Atypical fulminant Rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and Adult Respiratory Distress Syndrome

Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6% (7 samples (WHO 1993, Rozental et al. 2002, Walker 2004a. Until recently the rickettsiales order comprised the genus Rickettsia, Coxiella, Bartonella, Orientia, Anaplasma, and Ehrlichia (Raoult & Roux 1997) and despite of the resulting withdraw of some of them from this order especially due to 16S rRNA studies, they all can be functionally considered rickettsial agents (Raoult & Roux 1997, Walker 2004b.Most of the available publications of Brazilian rickettsial infections have focused on spotted fever group rickettsioses especially R. rickettsii infections (Lemos et al. 1994, Del Guercio et al. 1997, Rozental et al. 2002, Galvão et al. 2003. This issue has been extensively reviewed recently by Galvão (2004). Despite of the fact that new rickettsial agents have been described more recently in Brazil (Oliveira et al. 2002), the whole scenario of rickettsial infections still have black holes reinforcing the nonexistence concept for such infections in this part of the world.The Piau county as well as the southern part of the state of Minas Gerais had been considered free of any rickettsial diseases until 1994 when a family cluster of Brazilian spotted fever was reported (Hallack et al. 1996). Thereafter reports of Brazilian spotted fever have been Given these above mentioned facts and the much-appropriated local ecologic conditions for rickettsial infections we choose this particular region for studying the seroprevalence rates for R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis as well as R. rickettsii infections among healthy individuals from a Brazilian rural community. MATERIALS AND METHODSSerum samples from 437 healthy individuals of both sexes aged from 5 to 92 years old, living in the county of Piau, state of Minas Gerais, Brazil were tested for the presence of R. rickettsii, R. typhi, C. burnetii phase I and phase II, B. henselae, B. quintana, and E. chaffeensis IgG and IgM antibodies. This county (Fig. 1), located at latitude 21º30'34''S and longitude 43º19'25''W, has 3008 inhabitants, 58% of them living in the small village and the remainders scattered throughout the county, mostly in small farms. The local economics is somehow linked to cattle farming and the entire population has continuous contact with several domestic animals. Tick attack history is widespread affecting roughly 100% of the population. From March to April 2001, health officials offe...

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“…Thereafter reports of Brazilian spotted fever have been increasing in the Piau county and neighborgwoods (Costa et al 2002).…”

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confidence: 99%

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Costa

Brigatte

Greco

2005

Mem. Inst. Oswaldo Cruz

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“…This shows that the distribution of the pathogen is very high. Though rickettsiosis is not a life threatening disease in most cases, it can lead to severe or fatal disease in vertebrate animals as well as in humans (Azad and Beard, 1998;Costa et al, 2002;Nadchatram, 2008). The distribution of this pathogen in the reservoirs is useful in control of the disease and for taking precautionary measures in high rick localities.…”

Section: Discussionmentioning

confidence: 99%

Rickettsiae reservoirs among small mammals (Rats, Mice And Shrews) and their Arthropod Vectors in Sri Lanka

2018

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Rickettsioses are a group of emerging diseases caused by closely related bacteria. In Sri Lanka, to date, studies have been focused mainly on human subjects. The present study aimed to identify small mammal reservoir hosts and vectors of Rickettsia spp. and Orientia tsutsugamushi in two districts of Sri Lanka. Quantitative-PCR was carried out to detect Rickettsia using citrate synthase gene and Orientia using 47-kD outer membrane protein antigen gene in blood of small rodents and their infested ectoparasites. In both districts ~7.5% blood samples were positive for Rickettsia. Rattus rattus, Bandicota indica and Mus fernandoni were carriers. Three individuals of Suncus murinus, B. indica and Golunda ellioti had only infected ectoparasites. Copies of gltA/100 µL ranged from 133-1.2 × 10 4 in blood and 197-1.9 × 10 7 in ectoparasites. Of small mammals with ectoparasites, 43% had Rickettsia positive ectoparasites. Rhipicephalus haemaphysaloides, Ixodes ceylonensis, Haemaphysalis spinigera, Haemaphysalis spp., Stivalius aporus and Xenopsylla cheopis were positive. All study sites except three had infected small mammals or ectoparasites. All samples were negative for O. tsutsugamushi. This is the first study to report Rickettsia spp. in small mammals and their ectoparasites in Sri Lanka. Haemaphysalis spinigera, I. ceylonensis and S. aporus are new records of vectors for Rickettsia. This is also the first report of endemic M. fernandoni as a carrier of Rickettsia and G. ellioti with Rickettsia infected ectoparasites. Though rickettsiosis is not life threatening in most cases, it can lead to severe or fatal disease in vertebrate animals and humans. Hence, the knowledge of the distribution of said pathogen in the reservoirs is essential to control the disease.

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“…This finding confirms previous data showing that the presence of rash was associated with favorable evolution 14 . This probably results from greater diagnostic suspicion in cases with rash, favoring the early and adequate initiation of antibiotic treatment targeting BSF, a crucial factor for preventing death 4,17 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics of Brazilian spotted fever in Minas Gerais State, Brazil, 2000-2008

et al. 2011

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Brazilian spotted fever is the most common rickettsiosis in Brazil, most prevalent in the States of São Paulo and Minas Gerais. The aim of this study was to describe the epidemiological characteristics of Brazilian spotted fever in Minas Gerais from 2000 to 2008. Of the 132 cases of Brazilian spotted fever, 53 patients died, representing a case-fatality rate of 40.2%. Males predominated, with 78.8% of confirmed cases, and median age was 26.5 years. Absence of rash was associated with increased risk of death (p = 0.005). Greater Metropolitan Belo Horizonte, Rio Doce Valley, and Zona da Mata accounted for 70.6% of the cases, which occurred mainly from May to November. There was an increase in the number of cases, which could suggest an expansion of the disease, but probably resulted from an increase in the health system's diagnostic capacity and sensitivity. Despite this improvement, the case-fatality rate remains high and with no apparent tendency to decrease, thus indicating the need for improved prevention and patient care.

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Atypical fulminant Rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and Adult Respiratory Distress Syndrome

Cited by 7 publications

References 29 publications

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Rickettsiae reservoirs among small mammals (Rats, Mice And Shrews) and their Arthropod Vectors in Sri Lanka

Epidemiological characteristics of Brazilian spotted fever in Minas Gerais State, Brazil, 2000-2008

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