Frecuencia de anticuerpos y seroconversión frente a Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, 2016-2019 / Frequency of antibodies and seroconversion against Rickettsia spp in patients consulting health institutions in the department of Caldas, Colombia, 2016-2019

Resumen | Introducción. Las rickettsiosis son enfermedades zoonóticas transmitidas por artrópodos que cumplen el papel de vectores y reservorios, y cuyos síntomas son inespecíficos, por lo que su diagnóstico clínico es difícil. La inmunofluorescencia indirecta (IFI) es el método de referencia para el diagnóstico. En Colombia, ha resurgido el interés por su estudio por los casos de rickettsiosis detectados en el norte del departamento de Caldas a partir del 2001. Objetivo. Establecer la frecuencia de anticuerpos y la seroconversión contra Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, entre 2016 y 2019. Materiales y métodos. Se hizo un estudio de diseño cuantitativo, observacional y descriptivo, con una muestra no probabilística de 175 pacientes atendidos en diferentes municipios de Caldas, a quienes se les realizó IFI para la detección de anticuerpos en fase aguda y convaleciente contra Rickettsia rickettsii, R. typhi y R. felis. Resultados. El promedio de edad de los pacientes fue de 31 años. Los municipios con mayor proporción de seropositivos fueron Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced y Manizales. El 66 % tenía mascotas y el 12 % reportó picaduras por artrópodos. Los signos y síntomas más frecuentes fueron cefalea (69,7 %), artromialgia (60 %), y fiebre (58,2 %). La seroprevalencia por IgG fue de 60 % para R. rickettsii, 47,9 % para R. typhi y 24 % para R. felis. Ocho pacientes presentaron seroconversión. Conclusión. Se encontró evidencia de la circulación de rickettsias del grupo de las fiebres manchadas y del grupo del tifus asociada con casos humanos en el departamento de Caldas.

Abstract | Introduction: Rickettsioses are zoonotic diseases transmitted by arthropods acting as vectors and reservoirs. Disease symptoms are nonspecific and, therefore, their clinical diagnosis is difficult. Indirect immunofluorescence (IFA) is the gold standard assay for diagnosis. The interest for conducting studies on these pathologies has resurfaced in Colombia since 2001; besides, previous studies have evidenced cases of rickettsiosis in the north of the department of Caldas. Objective: To establish the frequency of antibodies and seroconversion against Rickettsia spp. In patients consulting health institutions in Caldas, Colombia, from 2016 to 2019. Materials and methods: We conducted a quantitative, observational, and descriptive study on a non-probabilistic sample of 175 patients with symptoms compatible with rickettsiosis who consulted in different municipalities of Caldas, Colombia; IFA was performed to detect antibodies in the acute and convalescent phases against Rickettsia rickettsii, Rickettsia typhi, and Rickettsia felis. Results: The average age of the patients was 31 years. The municipalities with the highest proportion of seropositive cases were Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced, and Manizales; 66% of patients owned pets and 12% reported arthropod bites. The most frequent signs and symptoms were headache (69.7%), arthromyalgia (60%), and fever (58.2%). IgG seroprevalence was 60% for R. rickettsii, 47.9% for R. typhi, and, and 24% for R. felis. Eight patients presented seroconversion. Conclusion: We found evidence of the circulation of Rickettsia species from the spotted fever group and the typhus group associated with human cases in Caldas.

Detección de Rickettsia typhi en Rhipicephalus sanguineus s.l. y Amblyomma mixtum en el sur de México / Detection of Rickettsia typhi in Rhipicephalus sanguineus s.l. and Amblyomma mixtum in South Mexico

Resumen: Objetivo: Determinar la presencia de Rickettsia typhi en Rhipicephalus sanguineus s.l. y Amblyomma mixtum, en el sur de México. Material y métodos: Las garrapatas fueron colectadas en humanos y animales domésticos. Se determinó la presencia de Rickettsia por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés) y secuenciación. Resultados: 10/39 viales de trabajo amplificaron fragmentos de los genes gltA, htrA y ompB, en 7/10 proveniente de Rh. sanguineus s.l. colectadas de perros y en 3/10 de A. mixtum colectadas de caballo y humano. La secuenciación indicó R. typhi en Rh. sanguineus y A. mixtum con homología de 100% (LS992663.1), para una región del gen de htrA, y de 99% (LS992663.1), con las regiones de los genes de gltA y OmpB. La tasa mínima de infección (TMI) para R. typhi fue de 3.88. Conclusiones: Las garrapatas Rhipicephalus sanguineus s.l. y Amblyomma mixtum están infectadas naturalmente con R. typhi en el sur de México.

Abstract: Objective: To determine the presence of Rickettsia typhi in Rhipicephalus sanguineuss.l. and Amblyomma mixtum in southern Mexico. Materials and methods: Ticks were collected in humans and domestic animals. The presence of Rickettsia was determined by PCR and sequencing. Results: 10/39 work vials amplified fragments of the gltA,htrA and ompB genes. On 7/10 from Rh. sanguineus s.l collected from dogs and in 3/10 of A. mixtum collected from horse and human. Sequencing indicated R. typhi in Rh. Sanguineus and A. mixtum with 100% homology (LS992663.1) for a region of the htrA gene and 99% (LS992663.1) with the regions of the gltA and OmpB genes. The minimum infection rate (TMI) for R. typhi was 3.88. Conclusions: Rhipicephalus sanguineuss.l. and Amblyomma mixtum are naturally infected with R. typhi in Southern Mexico.

First description of a clinical case of murine typhus in Campeche, Mexico

Abstract Murine typhus is a flea-borne disease caused by Rickettsia typhi, which was first detected in Mexico in 1927. It was not until 1996 that the first systematized study involving this pathogen was conducted in two coastal states of Mexico. We now report the first confirmed case of murine typhus in the state of Campeche, which occurred in a male patient who exhibited fever, thrombocytopenia, hyperbilirubinemia, and a rash. Furthermore, the patient reported having had previous contact with Rickettsia reservoirs.

Respuesta a la carta de Faccini et al / Reply to Faccini et al

Sr. Editor, Agradecemos los aportes en relación con nuestra publicación. El objetivo del artículo "Enfoque clínico del síndrome febril agudo en Colombia" fue el de considerar los posibles diagnósticos etiológicos que se enmarquen dentro de la definición de la duración de la fiebre en el tiempo, definiendo como aguda aquella que tiene una duración de hasta 7 días. Sin embargo, el cuadro de Chagas agudo incluye en su definición de caso probable "Fiebre continua o prolongada mayor de 7 días, acompañado o no de alguno de los siguientes síntomas. . .". Este criterio ha sido utilizado en los estudios de brotes referenciados en Colombia. Por esta razón, no fue incluido como parte de la revisión

Mr. Editor, We appreciate the contributions in relation to our publication. The aim of the article "Clinical approach to acute febrile syndrome in Colombia" was to consider the possible etiological diagnoses that fall within the definition of the duration of fever over time, defining as acute that which has a duration of up to 7 days. However, acute Chagas disease includes in its probable case definition "Continuous or prolonged fever greater than 7 days, accompanied or not by any of the following symptoms . . .". This criterion has been used in outbreak studies referenced in Colombia. For this reason, it was not included as part of the review.

Caso probable de tifus murino con falla ventilatoria en una adolescente del área urbana de Cali, Colombia / Probable case of murine typhus with respiratory failure in an adolescent from the urban area of Cali, Colombia

El tifus murino es una enfermedad infecciosa de carácter zoonótico causada por Rickettsia typhi . Se presenta el caso de una paciente femenina de 13 años edad, procedente del área urbana de la ciudad de Cali, quien presentó un cuadro febril asociado a taquipnea y exantema maculopapular generalizado en tronco y extremidades. Durante las primeras 48 h en la UCI pediátrica desarrolló rápido deterioro clínico, fiebre persistente, aumento de reactantes de fase aguda, presencia de infiltrados pulmonares intersticiales bilaterales y derrame pleural, requiriendo ventilación mecánica no invasiva. Se inició tratamiento con doxiciclina frente a la sospecha de una posible infección por agentes rickettsiales. Veinticuatro horas más tarde la paciente presentó mejoría clínica, resolución del exantema y retiro de la ventilación no invasiva. Por medio de la prueba de inmunofluorescencia indirecta se evidenciaron títulos de 1:512 frente al grupo del tifus, constatando el diagnóstico probable de tifus murino.

Murine typhus is a zoonotic infectious disease caused by Rickettsia typhi . We report a case of a 13-year old female patient from the urban area of the city of Cali, who presented with fever, associated with tachypnoea and generalised maculopapular exanthema on the trunk and limbs. During the first 48 h in the paediatric ICU, she rapidly deteriorated, with persistent fever, increased acute phase reactants, bilateral interstitial pulmonary infiltrates and pleural effusion requiring noninvasive ventilation. Treatment with doxycycline was initiated due to a suspected infection by rickettsial agents. Twenty-four hours later the patient presented clinical improvement and resolution of the exanthema, thus the non-invasive ventilation was withdrawn. By means of a indirect immunofluorescence test, titres of 1:512 were shown against the typhus group, leading to the probable diagnosis of murine typhus.

Detección molecular de Rickettsia typhi en perros de una comunidad rural de Yucatán, México / Molecular evidence of Rickettsia typhi infection in dogs from a rural community in Yucatán, México

Introducción. Rickettsia typhi es la bacteria causante del tifus múrido o endémico, el cual es transmitido al ser humano principalmente por medio de las heces infectadas de pulgas y en cuyo ciclo de infección se encuentran involucrados distintos animales sinantrópicos y domésticos. En la comunidad rural de Bolmay, Yucatán, México, se reportaron casos de tifus múrido en seres humanos durante el periodo 2007-2010. Objetivo. Identificar la presencia de R . typhi y estimar la frecuencia de infección en perros de Bolmay, México. Materiales y métodos. Se tomaron muestras de sangre completa de 128 perros, se les extrajo el ADN total y se analizaron mediante reacción en cadena de la polimerasa (PCR) para amplificar los fragmentos del gen de 17 kDa y omp B , y confirmar la presencia de Rickettsia spp. Los productos de las reacciones se enviaron a secuenciación y se les hizo un análisis de alineamiento con Basic Local Alignment Search Tool (BLAST). Resultados. Se encontró una frecuencia de infección de 5,5 % (7/128). El alineamiento demostró 99 % de homologación para el gen de 17 kDa y 100 % para el gen omp B en R . typhi . Conclusión. Se detectó la presencia de R . typhi pero una baja frecuencia de infección en perros de la comunidad de estudio; sin embargo, la especie podría representar un riesgo de transmisión para los seres humanos.

Introduction: Rickettsia typhi causes murine or endemic typhus, which is transmitted to humans primarily through flea bites contaminated with feces. Synanthropic and domestic animals also contribute to the infection cycle of R. typhi . Cases of murine typhus in humans were reported in the rural community of Bolmay, Yucatán, México, between 2007 and 2010. Objective: To identify the presence of R . typhi and estimate the frequency of infection in dogs from Bolmay, México, a locality with previous reports of murine typhus in humans. Materials and methods: Whole blood samples were taken from 128 dogs. Total DNA was extracted for use in the polymerase chain reaction (PCR) to amplify fragments of the 17 kDa and omp B genes and confirms the presence of Rickettsia spp. The reaction products were sequenced, and alignment analysis was performed using the BLAST tool. Results: The frequency of R. typhi infection in dogs was 5.5 % (7/128). The alignment identified 99% and 100% homology to the R . typhi 17 kDa and omp B genes, respectively. Conclusion: We confirmed the presence of R . typhi in dogs in the studied community but at a low frequency. However, there is potential risk of transmission to humans.

Rickettsia typhi IN RODENTS AND R. felis IN FLEAS IN YUCATÁN AS A POSSIBLE CAUSAL AGENT OF UNDEFINED FEBRILE CASES / Rickettsia typhi y R. felis en roedores y sus pulgas en Yucatán como posible agente causal de casos febriles indefinidos

Rickettsia typhi is the causal agent of murine typhus; a worldwide zoonotic and vector-borne infectious disease, commonly associated with the presence of domestic and wild rodents. Human cases of murine typhus in the state of Yucatán are frequent. However, there is no evidence of the presence of Rickettsia typhi in mammals or vectors in Yucatán. The presence of Rickettsia in rodents and their ectoparasites was evaluated in a small municipality of Yucatán using the conventional polymerase chain reaction technique and sequencing. The study only identified the presence of Rickettsia typhi in blood samples obtained from Rattus rattus and it reported, for the first time, the presence of R. felis in the flea Polygenis odiosus collected from Ototylomys phyllotis rodent. Additionally, Rickettsia felis was detected in the ectoparasite Ctenocephalides felis fleas parasitizing the wild rodent Peromyscus yucatanicus. This study’s results contributed to a better knowledge of Rickettsia epidemiology in Yucatán.

Rickettsia typhi es el agente causal del tifo murino; una enfermedad zoonótica transmitida por vector mundialmente distribuida, comúnmente asociada con la presencia de roedores domésticos y silvestres. Los casos humanos de tifo murino en el Estado de Yucatán son frecuentes. Sin embargo, no existe evidencia de la presencia de Rickettsia typhi en mamíferos o vectores en Yucatán. En la búsqueda de vectores y reservorios de Rickettsia typhi, evaluamos la presencia de bacterias del género Rickettsia en roedores y sus ectoparásitos de un pequeño municipio del estado de Yucatán por medio de técnicas de PCR convencional y secuenciación de ADN. Se identificó la presencia de Rickettsia typhi en muestras de sangre obtenidas de Rattus rattus y reportamos por primera vez la presencia de Rickettsia felis en la pulga Polygenis odiosus colectado de Ototylomys phyllotis. Complementariamente, Rickettsia felis fue detectado en la pulga Ctenocephalides felis parasitando al roedor Peromyscus yucatanicus. No se identificó especie de Rickettsia en las muestras de sangre de O. phyllotis y P. yucatanicus analizados. Nuestros resultados contribuyen también en el conocimiento de ciclo de vida biológico del género Rickettsia.

Delayed-Onset Complete Atrioventricular Block in a Patient with Murine Typhus Myocarditis / 대한내과학회지

Murine typhus is a flea-borne infectious disease caused by Rickettsia typhi, of which myocarditis is a rare complication in the acute disseminating phase. A 62-year-old female presented with a fever and was diagnosed with murine typhus. She was treated with doxycycline and discharged after complete resolution of the fever. However, recurrent presyncope and exertional dyspnea developed 6-8 weeks later. Complete atrioventricular (AV) block with a wide QRS escape rhythm and a left bundle branch block configuration was documented. Subacute myocarditis was diagnosed based on persistent cardiac troponin-I elevation and typical cardiac magnetic resonance imaging findings. A permanent pacemaker was implanted for symptomatic complete AV block. Few reports of myocarditis in murine typhus have been published. We report a case of murine typhus myocarditis complicated by complete AV block in the late convalescence phase.

Murine Typhus: Clinical and epidemiological aspects / Tifo Murino: Aspectos clínicos y epidemiológicos

Rickettsia typhi is an intracellular bacteria who causes murine typhus. His importance is reflected in the high frequency founding specific antibodies against R. typhi in several worldwide seroepidemiological studies, the seroprevalence ranging between 3-36%. Natural reservoirs of Rickettsia typhi are rats (some species belonging the Rattus Genus) and fleas (Xenopsylla cheopis) are his vector. This infection is associated with overcrowding, pollution and poor hygiene. Typically presents fever, headache, rash on trunk and extremities, in some cases may occur organspecific complications, affecting liver, kidney, lung or brain. Initially the disease is very similar to other diseases, is very common to confuse the murine typhus with Dengue fever, therefore, ignorance of the disease is a factor related to complications or non-specific treatments for the resolution of this infection. This paper presents the most relevant information to consider about the rickettsiosis caused by Rickettsia typhi

A Case of Acute Renal Failure Resulting from Murine Typhus Infection Induced Acute Tubulointerstitial Nephritis / 대한신장학회잡지

Murine typhus is an infectious disease caused by Rickettsia typhi, an intracellular parasite that lives in the cytoplasm of host cells. Rickettsia typhi infection can induce lymphohistiocytic vasculitis leading to pulmonary, cardiovascular, central nervous system and renal complications. We experienced a case of acute renal failure resulting from acute tubulointerstitial nephritis associated with murine typhus infection. A 67 year old man was transferred from local hospital due to fever, confusion, oliguria with renal failure. Laboratory finding showed elevated liver enzyme with hypoalbuminemia and progressive azotemia. Despite supportive care, his azotemia progressed with anuria and acute hemodialysis was started. Kidney biopsy showed acute tubulointerstitial nephritis with vasculitis and indirect immunofluorecent antibody to murine typhus was 1: 3, 200. Doxycyclin was started and his renal function recovered. We report a case of acute renal failure resulting from murine typhus infection induced acute tubulointerstitial nephritis.

Antibody prevalence of Orientia tsutsugamushi, Rickettsia typhi and TT118 spotted fever group rickettsiae among Malaysian blood donors and febrile patients in the urban areas.

The seroprevalence of Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) among blood donors and febrile Malaysian patients in the urban areas was determined. Of the 240 blood donors, 5.4%, 9.2% and 1.7% had either present or previous exposure to OT, RT and SFG rickettsiae, respectively. Patients admitted to an urban hospital had high seroprevalences of OT (43.5%) and RT (22.9%), as compared to SFGR (11.6%). Antibody levels suggestive of recent infections of scrub typhus, murine typhus and tick typhus were detected in 16.8%, 12.7% and 8.2% of patients respectively. No significant difference was noted in the distribution of rickettsial antibodies among urban patients from 2 geographical locations. However, the serologic patterns of rickettsial infection in the urban areas were different form those of rural areas.

Murine Typhus Presenting as Hemorrhagic Vesicles and Dyspnea: A case report

Murine (endemic) typhus is a zoonotic infection caused by Rickettsia typhi (formerly known as Rickettsia mooseri). Rickettsia typhi is an obligate intracellular organism that multiplies within the cytoplasm of mainly endothelial cells. It is transmitted from rats by injection of contaminated flea feces into the skin of the host. The disease manifests itself with the gradual onset of fever, myalgia, and headache appearing 7-14 days after infection. A maculopapular rash is found in some patients (proportions ranging from 20 to 80% in different series). We report a rare case of murine typhus with presentation of hemorrhagic vesicles and dyspnea which was treated at our emergency department, and we give a brief review of the literature.

Seroepidemiologic Analysis of Acute Febrile Illness in Korea during 1997~1998

Hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine typhus and leptospirosis have been the principal acute febrile diseases in Korea for many years. To evaluate the seroepidemiologic patterns of the acute febrile illness, sera collected from 4,503 patients in 1997~1998 were examined for antibodies against Hantaan virus, Orientia tsutsugamushi and Rickettsia typhi by indirect immunofluorescent antibody technique (IFA) and macroscopic agglutination test for Leptospira interogans. Seropositive cases for Orientia tsutsugamushi, Rickettsia typhi, Leptospira interogans and Hantaan virus were 261 (12.4%), 242 (11.5%), 11 (0.5%), and 250 (11.9%) in 1997, and 415 (17.3%), 273 (11.4%), 16 (0.7%), and 357 (14.9%) in 1998, respectively. Male was affected more frequently by HFRS and leptospirosis while scrub typhus was more prevalent in female. Old age group was more susceptible to the acute febrile diseases. Most positive cases were occurred during October and November for scrub typhus, and during November and December for HFRS. These results showed similar patterns with previous epidemiological data obtained during recent several years, except the single scrub typhus epidemic in 1998, and implied that no significant changes occurred in ecologic system for acute febrile diseases in Korea.

Murine Typhus as a Cause of Acute Respiratory Distress Syndrome in Endemic Area / 결핵

BACKGROUND: Murine typhus is a fea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild byt sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the pateints who showed acute respiratory distress syndrome as the initial presentation. METHODS: The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress syndrome (ARDS) was define according to the American-European Consensus Conference. The characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. RESULTS: Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. CONCLUSIONS: Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.

Seroprevalence to Coxiella burnetii in Patients with Acute Febrile Episodes during 1993

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.

Characterization of a Species-specific Antigen in Rickettsia typhi

Murine typhus is an acute febrile illness caused by Rickettsia typhi. It is one of the four major acute febrile illnesses in Korea during autumn. To study a species-specific antigen of R. typhi, two clinical isolates (87-91 and 87-100) and two reference strains (VR-144 and VR-738) were analyzed by mouse antisera and monoclonal antibodies (MAbs). On SDS- polyacrylamide gel electrophoresis (PAGE), R. typhi showed major antigen bands of 135, 80, 75, 64, 47, 22, and 19 kDa and these bands differed with those of other species. On Western blot analysis, the MAbs reacting only with R. typhi could only detect 135 kDa protein. The 135 kDa protein appeared to be the species-specific antigen. Other MAbs showing cross-reactivity with R. prowazekii reacted with 135 kDa protein in fresh culture supernatant of R. typhi infected host cell. However, the cross-reacting antibody did also react with smaller protein bands, most of which seem to be degradation products of the 135 kDa protein since they increase in old protein stocks purified from R. typhi harvested from infected host cell. These suggest that 135 kDa protein is unstable and the R. typhi specific epitopes are located at the regions of 135 kDa protein that are removed when the protein is degraded. The 135 kDa protein or its specific and stable recombinant protein would serve an important target for the development of vaccine and specific diagnostic antigen.

No olvidar al tifo murino: informe de dos casos / Co not forget murine typhus: a report of two cases

El reconocimiento del tifo murino es importante desde el punto de vista epidemiológico, el diagnóstico diferencial es amplio y debe descartarse en los pacientes con infección del sistema reticuloendotelial. Se presentan dos casos clínicos de tifo murino: un hombre de 34 años de edad residente de la Ciudad de México, con historia de viajes a Morelia y Guadalajara, que desarrolló síndrome febril, con reacción febril positiva para Proteus OX-19 (1:160) y serología positiva por inmunofluorescencia (IFA) para Rickettsia typhi, IgM e igG a títulos mayores de 1:128. El segundo caso corresponde a una mujer de 22 años de edad, residente de la ciudad de Matamoros, Tamaulipas, con cuadro clínico compatible y reacción febril positiva para Proteus OX-19 a títulos de 1:320, sin realizarse IFA. Los dos pacientes se curaron, en el primer caso se administró cloramfenicol oral y en el segundo ciprofloxacina. Presentamos estos dos casos como refuerzo al llamado del Instituto Nacional de Diagnóstico y Referencia Epidemiológicos (INDRE) para considerar el diagnóstico de rickettsiosis en pacientes febriles de áreas endémicas en México. Creemos que estas afecciones están subdiagnosticadas en nuestro país

A Case of Murine Typhus Acquired in a Laboratory / 감염

Rickettia typhi is an obligate intracellular organism and usually seen microscopically as gram-negative pleomorphic coccobacilli. Murine typhus is an acute febrile illness caused by R. typhi and transmitted to human by fleas. Fever, skin rash, headache, and myalgia characterize the clinical illness. The risk for laboratory personnel is from exposure to infectious aerosols, accidental inoculation, or exposure to bites by infected ectoparasites. A 27-year old man was admitted to the hospital because of fever and myalgia. He had worked with R. typhi in a laboratory and was exposed to R. typhi 10 days ago. The present illness began seven days before admission, when he developed high fever and conjunctival injection. One day before admission, he developed generalized erythematous skin rash and generalized edema. Immunofluorescence test with rickettsial antigen was positive at 1:4,096 on admission. He received 200 mg of doxycycline for 7 days and became afebrile on the third day after treatment.

Seroepidemiologic Analysis of Acute Febrile Illness During 1994-1995 in Korea / 감염

BACKGROUND: The principal acute febrile diseases reported in autumn, Korea, have been hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine METHODS: To evaluate the seroepidemiologic patterns of acute febrile illness in Korea, sera were collected from 5330 patients from 1994 to 1995, and examined for antibodies against Hantaan virus, Orientia tsutsuga-mushi, Rickettsia typhi, and Borrelia burgdorf eri by indirect immunofluorescent antibody technique(IFA) and by macroscopic agglutination test for Leptosp ira intero-gans. RESULTS: Of 640 seropositive cases against O. tsutsu-gamushi, 60% were female; age group of the seventh decade occupied 30%; 89% were reported during October and November. By IFA test, the seropositive rate of murine typhus was 3.5% (187/5330) with high incidence rate (44%) in the period from October to December, and males in their forties and fifties were mostly affected. Cases seropositive for leptospirosis consisted 1% of 5330 acute febrile illness cases. Of 55 seropositive cases, 71% were male; 71% were in their sixties; 78% occurred during the period from August to October. Hantavirus seropositive rate was 12.2% (649/5330) with a high incidence rate (70%) in the period from October to January and males in the thirties were mostly infected. No seropositive case of Lyme disease was present. CONCLUSION: The above results indicate that hantavirus, O. tsutsugamushi, R. typhi, and L. interogans were the main causative agents of acute febrile diseases during autumn season in Korea.