Zazueta OE, Armstrong PA, Márquez-Elguea A, Hernández Milán NS, Peterson AE, Ovalle-Marroquín DF, Fierro M, Arroyo-Machado R, Rodriguez-Lomeli M, Trejo-Dozal G, Paddock CD. Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico-United States Border, 2009-2019.
Emerg Infect Dis 2021;
27. [PMID:
34014151 PMCID:
PMC8153879 DOI:
10.3201/eid2706.191662]
[Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Longevity, high prevalence, and multifocal distribution of this disease pose unprecedented public health challenges.
Epidemic levels of Rocky Mountain spotted fever (RMSF) have persisted in Mexicali, Mexico, since the initial outbreak was first reported in December 2008. We compared clinical and epidemiologic data of cases in Mexicali during 2009–2019 between patients with an IgG titer reactive with Rickettsia rickettsii bacteria by indirect immunofluorescence antibody (IFA) assay and those who demonstrated DNA of R. rickettsii in a whole blood sample when tested by PCR. We identified 4,290 patients with clinical and epidemiologic features compatible with RMSF; of these, 9.74% tested positive by IFA and 8.41% by PCR. Overall, 140 patients died (11-year case-fatality rate 17.97%). Substantial differences in the frequency of commonly recognized clinical characteristics of RMSF were identified between PCR-positive and IFA-positive cases. The Mexicali epidemic is unique in its size and urban centralization. Cases confirmed by PCR most accurately reflect the clinical profile of RMSF.
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