{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:19:37Z","timestamp":1759796377435,"version":"build-2065373602"},"reference-count":72,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Pathogens"],"abstract":"<jats:p>Rickettsia rickettsii is the most virulent agent of the genus Rickettsia that causes one of the most relevant vector-borne diseases in the Americas (RRSF). RRSF manifests with many non-specific acute clinical symptoms complicating its diagnosis and can lead to death if not treated appropriately. RRSF has been reported in Canada, the United States of America, Mexico, Costa Rica, Panama, Colombia, Brazil, and Argentina. In addition to R. rickettsii, mild and severe spotted fever group rickettsioses (SFGR) have been reported in the Americas; however, the true prevalence of these diseases is unknown. In Panama, RRSF have been reported in four of 14 provinces during two outbreak periods: five cases including two fatalities were identified in 1950\u20131951, and 23 cases including 17 fatalities between 2004 and 2025. This paper presents the clinical characterization of a fatal case of RRSF in Cocl\u00e9 province and a severe case of SFGR in a mountainous area of the Gn\u00e4be Bugl\u00e9 Indigenous Comarca (GBIC). Laboratory confirmation was performed by molecular analysis of tissues obtained from necropsies in the case of RRSF and by immunofluorescence assay (IFA) in the case of SFGR. Furthermore, this paper identifies existing gaps in the initial clinical suspicion and pertinent to SFGR in Panama, which may be applicable to other countries in the region. In the last 21 years, cases have occurred upon contact with ticks in rural areas (13), urban and suburban locations (7), rural woodlands (2), and forests (1). Provinces with more cases are Panam\u00e1 (7 of 23, 6 died), Cocl\u00e9 (5 of 23, 5 died), Col\u00f3n (3 of 23, 1 died), Panam\u00e1 Oeste (1 of 23, 1 died), and GBIC (7 of 23, 4 died), including a cluster of seven cases in 2019. Therefore, Cocl\u00e9 province is considered one of the endemic areas for RRSF in Panama, while the latest cases from the GBIC since 2019 indicate that mountainous areas are an eco-epidemiological scenario to include in the transmission of these diseases. Although this disease has a low prevalence, patients who present symptoms commonly associated with more common diseases such as dengue, other arboviruses, malaria, and leptospirosis, among others, should be included in the diagnostic suspicion. Without diagnostic suspicion and adequate treatment, the patient can die.<\/jats:p>","DOI":"10.3390\/pathogens14101006","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T08:10:51Z","timestamp":1759738251000},"page":"1006","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spotted Fever Rickettsioses in Panama: New Cases and the Gaps That Hinder Its Epidemiological Understanding"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-3133","authenticated-orcid":false,"given":"Sergio","family":"Berm\u00fadez","sequence":"first","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4747-7986","authenticated-orcid":false,"given":"Ericka Ferguson","family":"Amores","sequence":"additional","affiliation":[{"name":"Hospital Materno Infantil \u201cJos\u00e9 Domingo De Obald\u00eda\u201d, David, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2508-6871","authenticated-orcid":false,"given":"Naty","family":"Aguirre","sequence":"additional","affiliation":[{"name":"Hospital \u201cAquilino Tejera\u201d, Penonom\u00e9, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7445-6965","authenticated-orcid":false,"given":"Michelle","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Garrido","sequence":"additional","affiliation":[{"name":"Centro de Salud de Coclesito, Col\u00f3n, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4636-5876","authenticated-orcid":false,"given":"Lillian","family":"Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yamitzel","family":"Zald\u00edvar","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0055-9758","authenticated-orcid":false,"given":"Claudia","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Omar","family":"Castillo","sequence":"additional","affiliation":[{"name":"Hospital Materno Infantil \u201cJos\u00e9 Domingo De Obald\u00eda\u201d, David, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7816-3040","authenticated-orcid":false,"given":"Alexander","family":"Mart\u00ednez-Caballero","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7196-0867","authenticated-orcid":false,"given":"Ambar","family":"Moreno","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mabel","family":"Mart\u00ednez-Montero","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambar","family":"Poveda","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domicio","family":"Espino","sequence":"additional","affiliation":[{"name":"Hospital \u201cAquilino Tejera\u201d, Penonom\u00e9, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karina","family":"Baker","sequence":"additional","affiliation":[{"name":"Hospital Materno Infantil \u201cJos\u00e9 Domingo De Obald\u00eda\u201d, David, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1780-3729","authenticated-orcid":false,"given":"Franklyn","family":"Samudio","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panam\u00e1, Panama"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101823","DOI":"10.1016\/j.ttbdis.2021.101823","article-title":"Ehrlichiosis and Anaplasmosis subcommittee report to the tick-borne disease working group","volume":"12","author":"Dixon","year":"2021","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"de la Fuente, J., Estrada-Pe\u00f1a, A., Rafael, M., Almaz\u00e1n, C., Berm\u00fadez, S., Abdelbaset, A.E., Kasaija, P.D., Kabi, F., Akande, F.A., and Ajagbe, D.O. 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