Tick-Borne-Agents Detection in Patients with Acute Febrile Syndrome and Ticks from Magdalena Medio, Colombia

Abstract

Acute febrile illness (AFI) is a morbid condition with a sudden onset of fever with at least seven days of evolution, where no signs or symptoms related to an apparent infection have been identified. In Latin America, a high proportion of disease is typically due to malaria and arboviruses. However, among the infectious etiologies, tick-borne diseases (TBDs) should also be considered, especially in areas where people come into direct contact with these arthropods. This study aims to describe the etiology and epidemiology related to tick-borne agents in patients with AFI and the tick’s natural infection by agents of TBD in the rural tropical Magdalena Medio region in Colombia, and explore the factors associated with the presence of Coxiella burnetii infection. We conduct a cohort study enrolling 271 patients with AFI to detect the bacteria of the genera Anaplasma, Ehrlichia, Coxiella, Rickettsia, Borrelia, and Francisella through molecular techniques, and additionally evaluate the presence of IgG antibodies with commercially available kits. We also conduct tick collection in the patient’s households or workplaces for the molecular screening of the same bacterial genera. Seropositivity to IgG antibodies was obtained for all the bacteria analyzed, with Francisella being the most common at 39.5% (107/271), followed by R. rickettsii at 31.4% (85/271), Ehrlichia at 26.9% (73/271), R. typhi at 15.5% (42/271), Anaplasma at 14.4% (39/271), and Borrelia at 6.6% (18/271). However, these bacteria were not detected by the molecular techniques used. Coxiella burnetii infection was detected in 39.5% of the patients: 49.5% only by phase I and II IgG antibodies, 33.6% only by real-time PCR, and 16.8% had a concordant positive result for both techniques. A total of 191 adult ticks, 111 females and 80 males, were collected and identified as Rhipicephalus sanguineus s.l. and Rhipicephalus microplus. In the 169 adult ticks in which natural infection was evaluated, Ehrlichia spp. was detected in 21.3% (36/169), Coxiella spp. in 11.8% (20/169), and Anaplasma spp. in 4.7% (8/169). In conclusion, we identified the prior exposition to Francisella, Anaplasma, Ehrlichia, Rickettsia, Borrelia, and Coxiella in patients through serological tests. We also detected the infection of C. burnetii using molecular techniques. In the ticks, we identified bacteria of the genera Coxiella, Anaplasma, and Ehrlichia. These results suggest the importance of these zoonotic agents as possible causes of AFI in this region.

The intricate dance: host autophagy and Coxiella burnetii infection

“…Many different species of ticks, fleas, and lice have been identified as potential vectors for C. burnetii , and transmission also occurs through direct contact with infected animals or ingestion of contaminated food products ( Celina and Cerny, 2022 ). Ticks are considered the primary vector host for C. burnetii , with the most common species being Dermacentor variabilis and Rhipicephalus sanguineus ( Cabrera et al, 2022 ; Celina and Cerny, 2022 ). These ticks are known to feed on many different mammalian and avian hosts, and they can transmit C. burnetii to their hosts through their saliva.…”

Etiologies of Zoonotic Tropical Febrile Illnesses That Are Not Part of the Notifiable Diseases in Colombia

“…Exposure to Anaplasma spp. has also been evidenced in different Colombian regions, such as livestock farming workers in Córdoba and Sucre departments [ 88 ], febrile patients from Villeta municipality (Cundinamarca department) [ 85 ], livestock farming workers from San Pedro de Los Milagros (Antioquia department) [ 89 ], and febrile patients from the Magdalena Medio region ( Table 2 ) ( Figure 1 E) [ 90 ]. These findings suggest and reinforce the possibility that at least one human pathogenic Anaplasma sp.…”

“…Seropositivity against Borrelia spp. using B. burgdorferi antigens has been reported in patients in a hospital in Cali (Valle Del Cauca) [ 94 ]; rural workers from the municipalities of Monteria, Cereté, Lorica, and Cotorra (Córdoba department) [ 93 ]; and febrile patients from Puerto Berrio, Puerto Nare, and Cimitarra municipalities (Antioquia and Santander departments) [ 90 ]. However, these serological data must be interpreted carefully due to cross-reactivity among Borrelia spp.…”

“…Furthermore, several serological studies have evidenced exposure to Ehrlichia spp. in Antioquia department among livestock farmers from the North and Magdalena Medio regions [ 95 ] and San Pedro de Los Milagros municipality [ 89 ], and among febrile patients from the Magdalena Medio region ( Table 2 ) ( Figure 1 I) [ 90 ]. In addition, E. canis has been confirmed from dogs samples in several regions, including the Cauca department [ 161 ], where a comprehensive study was performed, revealing that humans are not usually infected by this species [ 162 ].…”

Etiological characterization of acute undifferentiated febrile illness in Apartadó and Villeta municipalities, Colombia, during COVID-19 pandemic

“…Furthermore, AUFI has been referred to using different names depending on the authors and the geographical region. Some of the most used names are "acute febrile illness", "acute fever of unknown origin", "short-term febrile illness", "acute undifferentiated fever", "undifferentiated tropical febrile illness", "tropical fever" and "acute febrile syndrome" highlighting the difficulties in identifying a specific etiology for these short lived febrile illnesses in the tropics [5][6][7][8][9][10]. Although AUFI can be a self-limited or a shortterm illness, it can also develop into a more severe, potentially lethal disease that requires prompt recognition.…”