Molecular detection and clinical characteristics of Bartonella bacilliformis, Leptospira spp., and Rickettsia spp. in the Southeastern Peruvian Amazon basin

Abstract

BackgroundAcute febrile illness (AFI) represent a significant health challenge in the Peruvian Amazon basin population due to their diverse etiologies and the unavailability of specific on-site diagnostic methods, resulting in underreporting of cases. In Peru, one of the most endemic regions to dengue and leptospirosis is Madre de Dios, a region also endemic to emergent bacterial etiologic agents of AFI, such as bartonellosis and rickettsiosis, whose prevalence is usually underreported.We aimed to molecularly identify the presence of Leptospira spp., Bartonella bacilliformis, and Rickettsia spp. by Polymerase Chain Reaction in serum samples from patients with AFI from Puerto Maldonado-Madre de Dios in Peru.MethodsSerum samples from patients with acute febrile illness were analyzed by real-time PCR for detecting the presence of Bartonella bacilliformis, Leptospira spp. and Rickettsia spp.ResultsBartonella bacilliformis was the most prevalent bacteria identified in 21.6% (30/139) of the samples, followed by Leptospira spp. in 11.5% (16/139) and Rickettsia spp. in 6.5% (9/139) of the samples. No co-infections were observed between these bacteria. The most frequent symptoms associated with fever among all groups, were headaches, myalgias, and arthralgias. We found no statistically significant differences in the clinical presentation between patients infected with each bacterium.ConclusionsIn a previous study, we shown the presence of dengue, chikungunya, Zika and oropouche virus. We were able to identify these pathogens in 29.5% of all the samples, with chikungunya and OROV as the most frequently found in 9.4 and 8.6% of all the samples, respectively. In this study we show that B. bacilliformis (21.6%), Leptospira spp. (11.5%) and Rickettsia spp. (6.5%) accounted for the main etiologies of AFI in samples from Puerto Maldonado-Madre de Dios, Perú. Our analysis of their clinical presentation, further shows the importance of implementing more sensitive and specific on-site diagnostic tools in the national surveillance programs.This study confirms that the un-specificity of signs and symptoms is not only associated with arboviral infections, but also with the clinical presentation of endemic bacterial infections.

Leptospirosis in febrile patients with suspected diagnosis of dengue fever

“…On the other hand, we could not determine the etiological agent in half of the patients studied. The detection of two pathogens of interest was evaluated, however, other emerging and re-emerging infectious pathogens causative of AFI have become more prevalent in our country, such as Zika virus, Chikungunya virus, Mayaro virus, Oropouche virus, Rickettsia spp, Bartonella spp, among others [ 32 – 34 ].…”

Dubious presence of Bartonella bacilliformis in ticks from Madre de Dios, Peru

“…This idea is reinforced with our last publication, where B. bacilliformis is identified in 30 samples of sera from patients with febrile syndrome in Madre de Dios [16].…”

“…Additionally, in our study we used PCR real time which has an advantage when compared to the method like the thick drop or conventional PCR which was used during this surveillance period, as it is expressed in the following official document: NTS N° 048 -MINSA/DGSP - V [15]. This idea is reinforced with our last publication, where B. bacilliformis is identified in 30 samples of sera from patients with febrile syndrome in Madre de Dios [16]. Due to the presence of B. bacilliformis in ticks in Madre de Dios and the high prevalence of patients with febrile syndrome, we conducted a second investigation to describe the presence and under-reporting of Bartonellosis in the Peruvian Amazon Basin.…”

Unidentified dengue serotypes in DENV positive samples and detection of other pathogens responsible for an acute febrile illness outbreak 2016 in Cajamarca, Peru

“…Regarding bacterial pathogens, 26 important emerging and reemerging bacterial infectious diseases have been described worldwide in the last 50 years; Bartonella and Rickettsia being among the most important causes of AFI [14]. Both pathogens are frequently reported in different regions of Peru, moreover studies have identified the presence of underported Rickettsia species in humans in four regions of the Peruvian territory [15,16,18].…”