Rickettsia felis in the Americas.

The authors describe their work in the Americas in Rickettsia felis cases in humans and the presence of Rickettsia felis in vectors.

Identification of Ctenocephalides felis fleas as a host of Rickettsia felis, the agent of a spotted fever rickettsiosis in Yucatan, Mexico.

In search for the vector of the recently recognized spotted fever rickettsiosis of the Yucatán, ticks, fleas, and lice were collected from vegetation and dogs in localities where seropositive persons had been found. The arthropods were examined by polymerase chain reaction (PCR) using primers for the genus-specific 17-kDa protein gene followed by restriction fragment length polymorphism (RFLP) and DNA sequencing. Eleven (20%) of 54 pools of Ctenocephalides felis fleas contained DNA of Rickettsia felis. None of 219 Amblyomma cajennense, 474 Rhiphicephalus sanguineus, 258 Boophilus sp. ticks, and 33 Poliplax species lice contained DNA of Rickettsia. The identity of the rickettsial DNA was confirmed as R. felis by PCR/RFLP for the citrate synthase and outer membrane protein A genes and by DNA sequencing. The results indicate that the host of R. felis in Yucatán is C. felis and suggest that the spotted fever rickettsiosis that has infected >5% of the population of the Yucatán and can present as a dengue-like illness is likely to be caused by R. felis.

Rickettsia felis: molecular characterization of a new member of the spotted fever group.

In this report, placement of Rickettsia felis in the spotted fever group (SFG) rather than the typhus group (TG) of Rickettsia is proposed. The organism, which was first observed in cat fleas (Ctenocephalides felis) by electron microscopy, has not yet been reported to have been cultivated reproducibly, thereby limiting the standard rickettsial typing by serological means. To overcome this challenge, several genes were selected as targets to be utilized for the classification of R. felis. DNA from cat fleas naturally infected with R. felis was amplified by PCR utilizing primer sets specific for the 190 kDa surface antigen (rOmpA) and 17 kDa antigen genes. The entire 5,513 bp rompA gene was sequenced, characterized and found to have several unique features when compared to the rompA genes of other Rickettsia. Phylogenetic analysis of the partial sequence of the 17 kDa antigen gene indicated that R. felis is less divergent from the SFG rickettsiae than from the TG rickettsiae. The data corroborate results from previous reports that analysed the citrate synthase, 16S rRNA, rompB (135 kDa surface antigen), metK, ftsY, polA and dnaE genes that placed R. felis as a member of the SFG. The organism is passed trans-stadially and transovarially, and infection in the cat flea has been observed in the midgut, tracheal matrix, muscle, hypodermis, ovaries and testes.

Rickettsia felis rickettsiosis in Yucatán.

Three patients with fever, exanthem, headache, and central-nervous-system involvement were diagnosed with Rickettsia fells infection by specific PCR of blood or skin and seroconversion to surrogate Rickettsia antigens. Although R. felis's relationship to other Rickettsia species is known and the pathogenic potential of this clade is well documented, R. felis's role as a pathogen has not been fully understood.

Serologic study of the prevalence of rickettsiosis in Yucatán: evidence for a prevalent spotted fever group rickettsiosis.

Because of the discovery of a spotted fever group rickettsiosis with signs and symptoms similar to dengue fever in Yucatan, Mexico, immunofluorescence assay (IFA) serology was performed on sera from 390 persons selected from a representative geographic distribution of rural Yucatan to detect antibodies reactive with Rickettsia rickettsii, R. akari, a Thai strain (TT-118) that is most closely related to a rickettsia identified in Amblyomma cajennense ticks in southern Texas, and R. typhi. The IFA antibodies at titers > or = 1:64 against R. akari were detected in 22 (5.6%) of the samples with the expected cross-reactivity against the other antigens of the spotted fever group. Immunoblotting with antigens of R. akari identified antibodies against antigens of spotted fever group lipopolysaccharides and not against rickettsial outer membrane proteins A and B, which contain the species-specific epitopes. A rickettsiosis most likely caused by a relative of R. akari appears to be both prevalent and widely distributed geographically in Yucatan.

Unrecognized spotted fever group rickettsiosis masquerading as dengue fever in Mexico.

Although Rocky Mountain spotted fever was documented in northern Mexico during the 1940s, spotted fever group (SFG) rickettsioses have subsequently received little attention in Mexico. In this study, sera collected in 1993 from 50 patients from the Mexican states of Yucatan and Jalisco, who were suspected clinically to have dengue fever but had no antibodies to dengue virus, were examined by indirect immunofluorescence for IgM antibodies reactive with Rickettsia rickettsii, R. akari, and R. typhi. Twenty (40%) of the patients' sera contained IgM antibodies to SFG rickettsiae at a titer of 128 or greater. Among five sera reactive only against R. akari, four were from patients in Jalisco where a cluster of cases occurred in June and July. Among five sera reactive only with R. rickettsii, all were from Yucatan patients. Sera of 10 patients contained antibodies reactive with antigens shared by R. rickettsii and R. akari. The clinical signs and symptoms (fever, 100%; myalgia, 95%; headache, 85%; rash, 85%) were similar to those of dengue fever patients identified in this study. However, the incidence of rash was substantially higher than the nondengue, nonrickettsiosis patients. One or more SFG rickettsioses appear to be present in areas of Mexico not previously recognized to harbor these organisms. The etiologic agent or agents are as yet unknown.

[Chronic Chagas cardiomyopathy detected in patients at the Regional General Hospital O'Horan, Merida, Yucatan, Mexico]. / Cardiopatiá Chagásica crónica detectada en pacientes del hospital general regional O'Horan, Mérida, Yucatán, México.

The purpose of this study was to determine the frequency of cardiopathy due to Chagas' disease in 36 patients of the cardiology department at the Regional General Hospital O'Horan in Merida, Yucatan. All patients included in the study had cardiac involvement compatible with acute or chronic stages of Chagas' disease. Medical records prepared for each one of the patients included a Chagas' disease targeted clinical history, chest X-ray, electrocardiogram, blood culture and serology using indirect immunofluorescence test. Out of the 36 patients studied, 7 were diagnosed as having Chagas' disease cardiopathy. Grade II cardiomegaly was established in 2 patients while the remaining 5 had grade III cardiomegaly. Conduction abnormalities were established in 6 patients while 2 of these had evidence of necrosis and/or ischemia. Chagas' disease cardiopathy, as our results suggest, is not a rare event in the cardiology ward at the O'Horan Hospital.