The case of Mediterranean spotted fever of the traveler returned from Zambia.

We report the case of a traveler who returned from Zambia and was diagnosed with Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii conorii. The patient presented to Sapporo City General Hospital with symptoms of fever, malaise, headache, and rash. The pathogen was identified by Polymerase Chain Reaction assays and subsequent analyses. The patient improved with 10-day treatment of oral doxycycline. Although some cases of MSF have been reported in sub-Saharan Africa, none have been reported in Zambia. Rhipicephalus sanguineus sensu lato, the vector of the Rickettsia conorii conorii, has been found in various areas of Zambia. Our case report highlights the potential threat of Mediterranean spotted fever in urban areas of Zambia.

Cervids as Sentinels for Rickettsia spp. in Portugal.

Cervids are highly exposed to ticks, however, their role in the life cycle of these rickettsiae has not been fully elucidated. Given the expanding distribution and growing population of deer species in Portugal, coupled with their direct and indirect interactions with humans during hunting, it becomes crucial to explore their role as sentinels and potential reservoirs of Rickettsia. The present investigation aimed to detect and evaluate exposure to Rickettsia in free-living deer from Portugal. Blood samples (n = 77) were collected from hunted game animals (red deer and fallow deer) from different areas throughout Portugal (Idanha-a-Nova, Monte Fidalgo, Montalvão and Arraiolos) and sera were tested by immunofluorescence assay, to detect antibodies. Additionally, blood DNA samples were screened for SFGR by nested-polymerase chain reaction targeting a fragment of the outer membrane protein B (ompB) gene, as well as for Anaplasma and Ehrlichia spp. targeting the 16S rRNA gene. Thirty-five per cent (25 deer and two fallow deer) tested positive (sera with a titer ≥1:64) for IgG antibodies against Rickettsia conorii. No rickettsial DNA was detected by PCR for the ompB gene, and all DNA samples tested negative for Anaplasma and Ehrlichia. As far as we know, this study is the first screening of cervid species in Portugal for Rickettsia antibodies. The findings suggest that these animals serve as useful sentinel indicators for the circulation of rickettsiae, offering a complementary perspective to studies focused on ticks. The increasing numbers of hunted deer in Portugal and the potential zoonotic features of Rickettsia spp. highlight the importance of continued surveillance directed at tick-borne diseases, especially those involving wild animals.

Rhipicephalus sanguineus from Hungarian dogs: Tick identification and detection of tick-borne pathogens.

The brown dog tick, Rhipicephalus sanguineus is a complex of tick species with an unsettled species concept. In Europe, R. sanguineus is considered mainly a Mediterranean tick with sporadic findings in central and northern Europe. R. sanguineus is known as a vector of a range of pathogens of medical and veterinary importance, most of which not yet reported as autochthonous in Hungary. A total of 1839 ticks collected by veterinarians from dogs and cats were obtained in Hungary. The study aims at precise determination of ticks identified as R. sanguineus and detection of pathogens in collected ticks. All ticks were morphologically determined and 169 individuals were identified as R. sanguineus. A subset of 15 ticks was selected for molecular analysis (16S rDNA, 12S rDNA, COI). Phylogenetic analyses invariably placed sequences of all three markers into a single haplotype identified as R. sanguineus sensu stricto. All 169 brown dog ticks were tested for the presence of A. platys, E. canis, R. conorii, B. vogeli and H. canis. None of the investigated ticks was positive for the screened pathogens, though A. phagocytophilum sequence was detected in a single tick.

Linfadenopatías por picaduras de garrapatas: a propósito de dos casos / Lymphadenopathy by tick bite: concerning two cases

Muchos niños manifiestan linfadenopatías en algún momento de su infancia, debidas sobre todo a enfermedades infecciosas. Es precisa una buena historia clínica, exploración física y pruebas complementarias que permitan su diagnóstico diferencial. Se describen los casos de dos niños que presentaban un cuadro clínico similar de linfadenopatías regionales, sin fiebre ni exantemas. Ambos tenían como antecedente la picadura de garrapata en el cuero cabelludo. El cuadro clínico y la serología positiva a rickettsias nos llevaron al diagnóstico de linfoadenopatía transmitida por garrapatas, TIBOLA, DEBONEL o SENLAT. El diagnóstico serológico en nuestros casos se encuentra limitado por la existencia de reacciones cruzadas con las distintas especies de rickettsias, en concreto con R. conorii (que es la habitualmente detectada en nuestro medio) e incluso con otras bacterias. La evolución de ambos casos fue favorable con tratamiento de azitromicina durante cinco días. Pese a la dificultad que supone la interpretación de los resultados serológicos, el diagnóstico de esta rickettsiosis se puede hacer a la luz de los datos clínicos y epidemiológicos. Debe plantearse la utilización simultánea de otras técnicas para aumentar la sensibilidad diagnóstica como pueden ser en la actualidad las técnicas de reacción en cadena de la polimerasa en biopsia cutánea que nos darán el diagnóstico etiológico de la infección

Many children manifest lymphadenopathy at some point in their childhood, mainly due to infectious diseases. A correct clinical history, physical examination and complementary tests are required to allow differential diagnosis. We describe the cases of two children who presented a similar clinical presentation of regional lymphadenopathies without fever or rash. Both had as antecedent the tick bite on the scalp. The clinical presentation and the positive serology to Rickettsias led us to the diagnosis of lymphadenopathy transmitted by ticks, TIBOLA, DEBONEL or SENLAT. The serological diagnosis in our cases is limited by the existence of cross reactions with the different species of Rickettsias in particular with R. conorii (which is the one usually detected in our environment) and even with other bacteria. The evolution of both cases was favorable with treatment of azithromycin for five days. Despite the difficulty involved in the interpretation of serological results, the diagnosis of this rickettsiosis can be made in the light of clinical and epidemiological data. It should be considered the simultaneous use of other techniques to increase diagnostic sensitivity, such as PCR techniques in skin biopsy that will give us the etiological diagnosis of the infection

Rickettsia conorii: causa inusual de diarrea / Rickettsia conorii: Unusual cause of diarrhoea

No disponible

Espectro de las enfermedades transmitidas por garrapatas / Spectrum of thick-borne diseases

No disponible

Retinitis por Rickettsia conorii, una infección emergente en el sureste de la península ibérica / Rickettsia conorii retinitis: an emerging infection in the southeast of the Iberian Peninsula

CASO CLÍNICO: Se presenta un caso de un paciente de 60 años con pérdida de agudeza visual de ambos ojos tras un cuadro de fiebre y erupción cutánea con afectación palmo plantar. Tras una exploración completa y las pruebas complementarias pertinentes se llegó al diagnóstico de retinitis en el contexto de infección por Rickettsia conorii. Se expone la evolución tras el tratamiento con doxiciclina y prednisona a las seis semanas con una mejora anatómica y funcional significativa. La rickettsiosis es una zoonosis emergente que puede presentar afectación ocular. Ésta suele ser una retinitis multifocal que afecta al polo posterior con un desprendimiento seroso macular y vitritis. La sospecha clínica necesitará de una confirmación serológica para el diagnóstico definitivo. El tratamiento con antibióticos y corticoesteroides ha demostrado ser efectivo. Habrá que tenerla en cuenta en áreas endémicas mediterráneas y en periodo estival, donde el riesgo es mucho mayor

CASE REPORT: A case is presented of a 60-year-old patient with loss of visual acuity in both eyes after fever and skin rash with palmoplantar involvement. After a complete examination and relevant complementary tests, the diagnosis of retinitis was made in the context of Rickettsia conorii infection. The evolution after treatment with doxycycline and prednisone at six weeks with significant anatomical and functional improvement is presented. Rickettsiosis is an emerging zoonosis that can present with ocular involvement. This is usually a multifocal retinitis affecting posterior pole with macular serous detachment and vitritis. Clinical suspicion will require serological confirmation for a definitive diagnosis. Treatment with antibiotics and corticosteroids has been shown to be effective. It should be taken into account in Mediterranean endemic areas, and in in the summer period, where the risk is much higher

TIBOLA: presentación de un caso clínico de esta entidad emergente / TIBOLA: reporting of a new clinical case of this emergent entity

Las rickettsiosis se encuentran dentro de las denominadas enfermedades emergentes. En nuestro país, el principal agente etiológico es Rickettsia conorii, que produce, en los meses de verano, una característica costra negra en el punto de inoculación y se acompaña de fiebre y exantema cutáneo. Algunas especies recientemente descubiertas de Rickettsia, como Rickettsia slovaca, producen cuadros clínicos con características diferentes respecto a la fiebre botonosa mediterránea. Ante un cuadro de linfadenitis y antecedente de picadura de garrapata debe sospecharse el cuadro clínico conocido como TIBOLA (tick-borne lymphadenopathy) o DEBONEL (Dermacentor-borne, necrosis, erithema, lymphadenopathy). El principal vector, Dermacentor marginatus, se encuentra en toda España, aunque la mayoría de casos publicados proceden del norte del país. Describimos el caso de un niño de 3 años de edad, con un bultoma cervical anterior de gran tamaño, localizado en la línea media, y se analizan los hallazgos clínicos y analíticos encontrados, así como el diagnóstico serológico (AU)

Rickettsioses are emerging diseases. In our country, the main causative agent is Rickettsia conorii. Some of the pathogenic species of Rickettsia, like Rickettsia slovaca, cause clinical profile with different characteristics respect to the Mediterranean spotted fever. In presence of lymphadenopathy and inoculation eschar associated should be suspected the clinical profile known as TIBOLA (tick-borne lymphadenopathy) or DEBONEL (Dermacentor-terminal, necrosis, erithema, lymphadenopathy). The main vector, Dermacentor marginatus, is found throughout Spain, although most of published cases are from the north of the country. We report the case of a 3 years old male with middle-sided cervical adenopathic conglomerate, and discusses the clinical and analytical findings and diagnosis confirmation with serological test(AU)

¿Dónde está la garrapata? Crucero & casa (resuelto en Atención Primaria) / Where is the tick? Cruise & home (resolved in primary health care)

Trabajar en Atención Primaria supone pensar en las patologías más frecuentes que se dan en nuestro entorno. Un paciente joven que presenta úlceras genitales nos hace pensar en una infección de transmisión sexual. Sin embargo, la falta de respuesta al tratamiento empírico correcto y los resultados de la serología muestran el diagnóstico definitivo: fiebre botonosa mediterránea, con una localización poco común. Debemos recordar que una enfermedad común en nuestro medio puede parecerse a otra igualmente común, por lo que una correcta historia clínica será fundamental para distinguirlas (AU)

Working in primary health care means thinking about the most common pathologies which we encounter in our workplace. A young patient with genital ulcers makes us think of a sexually transmitted infection. However, the lack of response to the correct empirical treatment and serology results show a definitive diagnosis: Mediterranean spotted fever (also known as boutonneuse fever), with a rare location. It should be remembered that a commonly occurring disease in our environment may resemble another equally common one, thus a correct clinical history is fundamental in order to distinguish them (AU)

'Tache noire': clave diagnóstica en un exantema febril / 'Tache noire': diagnostic clue in a febrile exanthem

No disponible

Evidencia clínica y serológica de rickettsiosis canina en Chile / Clinical and serological evidence of canine rickettsiosis in Chile

En Chile, no se han documentado infecciones por Rickettsias en mascotas; algunas de ellas tienen importante potencial zoonótico. Objetivos: Reportar dos casos de rickettsiosis canina con confirmación serológica y determinar seroprevalencia de Rickettsia sp un grupo de caninos. Métodos: IgG anti-Rickettsia conorii y anti-Anaplasma phagocitophilum por IFI en dos caninos con cuadro clínico sugerente de rickettsiosis. Determinación de IgG anti-R. conorii en 77 caninos. Resultados: Como casos clínicos hubo un canino con fiebre, mialgias y melena y otro con manifestaciones he-morrágicas y compromiso neurológico. Seroprevalencia: 35% de los caninos presentaban IgG anti-Rickettsia. Discusión: Se reporta por primera vez en Chile la presencia de rickettsiosis canina, tanto clínica como serológica. Se documenta co-infección por Rickettsia y Anaplasma, dos agentes transmitidos por garrapatas. Es necesario realizar estudios de biología molecular para confirmar la especie de rickettsia presente en Chile. Además, debe estudiarse el rol zoonótico de estas infecciones en nuestro medio.

Rickettsial infections in pets have not been documented in Chile. Some of those infections have relevant zoonotic potential. Objectives: To report two serologically confirmed cases of canine rickettsiosis. To determine seroprevalence to Rickettsia sp in a group of dogs. Methods: IgG antibodies anti-R. conorii and anti-A. phagocitophilum by IFI in two dogs with clinical rickettsiosis. IgG antibodies anti-R. conorii in a group of 77 dogs. Results: Clinical cases: a dog presented with fever, myalgias and melena, another dog with bleeding and neurological involvement. Seroprevalence: 35% of the dogs had antibodies against Rickettsia. Discussion: This is the first evidence of canine rickettsiosis in Chile, both clinical and serological. Co-infection with two tickborne agents: Rickettsia and Anaplasma, is documented. Molecular studies are needed to confirm the rickettsial species present in Chile. The zoonotic role of these infections must be also studied.

Nen amb adenopaties doloroses occipitals i febreta: TIBOLA / A child with tender occipital limph nodes the low-grade fever: Tibola

Las enfermedades transmitidas por garrapatas son poco frecuentesen nuestro medio, aunque el antecedente de picadura y la presenciade síntomas como la fiebre y el rash obligan a descartar lafiebre botonosa o la enfermedad de Lyme.Una enfermedad emergente es la llamada TIBOLA o DEBONEL, quese presenta como una linfadenitis occipital con escara en el cuerocabelludo. Es una enfermedad transmitida por garrapatas que sepuede diagnosticar por las características clínicas que presenta.Se describe el caso de un niño de 9 años que consulta por adenopatíasdolorosas en zona occipital y cervical posterior y febrícula.Nen amb adenopaties doloroses occipitalsi febreta: TIBOLAAsunción Clopés, Rosa Rovira, Manuel Andrés Samper, Francisco J. Sanchís, Luis-EnriqueDelgado, Pilar TerradasServei de Pediatria. Pius Hospital de Valls. Valls. TarragonaEl diagnóstico de sospecha ante la presencia de escara en el cuerocabelludo y el antecedente de picadura de garrapata se confirmópor una serología cruzada positiva a Rickettsia conorii. Se efectuótratamiento con eritromicina con buena respuesta clínica y conuna alopecia cicatricial como secuela.Esta enfermedad está provocada por Rickettsia slovaca, germentransmitido por garrapatas, siendo un cuadro con pocas referenciasen nuestro medio, habitualmente por confundir la reacciónadenopática con una sobreinfección bacteriana.Ante un paciente con adenitis occipital y el antecedente de picadurapor garrapata y/o escara en el cuero cabelludo el diagnósticode TIBOLA es el más probable(AU)

Tick-borne diseases are rare in our environment; for usual differentialdiagnosis of, fever and rash in the presence of history oftick-bite, boutoneusse fever or Lyme disease should be considered.TIBOLA is an emergent tick-borne disease that presents with occipitallymphadenitis and a scalp eschar; this entity should be easyto diagnose based on its clinical presentation.We describe the case of a 9 year-old boy who presented with tenderoccipital lymphadenopathies and low-grade fever. In the presenceof a scalp eschar and the history of tick-bite, the diagnosisof TIBOLA was suspected, which was confirmed with cross-positiveserology to Rickettsia conorii. Treatment with erythromycin wasadministered, with prompt improvement of the symptoms and theonly sequel of residual alopecia at the eschar site.TIBOLA is caused by Rickettsia slovaca; there are few reports ofthis entity in our region, probably because it is often misdiagnosedas bacterial lymphadenitis.TIBOLA should be suspected in any patient that presents with occipitallymphadenitis and history of tick-bite or scalp eschar(AU)

Infección grave por Rickettsia conorii asociada a síndrome hemofagocítico / No disponible

No disponible

Brote de fiebre exantemática mediterránea por picaduras de garrapatas en una plaza pública / Outbreak of mediterranean exanthematic fever due to tick bites in a public square

No disponible

No disponible