Leptospirosis y rickettsiosis, reto diagnóstico para el síndrome febril en zonas endémicas / Leptospirosis and rickettsiosis, a diagnostic challenge for febrile syndrome in endemic areas

Resumen. Se presenta el caso de un hombre de 50 años de edad proveniente de la región de Urabá, Colombia, con una infección mixta por Rickettsia rickettsii y Leptospira interrogans serovar Copenhageni ST78, y pruebas negativas para malaria y dengue. El paciente presentó un síndrome febril que no mejoró con el tratamiento antibiótico sistémico y, finalmente, falleció en la unidad de cuidados intensivos. El diagnóstico post mortem se hizo mediante tipificación molecular de los dos agentes etiológicos. En la inspección del domicilio del paciente, se encontró un ejemplar de Rattus rattus infectado con L. interrogans del mismo serovar detectado en él. No se encontraron garrapatas en los animales domésticos que habitaban con el paciente. Se reporta una infección mixta con síntomas clínicos progresivos y fatales en un paciente con antecedentes laborales de riesgo en una zona endémica para enfermedades tropicales, lo que obliga a tener presente la posibilidad de infecciones simultáneas en personas procedentes de áreas endémicas que consulten reiteradamente por síndrome febril sin resolución y tengan riesgo laboral relacionado con actividades agrícolas.

Abstract. This is the case of a 50-year-old male from the region of Urabá, Colombia, with a mixed infection by Rickettsia rickettsii and Leptospira interrogans serovar Copenhageni ST78 and negative test for malaria and dengue fever. The patient presented with febrile syndrome and was unresponsive to systemic antibiotic treatment, who finally died in the intensive care unit. We established the postmortem diagnosis through molecular typification of the two etiological agents. In the inspection at the patient's home, we found a Rattus rattus specimen infected with L. interrogans of the same serovar found in him. We found no ticks parasitizing the domestic animals cohabitating with the patient. This case of a mixed infection with progressive and fatal symptoms in a patient with occupational risk in a tropical disease endemic zone highlights the importance of considering the potential presentation of simultaneous etiologies in patients with multiple medical visits for unresolved febrile syndromes associated with risky exposure during agricultural activities.

Sociocultural descriptions of febrile syndromes in rural areas of Urabá, Colombia: An exploration of "tick fever" / Descrição sociocultural de síndromes febris em áreas rurais de Antioquia Urabá: um olhar sobre a "febre do carrapato"

Abstract Introduction: In 2006 and 2008 there were two lethal outbreaks of rickettsioses in the rural areas of Urabá, characterized by the lack of immediate diagnosis and antibiotic treatment. Objective: Describe sociocultural aspects about knowledge, attitudes and practices in relation to febrile syndromes and "tick fever" in rural areas of Urabá. Materials and methods: We conducted an exploratory study using knowledge, attitudes, and practices questionnaires and semi-structured interviews about febrile syndromes and "tick fever". We surveyed 246 heads of households and interviewed nine individuals. Results: We observed that people tended to identify febrile syndromes with signs and clinical symptoms of dengue, malaria, leptospirosis and rickettsioses. A considerable proportion of individuals (32.93%) knew very little about "tick fever", thinking that is was transmitted by mosquitos. They mentioned intestinal parasitoids, malaria, dengue, and "evil eye" among the causes of febrile syndromes. "Tick fever" is linked by its name to the bite of the tick. Furthermore, the treatments for febrile syndromes mentioned by interviewees are associated to those commonly used in western medicine and medicinal plants. Conclusions: There is a need for educational programs in rural areas, to raise awareness about these potential lethal conditions that can be effectively treated.

Resumo Introdução: Nos anos de 2006 e 2008, dois surtos letais de riquetsiose foram relatados em áreas rurais de Urabá, caracterizados pela falta de atenção imediata para o diagnóstico e tratamento com antibióticos. Objetivo: Descrever aspectos socioculturais do conhecimento, atitudes e práticas de síndromes febris e "febre do carrapato" em áreas rurais de Antioquia, Urabá. Materiais e métodos: Realizou-se estudo exploratório, através de inquéritos sobre CAP (conhecimentos, atitudes e práticas) e entrevistas semiestruturadas sobre síndromes febris e "febre do carrapato", um nome que se refere às doenças das riquetsioses na área. Foram aplicados 246 inquéritos sobre a CAP foram realizadas aos chefes de agregados familiares e nove pessoas foram entrevistadas. Resultados: Observou-se que as pessoas tendem a identificar os sinais e sintomas clínicos característicos da dengue, malária, leptospirose e até riquetsiose. Um grande número de pessoas demonstra baixo conhecimento sobre "febre do carrapato" e indicou que ela é transmitida por mosquitos (32,93%). Os entrevistados indicaram que as causas das diferentes síndromes febris se devem a parasitas intestinais, malária, dengue ou, como crença cultural, ao "mau olhado". A "febre do carrapato" o associa, pelo nome, com a mordida do carrapato. Além disso, o tratamento das síndromes febris referidas pelos entrevistados está intimamente relacionado ao uso comum da medicina ocidental e ao uso de "plantas medicinais". Conclusões. É necessário ter programas de educação nessas áreas rurais para que essas entidades potencialmente letais tenham um tratamento efetivo e acessível.

Rickettsialpox in a Pediatric Patient.

Rickettsialpox is a rare vector-borne rickettsiosis that manifests in hosts living in urban populations, particularly in New York City. The following is a case discussion of a 12-year-old girl with history of fever and right-ankle swelling. She was initially evaluated and treated for cellulitis. She later developed a maculopapular rash completing the classic triad for rickettsialpox: black eschar, papular rash, and fever. Her convalescent rickettsial titers returned positive, confirming the diagnosis of rickettsialpox.

Rickettsiosis, un caso de TIBOLA / Rickettsia, a case of TIBOLA

Las rickettsiosis están cobrando especial protagonismo a raíz de nuevas especies descritas en los últimos años. La más frecuente en nuestro medio es la infección por Rickettsia conorii, que produce la fiebre botonosa mediterránea. Recientemente se incluye con más frecuencia en el diagnóstico diferencial la denominada TIBOLA (tick-borne lymphadenopathy) o DEBONEL (dermacentor-borne necrosis eritema lymphadenopathy), cuya primera confirmación serológica data de 1997 en Francia y que es transmitida por la garrapata Dermacentor marginatus, producida por R. slovaca, entre otras, y con similares características clínicas a las de la fiebre botonosa mediterránea. Se presenta el caso de una niña de ocho años de edad que acude al Servicio de Urgencias con la presencia de fiebre y una lesión costrosa, de aspecto necrótico, en el cuero cabelludo, así como adenopatías de localización cérvico-occipital y retroauricular, refiriendo la picadura de una garrapata hace 15 días. El diagnóstico se confirma mediante la presentación clínica y serologías cruzadas con Rickettsia conorii. Tras pauta de eritromicina a dosis de 40 mg/kg/día durante ocho días se evidencia la desaparición progresiva de las lesiones a lo largo de un mes (AU)

Rickettsia are gaining special importance following new species discovered in recent years. The most common in our environment is Rickettsia conorii infection, which produces the so-called Mediterranean fever boutonneuse. Recently are included more often in the differential diagnosis the called TIBOLA (tick-borne lymphadenopathy) or also known as DEBONEL (dermacentor-borne necrosis lymphadenopathy erythema), whose first serologic confirmation dates back to 1997 in France and is transmitted by the tick Dermacentor marginatus, produced by R. slovaca among others and has similar clinical features as the Mediterranean spotted fever. The case of an 8 year-old who came to the Emergency Services with the presence of fever and scabby lesion, necrotic scalp and cervical lymphadenopathy of occipital and retroauricular location is presented, referring tick bite 15 days ago. The diagnosis is confirmed by clinical and serological tests Rickettsia conorii cross-presentation. After erythromycin dose regimen of 40 mg/kg/day for 8 days, progressive disappearance of lesions was evident after a month (AU)

Development and Validation of an Improved PCR Method Using the 23S-5S Intergenic Spacer for Detection of Rickettsiae in Dermacentor variabilis Ticks and Tissue Samples from Humans and Laboratory Animals.

A novel nested PCR assay was developed to detectRickettsiaspp. in ticks and tissue samples from humans and laboratory animals. Primers were designed for the nested run to amplify a variable region of the 23S-5S intergenic spacer (IGS) ofRickettsiaspp. The newly designed primers were evaluated using genomic DNA from 11Rickettsiaspecies belonging to the spotted fever, typhus, and ancestral groups and, in parallel, compared to otherRickettsia-specific PCR targets (ompA,gltA, and the 17-kDa protein gene). The new 23S-5S IGS nested PCR assay amplified all 11Rickettsiaspp., but the assays employing other PCR targets did not. The novel nested assay was sensitive enough to detect one copy of a cloned 23S-5S IGS fragment from "CandidatusRickettsia amblyommii." Subsequently, the detection efficiency of the 23S-5S IGS nested assay was compared to those of the other three assays using genomic DNA extracted from 40 adultDermacentor variabilisticks. The nested 23S-5S IGS assay detectedRickettsiaDNA in 45% of the ticks, while the amplification rates of the other three assays ranged between 5 and 20%. The novel PCR assay was validated using clinical samples from humans and laboratory animals that were known to be infected with pathogenic species ofRickettsia The nested 23S-5S IGS PCR assay was coupled with reverse line blot hybridization with species-specific probes for high-throughput detection and simultaneous identification of the species ofRickettsiain the ticks. "CandidatusRickettsia amblyommii,"R. montanensis,R. felis, andR. belliiwere frequently identified species, along with some potentially novelRickettsiastrains that were closely related toR. belliiandR. conorii.

TIBOLA: enfermedad emergente producida por picadura de garrapata / TIBOLA: an emergent disease caused by tick bite

Las enfermedades trasmitidas por garrapatas son poco frecuentes en nuestro medio. Presentamos un caso de linfadenopatía por picadura de garrapata (TIBOLA, por su nombre en inglés: tick-borne lymphadenopathy). Es una enfermedad emergente causada por Rickettsia slovaca. Se manifiesta como una escara necrótica en cuero cabelludo, en el lugar de la picadura, fiebre y múltiples adenopatías craneales y laterocervicales posteriores. La duración media del periodo de incubación desde la picadura es de siete días. Ante un paciente con adenitis cervical y el antecedente de picadura de garrapata y/o escara en el cuero cabelludo el diagnóstico de TIBOLA es el más frecuente (AU)

Tick-borne diseases are rare in our environment. We describe a case of tick-borne lymphadenopathy (TIBOLA), an emergent disease caused by Rickettsia slovaca. The patients have a necrotic eschar on the scalp, at the site of a bite, fever and multiple occipital and/or cervical lymphadenopathies. The medium duration of incubation since the bite is seven days. In the case of a patient with cervical adenitis and history of tick bite and/or eschar scalp, the diagnosis of TIBOLA is the most common (AU)

The role of CD8 T lymphocytes in rickettsial infections.

Arthropod-borne obligately intracellular bacteria pose a difficult challenge to the immune system. The genera Rickettsia, Orientia, Ehrlichia, and Anaplasma evolved mechanisms of immune evasion, and each interacts differently with the immune system. The roles of CD8 T cells include protective immunity and immunopathology. In Rickettsia infections, CD8 T cells are protective mediated in part by cytotoxicity toward infected cells. In contrast, TNF-α overproduction by CD8 T cells is pathogenic in lethal ehrlichiosis by induction of apoptosis/necrosis in hepatocytes. Yet, CD8 T cells, along with CD4 T cells and antibodies, also contribute to protective immunity in ehrlichial infections. In granulocytic anaplasmosis, CD8 T cells impact pathogen control modestly but could contribute to immunopathology by virtue of their dysfunction. While preliminary evidence indicates that CD8 T cells are important in protection against Orientia tsutsugamushi, mechanistic studies have been neglected. Valid animal models will enable experiments to elucidate protective and pathologic immune mechanisms. The public health need for vaccines against these agents of human disease, most clearly O. tsutsugamushi, and the veterinary diseases, canine monocytotropic ehrlichiosis (Ehrlichia canis), heartwater (Ehrlichia ruminantium), and bovine anaplasmosis (A. marginale), requires detailed immunity and immunopathology investigations, including the roles of CD8 T lymphocytes.

Frequência de anticorpos da classe IgG anti-Rickettsia rickettsiiem equinos na Universidade Federal Rural do Rio de Janeiro, Campus Seropédica

O objetivo do presente estudo foi verificar,através da reação de imunofluorescência indireta (RIFI), a frequência de anticorpos anti--Rickettsia rickettsii em equinos na Universidade Federal Rural do Rio de Janeiro (UFRRJ) campus Seropédica, estado do Rio de Janeiro. Foram analisadas amostras de soro de 42 equinos do Setor de Equinocultura da UFRRJ. Todas as amostras foram testadas utilizando lâminas fixadas com antígenos para R. rickettsii, Rickettsia rhipicephali e Rickettsia parkeri. Foi observada uma prevalência geral para Rickettsia spp. de 83,33% (35/42). Para o agente R. rickettsii observou-se uma soroprevalência de 66,67% (28/42), sendo ainda categorizados em títulos de 1:64 (19/28) e 1:128 (9/28). Nove dos 28 equinos positivos para R. rickettsii (21,43%) não foram reativos para os demais agentes, apresentando títulos de 1:64 (8/9) e 1:128 (1/9). As únicas espécies de carrapatos encontradas parasitando os equinos no campus da UFRRJ durante o período de coleta foram Amblyomma cajennense e Dermacentor nitens. O campus da UFRRJ apresenta um ambiente que propicia um nicho epidemiológico ideal para a circulação de bactérias do gênero Rickettsia. A alta prevalência encontrada no presente estudo indica uma provável circulação de Rickettsia spp., havendo assim, risco para infecção humana na área estudada...

The aim of this study was to verify, through the indirect immunofluorescence assay (IFA), the frequency of anti-Rickettsia rickettsii antibodies in horses at Universidade Federal Rural do Rio de Janeiro (UFRRJ) Seropédica campus, state of Rio de Janeiro. We analyzed serum samples from 42 horses from Department of Breeding Equine of UFRRJ. All samples were tested using fixed slides with antigens for R. rickettsii, Rickettsia rhipicephali and Rickettsia parkeri. We observed an overall prevalence of Rickettsia spp. 83.33% (35/42). For the agent R. rickettsii revealed a prevalence of 66.67% (28/42), still being categorized in titers of 1:64 (19/28) and 1:128 (9/28). Nine of the 28 positives horses for R. rickettsii (21.43%) were no reactive to other agents, with titers 1:64 (8/9) and 1:128 (1/9). The only tick species found parasitizing horses on the campus of UFRRJ during the collection period were Amblyomma cajennense and Dermacentor nitens. The UFRRJ presents an environment that provides a ideal epidemiological niche for the permanence of Rickettsia bacteria. The high prevalence found in this study indicates that attention to epidemiological agent of Brazilian Spotted Fever in the study area is of utmost importance...

New York City's innovative epidemiologist: the life and career of Morris Greenberg.

Dr Morris Greenberg was an eminent American epidemiologist who served with the New York City Department of Health for a 40 year period, from 1920 until his passing in 1960. In 1946, he became Director of the department's Bureau of Preventable Diseases. In this role, he set very high standards for outbreak and epidemic investigations joined with a commitment to scholarly research and collaboration with the city's medical centers. He received his medical degree from Columbia University College of Physicians and Surgeons and then interned at Bellevue Hospital in New York City. He later trained in pediatrics in Vienna, Austria and received a Master of Science in Public Health degree from Columbia University School of Public Health. In 1942, he became a member of the teaching staff at the School of Public Health. During his years with the New York City Department of Health he led efforts to control outbreaks of smallpox and rickettsialpox, and initiated important studies of poliomyelitis, hepatitis, trichinosis, congenital cardiac anomalies in children, and the embryopathic effects of rubella in pregnancy. Dr. Greenberg's outbreak and epidemic investigations were popularized by The New Yorker writer, Berton Roueché, whose most widely read book remains, Eleven Blue Men and other Narratives of Medical Detection. The book's title is based on Greenberg's investigation of accidental sodium nitrite poisoning among eleven elderly men in Manhattan who as a result, became cyanotic. A pioneer in epidemiology and the prevention and control of communicable disease, Greenberg established very high performance standards for the discipline before there was a Center for Disease Control and Prevention and an Epidemic Intelligence Service in the United States.

Human spotted fever group rickettsioses are underappreciated in southern Taiwan, particularly for the species closely-related to Rickettsia felis.

BACKGROUND: Despite increased identification of spotted fever group rickettsioses (SFGR) in animals and arthropods, human SFGR are poorly characterized in Taiwan. METHODS: Patients with suspected Q fever, scrub typhus, murine typhus, leptospirosis, and dengue fever from April 2004 to December 2009 were retrospectively investigated for SFGR antibodies (Abs). Sera were screened for Rickettsia rickettsii Abs by indirect immunofluorescence antibody assay (IFA), and those with positive results were further examined for Abs against R. rickettsii, R. typhi, R. felis, R. conorii, and R. japonica using micro-immunofluorescence (MIF) tests. Polymerase chain reaction (PCR) for detection of SFGR DNA was applied in those indicated acute infections. Case geographic distribution was made by the geographic information system software. RESULTS: A total of 413 cases with paired serum, including 90 cases of Q fever, 47 cases of scrub typhus, 12 cases of murine typhus, 6 cases of leptospirosis, 3 cases of dengue fever, and 255 cases of unknown febrile diseases were investigated. Using IFA tests, a total of 49 cases with 47 (11.4%) and 4 (1.0%) cases had sera potentially positive for R. rickettsii IgG and IgM, respectively. In the 49 cases screened from IFA, MIF tests revealed that there were 5 cases of acute infections (3 possible R. felis and 2 undetermined SFGR) and 13 cases of past infections (3 possible R. felis and 10 undetermined SFGR). None of the 5 cases of acute infection had detectable SFGR DNA in the blood specimen by PCR. Possible acute infection of R. felis was identified in both one case of Q fever and scrub typhus. The geographic distribution of SFGR cases is similar with that of scrub typhus. CONCLUSIONS: Human SFGR exist and are neglected diseases in southern Taiwan, particularly for the species closely-related to R. felis.

First case series of emerging Rickettsial neonatal sepsis identified by polymerase chain reaction-based deoxyribonucleic acid sequencing.

PURPOSE: To detect and identify the aetiological agent in the peripheral blood from the cases of neonatal sepsis. MATERIALS AND METHODS: Four neonates from geographically different regions of South India presented with signs of neonatal sepsis and all the routine clinical and laboratory investigations were performed. Blood culture by Bac T Alert 3D was negative. To establish the aetiology, polymerase chain reaction (PCR) for eubacterial genome and subsequent amplification with Gram positive and Gram negative primers were performed followed by deoxyribonucleic acid (DNA) sequencing. RESULTS: PCR for the detection of eubacterial genome was positive in all the four neonates and further amplification with designed Gram positive and Gram negative primers revealed the presence of Gram negative bacteria. The amplicons were identified as Orientia tsutsugamushi in three neonates and Coxiella burnetti in the other neonate. Multalin analysis was done to further characterise the strain variation among the three strains. CONCLUSION: PCR-based DNA sequencing is a rapid and reliable diagnostic tool to identify the aetiological agents of neonatal sepsis. This is the first case series of emerging Rickettsial neonatal sepsis in India .

Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group.

OBJECTIVES: To study the epidemiology, clinical features, and changing pattern of rickettsial infections on the western slopes of the hilly Central Province of Sri Lanka over 6 years. METHODS: All patients with rickettsial infections who presented to the Teaching Hospital, Peradeniya were studied prospectively from January 2002 to December 2007. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS: Of the 371 clinical cases of rickettsial infection, 122 underwent IFA to confirm the diagnosis. Species-specific IgG antibodies were positive in 105/122 (86.1%) cases: 43/105 (40.9%) to Rickettsia conorii and 6/105 (5.7%) to Orientia tsutsugamushi, with mixed antibody reactivity to more than one antigen in 56/105 (53.3%) cases, including Rickettsia typhi in 27/105 (25.7%). Among those with mixed IgG reactivity, IgM assays were used to detect pathogens responsible for acute infections. Finally, a total of 55 spotted fever group (SFG) infections, seven scrub typhus infections, and one case of murine typhus were identified. Of the 105 positive cases, 53 (50.5%) were male and 52 (49.5%) were female, and the mean age was 40 years (range 11-83 years). In the SFG patients, 13/55 (24%) had severe vasculitis with fern leaf type skin necrosis and 17/55 (31%) had arthritis. Three patients (5%) had an altered level of consciousness. A patient with scrub typhus had transient deafness. None of the 105 patients had an eschar. CONCLUSIONS: It appears that SFG rickettsioses are on the rise in the hilly Central Province of Sri Lanka, whilst murine typhus and scrub typhus are present at a lower rate.

Arthropod-borne bacterial diseases in pregnancy.

Arthropod-borne bacterial diseases affect more than 25,000 Americans every year and thousands more around the world. These infections present a diagnostic dilemma for clinicians because they mimic many other pathologic conditions and are often low on or absent from the differential diagnosis list. Diagnosis is particularly challenging during pregnancy, as these infections may mimic common pregnancy-specific conditions, such as typical and atypical preeclampsia, or symptoms of pregnancy itself. Concerns regarding the safety in pregnancy of some indicated antibiotics add a therapeutic challenge for the prescriber, requiring knowledge of alternative therapeutic options for many arthropod-borne bacterial diseases. Physicians, especially those in endemic areas, must keep this class of infections in mind, particularly when the presentation does not appear classic for more commonly seen conditions. This article discusses presentation, diagnosis, and treatment of the most common of these arthropod-borne bacterial diseases, including Lyme disease, Rocky Mountain spotted fever, tick-borne relapsing fever, typhus, plague, cat-scratch disease, and Carrión disease.

Prevalence of rickettsioses in Poland in 2006-2012.

INTRODUCTION: Tick-borne diseases, such as rickettsioses, anaplasmosis, Lyme boreliosis and bartonellosis are often difficult to correctly diagnose. All these disease are present in Poland. OBJECTIVES: The aim of the study was to estimate a prevalence of Rickettsia spp. infections in humans in Poland in 2006 to 2012 based on the results made in the Laboratory of Rickettsiae, Chlamydiae and Spirochetes, NIPH-NIH in Warsaw. MATERIAL AND METHODS: The levels of Rickettsia spp. and Anaplasma phagocytophilum IgM and IgG antibodies were determined by indirect immunofluorescent assay (IFA). From 2006 to 2012, serum samples derived from 180 humans suspected for rickettsioses, including 84 patients suspected for the infections with typhus and spotted fever group (SFG) rickettsiae, and 96 patients suspected for anaplasmosis. RESULTS: Specific serum antibodies to the SFG rickettsiae have been detected in 5 persons (2.7%). Granulocytic anaplasmosis has been recognized in 9 patients (4.9%). While the reporting and registration of rickettsioses are obligatory in Poland less than 50% of detected cases are reported. CONCLUSIONS: Presented date indicate that in Poland rickettsioses are often unrecognized resulting in their underestimation. If research for rickettsiosis are made immediately after infection, antibodies will not be detect.

Imaging of rickettsial, spirochetal, and parasitic infections.

This article is an update and literature review of the clinical and neuroimaging findings of the commonly known rickettsial, spirochetal, and eukaryotic parasitic infections. Being familiar with clinical presentation and imaging findings of these infections is crucial for early diagnosis and treatment especially in patients who live in or have a travel history to endemic regions or are immunocompromised.

[Rickettsial diseases in Switzerland, update for the general practitioner]. / Rickettsioses d'importation.

Rickettsial diseases are arthropod-borne zoonosis. They are still misdiagnosed in Switzerland. Since development in molecular genetics, number of pathogenic species increased dramatically. In recent years, the incidence rise worldwide. Climatic conditions and development of tropical travels could explain it. In a near future, the Swiss general practitioner may face an increase of cases. Clinical presentation is unspecified. The eschar is the key diagnostic element but can be easily overlooked. Serology, the indirect immunofluorescence assay is the reference method. PCR can give the diagnosis in acute phase. However empirical treatment should be prescribed as soon as diagnosis is suspected. No vaccine is currently available and use of repellent is still the best way of prevention.

A case of rickettsialpox in Northern Europe.

We report the first case of rickettsialpox caused by Rickettsia akari in the Netherlands. The diagnosis was suspected based on clinical grounds and was confirmed by Western blot analysis with cross-adsorption. Because the arthropod vector (Liponyssoides sanguineus) is ubiquitous, we suspect that the disease is under-diagnosed in non-endemic areas.

Rickettsiosis Variceliforme o Viruela Rickettsiósica / Varicelliform Rickettsiosis or Rickettsial pox

El género de las Rickettsias tiene como característica ser bacterias gramnegativas intracelulares que precisan de un vector para su transmisión. Las fiebres exantemáticas producidas por Rickettsias son endémicas en nuestra región (Albacete), sobre todo en áreas rurales. Se presenta el caso de un paciente con una variedad inusual de enfermedad producida por Rickettsias, caracterizada por lesiones papulovesiculosas (AU)

Rickettsia is a genus of intracellular, gram-negative bacteria that requires a vector for transmission. Spotted fever caused by Rickettsia is endemic in our region (Albacete), especially in rural areas. We present a patient with an unusual variety of Rickettsial disease, characterised by papulovesicular lesions (AU)