Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia.
Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA; Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia.
Ticks Tick Borne Dis. 2021 Jul;12(4):101734. doi: 10.1016/j.ttbdis.2021.101734. Epub 2021 May 1.
Rickettsia parkeri rickettsiosis is recognized as the second most prevalent tick-borne disease caused by spotted fever group rickettsiae in the Americas, where two pathogenic strains (R. parkeri sensu stricto and R. parkeri strain Atlantic rainforest) have been related to human infections and transmitted by Amblyomma spp. ticks. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of R. parkeri rickettsiosis, including confirmed and probable cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. We excluded papers that contained missing information of some variables and publications in which it was not possible to separate data for confirmed and probable cases. A total of 77 clinical cases (32 confirmed cases and 45 probable cases) were considered for this review. Overall, our results show that R. parkeri rickettsiosis is more frequent in males in the age group of 18-64 years and that a history of tick exposure was frequent (>90%). Cases were described in the United States, Argentina, Brazil, Uruguay and Colombia. Clinically, more than 60% of the cases had fever (mean of 93%), eschar (mean of 87%), and rash (mean of 68%). Headache and myalgia were predominant nonspecific symptoms (mean of 67% and 61%, respectively). Our results show that at least 60% of R. parkeri cases had altered laboratory parameters, most often showing an increase in transaminases and leukopenia. Tetracyclines-class antibiotics were used in most (>85%) of the patients. Overall, only 9% of cases required hospitalization and there was a 100% rate of clinical recovery in all of cases.
帕克氏立克次体斑疹热被认为是美洲第二大由斑点热群立克次体引起的常见蜱传疾病，其中两个致病株（帕克氏立克次体亚种和大西洋雨林帕克氏立克次体株）与人类感染有关，并通过硬蜱属（Amblyomma spp.）传播。我们进行了一项系统评价，评估了文献中关于帕克氏立克次体斑疹热的所有临床、流行病学和实验室特征的现有证据，包括确诊和可能病例。我们遵循系统评价和荟萃分析首选报告项目的建议。我们排除了一些变量信息缺失的论文和无法将确诊和可能病例的数据分开的出版物。共有 77 例临床病例（32 例确诊病例和 45 例可能病例）被纳入本综述。总体而言，我们的结果表明，帕克氏立克次体斑疹热在 18-64 岁的男性中更为常见，且蜱虫暴露史较为常见（>90%）。病例在美国、阿根廷、巴西、乌拉圭和哥伦比亚均有报告。临床上，超过 60%的病例有发热（平均 93%）、焦痂（平均 87%）和皮疹（平均 68%）。头痛和肌痛是最常见的非特异性症状（分别为 67%和 61%）。我们的结果表明，至少 60%的帕克氏立克次体病例的实验室参数发生改变，最常见的是转氨酶升高和白细胞减少。大多数（>85%）患者使用四环素类抗生素。总体而言，只有 9%的病例需要住院治疗，所有病例的临床康复率均为 100%。
