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Rickettsiosis en America Latina, el Caribe, Espana y Portugal.

Rickettsioses in Latin America, Caribbean, Spain and Portugal

Introduccion

El genero Rickettsia incluye las bacterias del orden rickettsiales subdivision alfa de la clase Proteobacteria, son cocobacilos Gram negativos de crecimiento obligado intracelular. Un numero apreciable de especies ha sido identificado en varios artropodos y recientemente en sanguijuelas y amebas (1,2). Tradicionalmente, las rickettsias patogenas fueron clasificadas en dos grupos: el tifus (TG) compuesta por Rickettsia prowazekii y Rickettsia typhi, cuyos vectores son piojos (Pediculus humanus) y pulgas respectivamente y, el grupo de las fiebres manchadas (SFG), compuesto por mas de 20 especies con garrapatas como vector principal (3). Otras rickettsias han mostrado antigenica y geneticamente particularidades que impiden su inclusion en el TG o en el SFG, tales como Rickettsia bellii y Rickettsia canadensis, reportadas en garrapatas del continente americano (4,5). Con el descubrimiento de una variedad de nuevas rickettsias en diferentes ordenes de artropodos terrestres, la mayoria viviendo de forma libre y tambien con los analisis geneticos de plasmidos como el de Rickettsia felis, el genero ha sido reclasificado en diferentes grupos: TG, SFG, grupo transicional (TRG), grupo bellii (BG), grupo canadensis (CG) y otros grupos basicos (6,7).

En las ultimas decadas ha habido un incremento de nuevas especies de Rickettsia de patogenicidad desconocida, muchas de ellas aisladas de garrapatas (8,9). Algunas de ellas previamente fueron consideradas no patogenas, pero recientemente demostraron ser patogenas para humanos, tal es el caso del SFG Rickettsia slovaca, Rickettsia aeschlimannii, Rickettsia massiliae y Rickettsia monacensis en Europa (8,9). Ademas, R. parkeri un viejo miembro del SFG reportado por primera vez en 1939, demostro 65 anos mas tarde ser patogena (10). Estos hechos demuestran que cualquier nueva rickettsia descrita en huespedes invertebrados, especialmente garrapatas, deberian ser consideradas potencialmente patogenas para los humanos.

El objetivo de este trabajo fue el de analizar y resumir los estudios de Rickettsia en Latinoamerica, el Caribe, Espana y Portugal.

Recoleccion de datos

Para el presente estudio, se obtuvieron datos retrospectivos del genero Rickettsia de la literatura cientifica de los paises de Latinoamerica y de las islas del Caribe. Se realizaron esfuerzos para obtener toda la informacion disponible de cada pais. Ademas, para efectos de comparacion, tambien se obtuvo informacion de Espana y Portugal, ya que estos paises fueron los que colonizaron principalmente a Latinoamerica. Se consideraron todas las rickettsias reportadas como patogenas tanto para humanos como animales o huespedes animales, y/o huespedes invertebrados (ej, garrapatas, piojos y pulgas) y que fueron consideradas ser el vector asociado al agente etiologico. Cuando no existio evidencia directa de Rickettsia del grupo TG o SFG u otra especie disponible en el cada pais, la deteccion indirecta basada en la serologia fue considerada como el unico reporte disponible.

Distribucion geografica de Rickettsia.

Todos los datos disponibles por infeccion de Rickettsia o huespedes (humanos o animales) y vectores de Latinoamerica y el Caribe se presentan para cada pais en las tablas 1-6. Espana y Portugal se muestran en la tabla 7.

Un total de 13 especies de Rickettsia se han documentado en Latinoamerica y el Caribe. Las especies con mayor frecuencia reportadas en los diferentes paises fueron: Rickettsia felis (9 paises) R. prowazekii (7 paises), R. typhi (6 paises), R. rickettsii (6 paises), R. amblyommii (5 paises) y R. parkeri (4 paises).

Los datos de las islas de las antiguas Antillas, se agruparon como un solo pais (Tabla 6). R. bellii, R. akari y Candidatus 'R. andeane' han sido reportados en solo 2 paises cada uno, mientras que R. massiliae, R. rhipicephali, R.monteiro y R. africae han sido reportados en un solo pais. En este caso R. africae ha sido documentada en nueve islas del Caribe.

Ocho especies de Rickettsia han sido asociadas con enfermedad humana en Latinoamerica y el Caribe: R. rickettsii agente de etiologico de la fiebre de las montanas rocosas en Mexico, Costa Rica, Panama, Colombia, Brasil y Argentina; R. prowazekii es el causante del tifus epidemico en Argentina, Bolivia, Chile, Ecuador, Guatemala, Mexico y Peru; R. typhi es el agente en Brasil, Colombia, Guatemala, Mexico, Panama y Puerto Rico; R. felis causa la fiebre manchada de las pulgas en Mexico y Brasil; R. parkeri es la causa de la fiebre manchada en Brasil, Uruguay y Argentina; R. africae produce la fiebre africana por garrapatas en las Antillas menores; R. akari es la causa de la viruela rickettsial en Costa Rica y Mexico; R. massiliae es el agente de la fiebre manchada en Argentina, que fue reportada en un viajero espanol procedente de Argentina el cual se presume adquirio la infeccion en ese pais suramericano (Tabla 8). La distribucion de pulgas infectadas por R. felis incluyo siete paises (Costa Rica, Panama, Antillas menores, Peru, Argentina, Chile y Uruguay) donde sin embargo, no se han presentado casos humanos hasta ahora. Un total de cinco especies de Rickettsia aun no han sido descritas como patogenas para humanos: R. amblyommii (5 paises), R. bellii (2 paises), Candidatus 'R. andeanae' (2 paises), R. monteiroi (1 pais) y R. rhipicephali (1 pais).

Un total de 10 especies de Rickettsia han sido reportadas en Espana y Portugal: R. conorii, R. helvetica, R. monacensis, R. felis, R. slovaca, R. raoultii, R. sibirica, R. aeschlimannii, R. typhi y R. prowazekii. Ademas, R. rioja ha sido reportada en Espana y R. massiliae en Portugal (Tabla 7). De estas especies de Rickettsia, solamente R. prowazekii, R. typhi, R. felis y R. massiliae han sido documentadas en Latinoamerica.

Dos casos fatales de fiebre manchada por R. conorii se diagnosticaron en Brasil, sin embargo, estos 2 pacientes adquirieron la infeccion en Portugal y Sur Africa respectivamente y desarrollaron la enfermedad unos dias despues de arribar a Brasil (Tabla 8). De igual manera, un caso de R. africae fue adquirido en Africa antes que el paciente regresara a Espana.

Con respecto a El Salvador, Honduras y Nicaragua, aunque hasta ahora no se han reportado especificamente especies de Rickettsia, se han demostrado evidencia serologica de infeccion humana y/o animal por los grupos de las fiebres manchadas y/o tifus (Tabla 4).

De acuerdo con los datos compilados, los siguientes paises no presentan ningun tipo de registro de rickettsias en America Central y America del Sur: Belice, Venezuela, Guyana, Surinam y Paraguay. Ademas, a excepcion de las 10 islas del Caribe de este trabajo, muchas de ellas tambien permanecen sin registro. La distribucion geografica de las 13 especies de Rickettsia que se han identificado en America Latina y el Caribe se muestra en la figura 1.

Analisis de los datos

Al final del ultimo siglo, solamente R. rickettsii, R. prowazekii y R. typhi eran conocidas en Latinoamerica y el Caribe. Con la aparicion de los metodos moleculares en los anos 90, otras especies fueron descubiertas tales como R. africae en las Antillas (147), y R. felis en Mexico (133) y mas tarde en Brasil (59). En este siglo, se han desarrollado una gran cantidad de investigaciones sobre Rickettsia en Latinoamerica y al menos 8 especies nuevas se han descubierto en los ultimos 10 anos, la mayoria asociadas con garrapatas: R. amblyommii, R. bellii, R. rhipicephali, R. parkeri, R. massiliae, R. akari, R. monteiroi, and Candidatus 'R. andeanae' (73,93,105,137).

Teniendo en cuenta que R. rickettsii, R. prowazekii y R.. typhi se describieron a mediados del siglo veinte, solamente R. rickettsii el agente de la fiebre manchada de las montanas rocosas, mostro en Latinoamerica un incremento en su distribucion y expansion en las ultimas decadas. De hecho, la fiebre manchada de las montanas rocosas, es actualmente considerada una enfermedad reemergente en Mexico, Sur y Centro America (81,93,112,131).

La presencia de R. typhi en el continente americano ha estado practicamente descuidada. Sin embargo, este agente ha sido reportado en algunos paises de Latinoamerica recientemente (49,146,184), la mayoria de los rickettsiologos creen que R. typhi esta ampliamente distribuida en el continente, junto con las ratas sinantropicas y su pulga Xenopsylla cheopis (185). Finalmente, el escaso numero de datos recientes de R. prowazekii en las ultimas decadas parece ser el resultado del descenso de la prevalencia de su principal vector el piojo del cuerpo Pediculus humanus (185). Por lo tanto, casi todos los datos de R. prowazekii en Latinoamerica se refieren al ultimo siglo. Recientes estudios de casos humanos han sido reportados en areas altas de Peru, donde las infestaciones por el piojo del cuerpo son todavia un problema (185).

El avance significativo del conocimiento sobre rickettsiologia durante la ultima decada en Latinoamerica y el Caribe fue sin duda el resultado del gran interes de los investigadores sobre esta materia en el continente. Sin embargo, este avance deberia ser considerado todavia muy incipiente, si se tiene en cuenta la modesta lista de especies de Rickettsia y enfermedades rickettsiales de Latinoamerica y el Caribe, comparada con la de Espana y Portugal, donde la rickettsiologia ha tenido mucha mas atencion de los investigadores e instituciones gubernamentales. De verdad, que la lista de las enfermedades por Rickettsia se incrementaran en Latinoamerica en los proximos anos, no solamente en los paises con reportes previos, sino en otros donde nunca ha sido reportada. Una condicion basica para este incremento es la necesidad urgente de aumentar la capacidad de los laboratorios de Latinoamerica para llevar a cabo diagnostico de Rickettsia, ya que la ausencia de la enfermedad en estos paises podria ser meramente un resultado de la ausencia de investigaciones.

Agradecimientos

Este trabajo fue financiado por el Programa Ciencia y Tecnologia para el Desarrollo (CYTED) para la Red Iberoamericana de Investigacion y Control de Enfermedades por Rickettsia (RIICER). A Janneth Gallegos, M.Sc. Escuela Politecnica de Chimborazo. Facultad de Ciencias. Riobamba Ecuador. A Jorge Miranda, M.Sc. Universidad de Cordoba, Monteria, Colombia.

Introduction

The genus Rickettsia includes bacteria of the order rickettsiales in the alpha subdivision of the class Proteobacteria. They are Gram-negative coccobacilli in obligate association with eukaryote cells. A number of species have been identified in various terrestrial arthropods, and more recently in leeches and amoeba (1,2). Traditionally, pathogenic rickettsiae were classified into two groups: the typhus group (TG), composed of Rickettsia prowazekii and Rickettsia typhi, vectored by lice (Pediculus humanus) and fleas, respectively; and the spotted fever group (SFG), composed of more than 20 species mostly vectored by ticks (3). Other rickettsiae have shown antigenic and genetic particularities that preclude their inclusion in either the TG or SFG, such as Rickettsia bellii and Rickettsia canadensis, reported in ticks from the American continent (4,5). With the discovery of a variety of new rickettsiae in different orders of terrestrial arthropods, mostly free-living, and also with genetic analysis of rickettsial plasmids as R. felis, the genus Rickettsia has been re-classified into different groups, including the SFG, TG, transitional group (TRG), bellii group (BG), canadensis group (CG), and several other basal groups (6,7).

During the last decades, there has been an increasing number of new Rickettsia species of unknown pathogenicity, mostly isolated from ticks (8,9). Some of them, previously considered non-pathogenic, were recently shown to be pathogenic to humans, such as the SFG Rickettsia slovaca, Rickettsia aeschlimannii, Rickettsia massiliae, and Rickettsia monacensis in Europe (8,9). In addition, R. parkeri, an 'old' SFG organism first reported in ticks in the 1939 was shown to be pathogenic 65 years later (10). These facts indicate that any novel described Rickettsia from invertebrate hosts, especially ticks, should be regarded as potentially pathogenic for humans.

The aim of this study was to analize and to summarize the rickettsial reports in Latin America, Caribbean, Portugal and Spain.

Data collection

For the present study, retrospective data on bacteria of the genus Rickettsia were compilled from the available literature regarding all countries in Latin America, and Caribean. Efforts were done to gather all available information for each country. Futhermore, for comparison purposes, we also compiled all Rickettsia species that have been reported in Spain and Portugal, since these two countries were responsible for the main colonization of Latin America. We considered all Rickettsia records reported for human and/or animal hosts, and/or invertebrate hosts (e.g., ticks, lice, fleas), which were considered to be the vector associated with the agent. In a few cases, when no direct detection of a given Rickettsia group TG or SFG or species was available for a given country, the indirect detection through serologic-based methods was considered, when this was the only record available.

Geographic distribution of Rickettsia.

All available records on rickettsial infection on hosts (humans and animals) and vectors in Latin America and the Caribbean are represented by country, in tables 1-6. Spain and Portugal are presented in table 7.

A total of 13 Rickettsia species have been recorded in Latin America and the Caribbean. The species with the largest number of country confirmed records were Rickettsia felis (9 countries), R. prowazekii (7 countries), R. typhi (6 countries), R. rickettsii (6 countries), R. amblyommii (5 countries), and R. parkeri (4 countries).

Since the rickettsial records for the Caribbean islands were restricted to West Indies, we grouped these records like that they were represented as a single country (Table 6). R. bellii, R. akari, and Candidatus 'R. andeane' have been recorded in only 2 countries each, whereas R. massiliae, R. rhipicephali, R..monteiroi, and R.. africae have each been recorded in a single country in this case, R. africae has been recorded in nine islands from the West Indies.

Eight Rickettsia species have been associated with human diseases in Latin America and Caribbean: R. rickettsii causing rocky mountain spotted fever in Mexico, Costa Rica, Panama, Colombia, Brazil and Argentina; R. prowazekii causing epidemic typhus in Argentina, Bolivia, Chile, Ecuador, Guatemala, Mexico, and Peru; R. typhi causing endemic typhus in Brazil, Colombia, Guatemala, Mexico, Panama, and Puerto Rico; R. felis causing flea spotted fever in Mexico and Brazil; R. parkeri causing spotted feverin Brazil, Uruguay, and Argentina; R. africae causing African tick bite fever in the Caribbean islands; R. akari causing rickettsial pox in Costa Rica and Mexico; and R. massiliae causing spotted fever in Argentina. This R. massiliae case was reported in a Spanish traveler presumed to have acquired the infection in Argentina, but suffered the disease after her return to Spain (Table 8). The distribution of R. felis-infected fleas included seven countries (Costa Rica, Panama, Caribbean islands, Peru, Argentina, Chile, and Uruguay) where no human cases of infection have been reported so far. A total of five Rickettsia species of unknown pathogenicity has been reported: R. amblyommii (5 countries), R. bellii (2 countries), Candidatus 'R. andeanae' (2 countries), R. monteiroi (1 country), and R. rhipicephali (1 country).

A total of 10 Rickettsia species have been reported in both Spain and Portugal: R. conorii, R. helvetica, R. monacensis, R. felis, R. slovaca, R. raoultii, R. sibirica, R. aeschlimannii, R. typhi, and R. prowazekii. In addition, R. rioja has been reported in Spain, and R. massiliae has been reported to occur in Portugal (Table 7). Amongst these Rickettsia species reported in Portugal and Spain, only R. prowazekii, R. typhi, R. felis, and R. massiliae have also been reported in Latin America.

Two fatal cases of spotted fever caused by R. conorii have been diagnosed in Brazil, however, patients of these cases were considered to have acquired the infection in Portugal and South Africa, respectively, and then suffered the disease few days after they arrived in Brazil (Table 8). Likewise, one case of R. africae infection was acquired in Africa before the patient returned to Spain.

For El Salvador, Honduras and Nicaragua, although no specific Rickettsia species has been reported so far, there have been serological evidence of human and animal infection by spotted fever and/or typhus group rickettsioses in these countries (Table 4).

According to our compiled data, the following countries remain without any rickettsial records in Central America and South America: Belize, Venezuela, Guayana, Surinam and Paraguay. In addition, except for the 10 Caribbean islands of this paper, many of them also remain without records. The geographical distribution of the 13 Rickettsia species that have been identified in Latin America and Caribbean are shown in figure 1.

Analysis of data

Until the end of the last century, only three Rickettsia species were known to occur in Latin America and Caribbean: R. rickettsii, R. prowazekii, and R. typhi. With the increasing use of molecular methods since the 1990s, other Rickettsia species were discovered in the continent, such as R. africae in West Indies (147), and R. felis in Mexico (133) and later in Brazil (59). In this new century, there was a bulk in the study of Rickettsia in Latin America, with the discovery of at least 8 other Rickettsia species in the continent during the last 10 years, mostly associated with ticks: R. amblyommii, R. bellii, R. rhipicephali, R. parkeri, R. massiliae, R. akari, R. monteiroi, and Candidatus 'R. andeanae' (73,93,105,137).

[FIGURE 1 OMITTED]

Consindering the three species (R. rickettsii, R. prowazekii, and R. typhi) known to occur in the continent since the first half of the last century, only R. rickettsii, the agent of rocky mountain spotted fever, showed an increased expansion on its distribution area during the last decades. In fact, rocky mountain spotted fever is currently considered a re-emerging disease in Mexico, Central and South America (81,93,112,131).

The occurrence of R. typhi in the American continent has been practically neglected. Although this agent has been only scarcely reported in a few Latin American countries recently (49,146,184), most rickettsiologists believe that this rickettsia is widely distributed in the continent, together with its main hosts, synantropic rats and their flea Xenopsylla cheopis (185). Finally, the scarce number of recent records of R. prowazekii during the last few decades seems to be a result of decreased prevalence of its main vetcor, the body louse Pediculus humanus (185). Thus, almost all records of R. prowazekii in Latin America refer to the last century. More recent reports of human cases seem to have been restricted to highland areas of Peru, where body louse infestations are still a problem (185).

The significant advance in our knowlegment on rickettsiology during the last decade in Latin America and Caribbean was certainly a result of the increased interest of researchers on this subject in the continent. However, this advance should be considered still very incipient, if we compare the modest list of Rickettsia species and rickettsial diseases of Latin America and Caribbean with the greater lists here reported for the iberian countries, where rickettsiology has had much greater attention from researchers and governmental institutions. Indeed, the list of rickettsial diseases in Latin America will increase during the next years, not only in the countries with previous records, but also, in many of the American countries where Rickettsia has never been reported. A basal condition for this increase is the urgent need of increased capacity of Latin American laboratories to perform diagnosis of Rickettsia, since the absence of rickettsial dieases in such countries might be merely a result of absence of investigations.

Acknowledgments

This work was supported by the Programa Iberoamericano de Ciencias y Tecnologia para el Desarrollo (CYTED) to Red Iberoamericana para la Investigacion y Control de las Enfermedades Rickettsiales (RIICER). To Janneth Gallegos M.Sc, Escuela Superior Politecnica de Chimborazo. Facultad de Ciencias. Riobamba, Ecuador. To Jorge Miranda M.Sc, University of Cordoba, Colombia for the technical assistance.

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(160.) Oteo JA, Portillo A, Blanco JR, Ibarra V, Perez L, Izco C, et al. Low risk of developing human Rickettsia aeschlimannii infection in the North of Spain. Ann N Y Acad Sci 2005; 1063:349-351.

(161.) Hernandez Cabrera M, Angel-Moreno A, Santana E, Bolanos M, Frances A, Martin-Sanchez MS et al. Murine typhus with renal involvement in Canary Islands, Spain. Emerg Infect Dis 2004; 10:740-743.

(162.) Blanco JR, Oteo JA. Rickettsiosis in Europe. Ann N Y Acad Sci 2006; 1078:26-33.

(163.) Portillo A, Ibarra V, Santibanez S, Perez-Martinez L, Blanco JR, Oteo JA. Genetic characterisation of ompA, ompB and gltA genes from Candidatus Rickettsia rioja. Clin Microbiol Infect 2009; 15(Suppl 2):307-308.

(164.) Bacellar F, Regnery RL, Nuncio MS, Filipe AR. Genotypic evaluation of rickettsial isolates recovered from various species of ticks in Portugal. Epidemiol Infect 1995; 114:169-178.

(165.) Bacellar F, Beati L, Franca A, Pocas J, Regnery R, Filipe A. Israeli spotted fever rickettsia (Rickettsia conorii complex) associated with human disease in Portugal. Emerg Infect Dis 1999; 5:835-836.

(166.) Bacellar F. Ticks and Spotted fever rickettsiae in Portugal. In: Raoult D, Brouqui F, (Eds.) Rickettsiae and rickettsial diseases at the turn of the third millennium. Paris: Elsevier; 1999.

(167.) Sousa R, Santos-Silva M, Santos AS, Barros SC, Torgal J, Walker DH. Rickettsia conorii Israeli tick typhus strain isolated from Rhipicephalus sanguineus ticks in Portugal. Vector Borne Zoonotic Dis 2007; 7:444-447.

(168.) Sousa R, Franca A, Doria Nobrega S, Belo A, Amaro M, Abreu T et al. Host- and microberelated risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. J Infect Dis 2008; 198:576-585.

(169.) Santos-Silva MM, Sousa R, Santos AS, Melo P, Encarnacao V, Bacellar F. Ticks parasitizing wild birds in Portugal: detection of Rickettsia aeschlimannii, R. helvetica and R. massiliae. Exp Appl Acarol 2006; 39:331-338.

(170.) De Carvalho IL, Milhano N, Santos AS, Almeida V, Barros SC, De Sousa R. Detection of Borrelia lusitaniae, Rickettsia sp. IRS3, Rickettsia monacensis, and Anaplasma phagocytophilum in Ixodes ricinus collected in Madeira Island, Portugal. Vector Borne Zoonotic Dis 2008; 8:575-579.

(171.) Milhano N, De Carvalho IL, Alves AS, Arroube S, Soares J, Rodriguez P et al. Coinfections of Rickettsia slovaca and Rickettsia helvetica with Borrelia lusitaniae in ticks collected in a Safari Park, Portugal. Ticks and Tick-borne Dis 2010; 1:172-177.

(172.) Sousa R, Edouard-Fournier P, Santos-Silva M, Amaro F, Bacellar F, Raoult D. Molecular detection of Rickettsia felis, Rickettsia typhi and two genotypes closely related to Bartonella elizabethae. Am J Trop Med Hyg 2006; 75:727-731.

(173.) Alves AS, Milhano N, Santos-Silva M, Santos AS, Vilhena M, de Sousa R. Evidence of Bartonella spp., Rickettsia spp. and Anaplasma phagocytophilum in domestic, shelter and stray cat blood and fleas, Portugal. Clin Microbiol Infect 2009; 15(Suppl 2):1-3.

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(176.) Sousa R, Duque L, Anes M, Pocas J, Torgal J, Bacellar F et al. Lymphangitis in a Portuguese patient infected with Rickettsia sibirica. Emerg Infect Dis 2008; 14:529-530.

(177.) Santos-Silva M, Sousa R, Santos AS, Lopes D, Queijo E, Doreta A et al. Ticks and tickborne Rickettsiae surveillance in Montesinho Natural Park, Portugal. Ann N Y Acad Sci 2006; 1078:137-1342.

(178.) Bacellar F, Lencastre I, Filipe AR. Is murine typhus re-emerging in Portugal? Euro Surveill 1998; 3:18-20.

(179.) Freitas E, Freitas L, Barros A, Bacelar F, Filipe A, Almeida V. Murine typhus: an outbreak in Porto Santo Island-Madeira Archipelago. Eur J Int Med 1997; 8:120.

(180.) Andre E, Correia R, Castro P, Neto M, Roler J, Bacelar F et al. Tifo murino em Portugal. Acta Medica Portuguesa 1998; 11:81-85.

(181.) Oteo JA, Portillo A, Blanco JR, Ibarra V, Santibanez S. Rickettsia africae infection. Three cases confirmed by PCR. Med Clin (Barc) 2004; 122:786-788.

(182.) Gehrke FS. Deteccao e caracterizacao molecular de riquetsias em humanos, potenciais vetores e animais domesticos da regiao sudeste do Brasil. [Tese de Doutorado]. Sapo Paulo, Brasil: Instituto de Ciencias Biomedicas, Universidad de Sao Paulo; 2010.

(183.) Almeida DN, Favacho AR, Rozental T, Barcauib H, Guterres A, Gomes R et al. Fatal spotted fever group rickettsiosis due to Rickettsia conorii conorii mimicking a hemorrhagic viral fever in a South African traveler in Brazil. Ticks and Tickborne Diseases 2010; 1:149-150.

(184.) Hidalgo M, Salguero E, de la Ossa A, Sanchez R, Vesga JF, Orejuela L et al. Murine typhus in Caldas, Colombia. Am J Trop Med Hyg 2008; 78:321-322.

(185.) OPAS. Consulta de especialistas OPAS/OMS sobre rickettsioses nas Americas. Relatorio final. Rio de Janeiro: Organizacao PanAmericana da Saude, Brazil; 2004.

Marcelo B. Labruna, [1] * Ph.D, Salim Mattar V, [2] Ph.D, Santiago Nava, [3] Ph.D, Sergio Bermudez, [4] M.Sc, Jose M. Venzal, [5] Ph.D, Gaby Dolz, [6] Ph.D, Katia Abarca, [7] M.D, Luis Romero, [8] M.Sc, Rita de Sousa, [9] Ph.D, Jose Oteo, [10] M.D, Jorge Zavala-Castro, [11] Ph.D.

[1] Universidade de Sao Paulo, Departamento de Medicina Veterinaria Preventiva e Saude Animal, Faculdade de Medicina Veterinharia e Zootecnia, Sao Paulo, SP, Brazil; [2] Universidad de Cordoba, Instituto de Investigaciones Bilogicas del Tropico, Monteria, Colombia, [3] Instituto Nacional de Tecnologia Agropecuaria, Estacion Experimental, Agropecuaria Rafaela, Rafaela, Santa Fe, Argentina. [4] Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panama, Panama. [5] Universidad de la Republica de Uruguay. Facultad de Veterinaria, Departamento de Parasitologia Veterinaria, Regional Norte-Salto, Uruguay. [6] Universidad Nacional de Costa Rica, Facultad Ciencias de la Salud, Escuela de Medicina Veterinaria. Heredia, Costa Rica. [7] Pontificia Universidad Catolica de Chile, Facultad de Medicina, Chile. [8] Laboratorio Central de Diagnostico Veterinario, Ministerio de Agricultura y Ganaderia (MAG), San Salvador, El Salvador. [9] [L] aboratorio de Saude Publica, Lisboa, Portugal. [10] Hospital San Pedro, Area de Enfermedades Infecciosas, Logrono (La Rioja), Espana. [11]Universidad Autonoma de Yucatan. Centro de investigaciones regionales "Dr. Hideyo Noguchi", Merida Yucatan, Mexico. Corresponding author: labruna@usp.br

Recibido: Enero de 2011; Aceptado: Agosto de 2011.
Table 1. Infections by Rickettsia in Argentina, Chile and Uruguay.

Species           Geographical       Vector        Clinical
                  distribution                       cases
                                                   confirmed
                        ARGENTINA

R. amblyommii     Cordoba        Amblyomma            No
                                 neumanni

R. bellii         Cordoba        A. neumanni          No

                  Santiago       Amblyomma
                    del Estero   tigrinum

R. massiliae      Ciudad         Rhipicephalus        Yes
                  Autonoma de    sanguineus
                  Buenos Aires

R. parkeri        Buenos         Amblyomma            Yes
                  Aires          triste

R. rickettsii     Jujuy          Amblyomma            Yes
                                 cajennense

Cand.'R.          Cordoba        Amblyomma            No
  andeanae'                      parvum
  (1)             Santiago       Amblyomma
                    del Estero   pseudoconcolor

R. felis          Santa Fe       Ctenocephalides      No
                                 felis

R. prowazekii     Jujuy          Pediculus            Yes
                                 humanus

                           CHILE

R. felis          Metropolitan   Ctenocephalides      No
                  (2)            felis
                  Metropolitan   Rhipicephalus        No
                                 sanguineus

R. prowazekii     Metropolitan   Pediculus            Yes
                                 humanus

Orientia          Isla de        Leech                Yes
  tsutsugamushi     Chiloe

                           URUGUAY

R. parkeri        Canelones      Amblyomma          Yes (4)
                                 triste
                  Maldonado      A. triste            Yes
                  Montevideo     A. triste            Yes
                  San Jose       A. triste            Yes
                  Lavalleja      A. triste            Yes

R. felis          Montevideo     Ctenocephalides      No
                                 felis,
                                 Ctenocephalides
                                 canis

Species           Geographical    Animal     References
                  distribution   infection

                          ARGENTINA

R. amblyommii     Cordoba           No           11

R. bellii         Cordoba           No         11,12
                  Santiago
                    del Estero

R. massiliae      Ciudad            No         13,14
                  Autonoma de
                  Buenos Aires

R. parkeri        Buenos            No         15-17
                  Aires

R. rickettsii     Jujuy             No           18

Cand.'R.          Cordoba           No         12,19
  andeanae'       Santiago
  (1)               del Estero

R. felis          Santa Fe          No           20

R. prowazekii     Jujuy             No           21

                            CHILE

R. felis          Metropolitan    Yes (3)        22
                  (2)
                  Metropolitan      No           23

R. prowazekii     Metropolitan      No           24

Orientia          Isla de           No           25
  tsutsugamushi     Chiloe

                            URUGUAY

R. parkeri        Canelones         No         26-31

                  Maldonado         No         29,31
                  Montevideo        No           31
                  San Jose          No           27
                  Lavalleja         No           27

R. felis          Montevideo        No           32

(1) Reported as Rickettsia sp. strain Argentina (33).

(2) Santiago metropolitan area.

(3) Serologic evidence of infection of cats by this Rickettsia.

(4) Serologic evidence of infection in humans by this Rickettsia.

Table 2. Infections by Rickettsia in Brazil.

Species           Geographical        Vector         Clinical
                  distribution                         cases
                                                     confirmed

                             BRAZIL

R. rickettsii     Bahia          Amblyomma              Yes
                                   cajennense
                  Espirito       Amblyomma              Yes
                    Santo          cajennense
                  Minas          A. cajennense          Yes
                    Gerais
                                 Rhipicephalus
                                   sanguineus
                  Rio de         A. cajennense          Yes
                    Janeiro      R. sanguineus
                  Sao Paulo      Amblyomma              Yes
                                   aureolatum
                                 A. cajennense
                                 R. sanguineus

R. typhi          Sao Paulo      Xenopsylla             Yes
                                 cheopis

R. parkeri        Sao Paulo      Amblyomma              Yes
                                   triste
                                 Amblyomma
                                   ovale
                                 Amblyomma
                                   dubitatum
                                 Amblyomma
                                   nodosum
                  Bahia          No                     Yes

R. felis          Minas          Ctenocephalides        Yes
                    Gerais         felis
                  Rio de         C. felis               No
                    Janeiro
                  Sao Paulo      C. felis               No
                                 Ctenocephalides
                                   canis
                                 Polygenis
                                   atopus

R. amblyommii     Rondonia       A. cajennense          No
                                 Amblyomma
                                   coelebs
                                 Amblyomma
                                   longirostre
                  Sao Paulo      A. longirostre
                  Bahia          A. longirostre
                  Para           A. longirostre
                                 Amblyomma geayi

R. rhipicephali   Rondonia       Haemaphysalis          No
                                   juxtakochi
                  Sao Paulo      H. juxtakochi          No

R. bellii         Rondonia       A. ovale               No
                                 Amblyomma
                                   oblongoguttatum
                                 Amblyomma
                                   scalpturatum
                                 Amblyomma
                                   humerale
                                 Amblyomma
                  Sao Paulo      A. aureolatum          No
                                 A. dubitatum
                                 A. ovale
                                 Amblyomma
                                   incisum
                                 A. nodosum
                                 Ixodes
                                   loricatus
                                 H. juxtakochi

R. monteiroi      Sao Paulo      A. incisum             No

Spotted           Parana         No                     Yes
  fever           Santa
  group           Catarina
                  Rio Grande
                  do Sul

Typhus group      Minas          No                     Yes
                    Gerais

Species           Geographical    Animal     References
                  distribution   infection

                            BRAZIL

R. rickettsii     Bahia             No           34
                  Espirito         Yes *        35,36
                    Santo
                  Minas             Yes         37-40
                    Gerais
                  Rio de            No          41-43
                    Janeiro
                  Sao Paulo         Yes         44-48

R. typhi          Sao Paulo         Yes         49,50

R. parkeri        Sao Paulo        Yes *        51-56
                  Bahia             No           58

R. felis          Minas             No          59,60
                    Gerais
                  Rio de           Yes *         61
                    Janeiro
                  Sao Paulo         No        52,62,63

R. amblyommii     Rondonia         Yes *        64-67
                  Sao Paulo
                  Bahia
                  Para

R. rhipicephali   Rondonia         Yes *        68,69
                  Sao Paulo         No           70

R. bellii         Rondonia          No           64
                  Sao Paulo        Yes *     46, 51, 52,
                                               54, 55,
                                                70-72

R. monteiroi      Sao Paulo         No           73

Spotted           Parana           Yes *        74-77
  fever           Santa
  group           Catarina
                  Rio Grande
                  do Sul

Typhus group      Minas             No           78
                    Gerais

* Serologic evidence of infection by this Rickettsia

Table 3. Infections by Rickettsia in Bolivia, Colombia, Peru and Ecuador.

Species         Geographical       Vector        Clinical     Animal
                distribution                       cases     infection
                                                 confirmed

                                 BOLIVIA

R. parkeri      CochaBamba     Amblyomma            No          Yes
                               tigrinum

R. prowazekii   La Paz         Pediculus            No          No
                               humanus

Rickettsia      CochaBamba     A. tigrinum          No          No
  sp. (1)

                                 COLOMBIA

R. rickettsii   Cundinamarca   Amblyomma            Yes         No
                                 cajennense
                Antioquia      No                   Yes         No
                Cordoba        No                   Yes         No

R. typhi        Caldas         No                   Yes         No

Spotted         Cordoba        No                   No          No
  fever         Cundinamarca   No                   No          No
  group         Cordoba        No                   No          Yes

                                   PERU

R. felis        Piura          Ctenocephalides      No          No
                               felis

Cand. 'R.       Piura          Amblyomma            No          No
  andeanae'                      maculatum
                               Ixodes
                                 boliviensis

R. prowazekii   Apurimac       Pediculus            Yes         No
                                 humanus
                Arequipa       P. humanus           Yes         No
                Ayacucho       P. humanus           Yes         No
                Cuzco          P. humanus           Yes         No
                Puno           P. humanus           Yes         No

Spotted         Cuzco          No                   Yes         No
  fever         Piura          No                   Yes         No
  group         Junin          No                   Yes         No
                Loreto         No                   Yes         Yes

Typhus          Loreto         No                   Yes         Yes
  group

                                  ECUADOR

R. prowazekii   Pichincha      Pediculus            Yes         No
                                 humanus
                Azuay          No                   Yes         No
                Canar          No                   Yes         No
                Carchi         No                   Yes         No
                Cotopaxi       No                   Yes         No
                Chimborazo     No                   Yes         No
                Imbabura       No                   Yes         No
                Loja           No                   Yes         No
                Tungurahua     No                   Yes         No
                Napo           No                   Yes         No
                Pastaza        No                   Yes         No

Species         Geographical   References
                distribution

                  BOLIVIA

R. parkeri      CochaBamba         79

R. prowazekii   La Paz             80

Rickettsia      CochaBamba         79
  sp. (1)

                  COLOMBIA

R. rickettsii   Cundinamarca     81,82
                Antioquia        83,84
                Cordoba          85,86

R. typhi        Caldas             84

Spotted         Cordoba            87
  fever         Cundinamarca       88
  group         Cordoba            89

                    PERU

R. felis        Piura              90

Cand. 'R.       Piura              90
  andeanae'

R. prowazekii   Apurimac         91,92
                Arequipa         91,92
                Ayacucho         91,92
                Cuzco            91,92
                Puno             91,92

Spotted         Cuzco            90,93
  fever         Piura            90,93
  group         Junin              94
                Loreto             95

Typhus          Loreto             95
  group

                  ECUADOR

R. prowazekii   Pichincha          96
                Azuay              97
                Canar              97
                Carchi             97
                Cotopaxi           97
                Chimborazo         98
                Imbabura           97
                Loja               97
                Tungurahua         97
                Napo               97
                Pastaza            97

(1) Close-related to R. aeschlimannii

Table 4. Infections by Rickettsia in Costa Rica, El Salvador,
Guatemala, French Guayana, Honduras, Nicaragua and Panama.

Species          Geographical         Vector         Clinical
                 distribution                          cases
                                                     confirmed

                         COSTA RICA

R. rickettsii    Alajuela       No                      Yes
                 Cartago        No                      Yes
                 Heredia        No                      Yes
                 Limon          Haemaphysalis           Yes
                                  leporispalustris

R. akari         Limon          No                      Yes

R. amblyommii                   Amblyomma               No
                                  cajennense

R. felis                        Ctenocephalides         No
                                  felis

Spotted          Alajuela       No                      Yes
  fever          Limon          No                      Yes
  group

                         EL SALVADOR

Spotted          No data        No                    Yes (1)
  fever
  group

Typhus group     No data        No                    Yes (1)

                           GUATEMALA

R. prowazekii    Highlands      No                    Yes (1)
                 (>1.300 m)

R. typhi         Lowlands       No                    Yes (1)
                 (<1.300 m)

                        FRENCH GUAYANA

R. amblyommii    Regina         Amblyomma               No
                                coelebs

                           HONDURAS

Spotted          No data        No                    Yes (1)
  fever          Islas de       No                    Yes (1)
  group            la Bahia
                 No data        No                      no

                           NICARAGUA

Spotted          No data        No                    Yes (1)
  fever
  group

                            PANAMA

R. rickettsii    Panama         Amblyomma               Yes
                                  cajennense
                                Amblyoma sp.
                 Cocle          No                      Yes
                 Darien         Dermacentor             No
                                  nitens

R. amblyommii    Cocle          Amblyomma               No
                                  cajennense
                                Rhipicephalus
                                  sanguineus
                                Dermacentor
                                  nitens
                 Darien         Amblyomma               No
                                  cajennense
                                Rhipicephalus
                                  sanguineus
                                Dermacentor
                                  nitens
                 Kuna Yala      Rhipicephalus           No
                                  sanguineus

R. felis         Cocle          Ctenocephalides         No
                                  felis

R. typhi         Panama         No                      Yes

Species          Geographical    Animal     References
                 distribution   infection

                         COSTA RICA

R. rickettsii    Alajuela          No         99,100
                 Cartago           No         100,101
                 Heredia           No         100,102
                 Limon             No         100-103

R. akari         Limon             No           104

R. amblyommii                      No           105

R. felis                           No           105

Spotted          Alajuela          Yes          106
  fever          Limon             Yes          106
  group

                         EL SALVADOR

Spotted          No data           No         107,108
  fever
  group

Typhus group     No data           No         107,108

                          GUATEMALA

R. prowazekii    Highlands         No           104
                 (>1.300 m)

R. typhi         Lowlands          No           109
                 (<1.300 m)

                        FRENCH GUAYANA

R. amblyommii    Regina            No           109

                           HONDURAS

Spotted          No data           No           104
  fever          Islas de          No           110
  group            la Bahia
                 No data         Yes (2)        111

                           NICARAGUA

Spotted          No data           No           104
  fever
  group

                            PANAMA

R. rickettsii    Panama            No         112-115
                 Cocle             Yes          116
                 Darien            No           117

R. amblyommii    Cocle             Yes          116
                 Darien            No         115,117
                 Kuna Yala         Yes          115

R. felis         Cocle             No           116

R. typhi         Panama            No           118

(1) Serologic evidence of infection in humans by this Rickettsia,

(2) Serologic evidence of infection in animals.

Table 5. Infections by Rickettsia in Mexico.

Species         Geographical           Vector        Clinical
                distribution                           cases
                                                     confirmed

                              MEXICO

R. rickettsii   Baja California    Rhipicephalus        Yes
                                     sanguineus
                Coahuila           R. sanguineus        Yes
                Durango            R. sanguineus        Yes
                Nuevo Leon         Amblyomma            Yes
                                     imitator
                San Luis           R. sanguineus        Yes
                  Potosi
                Sinaloa            R. sanguineus        Yes
                Sonora             R. sanguineus        Yes
                Veracruz           Amblyomma            Yes
                                     cajennense
                Yucatan            No                   Yes

R. felis        Yucatan            Ctenocephalides      Yes
                                     felis

R. akari        Yucatan            R. sanguineus        Yes

R. prowazekii   Chiapas            No                   Yes
                Hidalgo            No                   Yes
                Jalisco            No                   Yes
                Estado             No                   Yes
                  de Mexico
                Nuevo Leon         Amblyomma sp         Yes
                Oaxaca             No                   Yes
                Puebla             No                   Yes
                Veracruz           No                   Yes

R. typhi        Ciudad             No                   Yes
                  de Mexico
                Guerrero           No                   Yes
                Hidalgo            No                   Yes
                Jalisco            No                   Yes
                Estado             No                   Yes
                  de Mexico
                Michoacan          No                   Yes
                Nayarit            No                   Yes
                Nuevo Leon         No                   Yes
                Oaxaca             No                   Yes
                Puebla             No                   Yes
                Queretaro          No                   Yes
                Tamaulipas         No                   Yes
                Zacatecas          No                   Yes
                Yucatan            No                   Yes

Species         Geographical        Animal     References
                distribution       infection

                              MEXICO

R. rickettsii   Baja California       No        119,120
                Coahuila              No          121
                Durango               No        120,122
                Nuevo Leon            No          123
                San Luis              No        121,122
                  Potosi
                Sinaloa               No          124
                Sonora                No        125-129
                Veracruz              No        119,130
                Yucatan               No        131,132

R. felis        Yucatan               No        133-136

R. akari        Yucatan               Yes       137,138

R. prowazekii   Chiapas               No          139
                Hidalgo               No          122
                Jalisco               No          140
                Estado                No        122,141
                  de Mexico
                Nuevo Leon            No        142,143
                Oaxaca                No          122
                Puebla                No          122
                Veracruz              No          122

R. typhi        Ciudad                No          144
                  de Mexico
                Guerrero              No          122
                Hidalgo               No          122
                Jalisco               No          122
                Estado                No          122
                  de Mexico
                Michoacan             No          122
                Nayarit               No          122
                Nuevo Leon            No          122
                Oaxaca                No        122,145
                Puebla                No          122
                Queretaro             No          122
                Tamaulipas            No          122
                Zacatecas             No          122
                Yucatan               No          146

Table 6. Infections by Rickettsia in Caribbean Islands.

Species      Geographical         Vector        Clinical     Animal
             distribution                         cases     infection
                                                confirmed

                             CARIBBEAN ISLES

R. africae   Guadaloupe       Amblyomma            Yes         Yes
                                variegatum
             St. Kitts        A. variegatum        No          No
             Nevis            A. variegatum        No          No
             Dominica         A. variegatum        No          No
             Virgin islands   A. variegatum        No          No
             Montserrat       A. variegatum        No          No
             St. Lucia        A. variegatum        No          No
             Martinique       A. variegatum        No          No
             Antigua          A. variegatum        No          No

R. felis     St. Kitts        Ctenocephalides      No          No
                              felis

R. typhi     Puerto Rico      Xenopsylla           Yes         Yes
                              cheopis

Species      Geographical     References
             distribution

           CARIBBEAN ISLES

R. africae   Guadaloupe        147,148
             St. Kitts           149
             Nevis               149
             Dominica            150
             Virgin islands      150
             Montserrat          150
             St. Lucia           150
             Martinique          151
             Antigua             152

R. felis     St. Kitts           153

R. typhi     Puerto Rico         154

Tabla 7. Infections by Rickettsia in Spain and Portugal.

Species            Geographical           Vector         Clinical
                   distribution                            cases
                                                         confirmed

                               SPAIN

R. conorii         All Spain        Rhipicephalus           Yes
                                      sanguineus

R. helvetica       All Spain        Ixodes                  No
                                      ricinus

R. monacensis      All Spain        I. ricinus              Yes

R. felis           All Spain,       Ctenocephalides         Yes
                   Canary Islands     felis

R. slovaca         All Spain        Dermacentor             Yes
                                      marginatus

R. raoultii        All Spain        D. marginatus           Yes

R. sibirica        Pais Vasco,      No                      Yes
                   La Rioja

R. aeschlimannii   Castilla Leon,   Hyalomma                No
                   La Rioja           marginatum

R. typhi           South Spain,     Xenopsilla              Yes
                   Canary Islands   cheopis,
                                    C. felis

R. prowazekii      All Spain        Pediculus               Yes
                                      humanus

R. rioja           Galicia,         D. marginatus           Yes
                   Pais Vasco,
                   La Rioja

                             PORTUGAL

R. conorii         Continental      Rhipicephalus           Yes
                   Portugal           sanguineus

R. helvetica       Continental      Ixodes                  No
                   Portugal,          ricinus
                   Madeira Island

R. monacensis      Continental      I. ricinus              No
                   Portugal,
                   Madeira Island

R. felis           Continental      Archaeopsylla           No
                   Portugal,          erinacei maura,
                   Madeira Island   Ctenophatalmus sp.
                                    Ctenocephalides
                                      felis

R. slovaca         Continental      Dermacentor             Yes
                   Portugal           marginatus
                                    Dermacentor
                                      reticulatus

R. raoultii        Continental      D. marginatus           No
                   Portugal

R. sibirica        Continental      Rhipicephalus           Yes
                   Portugal         pusillus,
                                    Rhipicephalus
                                    bursa,

R. aeschlimannii   Continental      Hyalomma                No
                   Portugal           marginatum

R. typhi           Continental      Leptopsylla             Yes
                   Portugal,          segnis
                   Madeira Island

R. prowazekii      Continental      Pediculus               Yes
                   Portugal           humanus

R. massiliae       Continental      R. sanguineus           No
                   Portugal

Species            Geographical      Animal     References
                   distribution     infection

                               SPAIN

R. conorii         All Spain           No          155

R. helvetica       All Spain           No          156

R. monacensis      All Spain           No           9

R. felis           All Spain,          No          157
                   Canary Islands

R. slovaca         All Spain           No          158

R. raoultii        All Spain           No          158

R. sibirica        Pais Vasco,         No          159
                   La Rioja

R. aeschlimannii   Castilla Leon,      No          160
                   La Rioja

R. typhi           South Spain,        No          161
                   Canary Islands

R. prowazekii      All Spain           No          162

R. rioja           Galicia,            No        158,163
                   Pais Vasco,
                   La Rioja

                              PORTUGAL

R. conorii         Continental         No        164-168
                   Portugal

R. helvetica       Continental         No        166,169
                   Portugal,
                   Madeira Island

R. monacensis      Continental         No        170,171
                   Portugal,
                   Madeira Island

R. felis           Continental         No        172,173
                   Portugal,
                   Madeira Island

R. slovaca         Continental         No       166, 169,
                   Portugal
                                                   174

R. raoultii        Continental         No        171,175
                   Portugal

R. sibirica        Continental         No        175,176
                   Portugal

R. aeschlimannii   Continental         No       166, 179,
                   Portugal                        177

R. typhi           Continental         No       175, 178-
                   Portugal,                       180
                   Madeira Island

R. prowazekii      Continental         No          162
                   Portugal

R. massiliae       Continental         No          166
                   Portugal

Table 8. Importated cases of Rickettsia in Latin
America and Iberian peninsula.

Species          Country       Country     Reference
                of origin      of event
                              occurrence

R. massiliae    Argentina       Spain         14
R. africae     South Africa     Spain         181
R. conorii       Portugal       Brazil        182
R. conorii     South Africa     Brazil        183
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Title Annotation:REVISION DE LITERATURA
Author:Labruna, Marcelo B.; Mattar V., Salim; Nava, Santiago; Bermudez, Sergio; Venzal, Jose M.; Dolz, Gaby
Publication:Revista MVZ (Medicina Veterinaria y Zootecnia)
Article Type:Report
Date:May 1, 2011
Words:11579
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