First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua

Reller, Megan E.; Chikeka, Ijeuru; Miles, Jeremy J.; Dumler, J. Stephen; Woods, Christopher W.; Mayorga, Orlando; Matute, Armando

doi:10.1371/journal.pntd.0005185

Cited by 17 publications

(23 citation statements)

References 40 publications

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“…14,30 A positive PCR result and/or a seroconversion (³ 4-fold increase in either IgM or IgG titer) was considered a confirmed case. 31,32 Microscopic agglutination test (MAT) for leptospirosis was performed using a set of 24 serovars at the Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, as described elsewhere. 33 The seroconversion was used to determine the positive result.…”

Section: Methodsmentioning

confidence: 99%

Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

Luvira

Silachamroon

Piyaphanee

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Acute undifferentiated febrile illness (AUFI) has been a diagnostic dilemma in the tropics. Without accurate point-of-care tests, information on local pathogens and clinical parameters is essential for presumptive diagnosis. A prospective hospital-based study was conducted at the Bangkok Hospital for Tropical Diseases from 2013 to 2015 to determine common etiologies of AUFI. A total of 397 adult AUFI cases, excluding malaria by blood smear, were enrolled. Rapid diagnostic tests for tropical infections were performed on admission, and acute and convalescent samples were tested to confirm the diagnosis. Etiologies could be identified in 271 (68.3%) cases. Dengue was the most common cause, with 157 cases (39.6%), followed by murine typhus (20 cases; 5.0%), leptospirosis (16 cases; 4.0%), influenza (14 cases; 3.5%), and bacteremia (six cases; 1.5%). Concurrent infection by at least two pathogens was reported in 37 cases (9.3%). Furthermore, characteristics of dengue and bacterial infections (including leptospirosis and rickettsioses) were compared to facilitate dengue triage, initiate early antibiotic treatment, and minimize unnecessary use of antibiotics. In conclusion, dengue was the most common pathogen for AUFI in urban Thailand. However, murine typhus and leptospirosis were not uncommon. Empirical antibiotic treatment using doxycycline or azithromycin might be more appropriate, but cost-benefit studies are required. Physicians should recognize common causes of AUFI in their localities and use clinical and laboratory clues for provisional diagnosis to provide appropriate treatment while awaiting laboratory confirmation.

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Section: Methodsmentioning

confidence: 99%

Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

Luvira

Silachamroon

Piyaphanee

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“… 41 In Nicaragua, the first evidence of SFG rickettsiosis was reported in 2016 from patients in the acute phase of infection, which also included diagnosis of Q fever. 42 In this study, the sample included 825 patients and about 1% was considered positive for SFG rickettsiosis, but specifically RMSF was not confirmed. In Belize, there is only one report that supports SFG rickettsial infection in humans; the study found a seroprevalence of 54% (IFA using R. rickettsii antigen) in a group of healthy pregnant women.…”

Section: Rickettsioses In Central Americamentioning

confidence: 95%

A review of the genus <em>Rickettsia</em> in Central America

Bermúdez

Troyo²

2018

RRTM

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In this paper, we present a historical review of rickettsiosis in Central America and also the most recent findings of Rickettsia in ectoparasites. All countries of Central America have records of rickettsiosis. Regarding the typhus group rickettsioses, there is clinical or serological evidence of Rickettsia prowazekii in Guatemala, Rickettsia typhi in Panama, Guatemala, and Costa Rica and unidentified species of the typhus group in El Salvador. Concerning spotted fever group rickettsiosis, there is serological evidence of infection by Rickettsia akari in Costa Rica and confirmed cases involving Rickettsia rickettsii in Panama and Costa Rica. There are also reports of spotted fever group rickettsiosis in acute patients from Guatemala, Honduras, and Nicaragua. Serological studies in Central America show reactivity of Rickettsia ambyommatis, Rickettsia bellii, Rickettsia felis, Rickettsia rhipicephali, and R. rickettsii in domestic and wild mammals. Eight species of Rickettsia have been detected in ectoparasites from Central America: R. africae (or very similar), R. amblyommatis, R. asembonensis, R. bellii, R. felis, R. parkeri, R. rhipicephali, and R. rickettsii, in addition to undescribed strains such as Atlantic Rainforest, Colombianensi, IbR/CRC, Barva, Aragaoi, and Candidatus “Rickettsia nicoyana;” the latter being the only one associated with Argasidae (Ornithodoros knoxjonesi). R. amblyommatis is the most common species in Central America, seeing as it has been reported in 10 species of ticks and one of fleas in five of the seven countries of the region. In this study, we demonstrate that the genus Rickettsia is widely distributed in Central America and that rickettsiosis could be an underestimated problem in the absence of greater diagnostic efforts in undetermined febrile cases.

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“…A study in Brazil found nine molecularly confirmed Q fever infections among 272 patients suspected of having DENV infection (3.3.%), one of them with co-infection with both agents confirmed [30]. In other Latin American countries, the proportion of fever attributable to Q fever varied from 2% to 5% [1,31]. Patients with C. burnetti pneumonia had more severe symptoms at presentation [29].…”

Section: Q Fevermentioning

confidence: 99%

“…Among the main species associated with human illness in Latin America are Rickettsia rickettsia, Rickettsia parkeri, Rickettsia typhi and Rickettsia massiliae. In surveys of febrile illness, the proportion of rickettsiaattributed fever varied from 0.9% to 18% [9,15,31,36,37]. The casefatality of Rocky Mountain spotted fever ranges between 40% and 95% [38].…”

Section: Rickettsiosismentioning

confidence: 99%

Epidemiology of acute febrile illness in Latin America

Moreira

Bressan

Brasil

et al. 2018

Clinical Microbiology and Infection

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DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.

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First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua

Cited by 17 publications

References 40 publications

Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

A review of the genus <em>Rickettsia</em> in Central America

Epidemiology of acute febrile illness in Latin America

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