Brazilian Spotted Fever: A Case Series from an Endemic Area in Southeastern Brazil

Abstract

This case series study is based on a retrospective review of medical records and case notification files of patients admitted to The Hospital das Clínicas da UNICAMP from 1985 to 2003 with a confirmed diagnosis of BSF either by fourfold rise in indirect immunofluorescence assay (IFA) titers of IgG antibodies reactive with R. rickettsii or isolation of R. rickettsii from blood or skin specimens. A median lethality of 41.9 % was observed between 1985 and 2004. The case-fatality ratio of 30 % in our study, lower than the overall São Paulo state ratio, could be explained by a higher index of suspicion and a larger experience in our hospital, a regional referral center for BSF. The presence of the classical triad of fever, rash, and headache as described in RMSF was observed in fever than half (35.2%) of our patients.

Infección por rickettsia en capibaras (Hydrochoerus hydrochaeris) de São Paulo, Brasil: evidencia serológica de infección por Rickettsia bellii y Rickettsia parkeri

“…In the pre-antibiotic era, mortality rates of BSF were nearly 80% (3). Currently, in the Brazilian state of São Paulo, mortality rates can reach 40% (4). In addition to R. rickettsii, another pathogenic tick-borne rickettsia occurring in Brazil is R. parkeri.…”

Experimental infection of dogs with a Brazilian strain of Rickettsia rickettsii: clinical and laboratory findings

“…Common clinical signs and symptoms are fever, nausea, vomiting, rash, myalgia, anorexia and headache. The case-fatality rate is 5-10% in the United States and 10-40% in Brazil , Angerami et al 2006, Chapman et al 2006.Like humans, dogs are also susceptible to R. rickettsii infection. However, despite the wide distribution of R. rickettsii in the Western Hemisphere, reports of R. rickettsii-induced illness in dogs have been restricted to the United States, where the following clinical abnormalities have been observed: fever, lethargy, anorexia, depression, cutaneous petechiae and echymoses, epistaxis, conjunctivitis, ocular discharge, lymph node enlargement, diarrhea, weight loss, dehydration and central nervous system involvement (mostly paraparesis or tetraparesis, ataxia and vestibular syndrome).…”

Spotted fever group Rickettsia infecting ticks (Acari: Ixodidae) in the state of Santa Catarina, Brazil

“…Therefore, these cases cannot be considered confirmed cases of R. rickettsii infection. However, the severe clini- cal signs, high fatality rate and epidemiological data suggest that most of these cases were caused by R. rickettsii (Lemos et al 2001, Angerami et al 2006a. In fact, a few of these infections were investigated more thoroughly using molecular methods and were confirmed to be caused by R. rickettsii (Nascimento et al 2005, Rozental et al 2006, Lamas et al 2008).…”