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Rickettsial infections in America: A persistent public health challenge at the Human–Animal–Environment interface
Infecciones Rickettsiales en América: Reto persistente para la salud pública en la interfase Humano-Animal-Ambiente
DOI:
https://doi.org/10.15446/rfnam.v79.129567Keywords:
Climate change, Diagnostic techniques, Public health, Reservoirs, Ticks, Vector-borne diseases (en)Cambio climático, Técnicas de diagnóstico, Salud pública, Reservorios, Garrapatas, Enfermedades transmitidas por vectores (es)
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Rickettsioses represent a growing and persistent public health challenge in the Americas, where incidence and case-fatality rates in Mexico and Brazil exceed those reported in the United States—a disparity associated with genomic variation among bacterial strains as well as environmental, socioeconomic, and health care factors. For this systematic review, a search was conducted in the Google Scholar, ACS Publications, and PubMed databases following the guidelines of the PRISMA 2020 statement. Articles published between January 2016 and July 2026 were included, using keywords such as "Rickettsiosis," "Vector-Borne Diseases," "Ticks," "One Health," "Climate change," and "Diagnosis," among others, combined with the Boolean operators AND and OR. Of the 33,133 documents initially identified, 110 were selected for full analysis. The analysis reveals that climate change and unplanned urbanization have favored the geographic expansion and prolonged seasonal activity of vectors such as Rhipicephalus sanguineus, while domestic and wild animals act as reservoirs. Diagnosis remains challenging because of the nonspecific nature of the initial clinical presentation and limited access to serological and molecular testing, which delays doxycycline treatment. Elevated mortality in Central and South America is associated not only with environmental factors but also with inequities in health care systems. The One Health approach is essential for addressing rickettsioses because their transmission cannot be explained, or interrupted, by acting on a single component. Rickettsia circulates through a cycle that links the environment, the arthropod vector, and vertebrate hosts. It is concluded that only through sustained multidisciplinary and social commitment will it be possible to reduce the impact of these diseases.
Las rickettsiosis representan un creciente y persistente desafío para la salud pública en América, donde su incidencia y letalidad, en México y Brasil, superan las tasas reportadas en Estados Unidos, lo cual se asocia a variables genómicas propias de las diferentes cepas bacterianas, factores medioambientales, socioeconómicos y de salubridad. Para esta revisión sistemática, se realizó una búsqueda en las bases de datos Google Académico, ACS Publications y PubMed, siguiendo los lineamientos de la guía PRISMA 2020. Se incluyeron artículos publicados entre enero de 2016 y julio de 2026, empleando palabras clave como "Rickettsiosis", "Vector Borne Diseases", "Ticks", "One Health", "Climate change", "Diagnosis", entre otras, con operadores booleanos AND y OR. De los 33.133 documentos identificados inicialmente, se seleccionaron 110 para su análisis completo. El análisis revela que el cambio climático y la urbanización no planificada han favorecido la expansión geográfica y la actividad estacional de vectores como Rhipicephalus sanguineus, mientras que los animales domésticos y silvestres actúan como reservorios. El diagnóstico continúa siendo un reto debido a la inespecificidad del cuadro clínico inicial y a las limitaciones en el acceso a pruebas serológicas y moleculares, lo que retrasa el tratamiento con doxiciclina. La mortalidad elevada en centro y Sudamérica no solo se asocia a factores medioambientales, sino también a desigualdades en los sistemas de salud. El enfoque de Una Sola Salud (One Health) es esencial para abordar las rickettsiosis porque su transmisión no puede explicarse, ni interrumpirse, actuando sobre un solo componente. Rickettsia circula a través de un ciclo que vincula el ambiente, el artrópodo vector y los hospederos vertebrados. Se concluye que solo mediante un compromiso multidisciplinario y social será posible reducir el impacto de estas enfermedades.
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