{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:39:55Z","timestamp":1759970395860,"version":"build-2065373602"},"reference-count":58,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Rocky Mountain spotted fever (RMSF) is a challenge for physicians because the disease can mimic other endemic febrile illnesses, such as dengue and COVID-19. The comparison of their main clinical and epidemiological manifestations in hospitalized children can help identify characteristics that improve empirical suspicion and timely therapeutic interventions. Methods: A cross-sectional study was conducted on a series of patients aged 0 to 18 years, hospitalized between 2015 and 2022, with a diagnosis of RMSF, dengue, or COVID-19. Data were retrieved from medical records. Subjects were categorized as patients with RMSF (group I) and patients with dengue and COVID-19 (group II). Descriptive statistics were used, and differences were evaluated using Student\u2019s t-test and the chi-squared test. Results: A series of 305 subjects were studied, with 252 (82.6%) in group I. Subjects in both groups presented fever, myalgias, arthralgias, and rash, but exposure to ticks distinguished group I. The fatality rate (21.0%) in group I was higher than in group II (3.8%). Conclusions: Although fever, myalgias, arthralgias, and rash are common in all three illnesses, they are more prevalent in hospitalized patients with RMSF. In the presence of such symptoms, a history of tick exposure can guide clinical decisions in regions where all three diseases are endemic.<\/jats:p>","DOI":"10.3390\/tropicalmed10010020","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T03:29:43Z","timestamp":1736825383000},"page":"20","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparison of the Clinical and Epidemiological Profile of Rocky Mountain Spotted Fever with Dengue and COVID-19 in Hospitalized Children, Sonora, M\u00e9xico, 2015\u20132022"],"prefix":"10.3390","volume":"10","author":[{"given":"Gerardo","family":"\u00c1lvarez-Hern\u00e1ndez","sequence":"first","affiliation":[{"name":"Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, Hermosillo 83000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6861-0612","authenticated-orcid":false,"given":"Cristian No\u00e9","family":"Rivera-Rosas","sequence":"additional","affiliation":[{"name":"Epidemiological Surveillance Unit, Family Medicine Unit 53, Mexican Institute of Social Security, Zapopan 45100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2312-4984","authenticated-orcid":false,"given":"Jes\u00fas Ren\u00e9 Tadeo","family":"Calleja-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Internal Medicine Service, General Zone Hospital 14, Mexican Institute of Social Security, Hermosillo 83260, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jehan Boniz\u00fa","family":"\u00c1lvarez-Meza","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of the State of Sonora, Hermosillo 83100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria del Carmen","family":"Candia-Plata","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, Hermosillo 83000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2087-4480","authenticated-orcid":false,"given":"Denica","family":"Cruz-Loustaunau","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of the State of Sonora, Hermosillo 83100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Alv\u00eddrez-Labrado","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences, University of Sonora, Ciudad Obregon 85199, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1056\/NEJMoa050043","article-title":"Rocky Mountain spotted fever from an unexpected tick vector in Arizona","volume":"353","author":"Demma","year":"2005","journal-title":"N. Eng. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kjemtrup, A.M., Padgett, K., Paddock, C.D., Messenger, S., Hacker, J.K., Feiszli, T., Melgar, M., Metzger, M.E., Hu, R., and Kramer, V.L. (2022). A forty-year review of Rocky Mountain spotted fever cases in California shows clinical and epidemiologic changes. PLOS Neglected Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010738"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1093\/cid\/civ115","article-title":"Rocky Mountain spotted fever characterization and comparison to similar illnesses in a highly endemic area-Arizona, 2002\u20132011","volume":"60","author":"Traeger","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40409-016-0077-4","article-title":"An update on the epidemiological situation of spotted fever in Brazil","volume":"22","author":"Oliveira","year":"2016","journal-title":"J. Venom. Anim. Toxins Incl. Trop. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e189","DOI":"10.1016\/S1473-3099(17)30173-1","article-title":"Rocky Mountain spotted fever in Mexico: Past, present, and future","volume":"17","author":"Milan","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6502a1","article-title":"Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain Spotted Fever and other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis\u2014United States","volume":"65","author":"Biggs","year":"2016","journal-title":"MMWR Recomm. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1017\/S0950268818000730","article-title":"Descriptions of two new cases of Rocky Mountain spotted fever in Panama, and coincident infection with Rickettsia rickettsii in Rhipicephalus sanguineus s.l. in an urban locality of Panama City, Panama","volume":"146","author":"Moreno","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"345","DOI":"10.4269\/ajtmh.2012.12-0153","article-title":"A fatal urban case of Rocky Mountain spotted fever presenting an eschar in San Jose, Costa Rica","volume":"87","author":"Hun","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"687","DOI":"10.4269\/ajtmh.2008.78.687","article-title":"Rocky Mountain spotted fever in Argentina","volume":"78","author":"Paddock","year":"2008","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102118","DOI":"10.1016\/j.ttbdis.2022.102118","article-title":"Rickettsioses in Colombia during the 20th century: A historical review","volume":"14","year":"2023","journal-title":"Ticks Tick Borne Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4269\/ajtmh.20-0854","article-title":"Epidemiology and clinical features of Rocky Mountain spotted fever from enhanced surveillance, Sonora, Mexico: 2015\u20132018","volume":"104","author":"Binder","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_12","first-page":"135","article-title":"Spotted fever rickettsioses. Study of cases reported in a secondary care pediatric hospital of northeastern Mexico, 2012\u20132022","volume":"159","year":"2023","journal-title":"Gac. Med. Mex."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2006.11.023","article-title":"Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children","volume":"150","author":"Buckingham","year":"2007","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.jpeds.2013.10.008","article-title":"Self-reported treatment practices by healthcare providers could lead to death from Rocky Mountain spotted fever","volume":"164","author":"Zientek","year":"2014","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1093\/clind\/15.3.439","article-title":"Rocky Mountain \u201cspotless\u201d and \u201calmost spotless\u201d fever: A wolf in sheep\u2019s clothing","volume":"15","author":"Sexton","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","unstructured":"Gobierno de M\u00e9xico (2024, December 08). Hist\u00f3rico Bolet\u00edn Epidemiol\u00f3gico [Internet]. Direcci\u00f3n General de Epidemiolog\u00eda. Available online: https:\/\/www.gob.mx\/salud\/acciones-y-programas\/historico-boletin-epidemiologico."},{"key":"ref_17","unstructured":"Gobierno de M\u00e9xico (2024, December 08). Consejo Nacional de Ciencia y Tecnolog\u00eda. COVID-19 Tablero M\u00e9xico [Internet]. Available online: https:\/\/datos.covid-19.conacyt.mx\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1038\/nrmicro1866","article-title":"Emerging and re-emerging rickettsioses: Endothelial cell infection and early disease events","volume":"6","author":"Walker","year":"2008","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1128\/CMR.00035-09","article-title":"Dengue virus pathogenesis: An integrated view","volume":"22","author":"Martina","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"de Andrade, S.A., de Souza, D.A., Torres, A.L., de Lima, C.F.G., Ebram, M.C., Celano, R.M.G., Schattner, M., and Chudzinski-Tavassi, A.M. (2022). Pathophysiology of COVID-19: Critical role of hemostasis. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.896972"},{"key":"ref_21","unstructured":"Organizaci\u00f3n Panamericana de la Salud (2024, December 08). CIE-10 en L\u00ednea [Internet]. Organizaci\u00f3n Panamericana de la Salud., Available online: https:\/\/ais.paho.org\/classifications\/chapters\/."},{"key":"ref_22","unstructured":"Organizaci\u00f3n Panamericana de la Salud (2024, December 08). Enfermedad Respiratoria Aguda Debido a Coronavirus\u2014RELACSIS: OPS\/OMS [Internet]. Organizaci\u00f3n Panamericana de la Salud., Available online: https:\/\/www.paho.org\/es\/relacsis\/foro-dr-roberto-becker\/enfermedad-respiratoria-aguda-debido-coronavirus."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1128\/JCM.01723-12","article-title":"Assessment of real-time PCR assay for detection of Rickettsia spp. and Rickettsia rickettsii in banked clinical samples","volume":"51","author":"Kato","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1542\/pir.26.4.125","article-title":"Rocky Mountain spotted fever: A physician\u2019s challenge","volume":"26","author":"Razzaq","year":"2005","journal-title":"Pediatr. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1097\/INF.0000000000002320","article-title":"When to think of Rickettsia","volume":"38","author":"Galanakis","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"882","DOI":"10.4269\/ajtmh.13-0403","article-title":"Incubation periods of mosquito-borne viral infections: A systematic review","volume":"90","author":"Rudolph","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_27","first-page":"e2235424","article-title":"Incubation period of COVID-19 caused by unique SARS-CoV-2 strains: A systematic review and meta-analysis","volume":"5","author":"Wu","year":"2022","journal-title":"JAMA Net. Work Open"},{"key":"ref_28","first-page":"517","article-title":"Etiological characterization of acute undifferentiated febrile illness in Apartad\u00f3 and Villeta municipalities, Colombia, during COVID-19 pandemic","volume":"31","author":"Arboleda","year":"2023","journal-title":"Infez. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.bjid.2012.08.020","article-title":"Comparison of clinical and laboratory characteristics between children and adults with dengue","volume":"17","author":"Pessanha","year":"2013","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1002\/ppul.24991","article-title":"Clinical characteristics of COVID-19 in children: A systematic review","volume":"55","author":"Yasuhara","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/jmv.26398","article-title":"A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19)","volume":"93","author":"Cui","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_32","unstructured":"Long, S.S., Prober, C.G., Fischer, M., and Kimberlin, D. (2022). Rickettsia rickettsii (Rocky Mountain Spotted Fever). Principles and Practice of Pediatric Infectious Diseases, Elsevier. [6th ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1056\/NEJMra1110265","article-title":"Dengue","volume":"366","author":"Simmons","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16055","DOI":"10.1038\/nrdp.2016.55","article-title":"Dengue infection","volume":"2","author":"Guzman","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e120","DOI":"10.1002\/ski2.120","article-title":"Rash morphology as a predictor of COVID-19 severity: A systematic review of the cutaneous manifestations of COVID-19","volume":"2","author":"Holmes","year":"2022","journal-title":"Skin Health Dis."},{"key":"ref_36","unstructured":"Panamerican Health Organization (2024, December 08). Dengue. [Internet]. Available online: https:\/\/www.paho.org\/en\/topics\/dengue."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1097\/EDE.0000000000001400","article-title":"Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis","volume":"32","author":"Kendall","year":"2021","journal-title":"Epidemiology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1586\/eri.09.94","article-title":"Managing Rocky Mountain spotted fever","volume":"7","author":"Minniear","year":"2009","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jemermed.2018.02.043","article-title":"The evaluation and management of Rocky Mountain spotted fever in the emergency department: A review of the literature","volume":"55","author":"Gottlieb","year":"2018","journal-title":"J. Emerg. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s12098-022-04394-8","article-title":"Management of dengue: An updated review","volume":"90","author":"Tayal","year":"2023","journal-title":"Indian J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Yuan, Y., Jiao, B., Qu, L., Yang, D., and Liu, R. (2023). The development of COVID-19 treatment. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1125246"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/INF.0000000000000496","article-title":"Clinical profile and predictors of fatal Rocky Mountain spotted fever in children from Sonora, Mexico","volume":"34","author":"Moro","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1093\/jpids\/piab035","article-title":"COVID- 19 in a subset of hospitalized children in Israel","volume":"10","author":"Livni","year":"2021","journal-title":"J. Pediatric. Infect. Dis. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1002\/ppul.25312","article-title":"COVID-19 under 19: A meta-analysis","volume":"56","author":"Oba","year":"2021","journal-title":"Pediatr. Pulmonol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Vuong, N.L., Le Duyen, H.T., Lam, P.K., Tam, D.T.H., Vinh Chau, N.V., Van Kinh, N., Chanpheaktra, N., Lum, L.C.S., Pleit\u00e9s, E., and Jones, N.K. (2020). C- reactive protein as a potential biomarker for disease progression in dengue: A multi-country observational study. BMC Med., 18.","DOI":"10.1186\/s12916-020-1496-1"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e67460","DOI":"10.7554\/eLife.67460","article-title":"Combination of inflammatory and vascular markers in the febrile phase of dengue is associated with more severe outcomes","volume":"10","author":"Vuong","year":"2021","journal-title":"Elife"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Vasey, B., Shankar, A.H., Herrera, B.B., Becerra, A., Xhaja, K., Echenagucia, M., Machado, S.R., Caicedo, D., Miller, J., and Amedeo, P. (2020). Multivariate time-series analysis of biomarkers from a dengue cohort offers new approaches for diagnosis and prognosis. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008199"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Raghavan, R.K., Goodin, D.G., Neises, D., Anderson, G.A., and Ganta, R.R. (2016). Hierarchical Bayesian spatio-temporal analysis of climatic and socio-economic determinants of Rocky Mountain spotted fever. PLoS ONE., 11.","DOI":"10.1371\/journal.pone.0150180"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1179\/2047773214Y.0000000168","article-title":"Is dengue a disease of poverty? A systematic review","volume":"109","author":"Mulligan","year":"2015","journal-title":"Pathog. Glob. Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s12939-021-01582-4","article-title":"A systematic review of racial\/ethnic and socioeconomic disparities in COVID-19","volume":"20","author":"Khanijahani","year":"2021","journal-title":"Int. J. Equity Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1001\/archinte.163.7.769","article-title":"Rocky Mountain spotted fever. A clinician\u2019s dilemma","volume":"163","author":"Masters","year":"2003","journal-title":"Arch. Int. Med."},{"key":"ref_52","first-page":"7","article-title":"Spotted fever and its potential coinfection with other vector-borne diseases","volume":"11","year":"2017","journal-title":"Epistemus"},{"key":"ref_53","first-page":"320","article-title":"Fatal case co-infected of rickettsiosis and dengue virus in Mexico","volume":"56","year":"2018","journal-title":"Rev. Med. Inst. Mex. Seguro Soc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"458","DOI":"10.18233\/apm.v45i5.2788","article-title":"Fatal pediatric case coinfected with Rickettsia rickettsii and SARS-CoV-2","volume":"45","year":"2024","journal-title":"Acta Pediatr. Mex."},{"key":"ref_55","first-page":"102","article-title":"Mortality among hospitalized dengue patients with comorbidities in Mexico, Brazil, and Colombia","volume":"105","author":"Macias","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1086\/314776","article-title":"Hidden Mortality Attributable to Rocky Mountain Spotted Fever: Immunohistochemical detection of fatal, serologically unconfirmed disease","volume":"179","author":"Paddock","year":"1999","journal-title":"J. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"ofac506","DOI":"10.1093\/ofid\/ofac506","article-title":"Morbidity and functional outcomes following Rocky Mountain Spotted Fever hospitalization\u2014Arizona, 2002\u20132017","volume":"9","author":"Close","year":"2022","journal-title":"Open Forum. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7705\/biomedica.v38i0.3507","article-title":"A case-series of fatal Rocky Mountain spotted fever in Sonora, Mexico","volume":"38","year":"2018","journal-title":"Biomedica"}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/10\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:28:11Z","timestamp":1759919291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/10\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":58,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["tropicalmed10010020"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed10010020","relation":{},"ISSN":["2414-6366"],"issn-type":[{"type":"electronic","value":"2414-6366"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}