Pesquisa de agentes transmitidos por carrapatos em fragmentos de mata urbana com presença de capivaras (Hydrochoerus hydrochaeris) no município de Dourados / Research on agents transmitted by ticks in urban forest fragments with the presence of capybaras (Hydrochoerus hydrochaeris) in the municipality of Dourados / Investigación sobre agentes transmitidos por garrapatas en fragmentos de bosque urbano con presencia de capibaras (Hydrochoerus hydrochaeris) en el municipio de Dourados

A febre maculosa é uma doença que vem se destacando dentro das patologias que acometem seres humanos, sendo esta causada pela bactéria do gênero Rickettsia cujo principal vetor são os carrapatos do gênero Amblyomma spp. As capivaras têm sido associadas ao ciclo dessa riquetsiose por serem hospedeiras naturais destes parasitas e desta forma constituírem os vetores da doença. As capivaras são amplamente encontradas no território urbano da cidade de Dourados ­ MS. Diante disso, o presente estudo foi realizado com o objetivo de detectar o DNA de bactérias do gênero Rickettsia rickettsii em carrapatos presentes no ambiente no Parque Arnulpho Fioravanti. Os carrapatos foram coletados por meio de armadilhas de CO2 e pano de arraste no parque urbano Arnulpho Fioravanti, em Dourados - MS, local de elevado fluxo de pessoas e morada de capivaras. Nesse estudo realizou-se a identificação da espécie e estágio de vida bem como a detecção do DNA de bactérias do gênero Rickettsia por meio da reação em cadeia da polimerase (PCR). Nos carrapatos coletados, independentemente da espécie, Amblyomma sculptum (58) e Amblyomma dubitatum (25), não foi detectado o DNA das bactérias do gênero Rickettsia. Esses resultados indicam que os carrapatos coletados não são vetores para a febre maculosa brasileira e que as capivaras ali presentes provavelmente estariam sadias para conviver em ambiente urbano.(AU)

Spotted fever is a disease that has been standing out among the pathologies that affect human beings, which is caused by bacteria of the genus Rickettsia whose main vector are ticks of the genus Amblyomma spp. Capybaras have been associated with the cycle of this rickettsiosis as they are natural hosts of these parasites and thus constitute the disease vectors. Capybaras are widely found in the urban territory of the city of Dourados ­ MS. Therefore, the present study was carried out with the aim of detecting the DNA of bacteria of the genus Rickettsia rickettsii in ticks present in the environment of Parque Arnulpho Fioravanti. The ticks were collected using CO2 traps and a drag cloth in the urban park Arnulpho Fioravanti, in Dourados - MS, a place with a high flow of people and home to capybaras. In this study, the identification of the species and life stage was carried out, as well as the detection of the DNA of bacteria of the genus Rickettsia through the polymerase chain reaction (PCR). In the ticks collected, regardless of the species, Amblyomma sculptum (58) and Amblyomma dubitatum (25), the DNA of bacteria of the genus Rickettsia was not detected. These results indicate that the ticks collected are not vectors for Brazilian spotted fever and that the capybaras present there would probably be healthy to live in an urban environment.(AU)

La fiebre maculosa es una enfermedad que se viene destacando entre las patologías que afectan al ser humano, la cual es causada por bacterias del género Rickettsia cuyo principal vector son las garrapatas del género Amblyomma spp. Los capibaras se han asociado con el ciclo de esta rickettsiosis, ya que son huéspedes naturales de estos parásitos y, por lo tanto, constituyen los vectores de la enfermedad. Los capibaras se encuentran ampliamente en el territorio urbano de la ciudad de Dourados - MS. Por tanto, el presente estudio se realizó con el objetivo de detectar el ADN de bacterias del género Rickettsia rickettsii en garrapatas presentes en el entorno del Parque Arnulpho Fioravanti. Las garrapatas se recolectaron mediante trampas de CO2 y un paño de arrastre en el parque urbano Arnulpho Fioravanti, en Dourados - MS, un lugar con un alto flujo de personas y hogar de capibaras. En este estudio se llevó a cabo la identificación de la especie y etapa de vida, así como la detección del ADN de bacterias del género Rickettsia mediante la reacción en cadena de la polimerasa (PCR). En las garrapatas recolectadas, independientemente de la especie, Amblyomma escultum (58) y Amblyomma dubitatum (25), no se detectó ADN de bacterias del género Rickettsia. Estos resultados indican que las garrapatas recolectadas no son vectores de la fiebre maculosa brasileña y que los capibaras presentes allí probablemente serían saludables para vivir en un entorno urbano.(AU)

Fiebre manchada de montañas rocosas: experiencia en 5 años de vigilancia activa en un hospital pediátrico de segundo nivel en el noreste de México / Rocky mountain spotted fever: five years of active surveillance experience in a second level pediatric hospital in northeastern Mexico

Resumen: Introducción: La fiebre manchada de las montañas rocosas (FMMR) es causada por Rickettsia rickettsii. En Coahuila, la región de la Comarca Lagunera se considera una zona endémica. No se han reportado casos en la zona sur del estado, específicamente en la ciudad de Saltillo. Métodos: Estudio prospectivo, reporte de casos. Se incluyeron los casos de niños atendidos en el Hospital del Niño Dr. Federico Gómez Santos en la ciudad de Saltillo, Coah., del mes de septiembre de 2012 a septiembre 2017 con diagnóstico confirmado clínicamente y por reacción en cadena de la polimerasa (PCR) de FMMR. Se presentan los antecedentes epidemiológicos, las características clínicas y evolución de los pacientes. Resultados: Se confirmaron 14 pacientes. La relación masculino:femenino fue de 1.8:1, la edad promedio de los pacientes fue de 7.6 años (18 meses a 13 años). El 42.8% de los pacientes refirió el contacto con perros y el 57.1% afirmó tener contacto con garrapatas. En todos los casos hubo fiebre y exantema purpúrico; alrededor del 70% manifestaron mialgias y artralgias; el 28% tuvo sangrado del tubo digestivo, y el 11% alteraciones neurológicas graves. El 64.2% de los casos recibió tratamiento adecuado con doxiciclina. Fallecieron 8 pacientes, con una tasa de letalidad de 57.1%. Conclusiones: La zona sur de Coahuila debe considerarse una zona endémica para FMMR. El retraso en el diagnóstico y tratamiento favorecen una mayor letalidad.

Abstract: Background: Rocky Mountain Spotted Fever (RMSF) is caused by Rickettsia rickettsii. In Coahuila, Comarca Lagunera is considered an endemic zone; no cases have been reported in the southern zone of the state, specifically in the city of Saltillo­. Methods: Prospective study, cases report. Children evaluated in the Hospital del Niño Dr. Federico Gómez Santos from September 2012 to September 2017, with clinically and laboratory (by polymerase chain reaction, PCR) confirmed diagnosis of FMMR were included. The epidemiological antecedents, clinical characteristics and patient's evolution are presented. Results: 14 patients were confirmed. The male: female ratio was 1.8: 1, the average age of the patients was 7.6 years (18 months to 13 years). 42.8% reported contact with dogs and 57.1% confirmed contact with ticks. In all cases, there was fever and purpuric rash; around 70% manifested myalgias and arthralgias; 28% presented digestive tract bleeding and 11% had severe neurological alterations. 64.2% of the cases received adequate treatment with doxycycline. Eight patients died with a case fatality rate of 57.1%. Conclusions: The southern zone of Coahuila should be considered an endemic area for FMMR. The delay in diagnosis and treatment favor a greater lethality.

[Fiebre manchada de montañas rocosas: experiencia en 5 años de vigilancia activa en un hospital pediátrico de segundo nivel en el noreste de México]. / Rocky mountain spotted fever: five years of active surveillance experience in a second level pediatric hospital in northeastern Mexico.

Introducción: La fiebre manchada de las montañas rocosas (FMMR) es causada por Rickettsia rickettsii. En Coahuila, la región de la Comarca Lagunera se considera una zona endémica. No se han reportado casos en la zona sur del estado, específicamente en la ciudad de Saltillo. Métodos: Estudio prospectivo, reporte de casos. Se incluyeron los casos de niños atendidos en el Hospital del Niño Dr. Federico Gómez Santos en la ciudad de Saltillo, Coah., del mes de septiembre de 2012 a septiembre 2017 con diagnóstico confirmado clínicamente y por reacción en cadena de la polimerasa (PCR) de FMMR. Se presentan los antecedentes epidemiológicos, las características clínicas y evolución de los pacientes. Resultados: Se confirmaron 14 pacientes. La relación masculino:femenino fue de 1.8:1, la edad promedio de los pacientes fue de 7.6 años (18 meses a 13 años). El 42.8% de los pacientes refirió el contacto con perros y el 57.1% afirmó tener contacto con garrapatas. En todos los casos hubo fiebre y exantema purpúrico; alrededor del 70% manifestaron mialgias y artralgias; el 28% tuvo sangrado del tubo digestivo, y el 11% alteraciones neurológicas graves. El 64.2% de los casos recibió tratamiento adecuado con doxiciclina. Fallecieron 8 pacientes, con una tasa de letalidad de 57.1%. Conclusiones: La zona sur de Coahuila debe considerarse una zona endémica para FMMR. El retraso en el diagnóstico y tratamiento favorecen una mayor letalidad. Background: Rocky Mountain Spotted Fever (RMSF) is caused by Rickettsia rickettsii. In Coahuila, Comarca Lagunera is considered an endemic zone; no cases have been reported in the southern zone of the state, specifically in the city of ­Saltillo. Methods: Prospective study, cases report. Children evaluated in the Hospital del Niño Dr. Federico Gómez Santos from September 2012 to September 2017, with clinically and laboratory (by polymerase chain reaction, PCR) confirmed diagnosis of FMMR were included. The epidemiological antecedents, clinical characteristics and patient's evolution are presented. Results: 14 patients were confirmed. The male: female ratio was 1.8: 1, the average age of the patients was 7.6 years (18 months to 13 years). 42.8% reported contact with dogs and 57.1% confirmed contact with ticks. In all cases, there was fever and purpuric rash; around 70% manifested myalgias and arthralgias; 28% presented digestive tract bleeding and 11% had severe neurological alterations. 64.2% of the cases received adequate treatment with doxycycline. Eight patients died with a case fatality rate of 57.1%. Conclusions: The southern zone of Coahuila should be considered an endemic area for FMMR. The delay in diagnosis and treatment favor a greater lethality.

[Rocky Mountain spotted fever in Brazil]. / A febre maculosa no Brasil.

Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20% to 30%) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

A febre maculosa no Brasil / Rocky Mountain spotted fever in Brazil

Embora no Brasil o número de casos confirmados de febre maculosa esteja em declínio desde 2005, a taxa de mortalidade (20 a 30 por cento) ainda é muito alta quando comparada a outros países. Esse alto índice de mortalidade tem estreita relação com a dificuldade em fazer o diagnóstico e estabelecer a terapia apropriada. Apenas dois grupos de antibióticos têm comprovada eficácia clínica, o cloranfenicol e as tetraciclinas. Até pouco tempo atrás, as tetraciclinas eram reservadas aos pacientes adultos em virtude das alterações dentárias e ósseas em crianças. Recentemente, entretanto, a Academia Americana de Pediatria e diversos autores têm recomendado a utilização da doxiciclina também em crianças. Em casos mais severos, a falta de experiência com uma tetraciclina injetável no Brasil faz com que se opte pelo cloranfenicol injetável. Como o pronto diagnóstico e a escolha adequada do fármaco são fatores determinantes de um prognóstico positivo, todos os profissionais da saúde devem estar melhor preparados para reconhecer e tratar a febre maculosa.

Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20 percent to 30 percent) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children.

OBJECTIVES: To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits. STUDY DESIGN: Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression. RESULTS: Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm3 in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes. CONCLUSIONS: Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.

Evidence of rickettsial spotted fever and ehrlichial infections in a subtropical territory of Jujuy, Argentina.

Between November 1993 and March 1994, a cluster 6 pediatric patients with acute febrile illnesses associated with rashes was identified in Jujuy Province, Argentina. Immunohistochemical staining of tissues confirmed spotted fever group rickettsial infection in a patient with fatal disease, and testing of serum of a patient convalescing from the illness by using an indirect immunofluorescence assay (IFA) demonstrated antibodies reactive with spotted fever group rickettsiae. A serosurvey was conducted among 16 households in proximity to the index case. Of 105 healthy subjects evaluated by IFA, 19 (18%) demonstrated antibodies reactive with rickettsiae or ehrlichiae: 4 had antibodies reactive with Rickettsia rickettsii, 15 with Ehrlichia chaffeensis, and 1 with R. typhi. Amblyomma cajennense, a known vector of R. rickettsii in South America, was collected from pets and horses in the area. These results are the first to document rickettsial spotted fever and ehrlichial infections in Argentina.