Campinas treats cases of Rocky Mountain spotted fever as an outbreak – 06/13/2023 – Health

The Prefecture of Campinas (93 km from SP) said this Tuesday (13) that there is a fourth suspected case of spotted fever contracted in the municipality. According to the Municipal Health Department, a 16-year-old teenager who lives in the city has been hospitalized since the last 9th in a private hospital.

The young woman attended the feijoada held on May 27 at a farm in the Joaquim Egídio district, where dentist Mariana Giordano, 36, her boyfriend, pilot Douglas Pereira Costa, 42, from Jundiaí (SP), and a 28-year-old woman from Hortolândia (SP). The three died of Rocky Mountain spotted fever on the 8th.

According to the City of Campinas, the teenager’s case had already been notified to the State Health Surveillance as suspected of having spotted fever, dengue, leptospirosis or meningitis.

“However, the family only mentioned the event at Fazenda Santa Margarida [onde ocorreu a feijoada] this Tuesday, June 13, when seeing the repercussions in the press”, says the municipal administration, in a note.

The material collected is being analyzed in the capital by the Instituto Adolfo Lutz, of the Government of São Paulo.

The Municipal Health Department already treats the situation as an outbreak of spotted fever. The district of Joaquim Egídio is mapped as a risk area for the disease.

Rocky Mountain spotted fever is curable, but treatment needs to be started early with appropriate antibiotics.

The Seo Rosa restaurant, responsible for the event, said that it heard about the “fatality”, but that “it is not confirmed that they caught the tick at the Farm”.

The city hall stated that, immediately after being notified of the cases, Devisa (Department of Health Surveillance) triggered a series of prevention, information and mobilization actions against spotted fever at Santa Margarida Farm.

Those responsible for the farm were notified about the importance of signaling regarding the risk of the disease. This information is essential for the person to adopt safe behavior when visiting these spaces and also so that, after the visit, if they have signs and symptoms, they can inform the doctor and facilitate the diagnosis. In the next few days, technicians from Devisa will carry out a survey to check the tick infestation (acarological survey) at the site.

The City Hall of the interior of São Paulo also stated that, last week, it reinforced communication, information and mobilization actions against Rocky Mountain spotted fever in the city’s parks.

According to the State Department of Health, in 2023 there were 12 cases of spotted fever in the state of São Paulo, with six deaths, including the three confirmed this Monday and Tuesday.

In 2022, 53 cases were recorded, with 37 confirmed deaths. In 2021, there were 76 cases and 42 deaths.

WHAT IS SPOTTED FEVER?

Acute febrile infectious disease transmitted by ticks infected by the bacterium Rickettsia rickettsii, present mainly in the star tick. The ticks that transmit Rickettsia are called Amblyomma cajennense and are found throughout the national territory. For transmission to occur, the tick needs to be attached to the skin for at least four hours. There is no transmission from person to person.

According to the Ministry of Health, in Brazil, two Rickettsia species are associated with Rocky Mountain spotted fever: rickettsii, considered a serious disease, registered in the north of Paraná and in the states of the Southeast region; and parkeri, which has been registered in environments of the Atlantic Forest (Rio Grande do Sul, Santa Catarina, Bahia and Ceará), linked to less severe clinical conditions.

WHAT ARE THE SYMPTOMS?

The symptoms are, at first, sudden: high fever, pain in the body, in the head, prostration, loss of appetite, nausea, vomiting and the appearance of reddish spots mainly on the hands and feet, from the second to the fifth day, which can progress to petechiae (small red spots on the skin that resemble mosquito bites) and ecchymosis (purple spots). The disease has mild and severe forms, including hemorrhagic, with evolution to death. The fatality rate can exceed 50%.

TREATMENT

Antibiotics are administered —Tetracycline and chloramphenicol— which prevent the proliferation of bacteria, containing the worsening of the disease. Medication should be used even before the diagnosis is confirmed.

HOW LONG DOES IT TAKE TO EVOLVE TO DEATH?

The individual can progress to death between the 5th and 15th day after the onset of symptoms. It will depend on the speed of diagnosis and initiation of treatment. Rocky Mountain spotted fever is difficult to diagnose because it has nonspecific symptoms that can be confused with other diseases, such as leptospirosis, zika, dengue and meningitis, among others.

DOES ANY TICK TRANSMIT SPOTTED FEVER?

The main ticks that transmit Rocky Mountain spotted fever in Brazil are three: Amblyomma cajennense, Amblyomma cooperi (dubitatum) and Amblyomma aureolatum (yellow dog tick).

In the interior of São Paulo, spotted fever is associated with the star tick, which, in general, occurs in areas of wild forest and riversides. Adult men are usually more affected, as they work in these regions. Nymphs (immature forms of the tick) are the main evolutionary stages involved in transmission and predominate in the colder months.

HOW TO AVOID A TICK BITE?

Those who circulate through endemic areas must wear boots, pants and blouses with long sleeves, covering the whole body. It is important to avoid places with tall weeds.

IS THERE A RISK OF INFECTION IN URBAN AREAS?

Yes. O Amblyomma aureolatum found in dogs are involved in the transmission of the disease in metropolitan regions, mainly in cities in the Southeast and South of the country, where the highest number of cases occurs.

WHAT ARE THE ENDEMIC AREAS IN SÃO PAULO?

Jundiaí, Campinas and Piracicaba, in particular.

Sources: Tania Chaves, infectologist, professor at the Faculty of Medicine at the Federal University of Pará, and Marcelo Simão, infectologist, professor at the Federal University of Uberlândia (MG). Both are consultants to the Brazilian Society of Infectology.