Features of Brazilian spotted fever in two different endemic areas in Brazil

Experimental infection of wild boars (Sus scrofa) with Rickettsia rickettsii and evaluation of the transmission potential to Amblyomma sculptum ticks

BACKGROUND

Brazilian spotted fever is a tick-borne disease caused by the bacterium Rickettsia rickettsii, whose main vector in Brazil is the tick Amblyomma sculptum. Amplifying hosts are essential for the perpetuation of this bacterium in the tick population as they can be sources of infection during bacteremic periods. Recent studies demonstrated the ability of suids (Sus scrofa) to sustain populations of A. sculptum, one of the main tick species found parasitizing wild boars in the midwestern and southeastern regions of Brazil. In this study, wild boars were experimentally infected with R. rickettsii by tick infestation and were evaluated for their ability to transmit the infection to A. sculptum ticks, under laboratory conditions.

METHODS

Four wild boars were infected with R. rickettsii through infestation with R. rickettsii-infected A. sculptum adults (infected group); a fifth wild boar was infested with uninfected A. sculptum adults (control group). Simultaneously, the animals were infested with uninfected larvae and nymphs of A. sculptum. The wild boars were monitored for 28 days by clinical examination and hematological tests, real-time quantitative PCR (qPCR) of blood for the detection of Rickettsia and inoculation of blood in guinea pigs. IgG antibody titers were followed until the end of the experiment. Unfed nymphs and adults, molted from engorged larvae and nymphs that fed on wild boars, were used to infest susceptible guinea pigs and rabbits; some of these unfed ticks were tested by qPCR for rickettsial detection.

RESULTS

The wild boars showed no clinical or hematological alterations, and bacteremia was not detected by qPCR or inoculation of wild boar blood into guinea pigs. Furthermore, wild boars showed a moderate humoral response, with anti-R. rickettsii endpoint titers up to 256 or 512. Rickettsial DNA was not detected in molted ticks after acquisition feeding on wild boars. Moreover, no disease or seroconversion was observed in guinea pigs and rabbits that were infested with ticks originated from wild boar acquisition feeding.

CONCLUSIONS

Wild boars seroconverted to Rickettsia spp. after being infested with R. rickettsii-infected A. sculptum; however, they did not develop bacteremia and did not act as competent amplifying hosts of R. rickettsii for A. sculptum ticks.

Do Commercial Insect Repellents Provide Protection against the Tick Amblyomma sculptum (Acari: Ixodidae)?

Amblyomma sculptum is a species of public health interest because it is associated with the transmission of the bacteria that causes Brazilian Spotted Fever (BSF). The use of repellents on humans is a prophylactic measure widely used to provide protection against a series of arthropod vectors, including mosquitoes and ticks. However, in Brazil, the effectiveness of commercial repellents against A. sculptum is little known. Therefore, it is necessary to carry out specific studies to evaluate the repellency of these commercial products, registered for use against mosquitoes, against the star tick. The main goal of the present work was to evaluate the effectiveness of six commercial repellents against A. sculptum. Unfed nymphs, aged between two and eight weeks, were tested against products based on DEET (OFF!® and Repelex®), Icaridin (Exposis® and SBP®), and IR3535 (Johnsons and Henlau). Three bioassays were conducted to evaluate tick behavior: (i) filter paper, (ii) fingertip, and (iii) field. All bases tested showed high repellent activity, differing significantly (p < 0.05) from the control. It was observed the formulation with DEET resulted in the best results in the filter paper bioassay. In the fingertip bioassay, the DEET base repelled a greater number of ticks compared to Icaridin. In the field bioassay, there was no significant difference between the Icaridin base and DEET, and both formulations differed from the control (p < 0.05). The six formulations tested showed significant percentages of repellency against ticks; however, for the fingertip and field bioassays, the products OFF!®, Repelex®, and Exposis® were tested as they showed better performance in the filter paper test. OFF!® showed the best percentage of repellency (100%), followed by Repelex® (96.8%), and Exposis® (93.1%), considering the two-hour period of the bioassay-field-test. Proving the effectiveness of repellents on the market against A. sculptum presented in this study is crucial, since this is the main ectoparasite of humans that can transmit Rickettsia rickettsii when infected. The effectiveness of commercial insect repellents against other tick species that parasitize humans can also be explored.

Capybara Ticks and the Urban Context of Spotted Fever in Brazil: An Overview

Spotted fever is caused by Rickettsia rickettsii and is transmitted through tick’s saliva. Humans, ticks, and capybaras (Hydrochoerus hydrochaeris) are often coexisting in environments that favor the spread of Brazilian spotted fever (BSF). Although capybaras do not transmit R. rickettsii, they can amplify these bacteria among tick vector populations, playing a significant role in the one health approach and epidemiology of the disease. Urban populations of capybaras have increased, especially in Southeast Brazil, as well as the number of cases and lethality of BSF have increased in the country since the 1980s. This expansion is mainly determined by the availability of food and the absence of predators. Thus, urban areas, including parks and university campuses, provide an abundance of food and protection against predators, ensuring the multiplication of the species and increasing the risk of transmission to humans due to the proximity of man with animals in the urban environment. Therefore, this chapter aims to address aspects of spotted fever, considering the many dimensions of the species involved, contributing to public strategies and policies.

Mapping potential risks for the transmission of spotted fever rickettsiosis: The case study from the Rio de Janeiro state, Brazil

Spotted fever rickettsiosis is a zoonosis transmitted by ticks, having a varied clinical course that can lead to death if not managed properly. In Brazil it is more commonly observed in the Southeast, being an emerging public health problem. Hazard mapping models are common in different areas of knowledge, including public health, as a way of inferring reality and seeking to reduce or prevent damage. The aim of this study is to offer a spatial heuristic methodology for assessing the potential risk of transmission of spotted fever in the Rio de Janeiro state, located in the southeastern region of Brazil. For this, we used geospatial tools associated with eco-epidemiological data related to the clinical profile of the disease. The results achieved were substantially encouraging, considering that there are territories with greater or lesser expectation of risk for spotted fever in the study area. We observed that there are important distinctions between the two rickettsiosis scenarios in the same geographic space and that the areas where there is a greater potential risk of contracting rickettsiosis coincide with the administrative regions that concentrated the cases of hospitalization and deaths from the disease, concluding that the scenery found are relevant to the case series for the disease and that the planning of surveillance actions can gain in quality if the use of this spatial analysis tool is incorporated into the routine of local health management.

Diversity of tick species (Acari: Ixodidae) in military training areas in Southeastern Brazil

Tick-borne pathogens belong to one of the two main groups of occupational biohazards, and occupational exposure to such agents puts soldiers at risk of zoonotic infections, such as those caused by rickettsiae. There are few studies on acarological fauna and occupational risk in military areas in Brazil. Thus, the present study aimed to analyze the diversity of ticks present in the military training areas of municipalities in the Southeast Region of Brazil. The ticks were collected from the selected areas using the dragging and flagging techniques as well as by visual detection on the operators' clothing, and environmental information was also recorded. A total of ten species were collected from the 66 surveyed areas, belonging to five genera and nine species: Amblyomma sculptum, Amblyomma dubitatum, Amblyomma brasiliense, Amblyomma longirostre, Amblyomma aureolatum, Dermacentor nitens, Rhipicephalus spp., Ixodes spp. and Haemaphysalis spp. The frequent presence of tick species in military training areas along with traces and sightings of wild animals, most commonly capybaras (Hydrochoerus hydrochaeris), in most of the studied areas, indicates high levels of exposure of the military to tick vectors of spotted fever group rickettsiae and the possible occurrence of infections among the troops.

Clinical, epidemiological, and laboratory features of Rickettsia africae infection, African tick-bite fever: A systematic review

African tick-bite fever (ATBF), caused by Rickettsia africae, is the main tick-borne rickettsiosis and the second most frequent cause of fever after malaria in travelers returning from sub-Saharan Africa. General descriptions on ATBF were made in the first two decades after recognized as a new infectious entity, and since then, many authors have contributed to the knowledge of the disease by reporting clinical cases in scientific literature. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of confirmed R. africae rickettsiosis cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. A total of 48 scientific publications (108 confirmed cases) were analyzed in order to extract data for developing this review. Overall, our results show that R. africae rickettsiosis is more frequent in males in the age group of 18-64 years, more than 80% of the cases occurred in European travelers, South Africa was the country where most infections were acquired, and almost 40% of cases occurred in clusters. Clinically, more than 80% of the cases had fever and eschar (55% developed multiple eschars), rash was present in less than the half of cases, and lymphangitis was not a common sign (11%). Headache, myalgia and regional lymphadenopathy were predominant nonspecific clinical manifestation (mean of 60%, 49% and 51%, respectively). Our results show that at least 70% of R. africae cases had altered laboratory parameters, most often showing an increase in transaminases and C-reactive protein. Tetracycline-class antibiotics, as monotherapy, were used in most (>90%) of the patients. Overall, only 4% of cases had complications, 12% required hospitalization, and there was a 100% rate of clinical recovery.

Ticks on humans in an Atlantic rainforest preserved ecosystem in Brazil: Species, life stages, attachment sites, and temporal pattern of infestation

We herein describe exposure and tick attachment to researchers and field staff within the greatest preserved inland Atlantic rainforest, located in Brazil, over a non-consecutive period of five years. Overall, 433 ticks from five species were collected, Amblyomma coelebs (n = 281), Amblyomma brasiliense (n = 79), Amblyomma incisum (n = 43), Amblyomma ovale (n = 4), Haemaphysalis juxtakochi (n = 4). Clusters of larvae belonged to the genus Amblyomma (n = 21) and Haemaphysalis (n = 1). Both Haemaphysalis and Amblyomma species were observed crawling on humans but only ticks from the latter genus were found attached. Most recovered ticks (59%) were found attached and, whereas A. brasiliense was the main host-seeking tick species in the forest, A. coelebs nymphs were the ones that overwhelmingly attached to humans (70% of all attachments). At the same time only 0.4% of human bites were of A. ovale, the Rickettsia parkeri strain Atlantic rainforest vector tick in Brazil. Tick attachment sites were recorded for 132 ticks and lower/upper limbs and the trunk were more parasitized than the head/neck. Tick bites were recorded throughout the year; while larvae did not show an evident seasonal pattern, nymphs attached to humans mainly in autumn and winter and the few adult bites were recorded in spring. Our results highlighted A. coelebs nymphs as major human-biters and evidenced the necessity of studies that discern human tick bites that occur after exposure to host-seeking ticks from those that occur after tick displacement from hosts that carry ticks to human dwellings.

Domestic dogs as amplifying hosts of Rickettsia rickettsii for Amblyomma aureolatum ticks

Brazilian spotted fever (BSF) is an acute infectious disease caused by the bacterium Rickettsia rickettsii, which is transmitted by different tick species. Due to deleterious effects caused on ticks, the horizontal transmission of R. rickettsii through amplifying hosts is crucial for its maintenance in tick populations among BSF-endemic areas. The tick Amblyomma aureolatum is the main vector of R. rickettsii in the São Paulo metropolitan area; nevertheless, it is not known which vertebrate could act as an amplifying host for this tick species. Herein, we evaluated the potential of domestic dogs - primary hosts for A. aureolatum adults in BSF-endemic areas - to act as amplifying hosts. For this purpose, A. aureolatum non-infected adults were allowed to feed on two groups of dogs: the control group (G1), composed of one dog not exposed to R. rickettsii; and, the infected group (G2), composed of three dogs infected with R. rickettsii via tick parasitism. All G2-dogs became ill, seroconverted to R. rickettsii, and rickettsial DNA was detected in 87% of the engorged females that fed on them. Transovarial transmission rate was estimated to be 25% and infected larvae successfully transmitted R. rickettsii to guinea-pigs, confirming transovarial transmission and vector competence. No rickettsial DNA was detected in individual samples of eggs or larvae, which precluded the estimation of filial infection rate, but implies that it was low. Our results suggest that domestic dogs act as amplifying hosts of R. rickettsii for A. aureolatum ticks in BSF-endemic areas in Brazil.

Rickettsia parkeri with a Genetically Disrupted Phage Integrase Gene Exhibits Attenuated Virulence and Induces Protective Immunity against Fatal Rickettsioses in Mice

Although rickettsiae can cause life-threatening infections in humans worldwide, no licensed vaccine is currently available. To evaluate the suitability of live-attenuated vaccine candidates against rickettsioses, we generated a Rickettsia parkeri mutant RPATATE_0245::pLoxHimar (named 3A2) by insertion of a modified pLoxHimar transposon into the gene encoding a phage integrase protein. For visualization and selection, R. parkeri 3A2 expressed mCherry fluorescence and resistance to spectinomycin. Compared to the parent wild type (WT) R. parkeri, the virulence of R. parkeri 3A2 was significantly attenuated as demonstrated by significantly smaller size of plaque, failure to grow in human macrophage-like cells, rapid elimination of Rickettsia and ameliorated histopathological changes in tissues in intravenously infected mice. A single dose intradermal (i.d.) immunization of R. parkeri 3A2 conferred complete protection against both fatal R. parkeri and R. conorii rickettsioses in mice, in association with a robust and durable rickettsiae-specific IgG antibody response. In summary, the disruption of RPATATE_0245 in R. parkeri resulted in a mutant with a significantly attenuated phenotype, potent immunogenicity and protective efficacy against two spotted fever group rickettsioses. Overall, this proof-of-concept study highlights the potential of R. parkeri mutants as a live-attenuated and multivalent vaccine platform in response to emergence of life-threatening spotted fever rickettsioses.

Space use and activity of capybaras in an urban area

Due to the rapid growth of urban environments, interactions between animals and humans in cities are increasingly common. Large mammals, such as capybaras (Hydrochoerus hydrochaeris), provide benefits to people and biodiversity of urban areas, but can also result in conflicts, such as animal–vehicle collisions or disease transmission. As a consequence, understanding the space use of urban capybara, and the effect of human activity on capybaras, is conducive to the promotion of coexistence. We studied the home range and the role of human disturbance on activity and habitat selection of urban capybaras in the city of Campo Grande (Brazil). We monitored nine groups of capybaras living at four parks: two parks subjected to high human visitation on workdays and two on weekends. Home range of the urban capybaras in the study is larger than those reported in previous studies of wild capybaras. The capybaras under study presented a bimodal activity pattern, which was delayed on days of high human presence, increasing animals’ nocturnality. In addition, habitat selection was completely altered on days of high human presence, leading animals to increase avoidance of urban areas and reversing the selectivity patterns for forests, grasslands, and water bodies, that capybaras show on days with low human presence. Even when completely surrounded by an anthropic environment, our results indicate that a mosaic of grasslands near a water body and forested areas will allow capybaras to maintain daily activity and large home ranges. However, human presence significantly altered the daily activity patterns and habitat selection of capybara. Urban planners should account for these data to improve the coexistence of capybaras with humans and thereby minimize the potential for conflicts.

Clinical, epidemiological, and laboratory features of Rickettsia parkeri rickettsiosis: A systematic review

Rickettsia parkeri rickettsiosis is recognized as the second most prevalent tick-borne disease caused by spotted fever group rickettsiae in the Americas, where two pathogenic strains (R. parkeri sensu stricto and R. parkeri strain Atlantic rainforest) have been related to human infections and transmitted by Amblyomma spp. ticks. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of R. parkeri rickettsiosis, including confirmed and probable cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. We excluded papers that contained missing information of some variables and publications in which it was not possible to separate data for confirmed and probable cases. A total of 77 clinical cases (32 confirmed cases and 45 probable cases) were considered for this review. Overall, our results show that R. parkeri rickettsiosis is more frequent in males in the age group of 18-64 years and that a history of tick exposure was frequent (>90%). Cases were described in the United States, Argentina, Brazil, Uruguay and Colombia. Clinically, more than 60% of the cases had fever (mean of 93%), eschar (mean of 87%), and rash (mean of 68%). Headache and myalgia were predominant nonspecific symptoms (mean of 67% and 61%, respectively). Our results show that at least 60% of R. parkeri cases had altered laboratory parameters, most often showing an increase in transaminases and leukopenia. Tetracyclines-class antibiotics were used in most (>85%) of the patients. Overall, only 9% of cases required hospitalization and there was a 100% rate of clinical recovery in all of cases.

Detection of Rickettsia felis in ectoparasites collected from domestic animals

Ticks and fleas are arthropods widely distributed around the world involved in the transmission of various vector-borne diseases (VBDs), including Brazilian Spotted Fever (BSF), Baggio-Yoshinari Syndrome and the plague, with outstanding consequences for the public health. The aim of this study was to investigate the presence of Rickettsia spp., Borrelia spp. and Yersinia pestis in arthropods collected from dogs, cats and horses living in the state of Pernambuco, Northeastern Brazil. From January 2017 to April 2019, ectoparasites were collected, morphologically identified and molecularly analysed through PCR and sequencing. In total 401 specimens were collected from 86 animals, being 68% (n = 273) and 32% (n = 128) from rural and urban areas, respectively. The most commonly detected species were the ticks Dermacentor nitens, Amblyomma sculptum, Rhipicephalus sanguineus sensu lato (s.l.), Rhipicephalus microplus, and Amblyomma ovale, and the fleas Ctenocephalides felis and Ctenocephalides canis. DNA of Rickettsia felis was detected in D. nitens collected from horses, and C. felis, and R. sanguineus s.l. collected from dogs. All samples scored negative for Borrelia spp. and Y. pestis DNA. This study provides valuable data on ectoparasite fauna from domestic animals and identifies the circulation of a zoonotic pathogen (i.e., R. felis) in the population of the arthropods assessed. Therefore, preventive measures should be adopted in order to reduce the risk of occurrence of neglected VBD caused by this pathogen in animal and human hosts.

Clinical and serological evaluation of capybaras (Hydrochoerus hydrochaeris) successively exposed to an Amblyomma sculptum-derived strain of Rickettsia rickettsii

Brazilian spotted fever (BSF), caused by Rickettsia rickettsii, is the most lethal tick-borne disease in the western hemisphere. In Brazil, Amblyomma sculptum ticks are the main vector. Capybaras (Hydrochoerus hydrochaeris), the largest living rodents of the world (adults weighing up to 100 Kg), have been recognized as amplifying hosts of R. rickettsii for A. sculptum in BSF-endemic areas; i.e., once primarily infected, capybaras develop bacteremia for a few days, when feeding ticks acquire rickettsial infection. We conducted experimental infections of five capybaras with an A. sculptum-derived strain of R. rickettsii and performed clinical and bacteremia evaluation during primary and subsequent infections. Bacteremia was detected in all capybaras during primary infection, but not in subsequent infections. All animals seroconverted to R. rickettsii (titres range: 64-32,768), and remained seropositive throughout the study. Primary infection resulted in clinical spotted fever illness in four capybaras, of which two had a fatal outcome. Subsequent infections in seropositive capybaras resulted in no clinical signs. Capybaras developed a sustained immune response that prevented a second bacteremia. This condition may imply a high reproduction rate of capybaras in BSF-endemic areas, in order to continuously generate capybaras susceptible to bacteremia during primary infection.

Presence of Rickettsia Species in a Marginalized Area of Yucatan, Mexico

In the state of Yucatan, Mexico, rickettsiosis has become a common vector-borne disease in the general population. Ectoparasite species such as Rhipicephalus sanguineus and Amblyomma mixtum have been identified as Rickettsia vectors in Yucatan by studies focused on the wild animal population in rural areas. There have been studies that have tried to determine the presence of Rickettsia species in ectoparasites collected in Yucatan, but these studies did not include marginalized areas, where living in close contact with domestic and peridomestic animals that carry ectoparasites is a high-risk factor for acquiring rickettsial infection or many other vector-borne diseases. We evaluated the vector diversity and the presence of Rickettsia species presence in the ectoparasite population that parasitizes domestic animals in a marginalized rural town of Yucatan, Mexico; we also evaluated the seroprevalence of rickettsial antibodies in the human population of this town in order to determine the prevalence of rickettsial infection. A total of 437 ectoparasites were collected from the study area. The tick specimens collected belonged to the species Rhipicephalus sanguineus (n=380, 49 positive), Amblyomma mixtum (n=3, 0 positive), Ixodes affinis (n=4, 0 positive), Ctenocephalides felis (n=33, 0 positive), and Trichodectes canis (n=17, 0 positive). Conventional polymerase chain reaction and sequencing were used to identify the DNA of Rickettsia. Six out of 354 (1.8%) serum samples were positive for antibody to R. typhi. The combination of low antibody titers and the presence of Rickettsia species infecting ectoparasite species found in the study area requires eco-epidemiological studies and the identification of potentially protective practices or habits.

Fatal case of spotted fever in a patient from Northeastern Brazil

Spotted fevers are diseases caused by bacterial agents belonging to the spotted-fever (SF) group of the genus Rickettsia. The first documented case of SF in Pernambuco State, Northeast Brazil, was reported here. Also, it is the first case described of fatal SF in Northeast region of Brazil. The patient was a resident of Arcoverde municipality and the probable site of infection lies in Sertania municipality, both in Pernambuco State, a semi-arid region of Brazil. The patient had not visited other areas where SF is endemic. The patient showed clinical manifestations and epidemiological exposure compatible with SF, and the infection was confirmed by molecular biology techniques.

Skin manifestations of tick bites in humans

Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Confirming Rickettsia rickettsii as the etiological agent of lethal spotted fever group rickettsiosis in human patients from Espírito Santo state, Brazil

Although Espírito Santo state is considered an endemic area for Brazilian spotted fever (BSF) with related lethal cases, it also constitutes the only state of southeastern Brazil that currently lacks a specific confirmation of the specific rickettsial agent. In an attempt to a species level confirmation of the etiological agent of fatal rickettsiosis cases in Espírito Santo state, in this study we tested human sera obtained between 2015 to 2017 by means of qPCR and subsequent conventional PCR protocols targeting gltA (citrate synthase) and ompA (190-kDA outer membrane protein) rickettsial genes. All samples were found to contain rickettsial DNA through the citrate synthase qPCR protocol. By conventional PCR, rickettsial gltA and ompA specific DNA fragments were detected in 25% (one sample) and 50% (2 samples) of the screened sera, respectively. Obtained consensuses for each gene partial sequences were 100% identical to Rickettsia rickettsii gltA and ompA genes. The present study confirms for the first time R. rickettsii as the etiological agent of a lethal spotted fever group rickettsiosis in human patients from Espírito Santo state.

Predictive Factors for Fatal Tick-Borne Spotted Fever in Brazil

In Brazil, two pathogenic Rickettsia species have been identified causing tick-borne spotted fever (SF). The aetiological agent Rickettsia rickettsii causes serious illness, particularly in the south-eastern region of the country. Moreover, the Rickettsia sp. strain Atlantic Rainforest cause milder clinical manifestations in south-eastern, south and north-east regions. This study has sought to analyse predictive factors for fatal SF. A case-control study was performed using disease notification records in Brazil. The cases included were individuals with laboratory confirmation and fatal progression of SF, while the controls included individuals with SF who were cured. A total of 386 cases and 415 controls were identified (1 : 1.1), and the cases and controls were similar in age. The factors identified as being protective against death were reported presence of ticks (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.88), residing in urban areas (OR, 0.47, 95% CI, 0.31-0.74) and presenting lymphadenopathy (OR, 0.43; 95% CI, 0.23-0.82). Males exhibited a greater chance of death (OR, 1.57; 95% CI, 1.13-2.18), as did patients who were hospitalized (OR, 10.82; 95% CI, 6.38-18.35) and who presented hypotension or shock (OR, 10.80; 95% CI, 7.33-15.93), seizures (OR, 11.24; 95% CI, 6.49-19.45) and coma (OR of 15.16; 95% CI, 8.51-27.02). The study demonstrates the severity profile of the SF cases, defined either as the frequency of hospitalization (even in cases that were cured) or as the increased frequency of the clinical complications typically found in critical patients. Opportune clinical diagnosis, a careful evaluation of the epidemiological aspects of the disease and adequate care for patients are determining factors for reducing SF fatality rates.

Association of the occurrence of Brazilian spotted fever and Atlantic rain forest fragmentation in the São Paulo metropolitan region, Brazil

Brazilian Spotted Fever (BSF) is a zoonotic disease caused by the bacterium Rickettsia rickettsii. In the São Paulo Metropolitan Region (SPMR) it is transmitted by Amblyomma aureolatum ticks. In this region, annual lethality of the disease can reach 80% and spatial occurrence depends on environmental factors and more particularly on the presence and interaction of domestic and wild carnivores as well as the presence and characteristics of the remnant Atlantic Rain Forest patches. This study analyzed the association between forest fragmentation and its influence on the risk of occurrence of the disease in the human population. Domestic dogs tested for R. rickettsii antibodies in nine different areas under the influence of different patterns of Rain Forest fragmented landscapes and human occupancy. Landscape metrics were obtained by analyzing satellite images and high-resolution orthophotos. Principal component analysis (PCA) was used to determine among the different landscape variables the one that could best explain the data variance, and the results were tested against canine seroprevalence in order to address disease occurrence risk levels. From 270 canine samples, the seroprevalence ranged from 0 to 37%. PCA showed an inverse correlation between functionally connected large forest patches and the canine seroprevalence for R. rickettsii (p=0.030; Spearman's R=-0.683), while there was a positive correlation between forest border effect and canine seroprevalence (p=0.037; Spearman's R=- 0.909). The further attributed disease occurrence risk level supported the real spatial prevalence of the disease reported for the last eight years (p=0.023; Spearman's R=0.63). The results suggest an important relation of deforestation and fragmentation with the occurrence of BSF in the SPMR.

A fatal case of Brazilian spotted fever in a non-endemic area in Brazil: the importance of having health professionals who understand the disease and its areas of transmission

Brazilian spotted fever (BSF) is caused by the bacterium Rickettsia rickettsii. Because of its high case-fatality rate and apparent increase in areas of transmission, it is considered to be the rickettsial illness of primary public health interest. Cases of this disease have historically occurred in Southeastern Brazil. This article reports the first fatal case of BSF in Southern Brazil. This case high lights the importance of BSF to be considered as a differential diagnosis for acute hemorrhagic fever in areas where cases of BSF may not be expected.

An update on the epidemiological situation of spotted fever in Brazil

Background

Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs.

Methods

This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015.

Results

In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed.

Conclusions

The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States

Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.

Tick-borne infections in human and animal population worldwide

The abundance and activity of ectoparasites and its hosts are affected by various abiotic factors, such as climate and other organisms (predators, pathogens and competitors) presenting thus multiples forms of association (obligate to facultative, permanent to intermittent and superficial to subcutaneous) developed during long co-evolving processes. Ticks are ectoparasites widespread globally and its eco epidemiology are closely related to the environmental conditions. They are obligatory hematophagous ectoparasites and responsible as vectors or reservoirs at the transmission of pathogenic fungi, protozoa, viruses, rickettsia and others bacteria during their feeding process on the hosts. Ticks constitute the second vector group that transmit the major number of pathogens to humans and play a role primary for animals in the process of diseases transmission. Many studies on bioecology of ticks, considering the information related to their population dynamics, to the host and the environment, comes possible the application and efficiency of tick control measures in the prevention programs of vector-borne diseases. In this review were considered some taxonomic, morphological, epidemiological and clinical fundamental aspects related to the tick-borne infections that affect human and animal populations.

Spotted fever group Rickettsia in Amblyomma dubitatum tick from the urban area of Campo Grande, Mato Grosso do Sul, Brazil

Rickettsia infection of each tick was evaluated by the hemolymph test and polymerase chain reaction (PCR) targeting gltA and ompA genes. All hemolymph tests were negative and PCR of one A. dubitatum detected both Rickettsia genes. Sequence of ompA exhibited a 99% identity with Rickettsia parkeri and R. africae and a 98% identity with R. sibirica. Rickettsia of the spotted fever group in A. dubitatum is described for the first time in an urban area within the municipality of Campo Grande in the state of Mato Grosso do Sul (MS), Brazil. This finding reinforces the importance of more detailed studies to determine the role of A. dubitatum in the transmission of spotted fever agents.

Feeding period required by Amblyomma aureolatum ticks for transmission of Rickettsia rickettsii to vertebrate hosts

Rocky Mountain spotted fever is endemic to the São Paulo metropolitan area, Brazil, where the etiologic agent, Rickettsia rickettsii, is transmitted to humans by adult Amblyomma aureolatum ticks. We determined the minimal feeding period required by A. aureolatum nymphs and adults to transmit R. rickettsii to guinea pigs. Unfed nymphs and unfed adult ticks had to be attached to the host for >10 hours to transmit R. rickettsii. In contrast, fed ticks needed a minimum of 10 minutes of attachment to transmit R. rickettsii to hosts. Most confirmed infections of Rocky Mountain spotted fever in humans in the São Paulo metropolitan area have been associated with contact with domestic dogs, the main host of A. aureolatum adult ticks. The typical expectation that transmission of tickborne bacteria to humans as well as to dogs requires ≥2 hours of tick attachment may discourage persons from immediately removing them and result in transmission of this lethal bacterium.

Genetic identification of rickettsial isolates from fatal cases of Brazilian spotted fever and comparison with Rickettsia rickettsii isolates from the American continents

Fifteen bacterial isolates from spotted fever group rickettsiosis in Brazil were genetically identified as Rickettsia rickettsii. In a phylogenetic analysis with other R. rickettsii isolates from GenBank, the Central/South American isolates showed low polymorphism and formed a clade distinct from two North American clades, with the North American clades having greater in-branch polymorphism.

Phylogeography of Rickettsia rickettsii genotypes associated with fatal Rocky Mountain spotted fever

Rocky Mountain spotted fever (RMSF), a tick-borne zoonosis caused by Rickettsia rickettsii, is among the deadliest of all infectious diseases. To identify the distribution of various genotypes of R. rickettsii associated with fatal RMSF, we applied molecular typing methods to samples of DNA extracted from formalin-fixed, paraffin-embedded tissue specimens obtained at autopsy from 103 case-patients from seven countries who died of RMSF. Complete sequences of one or more intergenic regions were amplified from tissues of 30 (29%) case-patients and revealed a distribution of genotypes consisting of four distinct clades, including the Hlp clade, regarded previously as a non-pathogenic strain of R. rickettsii. Distinct phylogeographic patterns were identified when composite case-patient and reference strain data were mapped to the state and country of origin. The phylogeography of R. rickettsii is likely determined by ecological and environmental factors that exist independently of the distribution of a particular tick vector.

Surface protein Adr2 of Rickettsia rickettsii induced protective immunity against Rocky Mountain spotted fever in C3H/HeN mice

BACKGROUND

Rickettsia rickettsii is the pathogen of Rocky Mountain spotted fever (RMSF), a life-threatening tick-transmitted infection. Adr2 was a surface-exposed adhesion protein of R. rickettsii and its immunoprotection against RMSF was investigated in mice.

METHODS

Recombinant Adr2 (rAdr2) was used to immunize C3H/HeN mice, and the rickettsial loads in organs of the mice were detected after challenge with R. rickettsii. The levels of specific antibodies of sera from the immunized mice were determined and the sera from immunized mice were applied to neutralize R. rickettsii. Proliferation and cytokine secretion of CD4(+) and CD8(+) T cells isolated from R. rickettsii-infected mice were also assayed after rAdr2 stimulation.

RESULTS

After R. rickettsii challenge, the rickettsial loads in spleens, livers, and lungs were significantly lower and the impairment degrees of these organs in rAdr2-immunized mice were markedly slighter, compared with those in negative control mice. The ratio of specific IgG2a/IgG1 of rAdr2-immunized mice kept increasing during the immunization. After treatment with rAdr2-immunized sera, the total number of R. rickettsii organisms adhering and invading host cells was significantly lower than that treated with PBS-immunized sera. Interferon-γ secretion by CD4(+) or CD8(+) T cells and tumor necrosis factor-α secretion by CD4(+) T cells from R. rickettsii-infected mice were respectively significantly greater than those from uninfected mice after rAdr2 stimulation.

CONCLUSION

Adr2 is a protective antigen of R. rickettsii. Protection offered by Adr2 is mainly dependent on antigen-specific cell-mediated immune responses, including efficient activity of CD4(+) and CD8(+) T cells to produce great amount of TNF-α and/or IFN-γ as well as rapid increase of specific IgG2a, which synergistically activate and opsonize host cells to killing intracellular rickettsiae.

Ecology, biology and distribution of spotted-fever tick vectors in Brazil

Spotted-fever-caused Rickettsia rickettsii infection is in Brazil the major tick-borne zoonotic disease. Recently, a second and milder human rickettsiosis caused by an agent genetically related to R. parkeri was discovered in the country (Atlantic rainforest strain). Both diseases clearly have an ecological background linked to a few tick species and their environment. Capybaras (Hydrochoerus hydrochaeris) and Amblyomma cajennense ticks in urban and rural areas close to water sources are the main and long-known epidemiological feature behind R. rickettsii-caused spotted-fever. Unfortunately, this ecological background seems to be increasing in the country and disease spreading may be foreseen. Metropolitan area of São Paulo, the most populous of the country, is embedded in Atlantic rainforest that harbors another important R. rickettsii vector, the tick Amblyomma aureolatum. Thus, at the city–forest interface, dogs carry infected ticks to human dwellings and human infection occurs. A role for R. rickettsii vectoring to humans of a third tick species, Rhipicephalus sanguineus in Brazil, has not been proven; however, there is circumstantial evidence for that. A R. parkeri-like strain was found in A. ovale ticks from Atlantic rainforest and was shown to be responsible for a milder febrile human disease. Rickettsia-infected A. ovale ticks are known to be spread over large areas along the Atlantic coast of the country, and diagnosis of human infection is increasing with awareness and proper diagnostic tools. In this review, ecological features of the tick species mentioned, and that are important for Rickettsia transmission to humans, are updated and discussed. Specific knowledge gaps in the epidemiology of such diseases are highlighted to guide forthcoming research.

Seroprevalence and risk factors for Rickettsia felis exposure in dogs from Southeast Queensland and the Northern Territory, Australia

Background

The recent detection of Rickettsia felis DNA in dogs in Australia suggests that dogs are potential mammalian reservoir hosts for this emerging rickettsia. To date, there is no published report addressing the seroprevalence of R. felis in dogs in Australia.

Methods

Antigens for R. felis were produced by inoculating confluent XTC-2 monolayer cell cultures with three pools of cat flea (Ctenocephalides felis) homogenates. Infection was confirmed by real-time (qPCR), conventional or nested PCRs targeting the ompB, gltA, 17 kDa and ompA genes. Two hundred and ninety-two dogs from Southeast Queensland and the Northern Territory were tested for the presence of R. felis antibodies using a microimmunofluorescence (IF) test and the seroprevalence and associated risk factors for exposure were determined using both uni- and multi-variate analyses.

Results

Rickettsia felis was successfully isolated in cell culture from all three cat-flea pools. One hundred and forty-eight dogs (50.7%) showed seropositivity with titres ≥64 and 54 (18.5%) with titres ≥128. At antibody titres ≥64, dogs with active ectoparasite control were less likely to be seropositive to R. felis (OR: 2.60; 95% CI: 1.20 - 5.56).

Conclusions

This first reported isolation of R. felis in cell culture in Australia allowed for the production of antigen for serological testing of dogs. Results of this serological testing reflects the ubiquitous exposure of dogs to R. felis and advocate for owner vigilance with regards to ectoparasite control on domestic pets.