Caracterización del primer caso de infección humana por Ehrlichia canis en Panamá

Sergio Eduardo Bermúdez Castillero, Carlos Daza, Julio Osorio, Amilcar Hurtado, José Suárez, Ana Santamaria

Resumen


[Characterization of the First Case of Human Infection by Ehrlichia canis in Panama]

Resumen

Ehrlichia canis fue considerada un patógeno exclusivo de caninos y tiene como su principal vector a garrapatas del complejo Rhipicephalus sanguineus. Diversos estudios de casos demuestran que también puede producir patología en humanos, de las que hasta el momento sólo se han asociado a infecciones asintomáticas y de leve a moderada intensidad. El objetivo de este manuscrito es describir la presentación clínica de un caso severo de ehrlichiosis en un joven inmunocompetente y presentar el diagnóstico diferencial de E. canis. La determinación del agente etiológico se realizó por medio de pruebas serológicas (IFI) y moleculares (gltA, ompA, 16S rARN, ECC, ECB, Dsb-330 y Dsb-728) a muestras de sangre del paciente. No se obtuvieron resultados para pruebas serológicas contra dengue, hantavirus, HIV, Leptospira, tampoco dio resultado el PCR de parainfluenza (1, 2, 3), adenovirus, influenza (A y B) y rinovirus. Los resultados para Rickettsia demostraron sero-reacción IgG, pero no IgM ni para los análisis moleculares. Secuencias de los segmentos amplificados mostraron un 99% de homología con E. canis para el gen 16S rARN y de 100% el gen dsb. Este es el primer caso confirmado y descrito de infección de E. canis en un paciente inmunocompetente humano en Panamá.

Abstract
Ehrlichia canis was considered an exclusive canine pathogen and its main vector is ticks of the Rhipicephalus sanguineus complex. Several case studies show that it can also cause pathology in humans, which until now have only been associated with asymptomatic infections and mild to moderate intensity. The aim of this paper is describe the clinical presentation of a severe case of ehrlichiosis, an immuno-competent young man. Present the differential diagnosis of Ehrlichia canis. The determination of the etiological agent, serological (IFA) and molecular tests (gltA, ompA, 16S rRNA, ECC, ECB, Dsb-330 and Dsb-728) were performed on patient blood samples. No results were obtained for serological tests against dengue, hantavirus, HIV, Leptospira, nor on PCR for parainfluenza (1, 2, 3), adenovirus, influenza (A and B), and rhinovirus. The results for Rickettsia demonstrated sero-reaction IgG, but not IgM nor for molecular analyzes. Sequences of the amplified segments showed 99% homology with E. canis for the 16S rRNA gene and 100% for the dsb gene. This is the first confirmed and described case of E. canis infection in a human immunocompetent patient in Panama.


Texto completo:

[PDF]

Referencias


Dumler, S.J., Barbet, A.F., Bekker, C.P.J., Dash, G.A., Palmer, G.H., et al. Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales: unification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and HE agent as subjective synonyms of Ehrlichia phagocytophila. Int. J. Syst. Evol. Microbiol. 2001. 51, 2145–2165.

Dumler, J.S. Anaplasma and Ehrlichia infection. Ann. N. Y. Acad. Sci. 2005. 1063,361–373.

Donatien, A., Lestoquard, F. Existence en Algerie d’une Rickettsia du chien. Bull. Soc. Pathol. Exot, 1935. 28, 418-419.

Estrada-Peña A, Jongejan F. Ticks feeding on humans: a review of records on human-biting Ixodoidea with special reference to pathogen transmission. Exp Appl Acarol. 2001. 23:685-715.

Perez, M., Rikihisa, Y., Wen, B. Ehrlichia canis-like agent isolated from a man in Venezuela: antigenic and genetic characterization. J. Clin. Microbiol. 1996. 34,2133–2139

Pérez, M., Bador, M., Zhang, C., Xiong, Q., Rikihisa, Y. Human infection with Ehrlichia canis accompanied by clinical signs in Venezuela. Ann. N. Y. Acad. Sci. 2006. 1078, 110–117.

Silva, A. B., Pina-Canseco, S., Gabriel-De la Torre, M. P., Mayoral-Silva, A., Mayoral, M. A. et al. Infección humana asintomática por contacto con perros. Un caso de ehrlichiosis humana. G Med Mex, 2014. 150, 171-174.

Bouza-Mora, Dolz G, Solórzano-Morales A, Romero-Zúñiga J, Salazar-Sánchez L. et al. Novel genotype of Ehrlichia canis detected in samples of human bloodbank donors in Costa Rica. T Tick-Borne Dis 2016. 8(1): 36-40.

Harrus S, Waner T. Diagnosis of canine monocytotropic ehrlichiosis (Ehrlichia canis): an overview. The Veterinary Journal. 2011; 187(3): 292-6.

Varela-Petrucelli J, Bermúdez S. Clinical and Serological Evidence of Canine Anaplasmosis and Ehrlichiosis in Urban and Rural Panama. Ann Clin Cytol Pathology 2017. 3(1): 1050.

de Rodaniche E & Rodaniche A. Spotted fever in Panama. Isolation of the etiologic agent from a fatal case. Am J Trop Med Hyg 1950. 30:511-517.

Calero C, Nuñez J, Silva R. Rocky Mountain spotted fever in Panama. Report of two cases. Am. J. Trop. Med. Hyg. 1952. 1(4): 631-636.

Estripeaut D, Aramburú M, Sáez-Llorens X, Thompson H, Dasch G, Paddock C. et al. M. Rocky mountain spotted fever, Panama. Emerg Infec Dis 2007; 13:1763-1765.

Tribaldos M, Zaldivar Y, Bermúdez S, Samudio F, Mendoza Y, Martinez A, et al. J. Rocky Mountain spotted fever in Panama: a cluster description. J Infect Develop Countr. 2011. 5(10):737-741.

De Luca J, García G, García E, Castro A, Lyons C, Bermúdez S. Nuevo caso de rickettsiosis humana en Panamá: primer reporte proveniente de un área silvestre. Rev. Med Pan. 2013. 34: 40-43.

Bermúdez S, Castro A, Trejos T, García G, Gabster A, Miranda R. et al. Distribution of Spotted Fever Group Rickettsiae in hard ticks (Ixodida: Ixodidae) from Panamanian urban and rural environments. EcoHealth. 2016. 13: 274–284.

Perez A, Pile E, Torres A, Lasso J. Prevalence of canine ehrlichiosis among animals treated at the Corozal veterinary hospital of the faculty of veterinary medicine, university of Panama. Arq Inst Biol 2013; 80(2): 207-11.

Ferrer A, Brinkerhoff R.J, Bernal J, Bermúdez SE. Ticks and tick-borne pathogens of dogs along an elevational and land-use gradient in Chiriquí province, Panamá. Exp Appl Acarol 2017. 71(4): 375-381

Martínez-Caballero, Moreno B, González C. et al. Descriptions of two new cases of Rocky Mountain spotted fever in Panama, and coincident infection with Rickettsia rickettsii in Rhipicephalus sanguineus s.l. in an urban locality of Panama City, Panama. J. Epi Infect. In press 2018.

Bermúdez S, Castro A, Esser H, Liefting Y, García G, Miranda R. Ticks (Ixodida) on humans from central Panama, Panama (2010-2011). Exp Appl Acarol. 2012. 58 (1): 81-88. DOI 10.1007/S10493-012-9564-7.

Horta, M., Labruna, M., Pinter, A., Linardi, P., Schumaker, T. Rickettsia infection in five areas of the state of São Paulo. Mem. Inst. Oswaldo. Cruz. 2007. 102, 793–801.

Roux V, Fournier E, Raoult D. Differentiation of spotted fever group Rickettsiae by sequencing and analysis of restriction fragment length polymorphism of PCR amplified DNA of the gene encoding the protein rOmpA. J. Clin Mincrobiol. 1996. 34(9): 2058–2065

Murphy GL, Ewing SA, Whitworth LC, Fox JC, Kocan AA. A molecular and serologic survey of Ehrlichia canis, E. chaffeensis, and E. ewingii in dogs and ticks from Oklahoma. Vet Parasitol 1998; 79(4): 325-339. http://dx.doi.org/10.1016/S0304-4017(98)00179-4. PMid:9831955.

Doyle C, Labruna M, Breitschewerdt E, Tang Y, Cortvet R, Hegarty B et al.. Detection of medically important Ehrlichia by quantitative Multicolor TaqMan Real-Time Polymerase Chain Reaction of the dsb Gene. J Mol Diagn. 2005 Oct; 7(4): 504–510.

Mattar S, Alvis N, González M. Haemorrhagic Fevers Transmitted by Vectors in the Neotropics. In: Current topics of public health. 2013. Pag: 381-399.

Álvarez-Hernández G, González J, Hernández N, Lash R, Barton C, Paddock. Rocky Mountain spotted fever in Mexico: past, present and future. Lancet Infec Dis 2017. 17: 189-195.

Oteo J, Nava S, Sousa R, Mattar S, Venzal J, Abarca K, et al. Guías Latinoamericanas de la RIICER para el diagnóstico de las rickettsiosis transmitidas por garrapatas. Rev Chilena Infectol 2014; 31 (1): 54-65.

Valbuena G. Patogénesis de las infecciones producidas por Rickettsias en las Américas. Rev. MVZ Córdoba 2010. 15(1): 2004-2006

Billeter, S. A., Blanton, H. L., Little, S. E., Levy, M. G., Breitschwerdt, E.. Detection of “Rickettsia amblyommii” in association with a tick bite rash. Vector-Borne Zoonotic Dis, 2010. 7(4), 607-610.

Apperson, C. S., Engber, B., Nicholson, W. L., Mead, D. G., Engel, J. et al.. Tick-borne diseases in North Carolina: is “Rickettsia amblyommii” a possible cause of rickettsiosis reported as Rocky Mountain spotted fever?. Vector-Borne Zoonotic Dis, 2008. 8(5), 597-606.


Enlaces refback

  • No hay ningún enlace refback.


Académia Panameña de Medicina y Cirugía. Derechos reservados 2013. Un servicio de Infomedic International S,A.