing and the quick cellular close tube cultures (Shell-vial), new species has been involved as human pathogens. In these guidelines, we offer an update of the microbiological assays for diagnosing rickettsioses. Besides we have included a section in which the most important hard ticks involved in human rickettsioses in Latinoamerica are detailed.

Las rickettsiosis transmitidas por garrapatas son afecciones de distribución mundial, que por diferentes motivos se pueden considerar emergentes y reemergentes. Hasta hace escasos años la única rickettsiosis transmitida por garrapatas en Latinoamérica era la infección por Rickettsia rickettsii, pero en la actualidad y fundamentalmente, gracias a la incorporación de nuevas herramientas para el diagnóstico microbiológico como la reacción en cadena de la polimerasa y secuenciación o el cultivo celular rápido en tubo cerrado, se han descrito e involucrado otras especies de Rickettsia en la producción de patología humana. En estas guías se detallan y describen las diferentes técnicas utilizadas para el diagnóstico microbiológico de las rickettsiosis. Además, se incluye una sección en la que se detallan las especies más importantes de garrapatas duras relacionadas con las rickettsiosis en Latinoamérica, con claves para su clasificación taxonómica.

Rickettsiosis transmitidas por garrapatas en las Américas: avances clínicos y epidemiológicos, y retos en el diagnóstico / Tick-borne rickettsioses in the Americas: clinical and epidemiological advances, and diagnostic challenges

Las rickettsiosis son entidades clínicas de tipo zoonótico, causadas por bacterias intracelulares estrictas de los géneros Rickettsia y Orientia, pertenecientes a la familia Rickettsiaceae. Su ecología está determinada por factores ambientales y la presencia de vectores específicos que condicionan el establecimiento y la epidemiología en diferentes regiones del mundo. En las Américas, durante el siglo XX, únicamente eran reconocidas tres de estas enfermedades: la fiebre manchada de las Montañas Rocosas, el tifus epidémico y el tifus endémico, Sin embargo, a partir del año 2000 se han descrito mas de 10 especies diferentes previamente desconocidas en este continente, tanto en artrópodos como en casos clínicos, hecho que permite clasificarlas como entidades clínicas emergentes y reemergentes. Dadas las manifestaciones clínicas de las enfermedades causadas por rickettsias, siendo la gran mayoría inespecíficas y, por lo mismo, compartidas con otras enfermedades infecciosas, especialmente virales y bacterianas, han sido enmarcadas entre los diagnósticos diferenciales del síndrome febril agudo, tanto en áreas urbanas como tropicales. En la actualidad, se cuenta con métodos diagnósticos directos e indirectos, que son útiles en la identificación del agente infeccioso, en este caso, causante de rickettsiosis.

Rickettsioses are a group of zoonotic diseases caused by strict intracellular bacteria of the genus Rickettsia and Orientia which belong to the Rickettsiaceae family. Their ecology is influenced by environmental factors and the presence of specific vectors that determine the establishment and epidemiology in different world regions. In America, during the 20 th century, only three of these diseases were recognized: Rocky Mountain spotted fever, epidemic typhus and endemic typhus. However, since 2000, more than 10 different species that had previously been unknown in this continent have been described, both in arthropods and in clinical cases, fact that classifies them as emerging and re-emerging diseases. Given the clinical manifestations of the diseases caused by rickettsias, being the majority unspecific and, therefore, shared with other infectious diseases, especially viral and bacterial, they have been framed within the differential diagnoses of acute febrile syndrome in urban and tropical areas. Nowadays, there are direct and indirect diagnostic methods, which are useful in the definition of the infectious agent, in this case, the cause of rickettsioses.

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas" / Perfil dos pacientes com Síndrome Baggio-Yoshinari admitidos no "Instituto de Infectologia Emilio Ribas"

The aim of this study was to evaluate the epidemiological, clinical and laboratorial profile of patients with Baggio-Yoshinari Syndrome (BYS), who underwent internment at the Instituto de Infectologia Emilio Ribas in São Paulo, Brazil, during the period from July 1990 to July 2006. BYS is a new Brazilian tick-borne disease caused by Borrelia burgdorferi sensu lato microorganisms that resembles features of Lyme disease (LD), except for its epidemiological, clinical and laboratorial particularities. From 60 patients' records with positive serology to B. burgdorferi done by ELISA and Western-blotting methods, 19 cases were diagnosed as having BYS, according to criteria adopted at LIM-17 HCFMUSP, the Brazilian Reference Laboratory for the research of BYS. The other 41 remaining patients displayed miscellaneous infections or auto-immune processes. The beginning of symptoms in BYS group varied from one day to six years, from the onset of the disease. Four of 19 patients were included in acute disease stage, and 15 in latent. General unspecific symptoms were identified in almost all cases, with high frequencies of fever (78.9 percent) and lymphadenomegaly (36.8 percent). Six patients had skin lesions (31.5 percent); six arthralgia or arthritis (31.5 percent) and eight neurological symptoms (42 percent). Interestingly, two patients showed antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid. Since BYS is a new emergent Brazilian zoonosis and its diagnosis is sometimes complex, all the new knowledge about BYS must be scattered to Brazilian Medical specialists, aiming to teach them how to diagnose this amazing tick-borne disease and to avoid its progression to chronic irreversible sequels.

O objetivo do estudo foi avaliar o perfil epidemiológico, clínico e laboratorial dos pacientes com Síndrome Baggio-Yoshinari (SBY), internados no Instituto de Infectologia Emilio Ribas, São Paulo, Brasil, no período de julho de 1990 a julho de 2006. SBY é uma nova doença transmitida por carrapatos, causada pela Borrelia burgdorferi sensu lato, que se assemelha a Doença de Lyme (DL), exceto pelas particularidades epidemiológicas, clínicas e laboratoriais. A partir dos registros de 60 pacientes com sorologia positiva para B. burgdorferi pelos métodos de ELISA e Western-blotting, 19 casos foram diagnosticados como SBY, de acordo com critérios adotados pelo LIM-17 HCFMUSP, laboratório de referência para a pesquisa de SBY no Brasil. Os outros 41 pacientes restantes foram classificados como tendo infecções diversas ou processos auto-imunes. O início dos sintomas no grupo SBY variou de um dia a seis anos. Quatro dos 19 pacientes foram incluídos na fase aguda da doença e 15 na fase latente. Os sintomas gerais inespecíficos foram identificados em quase todos os casos, com altas freqüências de febre (78,9 por cento) e linfoadenomegalia (36,8 por cento). Seis pacientes tiveram lesões de pele (31,5 por cento); seis artralgia ou artrite (31,5 por cento) e oito sintomas neurológicos (42 por cento). Curiosamente, dois pacientes apresentaram anticorpos para B. burgdorferi exclusivamente no líquido cefalorraquidiano. Uma vez que a SBY é uma zoonose emergente brasileira e seu diagnóstico é complexo, todo o conhecimento novo sobre SBY deve ser difundido para os médicos brasileiros, com o objetivo de ensiná-los a diagnosticar esta surpreendente doença transmitida por carrapatos, evitando-se a sua progressão para sequelas crônicas irreversíveis.

Doença de lyme-símile brasileira ou síndrome baggioyoshinari: zoonose exótica e emergente transmitida por carrapatos: [revisão] / Brazilian lyme-like disease or baggio-yoshinari syndrome: exotic and emerging brazilian tick-borne zoonosis: [review]

A Doença de Lyme (DL) é uma zoonose frequente no hemisfério Norte e considerada uma enfermidade infecciosa causada por espiroquetas do complexo Borrelia burgdorferi sensu lato e transmitida pela picada de carrapatos do grupo Ixodes ricinus. Os primeiros casos semelhantes à DL no Brasil foram descobertos, em 1992, em irmãos que após serem picados por carrapatos desenvolveram eritema migratório, sintomas gripais e artrite. Criteriosa análise da casuística brasileira, mostrou que os aspectos epidemiológicos, clínicos e laboratoriais no país, divergiam bastante dos exibidos pelos pacientes com DL nos Estados Unidos da América e Eurásia. Não foram encontrados carrapatos do complexo Ixodes ricinus hematófago ao homem nas áreas de risco; a enfermidade no país é recorrente; a Borrelia burgdorferi jamais foi isolada no Brasil e os ensaios sorológicos específicos exibem positividade baixa e oscilante. Além disso, o exame do sangue periférico dos pacientes quando analisados à microscopia eletrônica exibe estruturas sugestivas de Mycoplasma spp, Chlamydia spp e bacteroides. Na verdade, estas estruturas podem representar as formas latentes das espiroquetas (forma L ou bactérias desprovidas de parede), adaptadas a sobreviver em condições inóspitas em hospedeiros vertebrados e invertebrados. Assim, a zoonose presente no país recebeu a denominação de Síndrome Baggio-Yoshinari e definida como: "Enfermidade infecciosa nova e emergente brasileira, transmitida por carrapatos não pertencentes ao complexo Ixodes ricinus, causada por espiroquetas na sua morfologia atípica e latente, que origina manifestações clínicas semelhantes às observadas na DL, exceto pela ocorrência de recidivas clínicas e desordens autoimunes".

Lyme disease (LD) is a frequent zoonosis found in the Northern Hemisphere and is considered an infectious disease caused by spirochetes belonging sensu lato to the Borrelia burgdorferi complex transmitted by ticks of the Ixodes ricinus group. In 1992, first cases similar to LD were described in Brazil, when brothers, after a tick bite episode developed symptoms , as erythema migrans, general flu-like symptoms and arthritis. Careful analysis of Brazilian LD-like illness casuistry showed that epidemiological, clinical and laboratorial features in the country were very different from those exhibited by North American and Eurasian LD patients. Human blood-suckers Ixodes ricinus complex ticks were absent at risk areas; the disease is recurrent in the country; Borrelia burgdorferi was never isolated in Brazil and specific serologic tests have shown little positivity with inconsistent results. Furthermore, peripheral blood analysis of patients on electron microscopy exhibited structures resembling Mycoplasma spp, Chlamydia spp and spirochete-like microorganisms. In fact, they were assumed to be latent forms of spirochetes (L form or cell wall deficient bacteria) adapted to survive at inhospitable conditions in vertebrate and invertebrate hosts. For these reasons, the Brazilian zoonosis was named Baggio-Yoshinari Syndrome (BYS) and defined as: "Exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes with atypical morphology, which originates LD-like symptoms, except for occurrence of relapsing episodes and auto-immune disorders".

Community Knowledge; Attitudes and Practices Related to Tick-Borne Relapsing Fever in Dodoma Rural District; Central Tanzania

Tick-borne Relapsing Fever (TBRF) is a vector-borne disease of humans which causes serious illness; primarily for children under five years old and pregnant women. Understanding people's knowledge; attitude and practices on the disease is important in designing appropriate interventions. This study was conducted to explore community knowledge; attitudes and practices regarding TBRF transmission and control to provide baseline data for the planned scaling up of intervention in Dodoma rural District in central Tanzania. A total of 198 heads of households were interviewed using a semi-structured questionnaire. Of these; 94.5were aware of TBRF. Fever of unknown origin (69.5); body pain (8.5); headache (8.5); chills (4.5) and vomiting (3.5) were the most commonly mentioned symptoms. The domestic tick-infestation and tickbites was known to 82.8. High domestic tick infestation reported to occur during dry season (85.4). The majority believed that the disease spreads through tick-bites (85.9). Regular plastering of house floors and walls was the most common method used by the community to control domestic tick infestation (96.5). Majority (84.3) of the respondents preferred public healthcare facilities for treatment. Only a small proportion (15.7) preferred using traditional medicines. Poor knowledge of the study subjects about the disease and its control underscores the need for health educational campaigns if any control and/or elimination programme is to succeed

Spotted fever group rickettsioses in Himachal Pradesh.

Rickettsiae are in many places of the world emerging or reemerging pathogens. The spotted fevers group (SFG) composes a large group of tick- and mite-borne zoonotic infections that are caused by closely related rickettsiae. The SFG rickettsiae of Southeast Asia are yet to be identified. Earlier reports have documented the endemicity of rickettsioses among adults in the Himalayan belt but no confirmed case of spotted fever have been reported from this region of India. We present two cases of SFG rickettsioses; from the northern hilly region of India that were confirmed using specific microimmunofluorescence assay.

Riquetsioses no Brasil e Portugal: ocorrência, distribuição e diagnóstico / Rickettsial diseases in Brazil and Portugal: occurrence, distribution and diagnosis

O presente artigo é uma atualização sobre a ocorrência e diagnóstico das riquetsioses existentes no Brasil e Portugal, com o objetivo de incentivar e incrementar a vigilância epidemiológica dessas doenças nos dois países. Realizou-se levantamento bibliográfico e foram apresentados dados não publicados de laboratórios e serviços de epidemiologia. Os resultados descreveram a ocorrência das riquetsioses no Brasil e Portugal, inclusive aquelas recém-descritas, advindas de riquétsias de potencial patogênico ainda incerto. Os métodos diagnósticos atualmente empregados foram discutidos. Como em outros países, as riquetsioses parecem assumir crescente importância em saúde pública. Relegadas a um plano secundário por muitas décadas, o interesse por essas infecções tem aumentado nos dois países, mas ainda carece de investigação para esclarecer seu real significado em saúde pública.

Implementación de la técnica de PCR enla identificación de Babesia ssp en equinos / Implementation or PCR techinique in the equine identification of Babesia ssp

Aunque las técnicas de referencias citadas por la USDA y OIE son IFI y FC, para el diagnóstico de las infecciones por Babesia equi y Babesia caballi, éstas no permite la diferenciación entre las especies y no descartan resultados falsos negativos. La implementación de la PCR como técnica directa, en la identificación y carac-terización de estos parásitos, sin duda constituye un soporte al diagnóstico clínico de la piroplasmosis equina. Dado lo anteriormente expuesto en el presente trabajo se estandarizó la PCr para la identificación de B. equi y B. caballi. El procedimiento contempló la implementación de un protocolo de extracción de DNA, a partir de muestras de sangre y la optimización de PCR, tanto para la mezcla de reacción como para el programa de termociclación, junto a 4 partidores: P1 y P2 para B equi y P3 y P4 para B caballi. Ambos amplifican en forma selectiva una secuencia conservada de los genes de 16S rDNA, equivalentes a 659 bp para B. caballi y 664 bp para B. equi. La sensibilidad técnica fue de 0,1ng/ml para B. equi y 1ng/ml para B. caballi. El estudio de especificidad técnica no mostró productos de amplificación al utilizar DNAs de Toxoplasma gondii, Trypanosoma cruzi, Echinococcus granulosus, Fasciola hepatica. Se estudiaron 77 muestras de sangre de equinos provenientes de la Región Metropolitana de Chile con y sin sospecha clínica, de las cuales 15 resultaron positivas (14 a B. equi y 1 a B. caballi). Nuestros resultados crearon la necesidad de una evaluación epidemiológica de la PCR y su confrontación con otras técnicas de diagnóstico directo, para lo cual en la actualidad se estudian muestras de sangre equina con sospecha a piroplasmosis.

Neuroborreliosis en Chile: caso pediátrico de probable adquisición por mascotas importadas / Neuroborreliosis in Chile: pediatric case probably due to imported pets

Lyme disease, caused by spirochete Borrelia burgdorferi, has several clinical manifestations and is transmitted to man by tick bites. In Chile and Latin America, several cases have been reported, but none with inmunoblot confirmation or isolation of the infecting organism. We report a 9 year old boy consulting with bilateral facila palsy, polyradiculoneuritis with tetraparesis and meningeal irritation. Cerebrospinal fluis analysis showed increased protein concentration without pleocytosis and negative viral or bacterial cultures. IgM antibodies against Borrelia burgdorferi, were positive by ELISA and were confirmed by immunoblot at the Reference Laboratory of the University of Connecticut. The child had a recent contact with hamsters brought from Germany. The substantiation of Lyme disease existence in Chile should prompt the search and isolation of the causal agent

Diagnósticos hechos a 1384 pacientes que consultaron por probable mordedura de arañas o picaduras de insectos / Diagnosis done to 1384 patients which had consulted for a probable spider bite or insect sting

Accumulate experience, from 1955 to 1995, in an outpatient univesity parasitology clinic in Santiago, which 1384 patients referred from diverse public and private medical institutions because of a probable spider bite or insect stings, is presented. It is noteworthy that only 618 (44,7 percent) of consultations corresponded to clinical conditions originated by arthropods, whereas from the remaining 766, 612 (44,2 percent) were due to a bacterial, viral or parasitic etiology and 154 (11,1 percent) were caused by physical or chemical agents. Frecuency of diagnosis was: loxoscelism 16,6 percent, spider bites (excluded loxosceles laeta) 1,3 percent, scorpion stings 0,9 percent, tick stings 2,2 percent insect bites 23,7 percent, impetigo 6,6 percent, folliculitis 11,3 percent, boil 22,7 percent, erysipelas 0,1 percent, pustula maligna 0,3 percent, herpes simplex 2,5 percent, palpebral herpes zoster 0,3 percent, acute Chagas's disease 0,4 percent, angioneurotic edema 0,1 percent, ecchymosis 3,0 percent, contact dermitis 7,8 percent and chemical dermitis 0,2 percent. These frequencies do not indicate the real occurrence of the diagnosed nosologies, but what happened in a specialized outpatient clinic dealing cheafly with parasitic diseases and arthropod envenomations. Description of relevant clinical features and epidemiological considerations of pathology observed conjointly with differential diagnosis are presented

Contribuicao ao conhecimento da borreliose de Lyme no Brasil / Contribution to the knowledge of Lyme borreliosis in Brazil

Entre 1989 a 1995 identificamos 25 casos de borreliose de Lyme confirmados pela sorologia no Brasil. Trata-se de zoonose causada pela espiroqueta Borrelia burgdorferi e transmitida pela picada de carrapatos Ixodideos. Pacientes contrairam a enfermidade visitando litoral ou zonas rurais, e aproximadamente 50 por cento dos casos tiveram contacto com carrapatos. O aspecto distintivo da enfermidade e a presenca do eritema migratorio. A borreliose no Brasil pode cursar de diferentes modos, podendo simular quadro gripal, doencas reumatologicas como artralgias, artrites ou fadiga cronica e queixas neurologicas como neurites cranianas ou perifericas e encefalite (agitacao, depressao, disturbios de sono e comportamento)