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

Benidipine impairs innate immunity converting sublethal to lethal infections in a murine model of spotted fever rickettsiosis

Spotted fever group rickettsiae are tick-borne obligate intracellular bacteria that infect microvascular endothelial cells. Humans and mammalian infection results in endothelial cell barrier dysfunction and increased vascular permeability. We previously demonstrated that treatment of Rickettsia parkeri-infected cells with the calcium channel blocker benidipine significantly delayed vascular barrier permeability. Thus, we hypothesized that benidipine, known to be safe and effective for other clinical processes, could reduce rickettsia-induced vascular permeability in vivo in an animal model of spotted fever rickettsiosis. Based on liver, lung and brain vascular FITC-dextran extravasation studies, benidipine did not reliably impact vascular permeability. However, it precipitated a deleterious effect on responses to control sublethal R. parkeri infection. Animals treated with benidipine alone had no clinical signs or changes in histopathology and splenic immune cell distributions. Benidipine-treated infected animals had marked increases in tissue and blood bacterial loads, more extensive inflammatory histopathologic injury, and changes in splenic architecture and immune cell distributions potentially reflecting diminished Ca2+ signaling, reduced innate immune cell activation, and loss of rickettsial propagation control. Impaired T cell activation by R. parkeri antigen in the presence of benidipine was confirmed in vitro with the use of NKT cell hybridomas. The unexpected findings stand in stark contrast to recent discussions of the benefits of calcium channel blockers for viral infections and chronic infectious or inflammatory diseases. A role for calcium channel blockers in exacerbation of human rickettsiosis and acute inflammatory infections should be evaluated by a retrospective review of patient's outcomes and medications.

Touching Base with Some Mediterranean Diseases of Interest from Paradigmatic Cases at the "Magna Graecia" University Unit of Infectious Diseases: A Didascalic Review

Among infectious diseases, zoonoses are increasing in importance worldwide, especially in the Mediterranean region. We report herein some clinical cases from a third-level hospital in Calabria region (Southern Italy) and provide a narrative review of the most relevant features of these diseases from epidemiological and clinical perspectives. Further, the pathogenic mechanisms involved in zoonotic diseases are reviewed, focusing on the mechanisms used by pathogens to elude the immune system of the host. These topics are of particular concern for individuals with primary or acquired immunodeficiency (e.g., people living with HIV, transplant recipients, patients taking immunosuppressive drugs). From the present review, it appears that diagnostic innovations and the availability of more accurate methods, together with better monitoring of the incidence and prevalence of these infections, are urgently needed to improve interventions for better preparedness and response.

Ticks and tick-borne rickettsiae from dogs in El Salvador, with report of the human pathogen Rickettsia parkeri

Twelve tick species have been reported in El Salvador; however, information regarding ticks infesting domestic dogs is lacking, and pathogenic tick-borne Rickettsia species have never been reported in El Salvador. This work evaluated ticks infesting 230 dogs from ten municipalities in El Salvador from July 2019 to August 2020. A total of 1,264 ticks were collected and identified into five species: Rhipicephalus sanguineus sensu lato (s.l.), Rhipicephalus microplus, Amblyomma mixtum, Amblyomma ovale, and Amblyoma cf. parvum. The tick R. sanguineus s.l. was the most frequent species in all localities (81.3% of sampled dogs), followed by Amblyomma mixtum (13.0%), Amblyomma ovale (10.9%) and Amblyomma cf. parvum (10.4%). The overall mean intensity of tick infestation was 5.5 ticks/dog. The highest specific mean intensity value was for R. sanguineus s.l. (4.8 ticks/dog), varying from 1.6 to 2.7 ticks/dog for the three Amblyomma species. From a random sample of 288 tick specimens tested molecularly for the presence of rickettsial agents, three spotted fever group Rickettsia were detected: Rickettsia amblyommatis in 90% (36/40) A. mixtum, 46% (11/24) A. cf. parvum, 4% (7/186) R. sanguineus s.l., and 17% Amblyomma spp.; Rickettsia parkeri strain Atlantic rainforest in 4% (1/25) A. ovale; and an unnamed rickettsia agent, designated as 'Rickettsia sp. ES-A.cf.parvum', in 4% (1/24) A. cf. parvum. Our finding of R. parkeri strain Atlantic rainforest in A. ovale is highly relevant because this agent has been associated to spotted fever illness in other Latin American countries, where A. ovale is implicated as its main vector. These findings suggest that spotted fever cases caused by R. parkeri strain Atlantic rainforest could be occurring in El Salvador.

Sharing of living area and exposure of domestic and wild canids to ticks, Rickettsia parkeri and Rangelia vitalii in the Atlantic Forest of southern Brazil

Spotted fever caused by the bacterium Rickettsia parkeri, and canine rangeliosis caused by the protozoan Rangelia vitalii, are emerging or re-emerging tick-borne diseases in Brazil, where the main tick vectors are Amblyomma ovale and Amblyomma aureolatum, respectively. In the present study, we evaluated exposure to R. parkeri and R. vitalii infection among domestic (Canis lupus familiaris) and wild (Cerdocyon thous) canids sharing living areas within an Atlantic Forest area of southern Brazil. Four different domestic dogs and three different wild canids were captured. Most of the ticks collected from either domestic or wild canids were identified as A. ovale and A. aureolatum. DNA of R. parkeri was amplified from 14% of the A. ovale specimens. Two domestic dogs and two wild canids were seroreactive to R. parkeri antigens with high endpoint titers (>1024). Rangelia vitalii DNA was detected in two wild canids; one of them was resampled 93 days later, again infected by R. vitalii. We report exposure/infection of domestic dogs and wild canids to R. vitalii and/or R. parkeri-infected ticks in an Atlantic Forest area shared by both canid species, indicating that they also shared the same populations of the tick vectors, A. aureolatum and A. ovale. While A. ovale, A. aureolatum, R. parkeri, R. vitalii and C. thous, are all native to the Atlantic Forest, further studies are needed to evaluate the impact of an exotic canine species - C. lupus familiaris - on the enzootic cycles of R. vitalii and R. parkeri, as well as the possible role of domestic dogs in emergence and re-emergence of R. parkeri-spotted fever in humans and canine rangeliosis, respectively.

Substantial viral and bacterial diversity at the bat-tick interface

Ticks harbour a high diversity of viruses, bacteria and protozoa. The soft tick Carios vespertilionis (Argasidae) is a common ectoparasite of bats in the Palearctic region and is suspected to be vector and reservoir of viruses and other microbial species in bat populations, some of which may act as zoonotic agents for human disease. The Soprano pipistrelle (Pipistrellus pygmaeus, Vespertilionidae) is widely distributed in Europe, where it can be found inside or close to human habitation. We used meta-transcriptomic sequencing to determine the RNA virome and common microbiota in blood-fed C. vespertilionis ticks collected from a Soprano pipistrelle bat roosting site in south-central Sweden. Our analyses identified 16 viruses from 11 virus families, of which 15 viruses were novel. For the first time in Sweden we identified Issuk-Kul virus, a zoonotic arthropod-borne virus previously associated with outbreaks of acute febrile illness in humans. Probable bat-associated and tick-borne viruses were classified within the families Nairoviridae, Caliciviridae and Hepeviridae, while other invertebrate-associated viruses included members of the Dicistroviridae, Iflaviridae, Nodaviridae, Partitiviridae, Permutotetraviridae, Polycipiviridae and Solemoviridae. Similarly, we found abundant bacteria in C. vespertilionis, including genera with known tick-borne bacteria, such as Coxiella spp. and Rickettsia spp. These findings demonstrate the remarkable diversity of RNA viruses and bacteria present in C. vespertilionis and highlight the importance of bat-associated ectoparasite surveillance as an effective and non-invasive means to track viruses and bacteria circulating in bats and ticks.

Prevalence of zoonotic and non-zoonotic Rickettsia in horses: A systematic review and meta-analysis

In a broad sense, Rickettsiae are a group of microorganisms that can be transmitted mechanically or biologically to animals and humans. Rickettsioses are associated with hematic manifestations. Its prevalence in humans, dogs and other animals has been widely explored, but not in equine species. To determine the prevalence of Rickettsia infection in horses. A systematic review of the literature was carried out in five databases for the proportion of horses infected with Rickettsia, defined by molecular and immunological techniques. A meta-analysis was performed using a random-effects model to calculate the pooled prevalence and 95% confidence intervals (CI). The Cochran's Q test and the I² statistic were used to assess the between-study-heterogeneity. The pooled prevalence of Rickettsia in equines was 37.0% (95% CI: 26.0%-47.0%), with significant heterogeneity among studies (I² = 98.12%). In the subgroup analysis, the prevalence of Rickettsia in horses was found to be 24.0% (95%CI: 10.0%-41.0%) for IFI, 47.0% (95%CI: 30.0%-64.0%) for IFA, 14.0% (95%CI: 11.0%-17.0%) for IFAT and 39.0% (95%CI: 0.0%-95.0%) for PCR. There was a high prevalence of Rickettsia among horses, with some of the species being zoonotic, with their corresponding implications for humans, which increasingly are in close contact with equines, particularly horses and their ticks, posing a risk for spillover and transmission.

Rickettsia-Host-Tick Interactions: Knowledge Advances and Gaps

Ticks are hematophagous ectoparasites capable of transmitting multiple human pathogens. Environmental changes have supported the expansion of ticks into new geographical areas that have become the epicenters of tick-borne diseases (TBDs). The spotted fever group (SFG) of Rickettsia frequently infects ticks and causes tick-transmitted rickettsioses in areas of endemicity where ixodid ticks support host transmission during blood feeding. Ticks also serve as a reservoir for SFG Rickettsia. Among the members of SFG Rickettsia, R. rickettsii causes Rocky Mountain spotted fever (RMSF), the most lethal TBD in the United States. Cases of RMSF have been reported for over a century in association with several species of ticks in the United States. However, the isolation of R. rickettsii from ticks has decreased, and recent serological and epidemiological studies suggest that novel species of SFG Rickettsia are responsible for the increased number of cases of RMSF-like rickettsioses in the United States. Recent analyses of rickettsial genomes and advances in genetic and molecular studies of Rickettsia provided insights into the biology of Rickettsia with the identification of conserved and unique putative virulence genes involved in the rickettsial life cycle. Thus, understanding Rickettsia-host-tick interactions mediating successful disease transmission and pathogenesis for SFG rickettsiae remains an active area of research. This review summarizes recent advances in understanding how SFG Rickettsia species coopt and manipulate ticks and mammalian hosts to cause rickettsioses, with a particular emphasis on newly described or emerging SFG Rickettsia species.

The Gulf Coast Tick, Amblyomma maculatum (Ixodida: Ixodidae), and Spotted Fever Group Rickettsia in the Highly Urbanized Northeastern United States

We report the multi-year collection of the Gulf Coast tick, Amblyomma maculatum Koch (Acaridae: Ixodida: Ixodidae) in Staten Island, New York City (NYC) as well as their detection in Brooklyn, NYC, and in Atlantic and Cumberland counties in southern New Jersey, USA. The first and most common detections were of adults, however in Freshkills Park on Staten Island larvae were also collected in a following year. The presence of larvae indicates that adults are successfully finding hosts in Staten Island. While it is still unknown how A. americanum reached Staten Island, immatures of this species often parasitize migratory birds, which are now often seen in Freshkills Park. We describe the landscape features of the area in Staten Island where populations were highest and larvae were detected, which could have facilitated the establishment of A. maculatum. Notably, we also report the presence of human pathogens Rickettsia parkeri in 5/10 (50%) of adults tested and R. felis in 1/24 (4.17%) of larvae tested. In addition to established populations in Staten Island we found evidence of A. maculatum in NJ and other NYC boroughs, suggesting current or future establishment is possible. The failure thus far to detect established populations in these areas may be due to inherent difficulties in detecting low density, spatially heterogeneous incipient populations, which could require targeted surveillance efforts for this species. We discuss the consequences to public health of the establishment of A. maculatum and detection of two additional rickettsial pathogens in the densely populated northeastern United States.

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.

Molecular confirmation of Rickettsia parkeri in humans from Southern Mexico

Human tick-borne rickettsioses are caused by Rickettsia africae, Rickettsia massiliae, Rickettsia parkeri, Rickettsia philipi and Rickettsia rickettsii in the American continent. Rickettsia parkeri represents the second most important agent of eschar-associated spotted fever throughout the American continent. In Mexico, the presence of three strains of this bacterium (Black Gap, Maculatum and Atlantic Rainforest) has recently been reported in four species of ticks from five states (Baja California, Campeche, Sonora, Tabasco and Veracruz) and rickettsaemia was demonstrated in a dog from the state of Yucatán. We report two human cases of R. parkeri-rickettsiosis from Yucatan, Mexico. These findings have increased the interest in R. parkeri surveillance in the human population, due to the fluctuating regional Spotted Fever morbidity and mortality in the country.

Rickettsiosis Caused by Rickettsia parkeri, Mexico

We report a human case of rickettsiosis caused by Rickettsia parkeri strain Atlantic Rainforest in Mexico in an adult woman from a small town in the north of Yucatan, Mexico. We confirmed diagnosis using conventional PCR and sequence analysis. Health providers should be aware of clinical manifestations of rickettsioses in this region.