Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy

Background: Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which Rickettsia conorii subsp. israelensis was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion. Methods: For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays. Results: Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to R. conorii and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from O. tsutsugamushi; also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology. Conclusions: MSF, especially when caused by R. conorii subsp. israelensis, may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe rickettsial disease and should not lead the physician away from this diagnosis

Sociodemographic profile and distribution of Spotted Fever cases per brazilian region between the years 2008 and 2017

This study aims to identify the clinical and sociodemographic characteristics of Spotted Fever in Brazil between 2008 and 2017. A descriptive, retrospective, cross-sectional study with a quantitative approach that used as a source of data the Sistema de Informação de Agravos de Notificação (SINAN) available in the public database of the Departamento de Informática do Sistema Único de Saúde (DATASUS), adopting the following variables within the pre-established period: Region of Notification, Sex, Age Group, Evolution, Infection Zone, Schooling, Environment of Infection, and Confirmation Criteria. Spotted fever was prevalent in the Southeast region of the country, although underreporting is a reality in other regions. The most affected population was male, economically active, living in rural areas, and with incomplete primary education. Thus, epidemiological surveillance is fundamental, especially in endemic and "silent" regions for the notification of the disease.

Epidemiological Community and Differences of Transmissive Infections in Astrakhan Region

Relevance. The territory of the Astrakhan region hosts natural foci of severe infections of arbovirus etiology – Crimean-Congo hemorrhagic fever (CCHF) and Astrakhan fever (spotted fever resembling the Mediterranean spotted fever, Astrakhan spotted fever (ASF). The long-term average incidence of CCHF and ASF in the Astrakhan region is to 11 and 135 times higher, respectively, than the average incidence in the Russian Federation. Aims. To present, based on epidemiological data, a comparative characterization of transmissible infections of CCHF and ASF in the Astrakhan region. Materials & Methods. The main method of the study was epidemiological. The data for 2000−2016 of primary medical documentation Ф.058/у «Emergency notification of infectious disease, food, acute occupational poisoning, unusual reaction to vaccination», federal statistical observation Ф. 2 «Information on infectious and parasitic diseases», Ф. 357/у «Epidemiological examination card of infectious disease focus», Ф. .003/у «Medical card of inpatient patient», presented by Center of hygiene and epidemiology in Astrakhan region. For retrospective epidemiological analysis, we studied the absolute and intensive morbidity indicators (per 100 ths population), by age, professional groups, and among the urban and rural population. Based on the average long-term morbidity indicators of the population, a mapping of the territory of the Astrakhan region was carried out. The influence of natural and climatic conditions on the epidemic process of CCHF and ASF was assessed by meteorological data (amount of precipitation, air temperature, etc.). Materials of long-term observation over 11 districts of Astrakhan region and Astrakhan city were analyzed, including data on the spread of Ixodid ticks, population contact with them (according to the attendance of people to treatment-and-prophylactic organizations of the region). Statistical data processing was carried out using the method of straight-line alignment of dynamic series of morbidity indicators, calculation of the average annual rate of decrease/increase. Correlation analysis was used to assess the direction and strength of the relationship between the indicators, and quantitative dependence between epidemic process characteristics. Differences between the indicators were considered to be reliable if p < 0.05. Results. During the analyzed period 151 cases of CCHF and 3951 cases of ASF were identified. By 2016. CCHF was registered in all 11 districts of the region and the area of foci covered 44,000 km2 and 44,100 km2, respectively. There are no differences significantly affecting the epidemic process of CCHF and ASF, so preventive measures are mainly aimed at controlling the vectors of the pathogens of these infections. The comprehensive study of the territory of Astrakhan region carried out in 2000–2016 revealed expansion of CCHF and ASF areal of disease (by 11.8% and 23.4% respectively) and determined the territories with the highest risk of infection, which allowed to increase and redistribute the volumes of acaricide treatments of the territories with the highest infection risk and ensure the decrease of CCHF and ASF morbidity rates. Conclusion. As a result of the comprehensive study conducted in 2000–2016 in the territory of Astrakhan region, the expansion of CCHF and ASF areal of disease was revealed (by 11.8% and 23.4% respectively) and the areas of highest infection risk were identified, which allowed to increase and redistribute the volume of acaricide treatments of the areas of highest infection risk and ensure the reduction of CCHF and ASF morbidity.

Human parasitism by the exotic tick Dermacentor variabilis (Parasitiformes: Ixodida) in Brazil: report of an imported case

In June 2012, a tick was found parasitizing a man in the city of São Paulo, who had recently returned from a visit to Pennsylvania, in the northeast of the United States. The tick was removed and sent to the São Paulo State Department of Health, where it was identified as a male of the species Dermacentor variabilis (Say, 1821), according to the literature and taxonomic keys. The tick was subjected to a PCR test to search for rickettsiae, but the result was negative. The fact that a human entered Brazilian territory unaware that he was parasitized by a hard tick not belonging to the national tick fauna is significant because of the possibility that an exotic species could be introduced and take hold in this country. Another major risk to public health is that this arthropod could be infected with the bacterium Rickettsia rickettsii, as this ectoparasite is the main vector of Spotted Fever on the East Coast of North America.

One Health Approach to Rickettsiosis: A Five-Year Study on Spotted Fever Group Rickettsiae in Ticks Collected from Humans, Animals and Environment

The spotted fever group of Rickettsiae is a heterogeneous group of Rickettsiae transmitted by ticks, causing similar diseases in humans (spotted fever). Until recently, it was supposed that a single pathogenic tick-borne SFG Rickettsia circulated in each different geographic area and that R. conorii subsp. conorii was the SFG Rickettsiae circulating in Italy, but in the last decade, thanks to molecular diagnostic, several different Rickettsia species, previously not considered pathogenic for decades, have been isolated from ticks and definitively associated to human disease, also in Italy. The present survey was carried out with the aim of investigating the presence of different SFG Rickettsia species in a geographic area where no information was available. Ticks collected from animals submitted to necropsy, removed from humans in local hospitals and collected from the environment were identified and tested by PCR for Rickettsia spp. based on the gltA gene, and positive PCR products were sequenced. A total of 3286 ticks were collected. Fifteen tick species were recognized, the most represented (79.52%) species in the collection was Ixodes ricinus, followed by Rhipicephalus sanguineus (9.13%). The overall prevalence of Rickettsia infection was 7.58%. Eight species of Rickettsia were identified, the most frequent was R. monacensis (56%), followed by R. helvetica (25.50%). Noteworthy, is the detection in the present study of Rrhipicephali, detected only twice in Italy. These are the first data available on SFG Rickettsiae circulation in the study area and they can be considered as starting point to assess the possible risk for humans.

Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014

Q fever and spotted fever group rickettsioses (SFGR) are common causes of severe febrile illness in northern Tanzania. Incidence estimates are needed to characterize the disease burden. Using hybrid surveillance—coupling case-finding at two referral hospitals and healthcare utilization data—we estimated the incidences of acute Q fever and SFGR in Moshi, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Cases were defined as fever and a four-fold or greater increase in antibody titers of acute and convalescent paired sera according to the indirect immunofluorescence assay of Coxiella burnetii phase II antigen for acute Q fever and Rickettsia conorii (2007–2008) or Rickettsia africae (2012–2014) antigens for SFGR. Healthcare utilization data were used to adjust for underascertainment of cases by sentinel surveillance. For 2007 to 2008, among 589 febrile participants, 16 (4.7%) of 344 and 27 (8.8%) of 307 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 80 (uncertainty range, 20–454) and 147 (uncertainty range, 52–645) per 100,000 persons, respectively. For 2012 to 2014, among 1,114 febrile participants, 52 (8.1%) and 57 (8.9%) of 641 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 56 (uncertainty range, 24–163) and 75 (uncertainty range, 34–176) per 100,000 persons, respectively. We found substantial incidences of acute Q fever and SFGR in northern Tanzania during both study periods. To our knowledge, these are the first incidence estimates of either disease in sub-Saharan Africa. Our findings suggest that control measures for these infections warrant consideration.