Fiebre manchada de montañas rocosas: experiencia en 5 años de vigilancia activa en un hospital pediátrico de segundo nivel en el noreste de México

Abstract

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.

Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019

“…For these reasons, we compared PCR-positive cases to those with only a positive IFA result and identified substantial differences between these groups. The clinical characteristics of PCR-positive case-patients in Mexicali matched closely with those described for well-characterized series from Arizona, USA, and Coahuila and Sonora, Mexico ( 3 , 22 , 36 , 37 ). In contrast, case-patients with a single IgG titer were less likely to demonstrate many of the classical characteristics of RMSF, including rash, myalgia, abdominal pain, nausea, and vomiting.…”

“…These highly lethal outbreaks, ignited by unchecked canine populations that supported massive peridomestic infestations by brown dog ticks, resulted in high attack rates among women and children and ended in death for most infected patients (13,18,19). Contemporary outbreaks in Sonora and Coahuila also involve predominantly economically vulnerable populations and are particularly devastating among children, for whom mortality rates range from 30% to 57% (13,(20)(21)(22). The Mexicali epidemic is similarly represented by a large number of pediatric patients and a nearly 37% case-fatality rate among PCR-positive cases.…”

Is Rocky Mountain spotted fever the only disease of the spotted fever group rickettsioses found in Mexico?

“…RMSF has been widely documented in the country. However, unlike the clinical characteristics reported in these publications (which are usually similar), national case fatality rates (CFRs) vary between 20.2% and 92% 1,3 , remaining high even when doxycycline is administered in the first 5 days of evolution 3 . Such differences are even more significant when compared to those published by the United States, where the CFR is < 1% 4 .…”

“…Dear Editor, We have read with great interest the articles published in your journal about the experience in the states of Coahuila and Sonora concerning pediatric cases of Rocky Mountain spotted fever (RMSF) 1,2 , which allows us to comment on aspects of the epidemiological and clinical relevance of this disease.…”

Rocky Mountain spotted fever in a pediatric hospital in northeastern Mexico

“…I have read with great interest the work on the treatment experience of Rocky Mountain spotted fever (RMSF) in a pediatric hospital in Saltillo, Coahuila 1 , which reports relevant facts that allow me to comment on some aspects of the disease in our environment. The reported overview is similar to the experience we have had in the state of Sonora.…”