Clinical and laboratory features of rickettsioses in Yucatan, Mexico.

Rickettsia species are obligate intracellular bacteria that can cause mild to severe human disease. Based on phylogeny, clinical symptoms, and antigenic properties, rickettsiae are classified into four groups. Infections by these agents are characterized by clinical symptoms ranging from self-limited to severe and even fatal febrile illnesses, depending on the Rickettsia spp. involved, the patient's predisposition, and timely medical care. The present study aimed to characterize rickettsial diseases in Yucatan according to clinical and laboratory features appearing in medical records corresponding to 427 samples taken between 2015 and 2018. A study was conducted over the period 2015-2018 on 427 samples. Clinical and laboratory features were documented from the patients' medical records. For molecular diagnosis, blood was collected in 3.8 % sodium citrate as anticoagulant, and DNA was extracted. Single-step and nested PCR amplification was performed using genus-specific primers for the rickettsial 17kDa and ompB genes. The amplicons obtained were purified and sequenced. A total of 22.7 % (97/427) positive cases of Rickettsia spp. were identified by PCR from 14.15 % (15/106) of the municipalities in Yucatan. 75.2 % (73/97) of the cases were from the city of Merida during the autumn (September-December). The age groups with the highest frequency of confirmed cases were pediatric (5-14 years) (57.7 %) and adults (25-49 years) (42.2 %). There were six fatal cases in children, one associated with R. typhi and five with R. rickettsii. In non-fatal cases, 32.9 % (32/97) corresponded to the spotted fever group (SFG), and 60.8 % (59/97) to the typhus group (TG). Significant differences in signs, and laboratory data, were observed between the pediatric and adult populations. For the treatment of patients, oral and intravenous doxycycline was used in severe hospitalized cases. Typhus group and spotted fever group Rickettsiae are endemic pathological agents found in urban and rural areas of our region. Molecular identification allows for greater diagnostic accuracy and timely treatment and consequently a better prognosis. It is necessary to implement or reinforce measures focused on the dissemination of knowledge regarding rickettsial diseases and their prevention.

Study on the relation of the characteristics of the capture sites with the Leptospira spp. occurrence in bats and rodents from Yucatan, Mexico.

This study aims to describe the natural Leptospira occurrence in small mammals from Yucatan, Mexico, and to explore the relation between the characteristics of the capture sites and the Leptospira occurrence. Bats and rodents were captured in five sites of Yucatan state, and from them, a kidney fragment was collected that was used in the genomic DNA extraction. Leptospira DNA was identified by PCR targeting the 16S-rRNA and LipL32 genes. Additionally, a bioinformatic analysis was carried out to know the Leptospira species and was corroborated with a phylogenetic tree. The assemblage of small mammals was compound of 82 (51.2 %) bats and 78 (48.8 %) rodents. A global frequency (bats plus rodents) of Leptospira occurrence of 21.2 % (34/160) was observed; in bats, it was 21.9 % (18/82), and in rodents, 20.5 % (16/78). The phylogenetic trees based on LipL32 gene showed that the recovered sequences most closely resemble the species L. borgpetersenii and L. noguchii. The ordination of the capture sites with tropical deciduous forests as original vegetation is more related to the abundance of Leptospira-infected rodents. The ordination of the capture sites with tropical sub-deciduous forests as original vegetation is more related to the diversity of Leptospira-infected bat species. The canonical ordering of the capture sites is by the original vegetation type and the diversity and abundance of Leptospira-infected bat and rodent species.

An unusual identification of Rickettsia parkeri in synanthropic rodents and domiciliated dogs of a rural community from Yucatán, Mexico.

Rickettsia parkeri belongs to the spotted fever group (SFG) of the Rickettsia genus. This bacterium causes mild rickettsiosis in humans and is mainly transmitted by Amblyomma ticks. Its medical importance is emerging in the Americas, including Mexico. Synanthropic rodents and domiciled dogs participate as accidental hosts in epidemiological cycles of Rickettsia of the SFG. The aim is to report the presence of R. parkeri in synanthropic rodents and domiciled dogs from a rural community of Yucatán, Mexico. Rodents were captured, and plasma samples were taken from dogs in 48 households from Ucú, Yucatán, Mexico. A spleen sample (rodents) and plasma (dogs) were used in the propagation of Rickettsia on Vero cells. These infected cells were used in the extraction of genomic DNA. Rickettsia DNA was identified using a semi-nested PCR (snPCR); some products were sent for sequencing. The recovered sequences were analysed with bioinformatics programs, and a phylogenetic tree was built to determine the Rickettsia species. One hundred animals were sampled: 36 synanthropic rodents and 64 dogs. The snPCR evidenced the presence of Rickettsia DNA in 10 rodents (10/36, 27.8%) and 18 dogs (18/64, 28.1%), which represents a global frequency of 28% (28/100) in this study. The bioinformatics analysis yielded homology to R. parkeri and was demonstrated in the phylogenetic tree. The first evidence of the presence of R. parkeri in synanthropic rodents (Mus musculus) from Mexico is presented; likewise, the participation of domestic dogs in the transmission cycle of this bacterium with potential importance in public health is confirmed.

Rickettsia Vaccine Candidate pVAX1-OmpB24 Stimulates TCD4+INF-γ+ and TCD8+INF-γ+ Lymphocytes in Autologous Co-Culture of Human Cells.

BACKGROUND: In recent years, promising vaccination strategies against rickettsiosis have been described in experimental animal models and human cells. OmpB is considered an immunodominant antigen that is recognized by T and B cells. The aim of this study was to identify TCD4+INF-γ+ and TCD8+INF-γ+ lymphocytes in an autologous system with macrophages transfected with the vaccine candidate pVAX1-OmpB24. Lymphocytes and monocytes from 14 patients with Rickettsia were isolated from whole blood. Monocytes were differentiated into macrophages and transfected with the plasmid pVAX1-OmpB24 pVax1. Isolated lymphocytes were cultured with transfected macrophages. IFN-γ-producing TCD4+ and TCD8+ lymphocyte subpopulations were identified by flow cytometry, as was the percentage of macrophages expressing CD40+, CD80+, HLA-I and HLA-II. Also, we analyzed the exhausted condition of the T lymphocyte subpopulation by PD1 expression. Macrophages transfected with pVAX1-OmpB24 stimulated TCD4+INF-γ+ cells in healthy subjects and patients infected with R. typhi. Macrophages stimulated TCD8+INF-γ+ cells in healthy subjects and patients infected with R. rickettsii and R. felis. Cells from healthy donors stimulated with OmpB-24 showed a higher percentage of TCD4+PD1+. Cells from patients infected with R. rickettsii had a higher percentage of TCD8+PD-1+, and for those infected with R. typhi the larger number of cells corresponded to TCD4+PD1+. Human macrophages transfected with pVAX1-OmpB24 activated TCD4+IFN-γ+ and CD8+IFN-γ+ in patients infected with different Rickettsia species. However, PD1 expression played an important role in the inhibition of T lymphocytes with R. felis.

Epidemiological Study of the Occurrence of Typhus Group Rickettsia Natural Infection in Domiciliated Dogs from a Rural Community in South-Eastern Mexico.

The aim is to describe the Typhus group (TG) Rickettsia infection in dogs and to identify factors associated with this infection. We collected blood samples and gathered exposure and clinical data of 142 dogs from a rural community of Yucatan. The Rickettsia group was determined by semi-nested PCR. Generalized linear models with binomial error distribution were used to model the associated factors from the dog sample for risk ratio (RR) estimation. Thirty-four dogs (23.9%) showed molecular evidence of TG Rickettsia DNA. The multivariate model showed that mixed-breed dogs (RR = 0.06) and dogs that had received antiparasitic treatment (RR = 0.049) had a lower risk of getting infected, taking as reference the purebred group and the non-treated dogs, respectively. Looking at variable interactions, adult dogs without outdoor activities had a lower infection risk than puppies (RR = 0.26). Among dogs with antiparasitic treatment, females had a higher infection risk than male dogs (RR = 26.2). The results showed enzootic TG Rickettsia circulation in dogs of a rural community. The factors outdoor activities, age and previous antiparasitic treatment, as well as the clinical variables signs of hemorrhages and epistaxis, were associated with a less chance of natural infection in the studied dogs. Prevention and control of the enzootic transmission risk of TG Rickettsia should help to reduce the potential zoonotic transmission of this pathogen.

Clinical Manifestations in a Fatal Case of Probable Rickettsia and Leptospira Coinfection in Yucatan, Mexico.

Clinical or serological coinfections of Rickettsia and Leptospira are uncommon but should be included in differential diagnosis when poor sanitation and cohabitation with infected animals may converge. Rickettsial and leptospiral infections have been continuously increasing throughout the past decade in Yucatan, Mexico. Leptospirosis is a zoonotic disease caused by aerobic spirochetes, while rickettsiosis is an arthropod-borne disease. In 2020, 16% of all rickettsiosis cases and 10% of leptospirosis in the country originated in Yucatan. The objective of the present case report was to document an unusual case of probable coinfection with Rickettsia and Leptospira with emphasis on clinical manifestations and the epidemiological context that may orient future multidisciplinary measures. Here, we presented the case of a 12-year-old female whose mother had recently recovered from a rickettsial infection. The patient presented with fever and developed unspecific signs and symptoms of infection; however, her condition quickly deteriorated with gastrointestinal, hepatic, renal, and neurological dysfunction. After discounting rabies and identifying infection with Rickettsia and Leptospira, antibiotic treatment was indicated, but it was too late to prevent death. Simultaneous infections of Rickettsia and Leptospira may be considered in endemic regions when environmental, epidemiological, and clinical conditions converge.

West Nile and Zika viruses in bats from a suburban area of Merida, Yucatan, Mexico.

Infections with viruses of the Flavivirus genus were explored in 22 bats (Artibeus jamaicensis) from Merida, Yucatan, Mexico. The detection of the viral genus was performed by RT-PCR, and infections with dengue (DENV 1-4), West Nile (WNV) and Zika (ZIKV) viruses were subsequently explored. Sequences from positive products were analysed using the BLAST algorithm to determine identity. In 7 (31.8%) and 2 (9.1%) bats, WNV and ZIKV were identified, respectively. The bioinformatic analysis showed 98%-100% coverage and identity for both viruses. Molecular evidence of WNV and ZIKV natural infection in bats from Yucatan, Mexico, is presented.

Morphological and molecular identification of helminths of the greater bulldog bat Noctilio leporinus (Quiroptera: Noctilionidae) from Campeche, Mexico.

Surveys on parasites of bats from the Americas have been conducted, but information on helminths is still scarce, especially in the Neotropical region. In Mexico, there are species of bats that lack of a record for helminth species, such as members of the family Noctilionidae. The present study describes for the first time the helminths of Noctilio leporinus in Campeche, Mexico. In 2017, six specimens of N. leporinus were studied for helminths. The species identification of helminths was based on morphological studies and molecular analysis of fragments of the 28S rDNA. All bat specimens were infected for at least one helminth species. Three helminth taxa were identified: the trematode Pygidiopsis macrostomum, and the nematodes Tricholeiperia cf. proencai, and Heligmonellidae gen. sp. The morphological identification of P. macrostomum was confirmed by sequence analysis of 28S rDNA gene. The phylogeny of P. macrostomum grouped our sequence with other sequences of the same species collected in Brazil. The phylogenetic tree of Heligmonellidae gen. sp. indicated that the helminth belongs to clade formed by the species Odilia bainae, Nippostrongylus magnus and Nippostrongylus brasiliensis of the family Heligmonellidae. The phylogenetic analysis of the 28S sequences of T. cf. proencai did not show any similarity or close affinity with nematodes from which that gene has been sequenced to date. The findings of the present study increase the number of helminth species parasitizing bats in Mexico.

The genus Rickettsia in Mexico: Current knowledge and perspectives.

The genus Rickettsia encompasses 35 valid species of intracellular, coccobacilli bacteria that can infect several eukaryotic taxa, causing multiple emerging and re-emerging diseases worldwide. This work aimed to gather and summarise the current knowledge about the genus Rickettsia in Mexico, updating the taxonomy of the bacteria and their hosts by including all the records available until 2020, to elucidate host-parasite relationships and determine the geographical distribution of each Rickettsia species present in the country. Until now, 14 species of Rickettsia belonging to four groups have been recorded in Mexico. These species have been associated with 26 arthropod species (14 hard ticks, three soft ticks, two sucking lice, and seven fleas) and 17 mammal species distributed over 30 states in Mexico. This work highlights the high biological inventory of rickettsias for Mexico and reinforces the need to approach the study of this group from a One Health perspective.

Urban ecology of hosts and vectors of Rickettsia in a rickettsiosis-endemic city of the Yucatan peninsula, Mexico.

Rickettsioses are vector-borne zoonotic diseases that occur in urban environments. Currently, they are associated with the presence of domestic and synanthropic animals, the ectoparasites that they harbor, and their local habitat. The implementation of prevention actions relies on the understanding of the local ecology of interactions between hosts, vector species, and the etiologic agents. In this context, this study aimed to explore and describe the occurrence of infected mammals and their ectoparasites in human urban dwellings, and those characteristics of urban dwellings associated to the presence of Rickettsia infected animals in groups of households where at least one human case of rickettsiosis has occurred in the previous year of the study. Briefly, blood-samples and ectoparasites from synanthropic and domestic animals, were obtained from groups of households from different areas of an urban settlement. Serologic and molecular diagnostics helped to identify Spotted Fever Group (SFG) and TG (Typhus Group) Rickettsia in animal and ectoparasite samples. A total of 99 mammals were sampled, 29 opossums (Didelphis virginiana), 13 house mice (Mus musculus), seven black rats (Rattus rattus) and 50 dogs. Infection occurrence in opossums was 8.3% of SFG, 50% for TG, and 4.2% of undetermined group. For house mice 46.2% for SFG and 30.8% were undetermined. Black rats 28.6% of SFG and 57.1% undetermined. Finally, dogs were 19.1% of SFG, 57.4% to TG, and 23.4% belonged to undetermined group. A total of 424 ectoparasites were collected from the mammals. In opossums occurred the ticks Ambyomma sp., Ornithodoros (Alecterobius) nr. talaje, and the flea Ctenocephalides felis. In dogs we found the ticks Rhipicephalus sanguineus s. l., Amblyomma sp., O. (A.) nr. talaje, and the flea Ct. felis. No ectoparasites were collected from rodents. The occurrence of infected animals was associated primarily with the material of the backyard floor, the type of sanitary system in the household, the presence of garbage in the backyard, presence of firewood storage, stored polyethylene terephthalate (PET) containers for sale to recyclers, and the store of construction supplies in the backyard. Nonetheless a generalized linear model showed that the household with a backyard with a dirt floor or other non-concrete material has more chances of harboring infected animals (RR= 1.74, 95% CI= 1.07-2.84 and RR= 1.03, 95% CI= 0.39-2.32 respectively). In contrast, when the house has a sanitary system of urban sewer system or a latrine outside de house, the chances of having infected animals decreased significantly (RR= 0.39, 95% CI= 0.12-0.94 and RR= 0.46, 95% CI= 0.03-2.22). We conclude that both SFG and TG rickettsioses occur in animals and their ectoparasites in peridomiciles of urban households were at least one human rickettsiosis case had occurred.

Fatal murine typhus with hemophagocytic lymphohistiocytosis in a child.

Hemophagocytic lymphohistiocytosis is a rare complication in Rickettsia typhi infections. We report the case of a 2-year-old boy with sudden night-onset fever, pallor, neck adenopathy and erythematous macular rash on the thorax, thighs and buttocks. During admission, he developed hyponatremia, hypoalbuminemia, anemia, thrombocytopenia, leukopenia, neutropenia, liver damage, hemorrhages and persistent fever. No hematological improvement was observed after the initial management, neoplastic diseases were discarded by bone marrow aspiration and lymph node biopsy; hemophagocytic lymphohistiocytosis was diagnosed. By immunohistochemistry and indirect immunofluorescence, murine typhus was also diagnosed and doxycycline was started with transitory recovery. Later, the child developed kidney failure and distributive shock that evolved to cardiac arrest and death. This is the first case report in Mexico on a fatal murine typhus associated with hemophagocytic lymphohistiocytosis in which the etiology was evidenced by histopathology.

Understanding risk perception from traditional knowledge of Mayan farmers on Rickettsioses.

Rickettsioses are a group of tick-borne infectious diseases. The clinical presentation is characterised by unspecified manifestations seen in illnesses such as dengue, zika, and chikungunya, so identification is complicated. The greatest impact occurs among the world's poorest populations. Rickettsioses have hardly been studied from a qualitative perspective to show the cultural horizon of the people affected. We aimed to describe the perception of Mayan indigenous farmers about their risk perception for disease transmission. We used the ethnographic method and built life stories. From the perspective of people interviewed, their relationship with the reservoirs for vectors did not represent a high risk, did not consider that blisters and other skin lesions are caused by tick bites. Contributions as this article show the thinking logic underlying the perception of risk of these impoverished populations. To produce synergy with prevention efforts, it is necessary to know the cultural perspectives of targeted groups.

Personal and household factors involved in recent Rickettsia exposure in a rural population from Yucatán, Mexico.

The aim of the study was to describe the epidemiological factors associated with the risks of recent Rickettsia exposure in inhabitants of a rural population from Yucatán, Mexico. The study included 130 inhabitants from Maxcanú, Yucatán. Blood samples were collected to detect IgM and IgG antibodies against Rickettsia typhi and Rickettsia rickettsii by an indirect immunofluorescence antibody test. Additionally, nested polymerase chain reaction was performed to amplify fragments of the 17kDa and sca5 genes. Previously, an epidemiological questionnaire was applied focused on collecting information on personal and housing exposure variables related to the recent infection with Rickettsia to determine epidemiological associations. Results that exhibited a p-value < .25 were included in a generalized multinomial logistic linear model to determine the variables involved with the risk of contact or Rickettsia infection. In all, 76% (99/130) of the participants presented with immunoglobulin titres against the Rickettsia species evaluated, while rickettsial DNA was detected in 35.4% (46/130) of the participants. The association analysis with the personal exposure variables showed that the productive age group (OR = 0.32; 95% CI = 0.10-1.03) and the elders group (OR = 0.12; 95% CI = 0.01-0.83) were protective factors for recent infection with R. typhi, taking as reference the school group. The presence of a family orchard in the home (OR = 7.56; 95% CI = 1.62-35.29) was a risk factor for recent infection with R. rickettsii. Presumably, the presence of ectoparasites (OR = 2.71; 95% CI = 0.90-8.09) at home was a risk factor for recent infection with both Rickettsia species. Recent infection was demonstrated in inhabitants from Maxcanú, Yucatán. A high seropositive frequency was obtained. The results highlight the importance of the family garden and the presence of ectoparasites in the home as risk factors associated with recent infection with Rickettsia in inhabitants from Maxcanú.

Rickettsia species in ticks that parasitize amphibians and reptiles: Novel report from Mexico and review of the worldwide record.

Ticks are obligate haematophagous ectoparasites that are associated with a wide range of vertebrate hosts, among them also reptiles and amphibians. They have dynamic ecological interactions with multiple microorganisms, ranging from endosymbionts to pathogens, such as the members of the genus Rickettsia. The aim of this work was to detect Rickettsia in ticks from amphibians and reptiles from southern Mexico by the amplification, sequencing and phylogenetic reconstruction of the gltA and ompA genes, and also to compile all the published records worldwide of Rickettsia associated with ticks attached to reptiles and amphibians, in order to elucidate the host-parasite relationships, and to identify the geographical distribution of each bacterial species. We record for the first time the presence of Rickettsia sp. strain Colombianensi and Rickettsia amblyommatis in ticks from several reptiles and amphibians collected in three new localities from the states of Guerrero and Veracruz, Mexico. Additionally, we here report 23 Rickettsia taxa associated with 18 tick species attached to 42 host taxa of amphibians and reptiles in 36 countries. Our findings increase the inventory of rickettsia reported in Mexico and summarizes the knowledge of these bacteria associated with ticks of this particular group of vertebrate host worldwide.

Long term neurologic sequelae in a Mexican rocky mountain spotted fever case.

During the second half of the twentieth century, neurologic sequelae associated with central nervous system impairment caused by Rickettsia rickettsii were studied widely and exclusively in the United States. We present the case of a Mexican pediatric patient with neurologic sequelae 10 years after an acute infection by R. rickettsii.

Long term neurologic sequelae in a Mexican rocky mountain spotted fever case

ABSTRACT During the second half of the twentieth century, neurologic sequelae associated with central nervous system impairment caused by Rickettsia rickettsii were studied widely and exclusively in the United States. We present the case of a Mexican pediatric patient with neurologic sequelae 10 years after an acute infection by R. rickettsii.

Attitudes and Practices from People of a Mayan Community of Mexico, Related to Tick-Borne Diseases: Implications for the Design of Prevention Programs.

BACKGROUND: Tick-borne diseases are caused by several pathogens whose transmission could be associated to the life conditions of communities settled in endemic areas. We aimed to determine the knowledge, attitudes, and practices related to the exposition and prevention of tick-borne diseases among people living in a typical Mayan community of Yucatan, Mexico between Dec 2012 and May 2013. METHODS: A directed survey was applied to 212 (100%) householders (women and men) from Teabo, Yucatan, Mexico. Answers and field notes were recorded and analyzed with central statistics. RESULTS: People have been bitten at least once in the community, but the majority of them consider those bites innocuous. In addition, people do not consider prevention measures, and only a few mentioned the use of some chemicals on their backyards. CONCLUSION: This study found little awareness among the participants regarding the importance and the transmission of these diseases even though they possess a vast knowledge regarding ticks. Therefore, educational strategies and prevention programs that include these habits for its modification are required to minimize the exposition to the vectors.