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Volume 26, Number 4—April 2020
Research Letter

Needlestick-Associated Rocky Mountain Spotted Fever, Brazil

Stefan Vilges de Oliveira, Álvaro A. Faccini-MartínezComments to Author , Talita Emile Ribeiro Adelino, Ana Íris de Lima Duré, Amalia R.M. Barbieri, and Marcelo B. Labruna
Author affiliations: Universidade Federal de Uberlândia, Uberlândia, Brazil (S.V. de Oliveira); Universidade Federal do Espírito Santo, Vitória, Brazil (Á.A. Faccini-Martínez); Fundação Ezequiel Dias, Belo Horizonte, Brazil (T.E. Ribeiro Adelino, A.Í. de Lima Duré); University of São Paulo, São Paulo, Brazil (A.R.M. Barbieri, M.B. Labruna)

Main Article

Table

Information about confirmed fatal case of needlestick-associated Rocky Mountain spotted fever and related source case in Minas Gerais state, Brazil, 2018*

Case-patient Age, y/sex Clinical signs and symptoms Exposure factors Date
qPCR (gltA) Conventional heminested PCR (ompA)†
Symptom onset Serum collected Death
A, patient 74/M Fever, myalgia, dysuria, oliguria Environmental exposure to woods, rivers, waterfalls; report of insect bite Jul 20 Jul 22 Jul 24 + +
B, nurse 30/M Fever, maculopapular rash, acute respiratory distress syndrome, shock, oliguria No reported tick or insect bites or environmental exposures; accidental percutaneous needlestick injury associated with case-patient A on July 23 Jul 30 Aug 2 Aug 5 + +

*Clinical and epidemiological data were retrieved from official spotted fever–rickettsiosis case forms collected for each patient by the Ministry of Health, Brazil (4). gltA, rickettsial citrate synthase gene; ompA, rickettsial outer membrane protein A gene; qPCR, quantitative PCR; +, positive.
†All PCR amplicons were sequenced and confirmed a 100% identity with Rickettsia rickettsii.

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References
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  3. de Oliveira  SV, Guimarães  JN, Reckziegel  GC, Neves  BM, Araújo-Vilges  KM, Fonseca  LX, et al. An update on the epidemiological situation of spotted fever in Brazil. J Venom Anim Toxins Incl Trop Dis. 2016;22:22. DOIPubMed
  4. Ministry of Health. Brazil. Official spotted fever/rickettsiosis case report [in Portuguese]. Brazil: The Ministry; 2018 [cited 2020 Feb 17]. http://portalsinan.saude.gov.br/images/documentos/Agravos/Febre%20Maculosa/Febre_Maculosa_v5.pdf
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  6. Faccini-Martínez  ÁA, Muñoz-Leal  S, Acosta  ICL, de Oliveira  SV, de Lima Duré  , Cerutti  C, et al. Confirming Rickettsia rickettsii as the etiological agent of lethal spotted fever group rickettsiosis in human patients from Espírito Santo state, Brazil. Ticks Tick Borne Dis. 2018;9:4969. DOIPubMed
  7. Johnson  JE III, Kadull  PJ. Rocky Mountain spotted fever acquired in a laboratory. N Engl J Med. 1967;277:8427. DOIPubMed
  8. Sexton  DJ, Gallis  HA, McRae  JR, Cate  TR. Letter: Possible needle-associated Rocky Mountain spotted fever. N Engl J Med. 1975;292:645. DOIPubMed
  9. Kaplowitz  LG, Lange  JV, Fischer  JJ, Walker  DH. Correlation of rickettsial titers, circulating endotoxin, and clinical features in Rocky Mountain spotted fever. Arch Intern Med. 1983;143:114951. DOIPubMed

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Page created: March 17, 2020
Page updated: March 17, 2020
Page reviewed: March 17, 2020
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