Prevalence of Rickettsia rickettsii in Ticks: Systematic Review and Meta-analysis.

Background and Objectives:Rickettsia rickettsii is a pathogen that is known to cause spotted fever, a zoonosis that is endemic in several regions of the Americas. However, no systematic review and meta-analysis has been conducted to estimate the prevalence of this rickettsial disease in the Americas. Therefore, the objective of this study was to estimate the prevalence of R. rickettsii in ticks in the Americas. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were retrieved from four electronic databases: MEDLINE/PubMed, SciELO, ScienceDirect, and Directory of Open Access Journals. The pooled prevalence and heterogeneity were determined using a random-effects model and using Cochran's Q test and I2 index, respectively. Publication bias was assessed using a funnel plot and Egger's method. Results: The pooled prevalence of R. rickettsii in ticks was highest in Colombia (17.00%; confidence interval [95% CI]: 7.01-30.24), followed by Mexico (9.89%; 95% CI: 2.03-22.74), Panama (2.76%; 95% CI: 0.45-6.93), Brazil (2.03%; 95% CI: 0.66-4.14), and the United States (0.50%; 95% CI: 0.15-1.05). The tick species most frequently infected by R. rickettsii were Rhipicephalus sanguineus sensu lato (6.23%; 95% CI: 2.79-10.92) and Amblyomma mixtum (4.36%; 95% CI: 0.25-13.14). Interpretation and Conclusion: It can be suggested that studies aiming to identify the potential vectors of R. rickettsii should be conducted more intensively to better understand the epidemiology of spotted fever in the Americas.