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Acta Médica Costarricense
On-line version ISSN 0001-6002Print version ISSN 0001-6012
Acta méd. costarric vol.55 suppl.1 San José Jul. 2013
Conferencias Magistrales
Enfermedades rickettsiales: ¿Un problema de salud pública en América Latina?
Rickettsial diseases: a public health problem in
Márcio Antônio Moreira Galvão, Amanda de Freitas Padilha
Resumen
Para que una enfermedad sea considerada un problema de salud pública, los parámetros epidemiológicos son magnitud, vulnerabilidad y trascendencia. Si se considera sólo magnitud y vulnerabilidad basadas en la incidencia de las enfermedades rickettsiales en América Latina y en la ausencia de una vacuna efectiva contra esta clase de enfermedades, se puede decir que las enfermedades rickettsiales no son una prioridad ni un problema de salud pública. Sin embargo, si se investigan otros parámetros epidemiológicos se puede tener otra visión acerca de estas enfermedades. El objetivo de este trabajo es analizar mediante un estudio histórico retrospectivo, los factores de riego epidemiológicos en las enfermedades rickettsiales, para confirmar nuestra hipótesis sobre su relevancia en salud pública.
Descriptores: salud pública, rickettsiosis, epidemiología.
Abstract
The epidemiologic parameters for a disease to be considered a public health problem are magnitude, vulnerability and transcendence. If you consider only magnitude and vulnerability based on incidence of rickettsial diseases in
Keywords: Public Health; rickettsioses; epidemiology.
Some countries, such
Spotted fever caused by R. rickettsii were identify too in Mexico, Panama, Costa Rica, Colombia and Argentina.2,8 The Argentine cases were described in Jujuy Province in 1999, when six children with fever, rash and a history of recent tick bite were evaluated for rickettsial infections and immunohistochemistry staining of tissues obtained by \autopsy from one fatal case.9 In Panama the description of R. rickettsii re emergence occurred in 2007 after more than fifty years without the description of spotted fever cases.10 In Mexico the first case of spotted fever caused by R. rickettsii was described in 1930. From 1930 to 1950 many cases of this disease were reported in many states.11 The same phenomenon that was seen in Panama was observed too in Mexico with an epidemiologic silence occurred from 1950 till 2005, when new cases of this re emergent disease initiated to happen again.10 Costa Rica registered the first outbreak of rickettsii spotted fever in 1975. After this date several cases were described in this country.12 In Colombia nothing was known or published about rickettsioses since 1937 when a report of an epidemic caused by R. rickettsii was related and named as “Fiebre de Tobia”. In 2007 two fatal cases of R. rickettsii spotted fever were related near the same locality were the disease was reported in the 1930s.13,14 Peru has a long history of epidemic typhus caused by Rickettsia prowazekii (transmitted by body lice), 15 isolated cases of murine typhus, and the detection of R. felis in Ctenocephalides canis fleas, indicating the possibility of human cases of this rickettsiose.
The principal vectors of rickettsioses found in
The rates of vector infection can variety depending of pathogen virulence, Rickettsia susceptibility, the presence of co-infections and modulation of immune response at the host. The R. rickettsii maintains in general levels of infection lower than 1%.1,16 Although some authors don´t consider difference between endemic and non endemic areas, asserting that the presence of infected ticks cannot be sufficient to produce human disease, the high infestations by ticks in the environment and in the animals can modify this relation.
Conclusions
To judge if rickettsial diseases are an important public health problem or not in
If you consider only magnitude and vulnerability based on incidence of rickettsial diseases in
The spotted fever caused by R. rickettsii is the more severe rickettsiose among the rickettsial diseases in Latin America with a high case-fatality ratio.1 The primary vectors for R. rickettsii in Latin American are ticks from Amblyomma cajennense specie (
Rickettsia parkeri is considered an emergent pathogen in Latin America with suspected human cases related in Uruguay17 and Amblyomma triste as vector.18
The riquetsiose felis caused by Rickettsia felis has the fleas of Ctenocephalides genus as the principal vector. Although the symptoms of this disease are common in other rickettsioses (fever, myalgia, rash and abdominal pain) and can be synonym of mild cases, neurologic symptoms occurred in Brazilian and Mexican cases can traduce the possibility of severity of this disease in some cases.19
The occurrence of epidemic typhus in Latin America caused by Rickettsia prowazekii can be observed in
Rickettsia typhi the agent of endemic typhus occurs in all
The analysis presented of the epidemiologic situation of each rickettsiose help us to conclude that rickettsial diseases are an important public health problem in
We conclude with the affirmation that the analysis of the spatial distribution of rickettsial diseases besides social/economic impact is fundamental to understand the occurrence and the spread of these diseases in the present moment in
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