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Between May and October 2002, a cluster of acute febrile illnesses occurred in the subtropical Andean foothills of Peru. Serologic evidence in villages where disease had been documented showed that the prevalence of IgM antibody to Leptospira ranged from 6% to 52%, that of IgM antibody to spotted fever group (SFG) rickettsia ranged from 10% to 19%, and that of IgM antibody to Coxiella burnetii from 1% to 15%. Measurement of IgG antibodies for SFG rickettsiae suggested that this disease was endemic. In contrast, IgG antibodies against C. burnetii were largely absent. In humans, microagglutination tests identified pathogenic variants of Leptospira. The presence of an SFG rickettsial infection was confirmed in four febrile patients following polymerase chain reaction and sequencing of the conserved 17-kD common antigen gene (htrA). Collectively, these analyses indicated that Rickettsia sp., C. burnetii, and Leptospira sp. were circulating in the region during the time of disease outbreak and implicate the involvement of an as yet undetermined SFG rickettsia in northwestern Peru.
Received October 1, 2003. Accepted for publication January 15, 2004.
Acknowledgments: We acknowledge the assistance provided during this investigation by Dr. Edwin Garcia, Edwin Alvarado, Gaston Carrion, Julio Niquen, Jose Carhuapoma, Claire Sosa, and Frank Castillo. We are grateful for the administrative assistance provided by G. Talledo, and the gifts of R. rickettsii, R. prowazekii, and C. burnetii antigen provided by Dr. H. Thompson (Centers for Disease Control and Prevention). We thank Dr. J. K. Baird for providing a helpful critique of the manuscript.
Financial support: This work was funded by The Department of Defense Global Emerging Infectious System (GEIS).
Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Defense, the Department of the Navy, or the U.S. Government.
Authors addresses: Patrick J. Blair, Roxana Caceda, Christopher Cruz, Vidal Felices, Carolina Guevara, Alfredo Huaman, Ricky Luckett, Zonia Rios, and James V. Olson, Viral Diseases Program, Naval Medical Research Center Detachment, Unit 3800, APO AA 34031-3800, Telephone: 51-1-562-3848, Fax: 51-1-561-3042, E-mails: blair{at}nmrcd.med.navy.mil and olson{at}nmrcd.med.navy.mil. George B. Schoeler, Navy Vector Ecology and Control Center, Bangor, 2850 Thresher Avenue, Silverdale, WA 98315, Telephone: 360-315-4450, E-mail: george.schoeler{at}ndvecc.navy.mil. Cecilia Moron, Pulmonary Diseases Laboratory, The University of Texas Health Center at Houston Medical School, Houston TX 77030, Telephone: 713-743-2090, Fax: 713-794-7853, E-mail: cmoron{at}bcm.tmc.edu. Elizabeth Anaya, Manuel Cespedes, Leonardo Mendoza, and Pablo Villaseca, Leonardo Mendoza Instituto Nacional de Salud, Capac Yupanqui No. 1400, Jesús Maria, Lima 11, Peru, Telephone: 51-1-471-9920. Allen L. Richards, Viral and Rickettsial Diseases Department, Navy Medical Research Center, 503 Robert Grant Avenue, Silver Springs MD 20910-7500, Telephone: 301-319-7668, Fax: 301-319-7460, E-mail: richardsA{at}nmrc.navy.mil. John W. Sumner, Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta GA 30333, Telephone: 404-639-3043, Fax: 404-639-3043, E-mail: jws3{at}cdc.gov.
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